Children in Side-Impact Motor Vehicle Crashes: Seating Positions and Injury Mechanisms

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.

Do NHTSA vehicle safety ratings affect side impact crash outcomes?

INTRODUCTION

Side impact crash injuries tend to be severe, mainly due to the effects of the mechanism of such crashes. This study addresses the relationship between side impact crash injury severities and side impact safety ratings of the passenger cars involved in such crashes. It is motivated by the lack of research on side impact safety ratings in relation to the real-world crash outcomes.

METHOD

Analysis of Crashworthiness Data System's (CDS) data show the head and thorax are the most common regions of impact of severe injuries, while the neck is the least. Irrespective of body regions, higher-rated vehicles were found to provide better occupant protection to both younger and older driver age groups. Assessment based on injury severity score (ISS) indicates that higher-rated vehicles have an overall lower average ISS compared to lower-rated vehicles.

RESULTS

Ultimately, this study shows that vehicles rated with National Highway Traffic Safety Administration's (NHTSA) new criteria had lower average ISS compared to vehicles rated under the old criteria. The 2011 NHTSA side impact rating criteria being relatively new, it has very few crashes to draw meaningful statistically significant conclusions. However, this paper establishes the fact that vehicles with higher star ratings (under experimental conditions) indeed offer increased occupant protection in the field conditions. Practical applications: Previous studies have found that safety was given priority while buying new vehicles. However, people associated vehicle safety with technologies and specific safety features rather than the vehicle's crash test results or ratings (Koppel, Charlton, Fildes, & Fitzharris, 2008). The results from this study provide a point of reference for safety advocates to educate the drivers about the importance of considering vehicle safety ratings during a vehicle purchase.

Epidemiology of injury patterns for 4- to 10-year-olds in side and oblique impacts

OBJECTIVES

With regard to the pediatric population involved in vehicle side impact collisions, epidemiologic data can be used to identify specific injury-producing conditions and offer possible safety technology effectiveness through population-based estimates. The objective of the current study was to perform a field data analysis to investigate injury patterns and sources of injury to 4- to 10-year-olds in side and oblique impacts to determine the potential effect of updated side impact regulations and airbag safety countermeasures.

METHODS

The NASS-CDS, years 1991 to 2014, was analyzed in the current study. The Abbreviated Injury Scale (AIS) 2005-Update 2008 was used to determine specific injuries and injury severities. Injury distributions were examined by body region as specified in the AIS dictionary and the Maximum AIS (MAIS). Children ages 4 to 10 were examined in this study. All occupant seating locations were investigated. Seating positions were designated by row and as either near side, middle, or far side. Side impacts with a principal direction of force (PDOF) between 2:00 and 4:00 as well as between 8:00 and 10:00 were included. Restraint use was documented only as restrained or unrestrained and not whether the restraint was being used properly. Injury distribution by MAIS, body region, and source of injury were documented. Analysis regarding occupant injury severity, body region injured, and injury source was performed by vehicle model year to determine the effect of updated side impact testing regulation and safety countermeasures. Because the aim of the study was to identify the most common injury patterns and sources, only unweighted data were analyzed.

RESULTS

Main results obtained from the current study with respect to 4- to 10-year-old child occupants in side impact were that a decrease was observed in frequency of MAIS 1-3 injuries; injuries to the head, face, and extremities; as well as injuries caused by child occupant interaction with the vehicle interior and seatback support structures in 1998 model year passenger cars and newer.

CONCLUSIONS

Results from this study could be useful in design advances of pediatric anthropomorphic test devices, child restraints, as well as vehicles and their safety countermeasure systems.

