Katarina Bohman

Head Injury Causation Scenarios for Belted, Rear-Seated Children in Frontal Impacts

Objectives: Head injuries are the most common serious injuries sustained by children in motor vehicle crashes and are of critical importance with regard to long-term disability. There is a lack of understanding of how seat belt–restrained children sustain head injuries in frontal impacts. The aim of the study was to identify the AIS2+ head injury causation scenarios for rear-seated, belt-restrained children in frontal impacts, including the set of parameters contributing to the injury. Method: In-depth crash investigations from two National Highway Traffic Safety Administration (NHTSA) databases, the National Automotive Sampling System–Crashworthiness Data System (NASS-CDS; 1997–2008) and the Crash Injury Research and Engineering Network (CIREN; 1996–2009), were collected and analyzed in detail. Selection criteria were all frontal impacts with principal direction of force (PDOF) of 11, 12, and 1 o’clock involving rear-seated, three-point belt-restrained, with or without booster cushion, children from 3 to 13 years with an AIS2+ head injury. Cases were analyzed using the BioTab method of injury causation assessment in order to systematically analyze the injury causation scenario for each case. Results: There were 27 cases meeting the inclusion criteria, 19 cases with MAIS2 head injuries and 8 cases with MAIS3+ head injuries, including 2 fatalities. Three major injury causation scenarios were identified, including head contact with seatback (10 cases), head contact with side interior (7 cases,) and no evidence of head contact (9 cases). Conclusions: Head injuries with seatback or side interior contact typically included a PDOF greater than 10 degree (similar to the Insurance Institute for Highway Safety [IIHS] and EuroNCAP offset frontal testing) and vehicle maneuvers. For seatback contact, the vehicles movements contributed to occupant kinematics inboard the vehicle, causing a less than optimal restraint of the torso and/or torso roll out of the shoulder belt. For side interior contact, the PDOF and/or maneuvers forced the occupant toward the side interior. The cases without evidence of head/face contact were characterized by high crash severity and accompanied by severe injuries to the thorax and spine. These data lead to increased understanding of the injury patterns and causation in this crash restraint scenario so that interventions to mitigate the burden of injury can be advanced.

Kinematics of Child Volunteers and Child Anthropomorphic Test Devices During Emergency Braking Events in Real Car Environment

Objectives: The objective of this study was to present, compare, and discuss the kinematic response of children and child anthropomorphic test devices (ATDs) during emergency braking events in different restraint configurations in a passenger vehicle. Methods: A driving study was conducted on a closed-circuit test track comprising 16 children aged 4 to 12 years old and the Q3, Hybrid III (HIII) 3-year-old, 6-year-old, and 10-year-old ATDs restrained on the right rear seat of a modern passenger vehicle. The children were exposed to one braking event in each of the 2 restraint systems and the ATDs were exposed to 2 braking events in each restraint system. All events had a deceleration of 1.0 g. Short children (stature 107–123 cm) and the Q3, HIII 3-year-old, and 6-year-old were restrained on booster cushions as well as high-back booster seats. Tall children (stature 135–150 cm) and HIII 10-year-old were restrained on booster cushions or restrained by 3-point belts directly on the car seat. Vehicle data were collected and synchronized with video data. Forward trajectories for the forehead and external auditory canal (ear) were determined as well as head rotation and shoulder belt force. Results: A total of 40 trials were analyzed. Child volunteers had greater maximum forward displacement of the head and greater head rotation compared to the ATDs. The average maximum displacement for children ranged from 165 to 210 mm and 155 to 195 mm for the forehead and ear target, respectively. Corresponding values for the ATDs were 55 to 165 mm and 50 to 160 mm. The change in head angle was greater for short children than for tall children. Shoulder belt force was within the same range for short children when restrained on booster cushions or high-back booster seats. For tall children, the shoulder belt force was greater when restrained on booster cushions compared to being restrained by seat belts directly on the car seat. Conclusions: The forward displacement was within the same range for all children regardless of stature and restraint system. However, the maximum forward position depended on the initial seated posture and shoulder belt position on the shoulder. Differences could also be seen in the curvature of the neck and spine. Short children exhibited a greater flexion motion of the head, whereas a more upright posture at maximum forward position was exhibited by the tall children. The ATDs displayed less forward displacement compared to the children. Supplemental materials are available for this article. Go to the publishers online edition of Traffic Injury Prevention to view the supplemental file.

