Head injury causation scenarios for belted, rear-seated children in frontal impacts

Basilar, skull and facial fractures in 2nd row occupants by crash type with a focus on side and rear impacts

OBJECTIVE

Field data was analyzed to assess the risk of basilar, skull and facial fractures in 2^nd row occupants by crash type. The study determined the rate of fractures in seriously injured (MAIS 3 + F) occupants to establish priorities for 2^nd row occupant safety.

METHODS

Field accident data on seriously injured (MAIS 3+) occupants was determined using 1993-2015 NASS-CDS and 2017-19 CISS by crash type identified with damage area variables for non-ejected occupants in the 2^nd row. Occupants with serious head and face injuries (AIS 3+) were subdivided by fractures to the skull, basilar skull and face. Moderate-to serious (AIS 2+) orbit fractures were included. The rate of injury was determined. Individual electronic cases were analyzed for occupants with basilar fracture in rear and side impacts.

RESULTS

The proportion of 2^nd row occupants with AIS 3+ head and face injury was highest at 73.7% in rear impacts followed by side impacts at 54.2% for those with MAIS 3 + F injury. Basilar fractures (AIS 3+) occurred in 53.9% of 2^nd row occupants with skull fracture in rear impacts but only 20.3% in side impacts. Overall, basilar fractures occurred in 10.8% of 2^nd row occupants with serious injury (MAIS 3 + F) in rear impacts and 2.7% in side impacts. The frequency of AIS 3+ facial fractures was highest in side impacts (40.2%) and lowest (7.6%) in rear impacts.

CONCLUSIONS

While basilar skull fractures are rare in 2^nd row occupants, at 0.083% in rear and 0.044% in side impacts, they represent 53.9% of 2^nd row occupants with a skull fracture and serious injury in rear impacts and 20.3% in side impacts. The mechanism of injury is different in rear and side impacts, but frequently involves multi-impact crashes, severe impacts, intrusion into the seating area and head impact on hard surfaces.

Head excursion in frontal impacts is lower in high back booster seats than in forward facing child seats with internal harnesses designed for children up to 8 years of age

OBJECTIVE

It is often assumed that a child restraint with a five or six-point internal harness provides greater protection for children in frontal crashes than a booster seat with a lap-sash seat belt. However, most research comparing these restraint types has focused on protection for children aged up to approximately 3-4 years of age. Recently, harnessed child restraints for older children up to approximately 8 years of age have become available, but there is little data on their performance compared to booster seats for children over 4 years of age. This study aimed to compare frontal crash performance of a series of harnessed child restraints for children aged 4-8 years to booster seats.

METHODS

Four large harnessed child restraints (Type G in the Australian Standard, AS/NZS 1754:2013) and six high back booster seats (Type E in AS/NZS 1754:2013) were tested in frontal impact on a deceleration sled. Head and pelvis accelerations were recorded and head excursions were measured from high speed video.

RESULTS

Head excursion was an average of 92 mm greater in the large harnessed child restraints than the high back booster seats. The initial position of the head in Type G restraints, an average of 58 mm further forward compared to Type E boosters, was the main contributor to the larger head excursion during impact. Conversely, peak head accelerations in the impact phase were, on average, 37.2 g lower in the large harnessed child restraints than the high back booster seats.

CONCLUSIONS

These data suggest that recommendations for harnessed restraints and booster seats for children aged 4-8 years is not as obvious as is sometimes assumed. Harnessed restraints allow greater head excursion in frontal impacts, potentially increasing the chances of head impacts, especially in vehicles with limited clearance between the restraint and the seat in front. The likelihood, and types of, incorrect use that occur in each restraint type, the vehicle occupant space, and the restraint's crash performance under ideal conditions should be considered in recommending restraints for these older children.

Head contacts in second-row pediatric occupants when the front-seat is reclined during automated emergency braking

Seating configurations for autonomous driving will include reclined front seated occupants, which may expose child occupants seated directly behind to head impacts even in pre-crash scenarios. This study used mathematical modelling to investigate head contact for second-row child occupants seated behind a reclined front-seat during an automatic emergency braking (AEB) scenario. Although characterized by low speed (<1 m/s), head contacts were observed for a seatbelt-restrained 10-year-old and a 6-year-old in a low-back booster when the front-seat was reclined and in an aftward track position. Future seating configurations should consider the potential for head contact by second-row child occupants during crash-avoidance scenarios.

Comparative performance of rearward and forward-facing child restraint systems with common use errors: Effect on crash injury risk for a 1-year-old occupant

OBJECTIVE

To compare how errors in child restraint use influence crash injury risk in rearward and forward-facing restraints for a 1-year old occupant.