Traumatic fractures resulting from collisions in children and adolescents: A retrospective observational study

To investigate the incidence and pattern of child and adolescent (≤18 years old) traumatic fractures (TFs) as a result of collisions.We retrospectively reviewed 270 child and adolescent patients (228 males and 42 females aged 12.8 ± 5.1 years old) with TFs as a result of collisions admitted to our university-affiliated hospitals from 2001 to 2010. The incidence and patterns were summarized with respect to different age groups, sex, etiology, and whether the patient presented with nerve injury.The most common etiologies were struck by object (105, 38.9%) and wounded by person (74, 27.4%). The most common fracture sites were upper limb fractures (126, 46.7%) and craniofacial fractures (82, 30.4%). A total of 65 (24.1%) patients suffered a nerve injury. The frequency of early and late complications/associated injuries was 35.6% (n = 96) and 8.5% (n = 23), respectively. The mean age (P = .001) and frequency of wounded by person (P = .038) was significantly larger in male than in female patients. The frequency of earthquake injury (P < .001) and lower limb fractures (P = .002) was significantly larger in females than in male patients. The frequency of upper limb fracture was significantly higher in the wounded by machine group (83.3%) than in the other groups (all P < .05). The frequency of lower limb fractures was significantly higher in the earthquake injury group (64.7%) than in the other groups (all P < .05). The frequency of craniofacial fracture was significantly higher in the wounded by person group (54.1%) than in the other groups (all P < .05). The emergency admission rate (P = .047), frequency of wounded by person (P < .001), craniofacial fracture (P < .001), and early complications/associated injuries (P < .001) were significantly larger in patients with nerve injury than in other patients.Struck by object and upper limb fractures were the most common etiology and site, respectively. Wounded by person and craniofacial fractures were risk factors for nerve injury. Therefore, we should pay more attention to patients wounded by person, presenting with craniofacial fracture, to find whether there is nerve injury.

Analysis of mechanics of side impact test defined in UN/ECE Regulation 129

OBJECTIVE

This article discusses differences between a side impact procedure described in United Nations/Economic Commission for Europe (UN/ECE) Regulation 129 and scenarios observed in real-world cases.

METHODS

Numerical simulations of side impact tests utilizing different boundary conditions are used to compare the severity of the Regulation 129 test and the other tests with different kinematics of child restraint systems (CRSs). In the simulations, the authors use a validated finite element (FE) model of real-world CRSs together with a fully deformable numerical model of the Q3 anthropomorphic test device (ATD) by Humanetics Innovative Solution, Inc.

RESULTS

The comparison of 5 selected cases is based on the head injury criterion (HIC) index. Numerical investigations reveal that the presence of oblique velocity components or the way in which the CRS is mounted to the test bench seat fixture is among the significant factors influencing ATD kinematics. The results of analyses show that the side impact test procedure is very sensitive to these parameters. A side impact setup defined in Regulation 129 may minimize the effects of the impact.

CONCLUSIONS

It is demonstrated that an artificial anchorage in the Regulation 129 test does not account for a rotation of the CRS, which should appear in the case of a realistic anchorage. Therefore, the adopted procedure generates the smallest HIC value, which is at the level of the far-side impact scenario where there are no obstacles. It is also shown that the presence of nonlateral acceleration components challenges the quality of a CRS and its headrest much more than a pure lateral setup.

Top tether effectiveness during side impacts

OBJECTIVE

Few studies have looked at the effectiveness of the top tether during side impacts. In these studies, limited anthropomorphic test device (ATD) data were collected and/or few side impact scenarios were observed. The goal of this study was to further understand the effects of the top tether on ATD responses and child restraint system (CRS) kinematics during various side impact conditions.

METHODS

A series of high-speed near-side and far-side sled tests were performed using the FMVSS213 side impact sled buck and Q3s ATD. Tests were performed at both 10° and 30° impacts with respect to the pure lateral direction. Two child restraints, CRS A and CRS B, were attached to the bench using flexible lower anchors. Each test scenario was performed with the presence and absence of a top tether. Instrumentation recorded Q3s responses and CRS kinematics, and the identical test scenarios with and without a top tether attachment were compared.

RESULTS

For the far-side lateral (10°) and oblique (30°) impacts, top tether attachment increased resultant head accelerations by 8-38% and head injury criterion (HIC₁₅) values by 20-140%. However, the top tether was effective in reducing lateral head excursion by 5-25%. For near-side impacts, the top tether resulted in less than 10% increases in both resultant head acceleration and HIC₁₅ in the lateral impact direction. For near-side oblique impacts, the top tether increased HIC₁₅ by 17.3% for CRS A and decreased it by 19.5% for CRS B. However, the injury values determined from both impact conditions were below current injury assessment reference values (IARVs). Additionally, the top tether proved beneficial in preventing forward and lateral CRS rotations.