Long-Term Medical Consequences for Child Occupants 0 to 12 Years Injured in Car Crashes

Objective: There is limited knowledge of the long-term medical consequences for children injured in car crashes. Thus, in the event of injury, the aim of the study was to specify patterns and risks of injuries resulting in permanent medical impairment of children (0–12 years) for different body regions and injury severity levels, according to Abbreviated Injury Scale (AIS). The aim was also to compare the impairment outcome with adults. Methods: Data were obtained from the Folksam insurance company, including reported car crashes from 1998 to 2010 with at least one injured child 0–12 years of age. In all, 2619 injured children with 3704 reported medical diagnoses were identified. All injuries were classified according to the AIS 2005 revision. If the child had not recovered within 1 year postinjury an assessment of permanent medical impairment (PMI) was made by one or several medical specialists. Results: In all, 55 children sustained 59 injuries resulting in PMI of which 75 percent were at AIS 1 or AIS 2. The head and cervical spine were the body regions sustaining the most injuries resulting in PMI. Sixty-eight percent of all injuries resulting in PMI were AIS 1 injuries to the cervical spine, with the majority occurring in frontal or rear impacts. Given an injury to the cervical spine, the risk of injuries resulting in PMI was 3 percent, and older children (≥6 years) had a significantly higher risk (3% versus 1%) than younger children. The head was the second most commonly injured body region with injuries resulting in PMI (12/59), which were predominantly AIS 2+. In addition, mild traumatic brain injuries at AIS 1 were found to lead to PMI. Whereas for children the injuries leading to PMI were primarily limited to the head and cervical spine, adults sustained injuries that led to PMI from a more diverse distribution of body regions. Conclusion: The pattern of injuries resulting in permanent medical impairment is different for children and adults; therefore, safety priorities for children need to be based on child data. The majority of those injuries leading to PMI were at lower AIS levels. Furthermore, AIS 1 cervical spine and AIS 1+ head injuries should be given priority concerning mitigation of long-term consequences for children.

Kinematics and Shoulder Belt Position of Child Anthropomorphic Test Devices During Steering Maneuvers

Objectives: The objective of this study was to quantify and compare the kinematics and shoulder belt position of child anthropomorphic test devices (ATDs) during emergency steering maneuvers. Furthermore, the ATDs were compared to the results from child volunteers aged 4 to 12 in the same test setup (Bohman, Stockman, et al. 2011). Methods: A driving study was conducted on a test track comprising 4 ATDs: the Q6, Q10, and Hybrid III (HIII) 6- and 10-year-old ATDs restrained in the rear seat of a passenger vehicle. The ATDs were exposed to 2 repeated steering maneuvers in each restraint system. The Q6 and HIII 6-year-old were restrained on booster cushions as well as high-back booster seats. The Q10 and HIII 10-year-old were restrained on booster cushions or restrained by 3-point seat belts directly on the seat. Lateral motion of the forehead and upper sternum was determined, as well as shoulder belt movement on shoulder and torso tilting angle. Results: All ATDs began to move approximately at the same point in time corresponding to a vehicle lateral acceleration of just below 0.2 g. In the later phase of the maneuver, Q10 had moved 26 percent less than the children when restrained by seat belt only and 35 percent less when on a booster cushion. Corresponding numbers for the HIII 10-year-old were 43 and 44 percent higher than for children. Compared to children, the Q6 had moved 34 percent less when restrained on a high-back booster seat and 31 percent less when on a booster cushion. Corresponding numbers for HIII 6-year-old were 7 and 28 percent higher than for children. Due to extensive variety of lateral displacements observed in the children, child performance range covers both ATD families for the evaluated sizes of 6- and 10-year-old ATDs. Conclusions: Compared to children, the HIII ATDs were closer with regards to mean values in the initial phase of the maneuver and the Q ATDs were closer in the end of the ramping phase of the lateral acceleration. The question regarding which ATD replicates better the behavior of children exposed to steering maneuvers still remains open. As shown in this study, it depends on the focus of the comparison and on what phase of the maneuver is of interest. This study provides valuable knowledge on how representative the current ATDs are for replicating potential precrash postures of children as a result of vehicle emergency steering maneuvers for a variety of restraint systems and ATD sizes.