METHODS

Three convertible child restraint systems (CRS) were subjected to frontal dynamic sled tests at 56 km/h in rearward-facing and forward-facing modes in a correct use (baseline) condition and in five incorrect use conditions: loose securing belt, loose harness, partial harness use, top tether slack, and three minor errors. Excursion, head, and chest 3 ms resultant acceleration, HIC15, and neck forces and moments of a Q1 anthropomorphic test device (ATD) seated in the restraints were measured. The effect of incorrect use on each outcome and restraint type was analyzed.

RESULTS

The influence of errors varied across different outcome variables, the three restraints tested and orientation modes. Excursion increased in four of five incorrect use conditions in both rearward and forward-facing orientations. A very loose harness increased four of five outcome variables in at least one forward-facing restraint, whereas only excursion was increased when rearward-facing. Overall, there tended to be a more negative effect of incorrect use (demonstrated through increases in outcome variables compared to the baseline) in the forward-facing orientation.

CONCLUSIONS

Overall, errors in use tended to have a larger negative impact on forward-facing restraints than rearward-facing restraints. Given the widespread nature of errors in use, this adds further weight to arguments to keep children rearward-facing to 12 months of age and older. The results also highlight a variation in response to errors across differently designed restraints, suggesting the influence of errors may be minimized by restraint design that is more resistant to errors.

Evaluation of static belt fit and belt torso contact for children on belt-positioning booster seats

Objective: Previous studies have indicated that gap between the seatbelt and torso (reduced belt torso contact) for children on belt-positioning booster seats (BPBs) may lead to less torso engagement and increased likelihood of shoulder belt slip-off during evasive vehicle maneuvers, potentially increasing injury risk during crashes. However, current BPB belt fit measures do not quantify belt gap and may not be able to fully discriminate between designs which provide good vs. poor dynamic outcomes. The goal of this study was to evaluate both novel (belt gap characteristics) and conventional measures of seatbelt fit for BPB-seated children.Methods: Ten BPBs and three seatbelt anchor locations were investigated. Fifty volunteers (4-14 years) were recruited and each evaluated on six unique combinations of BPB and seatbelt anchor location on a vehicle rear seat in a laboratory setting. A 3 D coordinate measurement system quantified positions of anatomic, seatbelt, BPB, and vehicle reference points. Novel belt gap (gap size, length, location, and percent torso contact) and conventional belt fit (position of belt on shoulder and pelvis) metrics were calculated using anatomic and seatbelt landmarks. Variation in belt fit and belt gap outcomes due to BPB, seatbelt anchor location, and anthropometry were investigated.Results: BPBs produced significantly different outcomes, while seatbelt anchor location did not. BPBs with features that directly routed the lower portion of the shoulder belt more forward on the buckle side produced the largest (29.3 ± 12.6 mm) and longest (106.9 ± 68.2 mm) belt gap on average, while BPBs that pulled the belt less forward or did not directly route the belt produced the smallest (13.9 ± 6.7 mm) and shortest (16.9 ± 33.9 mm) gap on average. Belt gap outcomes were not strongly correlated with conventional belt fit metrics, indicating that evaluation of belt gap may provide additional insight when attempting to discriminate between BPBs which provide good vs. poor seatbelt engagement during vehicle maneuvers and crashes.Conclusions: This is the first study to evaluate belt gap characteristics for BPB-seated children. Results suggest that belt fit and belt gap are influenced by BPB design, particularly lower shoulder belt routings, and may have implications for belt engagement during dynamic events.

Kinematics of inboard-leaning occupants in frontal impacts

Objective: Up to one-half of drivers swerve before a crash, which may cause vehicle motions that displace an occupant from a normal seated position. How these altered postures affect occupant restraint in a crash is unknown. The goal of this study was to quantify the effect of an initial inboard lean on occupant kinematics in a frontal impact.Methods: 30 km/h frontal impact tests were performed with three postmortem human subjects (PMHS) seated in a neutral, upright posture and in a 20° inboard-leaning posture identified from simulated swerving tests with human volunteers.Results: In comparison to the upright posture, the inboard-leaning posture increased the initial distance from the D-ring to the belted shoulder by 105-156 mm. In the inboard-leaning tests, the occupant's head displaced 45-70 mm farther forward than in the upright tests and was also located 123-147 mm farther inboard at the time of maximum forward excursion. The peak resultant velocity of the occupant's head relative to the vehicle interior increased 1.40-1.54 m/s in the inboard-leaning tests.Conclusions: The posture-induced increase in the distance between the D-ring and the shoulder permitted the increased maximum forward head displacement and increased maximum head resultant velocity relative to the vehicle interior. Thus, an initial inboard lean in a frontal impact may increase the risk and severity of a head strike to the vehicle interior, and alter the location, timing, and nature of airbag engagement.