CONCLUSIONS

The results show that the effects of the top tether on Q3s responses were dependent on impact type, impact angle, and CRS. Tether attachments that increased head accelerations and HIC₁₅ values were generally counterbalanced by a reduction in head excursion and CRS rotation compared to nontethered scenarios.

Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study

The aim of this study is to investigate the incidence and pattern of traumatic fractures (TFs) as a result of falls in a population of children and adolescents (≤18 years old) in China.This was a cross-sectional study. We retrospectively reviewed 1412 patients who were children and adolescents with TFs as a result of falls admitted to our university-affiliated hospitals in China from 2001 to 2010. Etiologies included high fall (height ≥2) and low fall (height <2 m). The incidence and pattern were summarized with respect to different age groups, year of admission, etiologies, genders, and the neurological function.This study enrolled 1054 males (74.6%) and 358 females (25.4%) aged 10.8 ± 4.7 years. The etiologies were low fall (1059, 75.0%) and high fall (353, 25.0%). There were 2073 fractures in total and 92 patients (6.5%) presented with multiple fractures. The most common fracture sites were upper extremity fractures in 814 patients (57.6%) and lower extremity fractures in 383 patients (27.1%), followed by craniofacial fractures in 233 patients (16.5%). A total of 231 (16.4%) patients suffered a nerve injury. The frequencies of early and late complications/associated injuries were 19.5% (n = 275) and 9.2% (n = 130). The frequencies of emergency admission, nerve injury, spinal fracture, lower extremity fractures, craniofacial fracture, sternum and rib fracture, and early complications/ASOIs were significantly larger in high fall than low fall (all P <.001, respectively). The frequencies of medical insurance rate (P = .042) and upper extremity fractures (P <.001) were significantly larger in low fall than high fall. The frequencies of spinal fracture (P = .039), lower extremity fractures (P = .048), and craniofacial fracture (P = .041) were significantly larger in female than the male patients. The frequency of upper extremity fractures (P <.001) and the mean age (P <.001) was significantly larger in male than female patients. The frequencies of emergency admission, high fall, spinal fracture, and craniofacial fracture were significantly larger in patients with nerve injury than other patients without nerve injury (all P <.001, respectively).Low falls and upper extremity fractures were the most common etiologies and sites, respectively. High fall, spinal fracture and craniofacial fracture were risk factors for nerve injury. Therefore, we should focus on patients who were caused by high fall and presented with spinal and craniofacial fracture to determine the presence of a nerve injury so that we can provide early, timely diagnosis and targeted treatment to children.

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.

Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre

Introduction Paediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK. Methods This retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region. Results A total of 213 patients were included in the study, with a mean age of 7.8 years (standard deviation [SD]: 5.2 years). The most common cause of injury was vehicle related incidents (46%). The median length of hospital stay was 5 days (interquartile range [IQR]: 4-10 days). Approximately half (52%) of the patients had to stay in the intensive care unit, for a median of 1 day (IQR: 0-2 days). The mortality rate was 6.6%. The mean injury severity score was 19 (SD: 10). Pearson's correlation coefficient showed a positive correlation for injury severity score with length of stay in hospital (p<0.001). Conclusions There is significant variation in mechanism of injury, severity and pattern of paediatric trauma across age groups. A multidisciplinary team approach is imperative, and patients should be managed in specialist centres to optimise their care and eventual functional recovery. Head injury remained the most common, with significant mortality in all age groups. Rib fractures and pelvic fractures should be considered a marker for the severity of injury, and should alert doctors to look for other associated injuries.

Biofidelity assessment of the 6-year-old ATDs in lateral impact

OBJECTIVES

The objective of this study was to assess and compare the current lateral impact biofidelity of the shoulder, thorax, abdomen, and pelvis of the Q6, Q6s, and Hybrid III (HIII) 6-year-old anthropomorphic test devices (ATDs) through lateral impact testing.

