Occult abdominal injuries to airbag-protected crash victims: a challenge to trauma systems

Validating the danger of vehicular protective devices and bowel injury

INTRODUCTION

Protective devices such as seat belts and airbags have improved the safety of motor vehicle occupants, but limited data suggest they may be associated with increased blunt bowel (small bowel or colon) injuries (BI). Unfortunately, this risk is unquantified.

METHODS

We analyzed the National Trauma Data Bank (2017-2019) using ICD-10 codes to identify adult motor vehicle occupants with BI who underwent surgical repair. We used logistic regression modeling to compare the risk of undergoing surgical repair for BI after using a protective device.

RESULTS

Of 2,848,592 injured patients, 475,546 (16.7%) were motor vehicle occupants. Only 1.2% (n = 5627/475,546) of patients underwent a bowel repair or resection. Using a seat belt only was associated with an adjusted OR of 2.09 (95% CI 1.91, 2.28) for undergoing a bowel repair/resection when adjusting for Injury Severity Score (ISS) and age. Airbag deployment without a seat belt had an adjusted OR of 1.46 (95% CI 1.31, 1.62), while both devices combined conferred an OR of 3.27 (95% CI 3.02, 3.54). However, using a seat belt was protective against death with an OR of 0.50 (95% CI 0.48, 0.53), adjusted for age, sex, Charlson Comorbidity Score, and ISS.

CONCLUSION

Seat belts and airbags are essential public health safety interventions and protect against death in motor vehicle-associated injuries. However, patients involved in MVCs with airbag deployment or while wearing a seat belt are at an increased risk of bowel injury requiring surgery compared to unrestrained patients, despite these events being relatively uncommon.

Mortality of trauma patients treated at trauma centers compared to non-trauma centers in Sweden: a retrospective study

Objective

The main objective was to compare the 30-day mortality rate of trauma patients treated at trauma centers as compared to non-trauma centers in Sweden. The secondary objective was to evaluate how injury severity influences the potential survival benefit of specialized care.

Methods

This retrospective study included 29,864 patients from the national Swedish Trauma Registry (SweTrau) during the period 2013–2017. Three sampling exclusion criteria were applied: (1) Injury Severity Score (ISS) of zero; (2) missing data in any variable of interest; (3) data falling outside realistic values and duplicate registrations. University hospitals were classified as trauma centers; other hospitals as non-trauma centers. Logistic regression was used to analyze the effect of trauma center care on mortality rate, while adjusting for other factors potentially affecting the risk of death.

Results

Treatment at a trauma center in Sweden was associated with a 41% lower adjusted 30-day mortality (odds ratio 0.59 [0.50–0.70], p < 0.0001) compared to non-trauma center care, considering all injured patients (ISS ≥ 1). The potential survival benefit increased substantially with higher injury severity, with up to > 70% mortality decrease for the most critically injured group (ISS ≥ 50).

Conclusions

There exists a potentially substantial survival benefit for trauma patients treated at trauma centers in Sweden, especially for the most severely injured. This study motivates a critical review and possible reorganization of the national trauma system, and further research to identify the characteristics of patients in most need of specialized care.

Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden

OBJECTIVE

The objective of this study was to evaluate the proportion and characteristics of patients sustaining major trauma in road traffic crashes (RTCs) who could benefit from direct transportation to a trauma center (TC).

METHODS

Currently, there is no national classification of TC in Sweden. In this study, 7 university hospitals (UHs) in Sweden were selected to represent a TC level I or level II. These UHs have similar capabilities as the definition for level I and level II TC in the United States. Major trauma was defined as Injury Severity Score (ISS) > 15. A total of 117,730 patients who were transported by road or air ambulance were selected from the Swedish TRaffic Accident Data Acquisition (STRADA) database between 2007 to 2014. An analysis of the patient characteristics sustaining major trauma in comparison with patients sustaining minor trauma (ISS < 15) was conducted. Major trauma patients transported to a TC versus non-TC were further analysed with respect to injured body region and road user type.

RESULTS

Approximately 3% (n = 3, 411) of patients sustained major trauma. Thirty-eight percent of major trauma patients were transported to a TC, and 62% were transported to a non-TC. This results in large proportions of patients with Abbreviated Injury Scale (AIS) 3+ injuries being transported to a non-TC.  The number of AIS 3+ head injuries for major trauma patients transported to a TC versus non-TC were similar, whereas a larger number of AIS 3+ thorax injuries were present in the non-TC group. The non-TC major trauma patients had a higher probability of traveling in a car, truck, or bus and to be involved in a crash in a rural location.

