Injuries associated with airbag deployment

Two cases of driver death caused by airbag rupture

OBJECTIVE

This article reports two accidents caused by defective Takata airbags ruptured, which led to the deaths of the drivers. This is the first public report on the deaths caused by Takata airbags in China.

METHODS

Determine the relationship between the driver death and airbag rupture through autopsy indings and vehicle inspection.

RESULTS

Due to defects in the design of Takata's inflator, moist air was permitted to slowly enter the inflator, resulting the PSAN slowly degraded physically. The damaged propellant burned more rapidly than intended and overpressurized the inflator's steel housing, causing fragmentation and flying debris at high speed, killing or injuring vehicle occupants.

CONCLUSIONS

To date, there are still tens of millions of defective Takata airbags that have not been recalled for repair, posing safety risks. This article suggests taking preventive measures to avoid the occurrence of similar accidents.

Steering Wheel Aftermarket Rhinestone Emblem Projectile Injury in a Motor Vehicle Collision: A Case Report

Motor vehicle collisions are a leading cause of morbidity and mortality within the United States. Safety devices such as seatbelts and airbags have significantly reduced mortality rates for drivers. Some drivers personalize their vehicles with inexpensive items that may cause significant injury during vehicular collisions. We present a case of a face and neck penetrating injury from a metal aftermarket rhinestone emblem attached to the steering wheel during a motor vehicle collision. A 43-year-old female was involved in an accident where the airbag had deployed and projected two pieces of the metal emblem at her face and neck. The fragment in the neck was removed at the bedside, while that in the face required removal in the operating room. She recovered well postoperatively and was discharged the same day. This case highlights the potential for the dangers caused by aftermarket rhinestone emblems on steering wheels. We recommend that increased national advisories and legislative actions be considered to limit the use of these emblems.

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

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

The Documentation of Injuries Caused by Traffic Accidents

BACKGROUND

Persons injured in traffic accidents may have injuries of characteristic types that are of significance for the complex reconstruction of the accident and whose medicolegally sound clinical documentation is highly important. This is of particular relevance for the approximately 55 000 persons who are severely injured in traffic accidents in Germany each year. Gaps in documentation are often disadvantageous for the injured persons.

METHODS

This review is based on pertinent publications retrieved by a selective literature review, with additional consideration of relevant textbooks in traffic medicine and legal medicine, as well as the guidelines of the AWMF (Association of the Scientific Medical Societies in Germany).

RESULTS

Injuries in traffic accidents typically differ depending on the mode of participation of the injured person in traffic. They must be examined with a view toward the sequence of events of the accident and documented in medicolegally sound fashion. In particular, because of the different mechanical forces involved, it is important to document the seat that the injured person occupied in the automobile, the nature of the collision (pedestrian vs. automobile; bicycle, e-bike, e-scooter, and motorcycle accidents), and the protective devices that were in use.

CONCLUSION

The precise documentation of injuries and examination findings, with critical consideration of their plausibility in relation to the sequence of events of the accident as far as it is known, is an important duty of the physician. This documentation serves as the basis for further judicial steps leading to compensation when legally appropriate.

Nationwide Analysis of Biomechanics of Motor Vehicle Collisions Involving Passenger Vehicle and Associated Outcomes: Towards Improving Vehicle Safety Standards and Regulations

BACKGROUND

Motor vehicle collisions (MVCs) pose significant mortality and economic burden on the United States. Biomechanics research may guide future vehicle innovation. The objective of this study is to investigate the biomechanics of two-vehicle MVCs involving passenger vehicle (PV) to evaluate associated injury patterns and outcomes including mortality.

METHODS

A retrospective cohort study of cases from the Crash Injury Research Engineering Network database was performed to evaluate the biomechanics (angle of impact, seatbelt use, and airbag deployment) of two-vehicle MVCs involving at least one PV from 2005-2015.