Age Differences in Occupant Motion during Simulated In-Vehicle Swerving Maneuvers

Background: With active safety and automated vehicle features becoming more available, unanticipated pre-crash vehicle maneuvers, such as evasive swerving, may become more common, and they may influence the resulting effectiveness of occupant restraints, and consequently may affect injury risks associated with crashes. Therefore, the objective of this study was to quantify the influence of age on key occupant kinematic, kinetic, and muscular responses during evasive swerving in on-road testing. Methods: Seat belt-restrained children (10–12 years old), teens (13–17 years old), and adults (21–33 years old) experienced two evasive swerving maneuvers in a recent model sedan on a test track. Kinematics, muscle activity, and seat belt load distribution were determined and analyzed. Results: Compared to teens and adults, children showed greater head and trunk motion (p < 0.03), but similar muscle activation in the into-the-belt direction of swerving. In the out–of-the-belt direction, children showed head and trunk motion more similar to teens and adults (p < 0.02), but with greater muscle activation. Conclusions: Children showed different neuromuscular control of head and trunk motion compared to older occupants. This study highlights differences in the relationship between kinematics and muscle activation across age groups, and provides new validation data for active human body models across the age range.

The effect of vehicle countermeasures and age on human volunteer kinematics during evasive swerving events

Objective: Emergency maneuvers such as evasive swerving often precede a crash. These events are typically low-acceleration, time-extended events where the inertial forces have the potential to cause changes to the occupant's initial state (initial posture, position, muscle tension). The objective of this study was to systematically quantify the kinematics of pediatric and adult human volunteers during simulated pre-crash evasive swerving maneuvers and evaluate the effect of age and two vehicle-based countermeasures.Methods: A novel laboratory device was designed to expose subjects to non-injurious loading conditions that mimic real-world evasive swerving events. A four-cycle oscillatory lateral pulse with a maximum acceleration of 0.72 g (0.53 g for the first lateral movement in the first cycle) was applied. Forty seat belt restrained subjects across four age groups - 9-11 years (n = 10), 12-14 years (n = 10), 15-17 years (n = 10) and 18-40 years (n = 10) - were exposed to a series of test conditions (baseline, pre-pretensioned seat belt, sculpted vehicle seat with and without inflated torso bolsters) while their kinematics were captured using 3 D motion capture and muscle activity was recorded. Reaction loads were collected from the shoulder belt and footrest. Data are presented for the first cycle only.Results: Pre-pretensioning the shoulder belt before the onset of acceleration had the greatest restraining effect on the head and trunk for all age groups. In the pre-pretensioning trials, compared to baseline, subjects exhibited 34% and 33% less head excursion, into and out of the shoulder belt respectively. Similar reductions were observed with pre-pretensioning for trunk excursion (45% and 53% reductions, in and out of the belt respectively). Inflating seat torso bolsters reduced lateral kinematics relative to baseline but to a lesser extent than the pre-pretensioner (Head Out of belt: 11%; Head Into Belt: 32% and Trunk Out of Belt: 15%; Trunk Into Belt: 27%). Although there was no overall effect of age on the magnitude of lateral displacement, different age groups employed various neuromuscular strategies to control their kinematics.Conclusion: A pre-pretensioner was an effective vehicle countermeasure during evasive swerving maneuvers as it substantially reduced lateral head and trunk displacement for all age groups. Providing lateral restraint via a sculpted vehicle seat was less effective as the geometry of the torso bolsters when inflated did not provide substantial lateral support.

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

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

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.

Differences in the kinematics of booster-seated pediatric occupants using two different car seats

OBJECTIVE

The objective of this article is to compare the performance of forward-facing child restraint systems (CRS) mounted on 2 different seats.

METHODS

Two different anthropomorphic test device (ATD) sizes (P3 and P6), using the same child restraint system (a non-ISOFIX high-back booster seat), were exposed to the ECE R44 regulatory deceleration pulse in a deceleration sled. Two different seats (seat A, seat B) were used. Three repetitions per ATD and mounting seat were done, resulting in a total of 12 sled crashes. Dummy sensors measured the head tri-axial acceleration and angular rate and the thorax tri-axial acceleration, all acquired at 10,000 Hz. A high-speed video camera recorded the impact at 1,000 frames per second. The 3D kinematics of the head and torso of the ATDs were captured using a high-speed motion capture system (1,000 Hz). A pair-matched statistical analysis compared the outcomes of the tests using the 2 different seats.