METHODS

A series of lateral impact pendulum tests, vertical drop tests, and Wayne State University (WSU) sled tests was performed, based on the procedures detailed in ISO/TR 9790 (1999) and scaling to the 6-year-old using Irwin et al. ( 2002 ). The HIII used in this study was tested with the Ford-designed abdomen described in Rouhana ( 2006 ) and Elhagediab et al. ( 2006 ). The data collected from the 3 different ATDs were filtered using SAE J211 (SAE International 2003 ), aligned using the methodology described by Donnelly and Moorhouse ( 2012 ), and compared for each body region tested (shoulder, thorax, abdomen, and pelvis). The biofidelity performance in lateral impact for the 3 ATDs was assessed against the scaled biofidelity targets published in Irwin et al. ( 2002 ), the abdominal biofidelity target suggested in van Ratingen et al. ( 1997 ), and the biofidelity targets published in Rhule et al. ( 2013 ). Regional and overall biofidelity rankings for each of the 3 ATDs were performed using both the ISO 9790 biofidelity rating system (ISO/TR 9790 1999) and the NHTSA's external biofidelity ranking system (BRS; Rhule et al. 2013 ).

RESULTS

All 3 6-year-old ATD's pelvises were rated as least biofidelic of the 4 body regions tested, based on both the ISO and BRS biofidelity rating systems, followed by the shoulder and abdomen, respectively. The thorax of all 3 ATDs was rated as the most biofidelic body region using the aforementioned biofidelity rating systems. The HIII 6-year-old ATD was rated last in overall biofidelity of the 3 tested ATDs, based on both rating systems. The Q6s ATD was rated as having the best overall biofidelity using both rating systems.

CONCLUSIONS

All 3 ATDs are more biofidelic in the thorax and abdomen than the shoulder and pelvis, with the pelvis being the least biofidelic of all 4 tested body regions. None of the 3 tested 6-year-old ATDs had an overall ranking of 2.0 or less, based on the BRS ranking. Therefore, it is expected that none of the 3 ATDs would mechanically respond like a postmortem human subject (PMHS) in a lateral impact crash test based on this ranking system. With respect to the ISO biofidelity rating, the HIII dummy would be considered unsuitable and the Q-series dummies would be considered marginal for assessing side impact occupant protection.

Factors associated with mortality in rear-seated adult passengers involved in fatal motor vehicle crashes on US roadways

BACKGROUND

Recent efforts to pass rear seat belt laws for adults have been hampered by large gaps in the scientific literature. This study examines driver, vehicle, crash, and passenger characteristics associated with mortality in rear-seated adult passengers.

METHODS

The Fatality Analysis Reporting System (FARS) 2010 to 2011 was used to examine motor vehicle occupant mortality in rear-seated adult passengers 18 years and older. Side crash vehicle safety ratings were assessed in a subset analysis of vehicles struck on the same side as the rear-seated passenger. Multilevel logistic regression models used SAS GLIMMIX.

RESULTS

Of the 7,229 rear-seated adult passengers, 2,091 (28.9%) died. Multivariable predictors of increased mortality were advancing passenger age, younger driver age, excessive speed, ejection, being unbelted, rear impact, and same-side crash. Belt use was associated with a 67.0% reduction in total mortality. Despite this, belt wearing was low (48.1%) and differed by seating position, with less than one third of middle-seated passengers belted. Multivariable analysis showed mortality to be nearly three times higher in same-side crashes than other impact locations (odds ratio (OR) = 2.76, 2.22, 3.44). In a multivariable subpopulation analysis of same-side crashes, right-seated passengers had an increased mortality (52.7% vs. 43.2%, p < 0.01) compared to left-seated passengers (OR = 1.55, 1.02, 2.36). Vehicle side crash safety ratings, available for 27.7% (n = 172) of same-side crashes, were not predictive of mortality.

CONCLUSIONS

Except for same-side crashes, seat belts were associated with significantly lowered mortality. Despite this, seat belt wearing was low and represents one of several areas where further improvements in mortality might be realized.

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.