CONCLUSIONS

Our results show that the majority of RTC major trauma patients are transported to a non-TC. This may cause unnecessary morbidity and mortality. These findings can guide the development of improved prehospital treatment guidelines, protocols and decision support systems.

Risk of thoracic injury from direct steering wheel impact in frontal crashes

BACKGROUND

The combination of airbag and seat belt is considered to be the most effective vehicle safety system. However, despite the widespread availability of airbags and a belt use rate of more than 85%, US drivers involved in crashes continue to be at risk of serious thoracic injury. The objective of this study was to determine the influence of steering wheel deformation on driver injury risk in frontal automobile crash.

METHODS

The analysis is based on cases extracted from the National Automotive Sampling System Crashworthiness Data System database for case years 1993 to 2011. The approach was to compare the adjusted odds of frontal crash injury experienced by drivers in vehicles with and without steering wheel deformation.

RESULTS

Among frontal crash cases with belted drivers, observable steering wheel deformation occurred in less than 4% of all cases but accounted for 30% of belted drivers with serious (Abbreviated Injury Scale [AIS] score, 3+) thoracic injuries. Similarly, steering wheel deformation occurred in approximately 13% of unbelted drivers but accounted for 60% of unbelted drivers with serious thoracic injuries. Belted drivers in frontal crashes with steering wheel deformation were found to have two times greater odds of serious thoracic injury. Unbelted drivers were found to have four times greater odds of serious thoracic injury in crashes with steering wheel deformation. In frontal crashes, steering wheel deformation was more likely to occur in unbelted drivers than belted drivers, as well as higher severity crashes and with heavier drivers.

CONCLUSION

The results of the present study show that airbag deployment and seat belt restraint do not completely eliminate the possibility of steering wheel contact. Even with the most advanced restraint systems, there remains an opportunity for further reduction in thoracic injury by continued enhancement to the seat belt and airbag systems. Furthermore, the results showed that steering wheel deformation is an indicator of potential serious thoracic injury and can be useful to prehospital personnel in improving the diagnosis of serious injuries.

LEVEL OF EVIDENCE

Prognostic study, level III.

The impact of seat belts and airbags on high grade renal injuries and nephrectomy rate in motor vehicle collisions

PURPOSE

Motor vehicle collisions are the most common cause of blunt genitourinary trauma. We compared renal injuries with no protective device to those with seat belts and/or airbags using NTDB. Our primary end point was a decrease in high grade (grades III-V) renal injuries with a secondary end point of a nephrectomy rate reduction.

MATERIALS AND METHODS

The NTDB research data sets for hospital admission years 2010, 2011 and 2012 were queried for motor vehicle collision occupants with renal injury. Subjects were stratified by protective device and airbag deployment. The AIS was converted to AAST renal injury grade and nephrectomy rates were evaluated. Intergroup comparisons were analyzed for renal injury grades, nephrectomy, length of stay and mortality using the chi-square test or 1-way ANOVA. The relative risk reduction of protective devices was determined.

RESULTS

A review of 466,028 motor vehicle collisions revealed a total of 3,846 renal injuries. Injured occupants without a protective device had a higher rate of high grade renal injuries (45.1%) than those with seat belts (39.9%, p = 0.008), airbags (42.3%, p = 0.317) and seat belts plus airbags (34.7%, p <0.001). Seat belts (20.0%), airbags (10.5%) and seat belts plus airbags (13.3%, each p <0.001) decreased the nephrectomy rate compared to no protective device (56.2%). The combination of seatbelts and airbags also decreased total hospital length of stay (p <0.001) and intensive care unit days (p = 0.005). The relative risk reductions of high grade renal injuries (23.1%) and nephrectomy (39.9%) were highest for combined protective devices.

CONCLUSIONS

Occupants of motor vehicle collisions with protective devices show decreased rates of high grade renal injury and nephrectomy. Reduction appears most pronounced with the combination of seat belts and airbags.

Child passenger safety

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death for children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend inclusion of child passenger safety anticipatory guidance at every health-supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues that affect the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.

The importance of vehicle rollover as a field triage criterion

BACKGROUND

The objective of this article was to review the importance of vehicle rollover as a field triage criterion. In 1987, field triage criteria were developed by the American College of Surgeons Committee on Trauma that have been propagated repeatedly over the subsequent 20+ years. The field triage decision scheme is based on abnormal physiology, obvious abnormal anatomy, mechanism of injury likely to result in severe injury, and other factors (age, etc.) and was supported by available science at that time. In 2005, the triage scheme was revised by a committee, and vehicle rollover as a crash scene triage criterion was dropped in 2006.