RESULTS

Statistically significant differences in the kinematic response of the ATDs associated with the type of seat were observed. The maximum 3 ms peak of the resultant head acceleration was higher on seat A for the P3 dummy (54.5 ± 1.9 g vs. 44.2 ± 0.5 g; P =.012) and for the P6 dummy (56.0 ± 0.8 g vs. 51.7 ± 1.2 g; P =.015). The peak belt force was higher on seat A than on seat B for the P3 dummy (5,488.0 ± 198.0 N vs. 4,160.6 ± 63.6 N; P =.008) and for the P6 dummy (7,014.0 ± 271.0 N vs. 5,719.3 ± 37.4 N; P =.015). The trajectory of the ATD head was different between the 2 seats in the sagittal, transverse, and frontal planes.

CONCLUSION

The results suggest that the overall response of the booster-seated occupant exposed to the same impact conditions was different depending on the seat used regardless of the size of the ATD. The differences observed in the response of the occupants between the 2 seats can be attributed to the differences in cushion stiffness, seat pan geometry, and belt geometry. However, these results were obtained for 2 particular seat models and a specific CRS and therefore cannot be directly extrapolated to the generality of vehicle seats and CRS.

Automated recognition of rear seat occupants' head position using Kinect™ 3D point cloud

INTRODUCTION

Child occupant safety in motor-vehicle crashes is evaluated using Anthropomorphic Test Devices (ATD) seated in optimal positions. However, child occupants often assume suboptimal positions during real-world driving trips. Head impact to the seat back has been identified as one important injury causation scenario for seat belt restrained, head-injured children (Bohman et al., 2011). There is therefore a need to understand the interaction of children with the Child Restraint System to optimize protection.

METHOD

Naturalistic driving studies (NDS) will improve understanding of out-of-position (OOP) trends. To quantify OOP positions, an NDS was conducted. Families used a study vehicle for two weeks during their everyday driving trips. The positions of rear-seated child occupants, representing 22 families, were evaluated. The study vehicle - instrumented with data acquisition systems, including Microsoft Kinect™ V1 - recorded rear seat occupants in 1120 driving 26 trips. Three novel analytical methods were used to analyze data. To assess skeletal tracking accuracy, analysts recorded occurrences where Kinect™ exhibited invalid head recognition among a randomly-selected subset (81 trips). Errors included incorrect target detection (e.g., vehicle headrest) or environmental interference (e.g., sunlight). When head data was present, Kinect™ was correct 41% of the time; two other algorithms - filtering for extreme motion, and background subtraction/head-based depth detection are described in this paper and preliminary results are presented. Accuracy estimates were not possible because of their experimental nature and the difficulty to use a ground truth for this large database. This NDS tested methods to quantify the frequency and magnitude of head positions for rear-seated child occupants utilizing Kinect™ motion-tracking.

RESULTS

This study's results informed recent ATD sled tests that replicated observed positions (most common and most extreme), and assessed the validity of child occupant protection on these typical CRS uses.

SUMMARY

Optimal protection in vehicles requires an understanding of how child occupants use the rear seat space. This study explored the feasibility of using Kinect™ to log positions of rear seated child occupants. Initial analysis used the Kinect™ system's skeleton recognition and two novel analytical algorithms to log head location.

PRACTICAL APPLICATIONS

This research will lead to further analysis leveraging Kinect™ raw data - and other NDS data - to quantify the frequency/magnitude of OOP situations, ATD sled tests that replicate observed positions, and advances in the design and testing of child occupant protection technology.

The influence of personal protection equipment, occupant body size, and restraint system on the frontal impact responses of Hybrid III ATDs in tactical vehicles

OBJECTIVE

Although advanced restraint systems, such as seat belt pretensioners and load limiters, can provide improved occupant protection in crashes, such technologies are currently not utilized in military vehicles. The design and use of military vehicles presents unique challenges to occupant safety-including differences in compartment geometry and occupant clothing and gear-that make direct application of optimal civilian restraint systems to military vehicles inappropriate. For military vehicle environments, finite element (FE) modeling can be used to assess various configurations of restraint systems and determine the optimal configuration that minimizes injury risk to the occupant. The models must, however, be validated against physical tests before implementation. The objective of this study was therefore to provide the data necessary for FE model validation by conducting sled tests using anthropomorphic test devices (ATDs). A secondary objective of this test series was to examine the influence of occupant body size (5th percentile female, 50th percentile male, and 95th percentile male), military gear (helmet/vest/tactical assault panels), seat belt type (3-point and 5-point), and advanced seat belt technologies (pretensioner and load limiter) on occupant kinematics and injury risk in frontal crashes.