Headform impact tests to assess energy management of seat back contact points associated with head injury for pediatric occupants

Head injuries are the most common injuries sustained by children in motor vehicle crashes regardless of age, restraint and crash direction. Previous research identified the front seat back as relevant contact point associated with head injuries sustained by restrained rear seated child occupants. The objective of this study was to conduct a test series of headform impacts to seat backs to evaluate the energy management characteristics of relevant contact points for pediatric head injury. A total of eight seats were tested: two each of 2007 Ford Focus, Toyota Corolla, 2006 Volvo S40, and 2008 Volkswagen Golf. Five to six contact points were chosen for each unique seat model guided by contact locations determined from real world crashes. Each vehicle seat was rigidly mounted in the center track position with the seatback angle adjusted to 70 degrees above the horizontal. A 3.5 kg child pedestrian headform was fired at a velocity of 24 km/h (6.67 m/s) in accordance to FMVSS 201 at 22 degrees above the horizontal starting from 10 cm from the center of the target. Resultant acceleration and HIC (15 ms and 36 ms) were calculated for each impact. Within the class of small family vehicles, there was substantial variation in underlying seat structure across the locations of head impact identified in the case series resulting in a wide range of maximum resultant head acceleration - 27-165 g. Several impact locations, particularly those around the edge of seat back resulted in head acceleration greater than 80g used in regulatory tests. These data highlight the need to re-examine the current FMVSS 201, Occupant Protection in Interior Impact, to account for the typical impact locations of child occupants in crashes. In addition, further study is needed to understand the tolerance of the pediatric skull and brain to these types of impacts. Language: en

Kinematics and shoulder belt engagement of children on belt-positioning boosters during evasive steering maneuvers

ABSTRACT Objective: To increase the protection of child passengers in crashes preceded by evasive steering, understanding of how children interact with the seat belt in such situations is essential. This study aims to quantify child kinematics and describe child-to-restraint interaction during evasive steering maneuvers. Methods: Eighteen child volunteers (aged 5–10) were seated on the rear seat of a passenger vehicle. A professional driver made repeatable sharp turns at 50 km/h. Children were restrained by the seat belt on a booster cushion (BC) and on an integrated booster cushion (IBC). Kinematics of the nasion and upper sternum were analyzed with video tracking software and shoulder belt (SB) engagement and position were evaluated. Results: Children moved laterally inboard, and SB-to-body interaction was influenced by booster and stature. Shorter children displayed initial SB positions closer to the neck with less instances of gap between the SB and the lower torso, resulting in more curved belt paths on the IBC. On the BC, shorter children had less of the SB in contact with the torso and straight belt paths were observed throughout steering. Taller children generally had the SB initially mid-shoulder with less instances of gap, resulting in curved belt paths at initial and maximum displacements on both boosters. Children loaded the shoulder belt by axially rotating their torso into the SB more often on the IBC compared to BC. The SB generally stayed on the shoulder, with 89% of slip-off instances occurring for shorter children on the BC. Shorter children on the BC had the largest average inboard nasion displacement (120 mm). Taller children on the BC had the lowest average inboard displacement of the nasion (100 mm). All children initially displaced on average 90 mm inboard with their upper sternum. Conclusions: Initial SB position on the shoulder and torso differed with booster and stature, which influenced how children engaged with the seat belt during steering. Children with less SB initially in contact with the torso moved laterally behind the belt, resulting in straighter SB paths and outboard motion of the SB on the shoulder (often ending far out or slipped off). When more of the SB was initially in contact with the torso, children tended to engage the SB more, moving with the belt and causing the SB path to become more curved, resulting in less inboard head displacement and less outboard motion of the SB on the shoulder. Enhanced understanding of how evasive steering affects the kinematic response of children provides valuable data for protection of children in real-world situations.