RESULTS

Out of 629 MVCs evaluated, lateral collisions were most common (49.5%), followed by head-on (41.3%) and rear-end (9.2%) collisions. Thoracic injuries accounted for 30.1%, 31.4%, and 31.1% of injuries in lateral, head-on, and rear-end collisions, respectively, and were the most common body region injured for all collision types. Seatbelt use was associated with shorter ICU stay (10.9 vs 19.1 days, P = .036) and mortality (Cramer's V = .224, P < .001), but a greater average number of injuries (10.2 injuries vs 8.6 injuries, P = .011).

CONCLUSION

Passenger vehicle are commonly involved in MVCs nationwide and efforts are needed to prevent occupant injuries and fatalities. The incorporation of energy-absorbing material into common points of contact within the vehicle interior may decrease the severity of these injuries. Seatbelt use remains a protective factor against MVC-fatalities but is associated with collateral injuries and should be a focus of further innovation.

Airbag-related penetrating injuries: A case series from a level 1 trauma center

Background

Airbags have significantly reduced the morbidity and mortality associated with trauma following motor vehicle crashes. However, airbags can also be associated with unusual and complex patterns of injuries which could be fatal in some cases.

Methods

We collected data and described a series of six cases of penetrating injuries related to airbag deployment that were treated at the Hamad Trauma Center (HTC) of Hamad Medical Corporation which is the only level 1 trauma center in the country.

Results

The penetrating injuries were caused by a metal fragment from the inflator component of the airbag which acted as a projectile and was associated with two fatalities. Four of the victims were involved in head on collisions. Most injuries were directly attributable to the airbag projectile, and they occurred in vehicles that were 9 years or more since manufacture.

Conclusion

This case series would help the trauma healthcare providers to better understand the airbag-related injuries which influence the management approach for road traffic injuries associated with penetrating trauma. Also, it would bring attention to injury prevention teams as well as state and industrial authorities to reevaluate safety standards in vehicles. Sharing this information with local authorities who govern product safety standards and recalls is essential to ensure that more safety actions are taken to prevent further airbag deployment injuries.

Bilateral Angle Recession and Chronic Post-Traumatic Glaucoma: A Review of the Literature and a Case Report

Ocular trauma affects millions of people worldwide and is a leading cause of secondary glaucoma. Angle recession is the main cause of post-traumatic glaucoma after blunt eye trauma, and it is usually unilateral. The aim of this paper is to investigate the possible causes of angle recession with a bilateral presentation. Airbag activation during traffic accidents is a likely cause to be ruled out, along with repeated head or eye trauma, due to contact sports or a history of physical abuse. These aspects can aid in early detection, appropriate management, and improved outcomes for patients with ocular trauma. Finally, we report the case of a 75-year-old Caucasian man who developed a bilateral angle recession after an airbag impact, with advanced glaucoma in the right eye and ocular hypertension in the left eye. To our knowledge, this is the first case in the literature of chronic post-traumatic glaucoma probably caused by an airbag.

Breast Implants Decrease Chest Wall Trauma in Low-speed, Unrestrained Motor Vehicle Crash: An Experimental Model

Breast implants improve quality of life in patients seeking improved breast aesthetics, and are known to minimize human injury in the less common scenario of penetrating trauma. People commonly sustain rib and sternum fractures and thoracic injury in motor vehicle crashes (MVC), a form of blunt traumatic injury. Whether breast implants minimize injury during MVC is unknown. This study examines the potential protective effect of breast implants in low speed, unrestrained MVC.

Methods

Control (medical gel) and implant (medical gel with embedded breast implant) blocks were subjected to load approximating a low speed, 10mph MVC (n=12 blocks per group). Colormetric pressure film measured pressure at the neo-chest wall position in response to load, across the gel block base. Maximum pressure and average pressure across the gel block base were compared, by group.