METHODS

The medical literature and data from the Department of Transportation/National Highway Traffic Safety Administration (NHTSA) Fatal Accident Reporting System and the National Automotive Sampling System were analyzed to determine the contribution of rollover to morbidity and mortality.

RESULTS

Vehicle rollovers represent a small but significant percentage of crashes; of the almost 12 million vehicle crashes reported by NHTSA in 2004, only 2.4% were rollovers, but these accounted for one-third of all crash-related occupant deaths and about 25,000 serious injuries every year. Rollovers are associated with the second highest number of vehicle occupant deaths by crash mode, three times the risk of injury when compared with other impact directions (p < 0.0001), specific types of injury such as head and spinal cord injuries, and a risk of death >15 times the risk in nonrollover crashes.

CONCLUSION

The data and literature unequivocally show a strong and disproportionate association between vehicle rollover and injury severity and death. Because it is difficult to devise simple, accurate decision rules for point of wounding and vehicle crash scene triage, simple, powerful relationships should be used when possible. Thus, the exclusion of rollover as a triage criterion seems to be ill advised.

A fatal case of air-bag-mediated liver injury in an unrestrained driver

A middle-aged man, who drove a small vehicle while drunken and not wearing a seat belt, crashed head on into a pier wall at a high speed. The rapid air-bag deployment caused abdominal compression of the driver, who was found dead 2 m away from the car. There were facial front-glass injuries and multiple rib fractures, but no head injury. Autopsy disclosed liver laceration with intra-abdominal hemorrhage (2,000 mL), resulting in hemorrhagic shock. This is the first autopsy report of liver laceration caused by the rapid expansion of an air-bag during an automobile crash.

Steering wheel deformity and serious thoracic or abdominal injury among drivers and passengers involved in motor vehicle crashes

STUDY OBJECTIVE

We assess the relationship between steering wheel deformity and serious thoracic or abdominal injury among drivers and front seat passengers involved in motor vehicle crashes, while adjusting for important crash factors.

METHODS

This was a national population-based cohort of adults involved in motor vehicle crashes from 1995 to 2002 and included in the National Automotive Sampling System Crashworthiness Data System database. Participants were front seat occupants aged 16 years or older involved in motor vehicle crashes with collision. Outcome measure was serious thoracic or abdominal injury, defined as an Abbreviated Injury Scale score greater than or equal to 3 in these body regions.

RESULTS

There were 42,860 persons involved in motor vehicle crashes and seated in the driver or front passenger seat whose data were available for analysis. Five hundred fifty-four (1.3%) persons had serious thoracic injuries, and 169 (0.4%) persons had serious abdominal injuries. In multivariable logistic regression models that adjusted for important crash factors and the National Automotive Sampling System Crashworthiness Data System sampling design, increasing steering wheel deformity was associated with serious thoracic injury in drivers (odds ratio [OR] for each 5-cm increase in steering wheel deformity 1.28, 95% confidence interval [CI] 1.04 to 1.59) and front seat passengers (OR 1.77, 95% CI 1.26 to 2.49). Increasing steering wheel deformity was associated with serious abdominal injury in front seat passengers (OR 1.45, 95% CI 1.11 to 1.89) but not in drivers (OR 0.95, 95% CI 0.79 to 1.15).

CONCLUSION

Steering wheel deformity is an independent predictor of serious thoracic injury in drivers and front seat passengers and is associated with serious abdominal injury among front seat passengers. For these occupants, the risk of these injuries increases incrementally with increasing steering wheel deformity.

Injuries caused by airbags: a review

With the number of vehicles on the road increasing, the safety aspects of motoring are becoming a progressively more important consideration in health care provision and policy. Airbags are a relatively new introduction into our vehicles. Unlike other mechanisms such as seat belts, they offer protection without the need for any action on the part of the occupant. However, the necessarily violent nature of their deployment has led to the emergence of patterns of injury as a direct result. Knowledge of the potential dangers posed by these systems is useful both for emergency department physicians in order to prevent important injuries being missed, and for car manufacturers using increas ingly modern technology to design more efficient mechanisms. We undertook a review of the current literature to ascertain the spectrum of injuries that have been attributed to the use of airbags, while putting this into the wider context of their protective contribution.