Frontal and oblique crash tests of HIII 6-year-old child ATD using real-world, observed child passenger postures

ABSTRACT Objective: The aim of this study was to evaluate the consequences of frontal and oblique crashes when positioning a Hybrid III (HIII) 6-year-old child anthropometric test device (ATD) using observed child passenger postures from a naturalistic driving study (NDS). Methods: Five positions for booster-seated children aged 4–7 years were selected, including one reference position according to the FMVSS 213 ATD seating protocol and 4 based on real-world observed child passenger postures from an NDS including 2 user positions with forward tilting torso and 2 that combined both forward and lateral inboard tilting of the torso. Seventeen sled tests were conducted in a mid-sized vehicle body at 64 km/h (European New Car Assessment Programme [Euro NCAP] Offset Deformable Barrier [ODB] pulse), in full frontal and oblique (15°) crash directions. The rear-seated HIII 6-year-old child ATD was restrained on a high-back booster seat. In 10 tests, the booster seat was also attached with a top tether. In the oblique tests, the ATD was positioned on the far side. Three camera views and ATD responses (head, neck, and chest) were analyzed. Results: The shoulder belt slipped off the shoulder in all ATD positions in the oblique test configuration. In full frontal tests, the shoulder belt stayed on the shoulder in 3 out of 9 tests. Head acceleration and neck tension were decreased in the forward leaning positions; however, the total head excursion increased up to 210 mm compared to te reference position, due to belt slip-off and initial forward leaning position. Conclusions: These results suggest that real-world child passenger postures may contribute to shoulder belt slip-off and increased head excursion, thus increasing the risk of head injury. Restraint system development needs to include a wider range of sitting postures that children may choose, in addition to the specified postures of ATDs in seating test protocols, to ensure robust performance across diverse use cases. In addition, these tests revealed that the child ATD is limited in its ability to mimic real-world child passenger postures. There is a need to develop child human body models that may offer greater flexibility for these types of crash evaluations.

Seat belt pre-pretensioner effect on child-sized dummies during run-off-road events

ABSTRACT Objective: Run-off-road events occur frequently and can result in severe consequences. Several potential injury-causing mechanisms can be observed in the diverse types of run-off-road events. Real-world data show that different types of environments, such as rough terrain, ditch types, and whether multiple events occur, may be important contributing factors to occupant injury. Though countermeasures addressing front seat occupants have been presented, studies on rear seat occupant retention in situations such as run-off-road events are lacking. The aim of this study was to investigate the seat belt pre-pretensioner effect on rear-seated child-sized anthropomorphic test devices (ATDs) during 2 different types of run-off-road events. Methods: The study was carried out using 2 test setups: a rig test with a vehicle rear seat mounted on a multi-axial robot simulating a road departure event into a side ditch and an in-vehicle test setup with a Volvo XC60 entering a side ditch with a grass slope, driving inside the ditch, and returning back to the road from the ditch. Potential subsequent rollovers or impacts were not included in the test setups. Three different ATDs were used. The Q6 and Q10 were seated on an integrated booster cushion and the Hybrid III (HIII) 5th percentile female was positioned directly on the seat. The seat belt retractor was equipped with a pre-pretensioner (electrical reversible retractor) with 3 force level settings. In addition, reference tests with the pre-pretensioner inactivated were run. Kinematics and the shoulder belt position were analyzed. Results: In rig tests, the left-seated ATD was exposed to rapid inboard lateral loads relative to the vehicle. The displacement for each ATD was reduced when the pre-pretensioner was activated compared to tests when it was inactivated. Maximum inboard displacement occurred earlier in the event for all ATDs when the pre-pretensioner was activated. Shoulder belt slip-off occurred for the Q6 and Q10 in tests where the pre-pretensioner was inactivated. During in-vehicle tests, the left-seated ATD was exposed to an inboard movement when entering the road again after driving in the ditch. The maximum inboard head displacement was reduced in tests where the pre-pretensioner was activated compared to tests in which it was inactivated. Conclusions: During both test setups, the activation of the pre-pretensioner resulted in reduced lateral excursion of the Q6, Q10, and HIII 5th percentile female due to the shoulder belt remaining on the shoulder and supporting the side of the lower torso. The results provide new insights into the potential benefits of using a pre-pretensioner to reduce kinematic responses during complex run-off-road events through supporting the seat belt to remain on the shoulder. This study addresses potential countermeasures to improve real-world protection of rear-seated children, and it provides a broader perspective including the influence of precrash kinematics.