Pretensioner loading to rear-seat occupants during static and dynamic testing

OBJECTIVE

Pretensioners reduce the seat belt slack and couple the occupant early to the restraint system. There is a growing prevalence of rear seat pretensioners and it is essential to determine whether the load from the pretensioner itself can cause injuries to rear-seated children. The aim of the study was to investigate the loading to the neck, chest, and abdomen of various sizes of anthropometric test devices (ATDs) during the pretensioner deployment phase and the crash phase in low-severity frontal sled tests and during static deployment.

METHODS

Low-severity frontal sled tests were conducted with the Hybrid III (HIII) 3-year-old, HIII 6-year-old, HIII 5th percentile, and HIII 50th percentile ATDs. Two different retractor pretensioners with varying pretensioner force were used. The child ATDs were restrained on a booster cushion (BC), with and without a back. The loading to the neck and chest was compared to injury assessment reference values (IARVs) reported by Mertz et al. (2003). The chest loading to the HIII 5th percentile and HIII 50th percentile ATDs was also analyzed using age-related injury risk curves. Static pretensioner tests with the Q-series 10-year-old ATD, equipped with an advanced abdominal loading device, were conducted in standard ATD position and out-of-position with the lap belt positioned high on the abdomen.

RESULTS

During the crash phase, head excursion and neck loading were reduced for both pretensioners for all ATDs compared to testing without a pretensioner. The pretensioner reduced chest deflection to the adult ATDs but not to child ATDs when seated on a BC with a back during the crash phase. When the back was removed, chest deflection was reduced below IARV. The head excursion was reduced for all ATDs with both pretensioners. During the pretensioner deployment phase, the chest deflection exceeded the IARV for the HIII 3-year-old with the stronger pretensioner when seated on booster with a back and it was reduced below the IARV with the lower force pretensioner. For all ATDs, neck and chest loading during the pretensioner deployment phase were reduced when a pretensioner with lower force was used. Abdominal loading to the Q10 in the static pretensioner deployments indicated a low risk of abdominal injury in all tested positions.

CONCLUSION

This study indicates the need to balance the pretensioner force and seat belt geometry to gain good pretensioner performance in both the pretensioner deployment phase and the crash phase.

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.

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.

Child passenger restraints in relation to other second-row passengers: an analysis of the 2007-2009 National Survey of the Use of Booster Seats

OBJECTIVE

Child restraint systems (CRS) are increasingly being designed to accommodate larger children and to mitigate side impact injuries. Little is known about the impact of CRS on the safety of other vehicle passengers due to limitations of existing crash databases. This study provides the first assessment of the seating positions occupied by child passengers and the relationship between CRS and other second-row passengers in a national sample of vehicles transporting children.

METHODS

A secondary analysis was conducted of data from the 2007-2009 National Survey of the Use of Booster Seats (NSUBS), a direct in-vehicle observational study of child passenger restraint use. Passengers riding in the same vehicle were identified and passenger position was determined. Vehicles with second-row child passengers were included in analyses of seat positions occupied by child passengers with and without CRS. Frequency counts for the different combinations of CRS and passengers in second rows were calculated.

RESULTS

Of the 17,065 vehicles observed in 2007-2009 NSUBS, 14,506 (85%) vehicles contained at least 1 child passenger in a second row that contained no more than 3 total passengers. Of these 14,506 vehicles, 55 percent contained a lone child passenger in the second row. A CRS was in use in 4656 (59%) of the 7949 vehicles with a lone child passenger in the second row compared to 4077 (62%) of the 6557 vehicles with multiple passengers in the second row (P < .001). A passenger was adjacent to a CRS within 1333 (33%) of the 4077 vehicles containing a CRS in the second row. There were 3 second-row passengers in nearly 1 in 5 vehicles containing a CRS in the second row.

CONCLUSION

Adults and children not using CRS are frequently seated in vehicle second rows adjacent to a child restrained in a CRS. These findings should be used to inform the regulation, design, and testing of CRS and to determine the risks of larger CRS designs to other passengers seated in the same vehicle row relative to the benefits of the CRS for the passenger it restrains.

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.