METHODS

In total, 20 frontal sled tests were conducted using a custom sled buck that was reconfigurable to represent both the driver and passenger compartments of a light tactical military vehicle. Tests were performed at a delta-V of 30 mph and a peak acceleration of 25 g. The sled tests used the Hybrid III 5th percentile female, 50th percentile male, and 95th percentile male ATDs outfitted with standard combat boots and advanced combat helmets. In some tests, the ATDs were outfitted with additional military gear, which included an improved outer tactical vest (IOTV), IOTV and squad automatic weapon (SAW) gunner with a tactical assault panel (TAP), or IOTV and rifleman with TAP. ATD kinematics and injury outcomes were determined for each test.

RESULTS

Maximum excursions were generally greater in the 95th percentile male compared to the 50th percentile male ATD and in ATDs wearing TAP compared to ATDs without TAP. Pretensioners and load limiters were effective in decreasing excursions and injury measures, even when the ATD was outfitted in military gear.

CONCLUSIONS

ATD injury response and kinematics are influenced by the size of the ATD, military gear, and restraint system. This study has provided important data for validating FE models of military occupants, which can be used for design optimization of military vehicle restraint systems.

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

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.

Evaluation of 6 and 10 Year-Old Child Human Body Models in Emergency Events

Emergency events can influence a child’s kinematics prior to a car-crash, and thus its interaction with the restraint system. Numerical Human Body Models (HBMs) can help understand the behaviour of children in emergency events. The kinematic responses of two child HBMs–MADYMO 6 and 10 year-old models–were evaluated and compared with child volunteers’ data during emergency events–braking and steering–with a focus on the forehead and sternum displacements. The response of the 6 year-old HBM was similar to the response of the 10 year-old HBM, however both models had a different response compared with the volunteers. The forward and lateral displacements were within the range of volunteer data up to approximately 0.3 s; but then, the HBMs head and sternum moved significantly downwards, while the volunteers experienced smaller displacement and tended to come back to their initial posture. Therefore, these HBMs, originally intended for crash simulations, are not too stiff and could be able to reproduce properly emergency events thanks, for instance, to postural control.

The Large Omnidirectional Child (LODC) ATD: Biofidelity Comparison with the Hybrid III 10 Year Old

When the Hybrid III 10-year old (HIII-10C) anthropomorphic test device (ATD) was adopted into Code of Federal Regulations (CFR) 49 Part 572 as the best available tool for evaluating large belt-positioning booster seats in Federal Motor Vehicle Safety Standard (FMVSS) No. 213, NHTSA stated that research activities would continue to improve the performance of the HIII-10C to address biofidelity concerns. A significant part of this effort has been NHTSA's in-house development of the Large Omnidirectional Child (LODC) ATD. This prototype ATD is comprised of (1) a head with pediatric mass properties, (2) a neck that produces head lag with Zaxis rotation at the atlanto-occipital joint, (3) a flexible thoracic spine, (4) multi-point thoracic deflection measurement capability, (5) skeletal anthropometry representative of a seated child, and (6) an abdomen that can directly measure belt loading. The objective of this study was to evaluate the LODC by comparing its body region and full-body responses to both standard HIII-10C responses and pediatric biomechanical data. In body region tests, the LODC (BioRank = 1.21) showed improved biofidelity over the HIII-10C (BioRank = 2.70). The LODC also exhibited kinematics more similar to pediatric PMHS kinematics in a reconstruction test. In FMVSS No. 213 tests, the LODC was observed to have lower HIC values with the absence of hard chin-to-chest contacts, indicating that chin-to-chest contact severity is mitigated in the LODC design. LODC abdomen pressures and belt penetrations discriminated between restraint conditions. These results suggest the LODC has biofidelic characteristics that make it a candidate for improved assessment of injury risk in restraint system development.

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 children's 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.

A prospective study of children aged <16 years in motor vehicle collisions in Norway: severe injuries are observed predominantly in older children and are associated with restraint misuse

OBJECTIVE

The implementation of the compulsory wearing of seat belts (SBs) for children and improvements in child restraint systems have reduced the number of deaths and severe injuries among children involved in motor vehicle (MV) collisions (MVCs). Establishing the characteristics predictive of such injuries may provide the basis for targeted safety campaigns and lead to a further reduction in mortality and morbidity among children involved in MVCs. This study performed a multidisciplinary investigation among child occupants involved in MVCs to elucidate injury mechanisms, evaluate the safety measures used and determine the characteristics that are predictive of injury.

METHODS

A prospective study was conducted of all child occupants aged <16 years involved in severe MVCs in south-eastern Norway during 2009-2013. The exterior and interior of the MVs were investigated and the injured children were medically examined. Supplementary information was obtained from witnesses, the crash victims, police reports, medical records and reconstructions. Each case was reviewed by a multidisciplinary team to assess the mechanism of injury.