Misuse of booster cushions among children and adults in Shanghai - an observational and attitude study during buckling up

ABSTRACT Objective: Traffic crashes are one of the leading causes of fatalities among Chinese children. Booster cushion usage in China is low, and there are no studies showing how a population with limited experience handles booster cushions during buckling up. The purpose of this study was to evaluate the handling of and explore the attitudes toward booster cushions among children, parents, and grandparents in Shanghai. Methods: An observational study including a convenience sample of 254 children aged 4–12 years was conducted in 2 passenger cars at a shopping center in Shanghai. Parents, grandparents, or the children themselves buckled up the child on 2 types of booster cushions, a 2-stage integrated booster cushion (IBC) and an aftermarket booster cushion (BC). The test participants were observed during buckling up, first without and then with instructions. The test leaders conducted structured interviews. Results: Ninety-eight percent of the uninstructed participants failed to buckle up without identified misuse on the aftermarket booster cushion and 31% of those uninstructed on the integrated booster cushion. The majority of misuse was severe, including placing the belt behind the arm and the lap belt routing above the guiding loops. Instruction reduced misuse to 58% (BC) and 12% (IBC), respectively, and, in particular, severe misuse. Some misuse was related to limited knowledge of how to buckle up on the booster cushion, and some misuse was intentional in order to reduce discomfort. The participants, both children and adults, reported that they preferred the IBC due to good comfort and convenience. Safety was reported as the main reason for adults using booster cushions in general, whereas children reported comfort as the most important motivation. Conclusions: Education is needed to ensure frequent and correct use of booster cushions in China and to raise safety awareness among children and adults. Furthermore, it is important that the booster cushions offer intuitively correct usage to a population with limited experience of booster cushions. This is the first study published on the handling of and attitude toward booster cushions after child restraints laws were introduced in Shanghai 2014.

Children's and adults' comfort experience of extra seat belts when riding in the rear seat of a passenger car

Objective: The objective of this study was to explore passengers’ comfort experience of extra seat belts during on-road driving in the rear seat of a passenger car and to investigate how the use of extra belts affects childrens and adults’ attitudes to the product. Methods: Two different seat belt systems were tested, criss-cross (CC) and backpack (BP), consisting of the standard 3-point belt together with an additional 2-point belt. In total, 32 participants (15 children aged 6–10, 6 youths aged 11–15, and 11 adults aged 20–79, who differed considerably in size, shape, and proportions) traveled for one hour with each system, including city traffic and highway driving. Four video cameras monitored the test subject during the drive. Subjective data regarding emotions and perceived discomfort were collected in questionnaires every 20 min. A semistructured interview was held afterwards. Results: All participant groups accepted the new products and especially the increased feeling of safety (P <.01); 56% preferred CC and 44% preferred BP but the difference was not significant. In total, 81% wanted to have extra seat belts in their family car. CC was appreciated for its symmetry, comfort, and the perceived feeling of safety. Some participants found CC unpleasant because the belts tended to slip close to the neck, described as a strangling feeling. BP was simpler to use and did not cause annoyance to the neck in the way CC did. Instead, it felt asymmetric and to some extent less safe than CC. Body size and shape affected seat belt fit to a great extent, which in turn affected the experience of comfort, both initially and over time. Perceived safety benefit and experienced comfort were the most determinant factors for the attitude toward the extra seat belts. The extra seat belts were perceived as being better than the participants had expected before the test, and they became more used to them over time. Conclusion: This exploratory study provided valuable knowledge from a user perspective for further development of new seat belt systems in cars. In addition to an increased feeling of safety, seat belt fit and comfort are supplementary influencing factors when it comes to gaining acceptance of new seat belt systems.