Parameter study for child injury mitigation in near-side impacts through FE simulations

OBJECTIVE

The objective of this study is to investigate the effects of crash-related car parameters on head and chest injury measures for 3- and 12-year-old children in near-side impacts.

METHODS

The evaluation was made using a model of a complete passenger car that was impacted laterally by a barrier. The car model was validated in 2 crash conditions: the Insurance Institute for Highway Safety (IIHS) and the US New Car Assessment Program (NCAP) side impact tests. The Small Side Impact Dummy (SID-IIs) and the human body model 3 (HBM3) (Total HUman Model for Safety [THUMS] 3-year-old) finite element models were used for the parametric investigation (HBM3 on a booster). The car parameters were as follows: vehicle mass, side impact structure stiffness, a head air bag, a thorax-pelvis air bag, and a seat belt with pretensioner. The studied dependent variables were as follows: resultant head linear acceleration, resultant head rotational acceleration, chest viscous criterion, rib deflection, and relative velocity at head impact. The chest measurements were only considered for the SID-IIs.

RESULTS

The head air bag had the greatest effect on the head measurements for both of the occupant models. On average, it reduced the peak head linear acceleration by 54 g for the HBM3 and 78 g for the SID-IIs. The seat belt had the second greatest effect on the head measurements; the peak head linear accelerations were reduced on average by 39 g (HBM3) and 44 g (SID-IIs). The high stiffness side structure increased the SID-IIs' head acceleration, whereas it had marginal effect on the HBM3. The vehicle mass had a marginal effect on SID-IIs' head accelerations, whereas the lower vehicle mass caused 18 g higher head acceleration for HBM3 and the greatest rotational acceleration. The thorax-pelvis air bag, vehicle mass, and seat belt pretensioner affected the chest measurements the most. The presence of a thorax-pelvis air bag, high vehicle mass, and a seat belt pretensioner all reduced the chest viscous criterion (VC) and peak rib deflection in the SID-IIs.

CONCLUSIONS

The head and thorax-pelvis air bags have the potential to reduce injury measurements for both the SID-IIs and the HBM3, provided that the air bag properties are designed to consider these occupant sizes also. The seat belt pretensioner is also effective, provided that the lateral translation of the torso is managed by other features. The importance of lateral movement management is greater the smaller the occupant is. Light vehicles require interior restraint systems of higher performance than heavy vehicles do to achieve the same level of injury measures for a given side structure.

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

OBJECTIVES

Head injuries are the most common serious injuries sustained by children in motor vehicle crashes and are of critical importance with regard to long-term disability. There is a lack of understanding of how seat belt-restrained children sustain head injuries in frontal impacts. The aim of the study was to identify the AIS2+ head injury causation scenarios for rear-seated, belt-restrained children in frontal impacts, including the set of parameters contributing to the injury.

METHOD

In-depth crash investigations from two National Highway Traffic Safety Administration (NHTSA) databases, the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS; 1997-2008) and the Crash Injury Research and Engineering Network (CIREN; 1996-2009), were collected and analyzed in detail. Selection criteria were all frontal impacts with principal direction of force (PDOF) of 11, 12, and 1 o'clock involving rear-seated, three-point belt-restrained, with or without booster cushion, children from 3 to 13 years with an AIS2+ head injury. Cases were analyzed using the BioTab method of injury causation assessment in order to systematically analyze the injury causation scenario for each case.

RESULTS

There were 27 cases meeting the inclusion criteria, 19 cases with MAIS2 head injuries and 8 cases with MAIS3+ head injuries, including 2 fatalities. Three major injury causation scenarios were identified, including head contact with seatback (10 cases), head contact with side interior (7 cases,) and no evidence of head contact (9 cases).

CONCLUSIONS

Head injuries with seatback or side interior contact typically included a PDOF greater than 10 degree (similar to the Insurance Institute for Highway Safety [IIHS] and EuroNCAP offset frontal testing) and vehicle maneuvers. For seatback contact, the vehicle's movements contributed to occupant kinematics inboard the vehicle, causing a less than optimal restraint of the torso and/or torso roll out of the shoulder belt. For side interior contact, the PDOF and/or maneuvers forced the occupant toward the side interior. The cases without evidence of head/face contact were characterized by high crash severity and accompanied by severe injuries to the thorax and spine. These data lead to increased understanding of the injury patterns and causation in this crash restraint scenario so that interventions to mitigate the burden of injury can be advanced.