Effect of airbag deployment on head injuries in severe passenger motor vehicle crashes in Ontario, Canada

BACKGROUND

The purpose of this study was to identify and analyze factors contributing to both airbag deployment and resulting head injuries (HIs) and to quantify the effect of airbag deployment on head injuries, in terms of odds of head injury and severity, in severe motor vehicle collisions (MVCs).

METHODS

Data were derived from severely injured (Injury Severity Score [ISS] > 12) drivers treated at Ontario's lead trauma hospitals (n = 1,272), and included all MVC driver deaths in the province (n = 665) from 1997-98. We conducted an epidemiologic description and a case-control study to compare drivers with and without HIs. Statistical analysis included Pearson's chi2, Wilcoxon rank-sum, and multiple logistic regression tests.

RESULTS

Seventy-one percent of drivers were men, peaking in the 25- to 34-year age group. The most common impact involved multiple vehicles (62%) approaching each other. Overall, 59% of crashes had a frontal location of impact. HIs were significantly associated with a lower age (median, 36 vs. 43 years), seat belt use (53% vs. 59%), and airbag deployment (7% vs. 10%), with higher ISS (median, 34 vs. 22), ejection (20% vs. 10%), and mortality rate (44% vs. 35%). Airbag deployment was associated with higher age and seat belt use, and lower ISS, ejection, and deaths. Importantly, there were fewer HIs with the deployment of an airbag (64% vs. 73%) and a lower severity of HI. When logistic regression was used to control for the effects of possible confounders, airbag deployment was not statistically associated with one's odds of HI (odds ratio, 0.827; 95% confidence interval, 0.560-1.220), but ISS, age, and ejection were.

CONCLUSION

Airbag deployment did not significantly lower a driver's odds of head injury in a severe MVC, but it did significantly lower the severity of head injury. This is a significant finding, given that 72% of our study population sustained a head injury and the importance of lowering the severity of these head injuries in terms of patients' ultimate outcome. The most important factor associated with head injuries was ejection, which nearly doubled a driver's odds of head injury (odds ratio, 1.759; 95% confidence interval, 1.201-2.577). This reinforces the supplementary protective effect of an airbag and that "buckling up" and keeping occupants in the vehicle is of primary importance in the prevention of head injuries.

Pancreatic trauma in the adult: current knowledge in diagnosis and management

BACKGROUND/AIMS

Although pancreatic trauma, isolated or not, is uncommon, it carries significant morbidity and mortality because of the delay in recognition and consequent treatment.

METHODS

The current knowledge of pancreatic injury, concerning the incidence, mechanism of induction, diagnosis, treatment, complications and outcome, is herein presented based on a literature review and our limited experience.

RESULTS

The diagnosis of pancreatic trauma entails a high index of suspicion because neither clinical nor laboratory evaluation provide pathognomonic elements. Patients with penetrating injuries are usually evaluated during laparotomy, while those with a blunt trauma can be managed conservatively, provided they are in a stable condition, there is no pancreatic duct involvement and care is intensive. At laparotomy, minor pancreatic injuries are best managed by drainage. Distal pancreatectomy is best suited for distal pancreatic trauma with ductal involvement. For severe trauma, Roux-en-Y pancreaticojejunostomy, pancreaticogastrostomy, duodenal diversion operations and Whipple's procedure are all indicated according to the preoperative evaluation and intraoperative findings. Independent of the procedure to be performed, drainage is mandatory.

CONCLUSION

Because pancreatic injury is rare, most general surgeons lack experience and ability to deal with such injured patients. Therefore, an experienced and skilled surgeon should govern the management of pancreatic trauma in order to minimize the incidence of morbidity and mortality.

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.

Development of a Reusable, Rate-Sensitive Abdomen for the Hybrid III Family of Dummies

The objective of this work was to develop a reusable, rate-sensitive dummy abdomen with abdominal injury assessment capability. The primary goal for the abdomen developed was to have good biofidelity in a variety of loading situations that might be encountered in an automotive collision. This paper presents a review of previous designs for crash dummy abdomens, a description of the development of the new abdomen, results of testing with the new abdomen and instrumentation, and suggestions for future work. The biomechanical response targets for the new abdomen were determined from tests of the mid abdomen done in a companion biomechanical study. The response of the abdominal insert is an aggregate response of the dummy's entire abdominal area and does not address differences in upper versus lower abdominal response, solid versus hollow organs, or organ position or mobility. While the abdomen developed has demonstrated good biofidelity in rigid bar, seat belt and airbag loading situations, some work remains to be done before it can be used in crash testing.