RESULTS

In total, 158 child occupants involved in 100 MVCs were investigated, of which 27 (17%) exhibited Abbreviated Injury Scale (AIS) scores of 2+ injuries and 15 (9%) exhibited AIS 3+ injuries. None of the children died. Of those with AIS 2+ injuries (n=27), 89% (n=24) were involved in frontal impact collisions and 11% (3/27) were involved in side impacts. Multivariate analysis revealed that restraint misuse, age, the prevailing lighting conditions and ΔV were all independently correlated with AIS 2+ injuries. Safety errors were found in 74% (20/27) of those with AIS 2+ injuries and 93% (14/15) of those with AIS 3+ injuries. The most common safety error was misuse of restraints, and in particular loose and/or improperly positioned SBs.

CONCLUSION

The risk of injury among child occupants is significantly higher when the child occupants are exposed to safety errors within the interior of the vehicle. Future campaigns should focus on the prevention of restraint misuse and unsecured objects in the passenger compartment or boot.

Assessment of vehicle and restraint design changes for mitigating rear seat occupant injuries

OBJECTIVE

Investigate the combined effects of belt geometry, seat substructure, and seat belt pretensioners and load limiters on rear seat occupant injury risk.

METHODS

An instrumented Hybrid III 5th percentile adult female dummy was subjected to simulated frontal impacts (Δv = 45.8 km/h, peak acceleration = 27.1 g). Testing was conducted on a rear seat of a typical family sedan with modifications allowing for adjustment in upper anchorage position, mounting of an antisubmarining seat pan, and the use of seat belt pretensioners with load limiters.

RESULTS

Dummy seated posture had the strongest effect on submarining. Seat belt pretensioners with load limiters reduced head and femur excursion and decreased chest injury measurements but did not prevent submarining. The antisubmarining seat pan, on the other hand, prevented submarining in one case but could not prevent submarining with the dummy in a slouched posture. Upper anchorage position resulting in poor belt geometry was shown to increase both chest injury measures and submarining.

CONCLUSIONS

The results from this study demonstrate the importance of an upright seated posture and the potential benefits of including adjustable upper anchorages to allow good sash belt fit, antisubmarining seat pans, belt buckles positioned near the seat bight, and seat belts with pretensioners and load limiters for rear seat occupants. These data can be used to inform the design of a system of restraints to reduce injuries to rear seat occupants.

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.

Motor vehicle crash-related subdural hematoma from real-world head impact data

Abstract Approximately 1,700,000 people sustain a traumatic brain injury (TBI) each year and motor vehicle crashes (MVCs) are a leading cause of hospitalization from TBI. Acute subdural hematoma (SDH) is a common intracranial injury that occurs in MVCs associated with high mortality and morbidity rates. In this study, SDH volume and midline shift have been analyzed in order to better understand occupant injury by correlating them to crash and occupant parameters. Fifty-seven head computed tomography (CT) scans were selected from the Crash Injury Research Engineering Network (CIREN) with Abbreviated Injury Scale (AIS) level 3+ SDH. Semi-automated methods were used to isolate the intracranial volume. SDH and additional occupant intracranial injuries were segmented across axial CT images, providing a total SDH injury volume. SDH volume was correlated to crash parameters and occupant characteristics. Results show a positive correlation between SDH volume and crash severity in near-side and frontal crashes. Additionally, the location of the resulting hemorrhage varied by crash type. Those with greater SDH volumes had significantly lower Glasgow Coma Scale (GCS) scores at the crash site in near-side crashes. Age and fracture type were found to be significant contributors to SDH volume. This study is a volumetric analysis of real world brain injuries and known MVC impacts. The results of this study demonstrate a relationship among SDH volume, crash mechanics, and occupant characteristics that provide a better understanding of the injury mechanisms of MVC-associated TBI.

Rear seat child safety in near-side impacts: a modeling study of common sitting positions

OBJECTIVE

The purpose of this study was to evaluate and propose improvements to the injury mitigation systems, in near-side impacts, for 6 common sitting positions of young adolescents using a previously validated model.

METHODS

The evaluation was made by using a model of a complete passenger car, including head and thorax-pelvis air bags, which was impacted laterally by a barrier in 2 load cases. The SID-IIs finite element model was used for the evaluations and was seated in 6 different positions in the rear outboard seat: the nominal anthropomorphic test device (ATD) position, 1 inboard position, 3 outboard positions, and 1 braking (forward) position. These positions have previously been identified as common sitting positions in awake and asleep children. The studied dependent variables were head injury criterion (HIC) 36, resultant head linear acceleration, resultant head rotational acceleration, chest viscous criterion, and chest deflection.