Factors associated with clinically significant head injury in children involved in motor vehicle crashes

OBJECTIVE

Head injury is the most common cause of death for child occupants in motor vehicle crashes (MVCs). The morbidity associated with nonlethal MVC-related head injuries is of great clinical consequence as well. The purpose of this study was to identify the frequency of, and risk factors for, clinically significant head injury (CSHI) in child occupants in MVCs.

METHODS

A large, child-specific crash surveillance system linking insurance claims data to telephone survey data was utilized. Qualifying crashes involved model year 1990 or newer vehicles in crashes with one or more child occupants (age 4 to 15 years) occurring in 15 U.S. states. Data were accrued between March 2000 and December 2007. A probability sample of crashes was selected for telephone survey with the driver of the insured vehicle. A clinically significant head injury, as reported by the child's parent using a validated survey, included concussions, skull fractures, and intracranial hemorrhages. Multivariate logistic regression was used to identify factors associated with a CSHI.

RESULTS

During the period of study, completed interviews were obtained on 19,075 children aged 4-15, representing 318,527 children involved in 219,511 crashes. The overall rate of CSHI in child occupants was 1.08 percent. Factors associated with an increased risk of head injury included rollover (odds ratio [OR] = 8.60, 95% confidence interval [CI] 6.40-11.57) and near-side impact crashes (OR = 2.39, 95% CI 1.73-3.30) vs. frontal impact; lack of restraint (OR = 3.13, 95% CI 2.26-4.33) vs. restrained; and driver age < 25 years (OR = 1.43, 95% CI 1.12-1.81) vs. driver age ≥ 25 years. Some factors varied based on occupant age, and younger child age had a protective effect on the risk for head injury.

CONCLUSION

The risk of CSHI for 4- to 15-year-old child occupants was 1.08 percent. Several demographic and crash factors were associated with CSHI in child occupants. This information may help inform design safety initiatives.

Methods to mitigate injury to toddlers in near-side impact crashes

This research focuses on the injury potential of children seated in forward-facing child safety seats during side impact crashes in a near-side seated position. Side impact dynamic sled tests were conducted by NHTSA at Transportation Research Center Inc. (TRC) using a Hybrid III 3-year-old child dummy seated in a convertible forward/rearward child safety seat. The seat was equipped with a LATCH and a top tether and the dummy was positioned in forward-facing/near-side configuration. The test was completed using an acceleration pulse with a closing speed of 24.1 km/h, in the presence of a rigid wall and absence of a vehicle body. A fully deformable finite element model of a child restraint seat, for side impact crash investigations, has been developed which has also been previously validated for frontal and far side impacts. A numerical model utilizing a Hybrid III 3-year-old dummy, employing a similar set-up as the experimental sled test was generated and simulated using LS DYNA. The numerical model was validated by comparing the head and the chest accelerations, resultant upper and lower neck forces and moments from the experimental and numerical tests. The simulation results were observed to be in good agreement to the experimental observations. A numerical model of the near-side laboratory tests, utilizing a Q3s child dummy, was also created for parametric studies regarding different ISOFIX configurations. Further, numerical simulations were completed for both the dummy models with rectangular and cross-shaped sections of rigid ISOFIX systems. In addition, studies were conducted to confine lateral movement of the dummy's head by adding energy absorbing foam on the side wings in the vicinity of the contact region of the CRS. It was observed that the use of rigid ISOFIX system reduced the lateral displacement of the CRS and different injury parameters. Addition of energy absorbing foam blocks was effective in further reducing the lateral displacement of the dummy's head. The lateral displacement of the head was reduced by 68 mm by using cross-shaped section ISOFIX with energy absorbing foam near the vicinity of the head of the Hybrid III 3-year-old dummy compared to the flexible LATCH configuration without foam. For the Q3s dummy, the lateral displacement of the head was reduced by 48 mm by utilizing a cross-shaped section rigid ISOFIX system with the addition of energy absorbing foam compared to the flexible LATCH configuration.

