Full-thickness burn to the hand from an automobile airbag

Airbag injuries of the hand: a case-series and literature review

Motor vehicle accidents are a significant cause of morbidity and mortality worldwide. Airbags aim to reduce the severity of motor vehicle accidents, but their deployment is not without risks. This study presents five cases presenting with diverse forms of upper extremity injuries following airbag deployment. The presented cases highlight the variety of clinical presentations, the differences in diagnostics in terms of imaging modalities, as well as the spectrum of possible outcomes from complete healing to decreased range of motion to persistent neurological symptoms. Understanding the mechanisms and presentations of such injuries can only help in improving and creating new strategies for the prevention of such injuries, as well as their management.

A Systematic Review on Airbag-Induced Burns

Airbags significantly reduce fatalities and injuries in automobile crashes, but they have been found to be associated with burns. Specifically, airbags can cause burns through thermal or chemical mechanisms and commonly affect the arms, hands, face, and eyes. While most airbag-induced burns are minor, some may cause unfavorable outcomes. Our study aimed to systematically review airbag-induced burns to assess etiology, type, and treatment of these injuries. A systematic review of case reports pertaining to airbag-induced cutaneous and ocular burns was conducted. Data reviewed included type/location of burns, severity of burn, total number of patients, treatment, complications, and outcome after treatment. We identified 21 case reports that met our inclusion criteria with a total of 24 patients reported in the studies. Of the studies identified, 38% were chemical burns and 25% were thermal burns. Most commonly the upper extremities were burned in 42% of cases, followed by eyes (25%) and face (21%). Most burns identified were superficial partial thickness (58%). Treatment outcomes were good for cutaneous burns, with 95% healing without complication. However, ocular injuries lead to permanent impaired eye function in 71% of cases. In our systematic review, we highlighted the common risk factors, prognosis, and treatment for thermal, chemical, and ocular burns. Airbag-induced burns have a relatively good prognosis but must be recognized and treated immediately to reduce the risk of serious sequelae.

Mechanisms of motor vehicle crashes related to burns--an analysis of the German In depth Accident Study (GIDAS) database

BACKGROUND

Patients of motor vehicle crashes (MVCs) suffering burns are challenging for the rescue team and the admitting hospital. These patients often face worse outcomes than crash patients with trauma only. Our analysis of the German In-depth Accident Study (GIDAS) database researches the detailed crash mechanisms to identify potential prevention measures.

METHODS

We analyzed the 2011 GIDAS database comprising 14,072 MVC patients and compared individuals with (Burns) and without (NoBurns) burns. Only complete data sets were included. Patients with burns obviously resulting of air bag deployment only were not included in the Burns group. Data acquisition by an on call team of medical and technical researchers starts at the crash scene immediately after the crash and comprises technical data as well as medical information until discharge from the hospital. Statistical analysis was done by Mann-Whitney-U-test. Level of significance was p < 0.05.

RESULTS

14,072 MVC patients with complete data sets were included in the analysis. 99 individuals suffered burns (0.7%; group "Burns"). Demographic data and injury severity showed no statistical significant difference between the two groups of Burns and NoBurns. Injury severity was measured using the Injury Severity Score (ISS). Direct frontal impact (Burns: 48.5% vs. NoBurns: 33%; p < 0.05) and high-energy impacts as represented by delta-v (m/s) (Burns: 33.5 ± 21.4 vs. NoBurns: 25.2 ± 15.9; p < 0.05) were significantly different between groups as was mortality (Burns: 12.5% vs. NoBurns: 2.1%; p < 0.05). Type of patients' motor vehicles and type of crash opponent showed no differences.

CONCLUSIONS

Our results show, that frontal and high-energy impacts are associated with a frequency of burns. This may serve automobile construction companies to improve the burn safety to prevent flames spreading from the motor compartment to the passenger compartment. Communities may impose speed limits in local crash hot spots.

Air bag-associated burn

Burns due to the deployment of air bags have been occasionally described in recent years. Most reports are about injuries in the USA. However, there have been few reports of this type of injury in Australia. This case report details such an injury that took place in a road traffic accident in Melbourne, Australia.

Modeling thermal burns due to airbag deployment

Automotive airbags are now a widely accepted safety measure designed to reduce morbidity associated with motor vehicle accidents. Their usage is increasing with multiple airbags (driver, passenger and side curtain) being fitted to many vehicles. However the deployment of airbags has been identified as causing injuries in some instances including minor burns. There are three mechanisms for thermal burns due to an airbag; contact with the hot expelled gases from the airbag, contact with the hot airbag itself and melting of clothing from either of these contacts. A mathematical model is used here to predict the likelihood and severity of the first two types of burns. It is shown that direct contact with high temperature exhaust gases venting from the airbag can indeed lead to burns and that burns from contacting the hot airbag material are possible but far less likely to occur.