Mortality reduction with air bag and seat belt use in head-on passenger car collisions

To assess the efficacy of occupant protection systems, the authors measured the mortality reduction associated with air bag deployment and seat belt use for drivers involved in head-on passenger car collisions in the United States. They used a matched case-control design of all head-on collisions involving two passenger cars reported to the Fatality Analysis Reporting System in 1992-1997, and driver mortality differences between the paired crash vehicles for air bag deployment and seat belt use were measured with matched-pair odds ratios. Conditional logistic regression was used to adjust for multiple effects. There were 9,859 head-on collisions involving 19,718 passenger cars and drivers. Air bag deployment reduced mortality 63% (crude odds ratio (OR) = 0.37, 95% confidence interval (CI): 0.32, 0.42), while lap-shoulder belt use reduced mortality 72% (OR = 0.28, 95% CI: 0.25, 0.31). In a conditional logistic model that adjusted for vehicle (rollover, weight, age) and driver (age, sex) factors, air bags (OR = 0.71, 95% CI: 0.58, 0.87) and any combination of seat belts (OR = 0.25, 95% CI: 0.22, 0.29) were both associated with reduced mortality. Combined air bag and seat belt use reduced mortality by more than 80% (OR = 0.18, 95% CI: 0.13, 0.25). Thus, this study confirms the independent effect of air bags and seat belts in reducing mortality.

Atlanto-occipital dislocation: an unusual lethal airbag injury

Airbag-induced injury fatality is increasing in frequency. We present the case of a 6-year-old passenger who sustained a fatal atlanto-occipital dislocation associated with airbag deployment in a low-speed motor vehicle crash. The current literature regarding airbag fatalities and methods to ameliorate airbag-induced injury are reviewed.

On burn injuries related to airbag deployment

Airbags have been shown as a vital, supplemental restraining device that save lives and reduce morbidity associated with motor vehicles crashes. However, as with any developing technology, airbags have also been identified in some instances, as the source of injuries which, have been well described in the literature. To a significantly lesser degree, burns due to airbag deployment (about 7-8% of these injuries) have been reported. These injuries will be seen more frequently as more vehicles are equipped with airbags and should be suspected in drivers and passengers involved in accidents in which airbags have been activated. This article, reviews the various types of burns and their pathogenesis, found in crashes involving airbag deployments.

Seventy cases of injuries of the small intestine caused by blunt abdominal trauma: a retrospective study from 1970 to 1994

BACKGROUND

Injuries of the hollow viscera are far less common in blunt abdominal trauma than in penetrating abdominal trauma. This article is a 25-year retrospective study of 70 patients with injuries of the small intestine caused by blunt trauma. All patients were treated surgically at the trauma hospital (Unfallkrankenhaus) in Graz. In our series, blunt abdominal trauma causing hollow viscus injuries occurred in conjunction with multiple trauma in 68.8% of cases. The overall mortality rate was 25.7%.

METHODS

The following methods were used for evaluating the intestinal injury: detailed history of the accident and examination of the patients (e.g., transverse abdominal bruise) diagnostic peritoneal lavage before 1984, abdominal sonography since 1984, computed tomography, and laboratory tests.

RESULTS

Prognosis and results depended partly on the general condition of the patient, as well as the timeliness of diagnosis and surgical management of the small bowel injury. Delays in diagnosis were common because of the overall condition of the patient, as well as the difficulty in establishing a definitive diagnosis by using current radiologic and serologic modalities.

CONCLUSION

It should be stated that the high mortality of small bowel injuries after blunt abdominal trauma justifies an aggressive approach to diagnosis and surgical treatment of these injuries. This article focuses on injury mechanisms and current concepts in diagnosis and the therapy of small intestine lacerations in blunt abdominal trauma.

Is mechanism of injury dead?

Mechanism-of-injury data are frequently unavailable to the emergency physician. Furthermore, their value as a triage tool has recently been challenged. Motor vehicle crash patients have fewer external signs of injury, and commonly "look fine and feel fine" because of improvements in vehicle design, increased use of restraints, and airbag deployments. Yet forces involved in the crash may overcome all efforts at protecting the occupant, resulting in occult life-threatening injuries. Without data about the crash, physicians are blinded to violent crash forces that are ultimately transferred to the patient. Information technologies, such as on-scene photography by EMTs, automated collision notification systems, and telemedicine applications, may be used to deliver real-time crash information to aid the emergency physician in caring for these patients. Beyond improving patient care for any given encounter in emergency practice, collecting and evaluating these data will expand our knowledge about how to care for future motor vehicle crash patients.