Results

Presence of an implant significantly decreased, by 22.8%, maximum pressure experienced by the neo-chest wall (333.0 ± 58.7 psi vs 431.6 ± 37.3 psi, p=0.0006). Average pressure experienced by the neo-chest wall across the gel block base was also significantly decreased, by 28.1%, in the implant group (53.4 ± 5.6 psi vs 74.3 ± 15.7 psi, p=0.0017). Subjective analysis of all implant and control blocks supported an overall reduction in pressure for the implant group.

Conclusions

Presence of a breast implant decreased maximum pressure at the chest wall by 23%, and average pressure by 28%. Patients with breast implants involved in low speed, unrestrained MVC may be less likely to sustain rib and sternum fractures and thoracic injury, when compared to patients without implants.

Analysis of Biomechanics of Motor Vehicle Collisions for Passenger Cars: Implications for Passenger Vehicle Safety and Future Car Design Innovations

INTRODUCTION

Investigating biomechanics of injury patterns from motor vehicle collisions (MVCs) informs improvements in vehicle safety. This study aims to investigate two-vehicle MVCs involving a passenger car and specific injury patterns associated with sources of injury, collision biomechanics, vehicle properties, and patient outcomes.

METHODS

Retrospective cohort study conducted to evaluate the biomechanics of specific injury patterns seen in MVCs involving passenger cars using the Crash Injury Research Engineering Network database between the years 2005 and 2015.

RESULTS

A total of 631 MVC cases were included from 2005 to 2015. The majority of cases involved injuries to the head or neck, the thorax, and the abdomen (80.5%). Head/neck injuries from the steering wheel were associated with significantly higher injury severity score compared to those from seatbelts (26.11 versus 18.28, P < 0.001) and airbags (26.11 versus 20.10, P = 0.006), as well as a >6-fold higher fatality rate (P = 0.019). Thoracic injuries caused by the center console were twice as likely to be fatal than those caused by the seatbelt (P = 0.09).

CONCLUSIONS

Occupants suffering injuries to the head/neck, the thorax, and the abdomen had higher injury severity score and fatality rates compared to other body regions, demonstrating that manufacturing and safety guidelines should focus on minimizing these injury patterns. Head/neck injuries caused by the steering wheel were associated with worse outcomes compared to those caused by seatbelts and airbags, further emphasizing the benefits of these critical safety features. Integration of innovative safety features like center-mounted airbags may improve occupant safety.

Bilateral femur fractures are associated with concomitant femoral neck fracture

OBJECTIVE

The purpose of this study is to determine the rate of femoral neck fractures in patients who have sustained bilateral femur fractures compared to unilateral femur fractures.

DESIGN AND SETTING

A retrospective review of an institutional trauma database was completed at a single level 1 trauma academic medical center.

PATIENTS

All patients treated for a femur fracture between May 1, 2018 and December 31, 2020 were included.

RESULTS

Twenty-one patients sustained bilateral femur fractures (11%) and 166 sustained unilateral femur fractures. Fifteen associated ipsilateral femoral neck fractures were identified. Eight of the 15 (53%) associated femoral neck fractures were observed in patients who sustained bilateral femur fractures. Eight of the 21 patients with bilateral femur fractures, 42 fractures in total, had an associated ipsilateral femoral neck fracture (38% of patients; 19% of fractures, respectively), while only seven of the 166 patients (4%) with a unilateral femur fracture had an associated femoral neck fracture (p < 0.001). Of the 208 femur fractures, 19 (9%) were open fractures. Ten of the 21 patients with bilateral femur fractures, 42 fractures in total, were identified to have an open femur fracture (48% of patients, 24% of fractures), while only nine of the 166 (5%) unilateral femur fractures were open (p < 0.001).

CONCLUSIONS

Our results demonstrate an association between bilateral femur fractures, open femur fractures, and associated femoral neck fractures. Surgeons treating these injuries should maintain a high index of suspicion for associated ipsilateral proximal.