RESULTS

The lowest head injury measures were seen in the braking positions and in the nominal ATD position, and the highest were seen in the inboard and outboard positions. The lowest chest injury measures were recorded in the inboard and nominal ATD positions, and the highest were recorded in the outboard and braking positions. The occupant in the outboard positions interfered with the air bags during their deployment. The occupant in inboard and braking positions tended to push the curtain air bag over the windowsill.

CONCLUSIONS

Studies that investigate the injury mitigation effects in common sitting positions, beyond the nominal ATD position, are essential to highlight means to provide improved and robust safety for child occupants. This study was based on the SID-IIs 5th percentile female, which has very similar anthropometry to a 50th percentile 12-year-old. Therefore, the conclusions of this study are applicable to many 11-year-olds up to young adolescents, as well as to small females. The outboard and inboard positions of this study resulted in the highest head injury measures. Although all of the injury measures were only slightly higher than the nominal position, the trends suggest that, in near-side impacts, these positions should be discouraged. The extensively outboard positions resulted in unfavorable air bag positioning during deployment. The inboard position resulted in head strikes further forward of the nominal one; the curtain air bags need inflated cells at all locations of head strike.

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.

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.

Dynamic properties of the upper thoracic spine-pectoral girdle (UTS-PG) system and corresponding kinematics in PMHS sled tests

Anthropomorphic test devices (ATDs) should accurately depict head kinematics in crash tests, and thoracic spine properties have been demonstrated to affect those kinematics. To investigate the relationships between thoracic spine system dynamics and upper thoracic kinematics in crash-level scenarios, three adult post-mortem human subjects (PMHS) were tested in both Isolated Segment Manipulation (ISM) and sled configurations. In frontal sled tests, the T6-T8 vertebrae of the PMHS were coupled through a novel fixation technique to a rigid seat to directly measure thoracic spine loading. Mid-thoracic spine and belt loads along with head, spine, and pectoral girdle (PG) displacements were measured in 12 sled tests conducted with the three PMHS (3-pt lap-shoulder belted/unbelted at velocities from 3.8 - 7.0 m/s applied directly through T6-T8). The sled pulse, ISM- derived characteristic properties of that PMHS, and externally applied forces due to head-neck inertia and shoulder belt constraint were used to predict kinematic time histories of the T1-T6 spine segment. The experimental impulse applied to the upper thorax was normalized to be consistent with a T6 force/sled acceleration sinusoidal profile, and the result was an improvement in the prediction of T3 X-axis displacements with ISM properties. Differences between experimental and model-predicted displacement-time history increases were quantified with respect to speed. These discrepancies were attributed to the lack of rotational inertia of the head-neck late in the event as well as restricted kyphosis and viscoelasticity of spine constitutive structures through costovertebral interactions and mid-spine fixation. The results indicate that system dynamic properties from sub-injurious ISM testing could be useful for characterizing forward trajectories of the upper thoracic spine in higher energy crash simulations, leading to improved biofidelity for both ATDs and finite element models.

Head impact contact points for restrained child occupants

OBJECTIVE

Head injuries are the most common injuries sustained by children in motor vehicle crashes regardless of age, restraint, and crash direction. For rear seat occupants, the interaction of the subject with the seat back and the vehicle side interior structures has been previously highlighted. In order to advance this knowledge to the development of countermeasures, a summary of vehicle components that contributed to these injuries is needed. Therefore, the objective of this study was to create a contact map of the vehicle interior for head and face injuries to rear-seated restrained children in front crashes.

METHODS

The Crash Injury Research and Engineering Network (CIREN) was queried for rear-seated, restrained child occupants (age 0-15 years) in forward-facing child restraints, booster seats, or lap and shoulder belts who sustained an AIS2+ head and/or face injury in a frontal motor vehicle crash. Cases were analyzed to describe injury patterns and injury causation scenarios. A contact point map was developed to summarize the vehicle components related to injury causation of the head/face injury.

RESULTS

Twenty-one cases met the combined inclusion and exclusion criteria. Seven of the child occupants were restrained in forward-facing child restraints, 2 in belt-positioning booster seats, and 12 in lap and shoulder belts. There were 28 head and 17 facial injuries. For left rear occupants, the most common contact point was the pillar in front of the occupant's seat row; that is, B-pillar for second-row occupants, indicating a leftward kinematics. For right rear occupants, due to differences in crash dynamics, the most common contact point location was the passenger's seat back, suggesting that these occupants moved predominantly forward.