Air bags and the skin

Air bags, fitted in the majority of new automobiles, are safety devices activated when a sudden deceleration causes the ignition of a propellant cartridge containing sodium azide. The bag is inflated by nitrogen liberated during the combustion. Deployment releases various high-temperature gases, including nitrogen and carbon dioxide, and produces sodium hydroxide, a highly irritant alkaline substance. In about 7%-8% of cases, air bags cause dermatologic injuries such as traumatic lesions, irritant dermatitis, and chemical and thermal burns. Nondermatologic lesions, such as ocular damage (alkali keratitis, corneal abrasions), ear lesions, bone fractures, and contusive damage can also be caused by air bag deployment.

Burn injuries resulting from (accidental) airbag inflation

INTRODUCTION

Airbags are intended to minimize facial injuries, alone and when used in combination with seatbelts in high-velocity motor-vehicle accidents. They may occasionally perforate, resulting in the release of sodium azide or sodium hydroxide, which result in chemical burns when in contact with skin. The force of deployment may itself result in significant blunt trauma, and there is a temperature rise during the inflation causing thermal burns, possibly as a separate and unnecessary consequence of a relatively minor accident.

METHOD

A case report is presented. The literature on such injuries was reviewed and the mechanism of airbag deployment commented.

CONCLUSION

Alternative designs and mechanisms of linking the activation of the device to the velocity of travel or to add a switch which is activated when accessing a motorway are recommended.

Analysis of Burn Injuries in Frontal Automobile Crashes

The purpose of this study was to investigate burn injuries resulting from frontal automobile crashes and to determine the effects of frontal airbags on the incidence of burn injuries. The study included 25,464 individual cases from the National Automotive Sampling System database files for the years 1993 to 2000. Occupants were at a significantly higher risk to sustain a burn injury when exposed to an airbag deployment (1.54%) compared with those who received a burn injury when not exposed to an airbag deployment (0.02%; P = 0.02). In contrast to previous publications, this study found that 1.53% of front seat occupants exposed to an airbag deployment sustained an airbag-induced burn injury. The vast majority of airbag-induced burn injuries were minor (98.7%); however, in cases with no airbag deployment, the burns were often much more serious, including fatal burns (29.6%). Occupant weight, height, sex, seatbelt use, and seat position were all found not to be significant in predicting the risk of airbag induced burn injury, whereas age and crash velocity were found to be significant.

Effects of airbag deployment: lesions, epidemiology, and management

Airbags are restraining safety devices, but their activation may sometimes induce injuries during road accidents. Rapid deceleration due to an impact causes the ignition of a sodium azide cartridge, which releases nitrogen gas to inflate the nylon rubber bag. Numerous high-temperature gases, sodium hydroxide, carbon dioxide, and various other metallic oxides are also released producing a corrosive alkaline aerosol. Cutaneous and extracutaneous injuries due to airbag deployment may occur. Cutaneous injuries are frequent, and consist of irritant dermatitis, and chemical and thermal burns. Furthermore, numerous kinds of traumatic lesions (abrasions, friction burns, and lacerations) may be observed. Extracutaneous damage may involve the eyes, ears, cardiovascular system, nerves, joints, and bones. The nature of airbag lesions, their frequency, and management are reported. Even though the majority of airbag lesions are minor and do not require hospitalization, correct diagnosis and the choice of the most suitable treatment are necessary.

Air bag injuries--a literature review in consideration of demands in forensic autopsies

Air bags have been implicated in saving lives and reducing morbidity associated with motor vehicle crashes since their introduction in the mid-1970s. However, there is increasing evidence showing that air bags can be a source of injury and even death in certain circumstances. As the number of air bag-equipped vehicles increases, air bag-related injuries have occurred more frequently. Thus, a greater awareness of air bag-related injuries is required in forensic autopsies. Here, we review thoroughly the literature concerning air bag-related injuries with special regard to their nature and causative mechanisms, and summarize air bag-related injuries observed in adults, children and infants.

Sodium azide burn: a case report

Chemical burn injuries commonly occur at the workplace and can be caused by a variety of agents. Sodium azide is a volatile compound used in the industrial setting and it is also a constituent of car airbags. The known toxic effects of sodium azide include hypotension, bradycardia, and headaches. At the cellular level, it inhibits of ATP production by blocking the respiratory oxidation cascade. In the burn literature only one previous report documents a sodium azide hand burn caused by airbag malfunction. We report a case of massive exposure and resultant systemic toxicity from a sodium azide canister explosion.