Seating patterns and corresponding risk of injury among 0- to 3-year-old children in child safety seats

OBJECTIVE

Current guidelines for optimal restraint of children in motor vehicles recommend the center rear seating location for installing a child-restraint system. However, recent research on child occupants in child-restraint system has brought this into question. The objective of this study was to describe seating position patterns among appropriately restrained child occupants aged 0 to 3 years in the rear row of vehicles. In addition, we determined the association between rear row seating location and risk of injury.

METHODS

We studied data collected on child occupants from December 1, 1998, to December 31, 2006, via insurance claim records and a validated telephone survey. The study sample included child occupants aged 0 to 3 years seated in a child-restraint system in the rear row of the vehicle, model year 1990 or newer, involved in a crash in 16 states. Children were classified as injured if a parent or driver reported an injury corresponding with Abbreviated Injury Scale scores of > or = 2.

RESULTS

Seating position distribution for child occupants was as follows: left outboard (31%), center (28%), and right outboard (41%). There was an inverse relationship between the center position and increasing child age (39% for occupants < 1 year old versus 18% for occupants 3 years old), independent of the number of additional row occupants. Child occupants seated in the center had an injury risk 43% less than children seated in either of the rear outboard positions.

CONCLUSIONS

The most common seating position for appropriately restrained child occupants in a child-restraint system is the right rear outboard. The center rear seating position is used less often by children restrained by a child-restraint system as they get older. Children seated in the center rear have a 43% lower risk of injury compared with children in a rear outboard position.

Injury causation scenarios in belt-restrained nearside child occupants

Successful development of side impact safety systems for rear row child occupants requires an understanding of injury causation and mitigation. However, data to guide the design of such safety systems for seat belt-restrained occupants is limited to injury risk assessments. Thus, we sought to elucidate Injury Causation Scenarios (ICS's) in children restrained by seat belts in nearside impacts. Included in the study were 4 to 15 year old children, involved in a side impact, seated on the nearside in the rear rows, restrained by a seat belt alone (no booster seats or side airbags) and who received an AIS 2+ injury. A Contact Point Map summarized the vehicle components that contribute to the injuries. The majority of head and face contacts points were found horizontally within the rear half of the window, and vertically from the window sill to the center of the window, and were a result of contact with both interior structures and structures on the crash partner. The most prevalent intracranial injuries included cerebral contusions, diffuse axonal injury (DAI), and subdural or subarachnoid hematoma/hemorrhage. The most common cause of torso and abdominal injury was contact with the side interior structure, and injuries included spleen lacerations or ruptures, liver lacerations and contusions, lung contusions, rib fractures, and clavicle fractures. Protuberances on the door interior, such as the armrest, were the most common source of abdominal injury in this dataset. These data provide important guidance for the development of rear row safety systems for belt-restrained children with no side airbags in nearside crashes.

Improved protection for children in forward-facing restraints during side impacts

OBJECTIVE

This study aims to determine the potential for improved child occupant protection in side impacts that can be obtained using rigid and semi-rigid anchorage systems and the addition of energy-absorbing padding in the side structures of child restraints.

METHODS

This study uses a comprehensive set of simulated side impacts to evaluate the potential for improved side impact protection in forward-facing child restraints. Factors investigated included methods of anchoring the restraint to the vehicle, energy-absorbing materials in the side structure of restraints, and design features of the restraints such as side wing geometry and seat belt routing.

RESULTS

The results show clearly that completely rigid lower attachment of restraints offers the potential for great reductions in head injury risk, which anchorage systems employing a combination of a rigid anchorage bar and webbing attached to a child restraint cannot match. The addition of energy absorbing material in the side structure of restraint systems is effective when the head is fully contained within an adequately designed side wing structure. For restraints anchored by seat belts and loop style semi rigid anchorage straps, belt routing has the potential to significantly affect occupant head excursion.

CONCLUSIONS

The results suggest that current child restraint standards and consumer testing protocols do not adequately encourage best practice design of child restraints for side impact protection.