CONCLUSIONS

Contact points associated with head/face injury for restrained children 0 to 15 years in frontal crashes have been delineated. In a majority of the cases, the head/face injury was the most severe injury and severe injuries to other body regions were uncommon, suggesting that efforts to mitigate head injuries for these occupants would greatly improve their overall safety. The majority of the head/face contact points were to the first row seat back and B-pillar. In these frontal crashes, the importance of head/face contact with the vehicle side structure suggests that deploying a curtain air bag in frontal impacts may help manage the energy of impact. These data advance the current understanding of injury patterns and causation in frontal crashes involving restrained rear-row occupants and can be used to develop solutions to mitigate the injuries sustained.

Evaluation of the head kinematics of the Q3 model and a modified Q3 model by means of crash reconstruction

OBJECTIVE

One objective of this study is to evaluate the head kinematics of the Q3 model. Another objective is to evaluate the effect on head kinematics of increased thoracic spine flexibility; more humanlike mass distribution; and more humanlike body geometry in the Q3 model. The evaluations were based on the head kinematics of children deduced from real crashes and on new data of mass distribution and updated body dimensions for 3-year-olds.

METHODS

The head kinematics of the Q3 model was evaluated by comparing the Q3 model's head displacement response with the deduced response of 3-year-old children in real crashes. To do so, data from crashes were collected. The data were used to develop the mathematical vehicle and restraint system models (MADYMO, TASS, the Netherlands). Three crashes involving 3-year-old children in frontal impacts were reconstructed. The models were run 35 times each (one model per crash), each time with a different setting to each of the variables for which the exact value was not known. Examples of those variables include crash pulse, initial dummy position, and initial seat belt position. Two versions of the Q3 model were used: one that correlated with the Q3 ATD and one that was modified regarding anthropometry and thoracic flexibility. The basis for the updated anthropometry was new data regarding characteristic dimensions and mass distribution collected at a Swedish hospital.

RESULTS

In the anthropometry study, 26 children were measured. The main differences between the average of the measured children and the Q3 model were found in the mass distribution of the torso and thighs: the Q3's pelvis was too heavy and the thorax, abdomen/lumbar spine, and thighs were too light. Another difference was identified in the buttock-knee length. Two of the 3 reconstructed crashes had confirmed head impacts. The Q3 model responded with head kinematics that reflected the deduced courses of events for the real children in one of 3 crashes (the one without head impact). The modified Q3 model reflected the real children in 2 of 3 crashes.

CONCLUSIONS

In high-severity, straight frontal crashes, the Q3 model predicted non-head impact adequately. However, in oblique frontal crashes, the Q3 model did not sufficiently predict the head impacts. The modified Q3 model predicted the head impacts better than the Q3 model did. Greater flexibility of the thorax and redistributed mass made a positive difference regarding the head kinematics.

In-depth evaluation of real-world car collisions: fatal and severe injuries in children are predominantly caused by restraint errors and unstrapped cargo

OBJECTIVE

Major improvements have taken place in the development of child restraint systems and in-car safety in general, but motor vehicle accidents remain the leading cause of death and disability in children. An interdisciplinary study was therefore performed to investigate the injury mechanisms in car collisions involving children.

METHODS

Motor vehicle collisions (MVCs) resulting in death or serious injuries to the drivers or their passengers in the southeastern part of Norway in the period 2007-2009 were included in the study if children less than 16 years of age were passengers. An investigation team examined the crash scene within 24 h of the accident. The internal and external environment of the vehicle was investigated, with particular focus on safety equipment and registration of child occupant contact points. Information was collected from witnesses, crash victims, the police, road authority reports, and medical records. Clinical or postmortem examinations were performed on the child occupants.

RESULTS

Fifteen high-impact car crashes involving 27 child occupants were investigated: 7 children died (median [range] age 8 (0-15) years), 8 were severely injured (8 [5-13] years), and 12 sustained minor or no injuries (3.5 [0-14] years). Fourteen out of 15 fatalities or severe injuries (MAIS ≥3) were found to be due to various safety errors: harness straps or seat belts incorrectly routed (5/15) or poorly adjusted (4/15), unstrapped luggage (4/15), or technical errors (1/15). All 7 of the fatally injured children died at the crash scene, and 6 died due to head/upper neck trauma. No safety errors were found among the 12 children with either minor or no injuries. No association was found between the instantaneous change in velocity (ΔV) and the injury severity.

CONCLUSION

The risk of child passengers being severely or fatally injured in MVCs is significantly higher when they are incorrectly restrained or exposed to unsecured heavy luggage. Appropriate crash investigations may provide important information regarding the injury mechanisms, which will be necessary for the implementation of preventive measures to reduce future fatalities.