Air bag-associated injury to a child in the front passenger seat

We report the case of a 3.5-year-old front seat passenger who suffered significant head and neck injuries as a result of air bag deployment in a collision of <30 mph. These lesions included multiple abrasions of the lower half of the face, nose, forehead, and right ear, torn frenula, conjunctival petechiae, comminuted fractures of the left and right lateral frontal regions and right parietal bone, diastatic fracture of the coronal suture, subgaleal and subarachnoid hemorrhages, cortical contusions, subluxation of the atlantooccipital joint, and fracture of the C4 vertebral body. These lesions are consistent with trauma secondary to the deploying air bag and the head striking the interior of the car. The findings in this case further support the Centers for Disease Control and Prevention (CDC) guidelines of keeping children properly restrained, preferably in the back seat, or as far as possible from air bags.

Blunt and penetrating trauma--has anything changed?

Management of abdominal trauma has changed significantly in the last decade. The next decade will also see significant change as imaging and minimally invasive surgical techniques evolve and more approaches are examined in well-designed prospective studies.

Air bags: an update

Overwhelming evidence shows that air bags save lives and reduce morbidity associated with MVCs. The resulting benefits far outweigh the risks of air bag injury or death. Emergency nurses play a pivotal role in educating the public about active seat belt use in conjunction with passive restraint systems such as air bags. Air bags cannot be viewed as a single solution or panacea to occupant protection. Air bags are designed as supplemental devices to be used with seat belts and require the active participation of the user for maximum benefit and safety.

Facial nerve paresis involving passenger airbag deployment: a case report

The case of a 32-yr-old woman who developed transient facial nerve paresis following deployment of the passenger airbag is presented. Although a wide range of injuries including fatalities have occurred, this case represents a unique type of injury following passenger airbag deployment.

Air bag--mediated injury in the emergency department population

As the number of passenger vehicles equipped with air bags increases, the hazards associated with their use become more apparent. Certain occupants are at a greater risk of injury, depending on their size or their location in the vehicle. A predictable pattern of injury can be found; therefore a careful history and physical assessment are critical to avoid missing significant injuries.

Airbag protection versus compartment intrusion effect determines the pattern of injuries in multiple trauma motor vehicle crashes

OBJECTIVE

A prospective study of the interaction between airbag (AB) and seat-belt (Bt) protection versus vehicular compartment (VC) intrusion effects on injury patterns in motor vehicle crash (MVC) trauma patients.

METHODS

Two hundred MVC patients, nonejected drivers or front seat passengers with multiple trauma or severe lower extremity (LE) trauma admitted to two Level I trauma centers.

RESULTS

In frontal crashes, airbags (AB) more than Bt reduced Glasgow Coma Scale severity in brain injury, face fracture, shock, and the need for MVC extrication (all p < 0.05). Frontal AB also had a protective effect on LE fractures (41% vs. 66%, p < 0.01), but had no significant protective effect on pelvic fractures. When AB protection was present, it prevented brain and face fracture injuries caused by impact contacts and reduced the incidence of these injuries resulting from VC intrusions (p < 0.05). Thoracoabdominal injuries resulting from steering wheel intrusion showed AB protection against intrusions of twice the magnitude of those seen in non-AB vehicles (p < 0.05). In frontal MVCs, AB reduced LE fracture contact injuries but did not prevent LE fractures resulting from intrusions of instrument panel, toepan, or floor pedal structures. In lateral MVCs, Bt did not protect against brain, face, thorax, or pelvic injuries.

CONCLUSIONS

Safety measures beyond frontal airbags must address frontal crash LE injuries induced by steering wheel, instrument panel, and toepan passenger compartment structure intrusions. Lateral crash injuries may profit from side AB supplemental restraint protection.

Severe head injury caused by airbag deployment

Passenger-side airbags are present in over 21 million automobiles and will be required on all passenger vehicles by the model year 1999. Although airbags are effective supplemental restraint systems and have saved over 1,500 lives, airbag-related injuries have been reported. The National Highway Traffic Safety Administration recently reported 15 child deaths caused by airbag deployment. All of these children were believed to be improperly restrained in the front passenger position of a car equipped with a passenger-side airbag. This case represents the first serious injury caused by airbag deployment in a child that was properly positioned in an approved child restraint.