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.

Characterization of Laryngotracheal Fractures and Repairs: A TQIP Study

OBJECTIVES

Laryngotracheal trauma is poorly studied and associated with serious morbidity and mortality. This study reports features associated with laryngotracheal fractures, and factors associated with laryngeal fracture repair.

STUDY DESIGN

Retrospective database study SETTING: American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP®) METHODS: ACS-TQIP® 2014-2015 participant user data files were queried for laryngotracheal fractures using the International Classification of Diseases (ICD) 9th edition encodings. Demographic, diagnostic and procedure characteristics were analyzed with univariate chi-squared analysis and multivariate logistic regression.

RESULTS

We extracted 635 cases of laryngotracheal injury, with a median Injury Severity Score of 16 (IQR: 10 - 25). Most were caused unintentionally (65.7%), followed by assault (28.8%). Blunt trauma (79.5%) was more common than penetrating trauma (20.0%). These trends were upheld in the subgroup of repaired fractures, which made up 12.6% (80/635) of cases. The median length of hospital stay was 6 days (IQR: 3 - 13) in all fractures and 10 days (IQR: 6 - 14) in the subgroup of repaired fractures, while the median length of ICU stay was 4 days (IQR: 2 - 9) in all fractures and 4.5 (IQR: 6 - 14.3) in the subgroup of repaired fractures. Cut/pierce injuries (OR: 4.7, P < 0.001) and ISS (OR: 0.97, pP = 0.026) significantly affected rate of laryngeal fracture repair.

CONCLUSION

Laryngotracheal fractures are uncommon but serious injuries. Our results show that penetrating causes of injuries have the shortest time to repair, and that a higher ISS score is negatively associated with repair.

A case report on air bag induced skin burn in a road traffic injury: An experience

INTRODUCTION

Air bag deployment after high velocity trauma has been associated with burn injuries. So, we aimed to present a clinical case report associated with air bag deployment experienced by the author himself.

CASE PRESENTATION

The author was driving a hatchback car which collided head on with the high speeding vehicle from opposite direction. He sustained a burn injury around 4 × 3 cm in size in the flexor aspect of right forearm involving epidermis and some part of dermis which was superficial partial thickness in nature when the air bag deployment was observed at both the sides. Burn injury was healed with topical antibiotics and regular dressings with no any complications.

DISCUSSION

Air bag deployment has always been a safety measures for the road traffic injuries but the safety comes with a cost. It has been associated with burn injuries, especially chemical induced, thermal and frictional burns. Timely diagnosis of type of burn and intervention is required in order to minimize complications associated with burns.

CONCLUSION

Though burn injuries associated with air bag deployment cause less harm or complications, the companies making such commodities should explore the further options in order to develop burn injury free vehicle safety.

Self-reported Non-nominal Sitting in Passengers is Influenced by Age and Height

Automotive safety devices, such as airbags and seatbelts, are generally designed for optimal performance when occupants adopt a "nominal" upright anatomical sitting position. While a driver's sitting behavior is largely influenced by the requirements of driving, a passenger may adopt any number of non-nominal positions and behaviors. Very few studies have investigated the behaviors that teen and adult passengers actually adopt. The present study investigates self-reported nonnominal sitting in passengers and quantifies the influence of age and anthropometrics on these behaviors. A better understanding of passenger behavior is a timely research topic because advanced sensors may eventually allow better detection of non-nominal sitting and the advent of autonomous vehicles increases the number of passengers and seating options. Ten online survey questions were created to assess how frequently non-nominal sitting was adopted. Results were obtained from 561 anonymous participants, ranging in age from 14 to 83 years old. Analyses included 1) averages for each question, 2) a statistical linear mixed model to test for the influence of age and height on responses, and 3) correlations between all questions. Statistical significance was set at p<0.05. In summary, there was a sizable percentage of participants who self-reported behaviors or sitting positions that potentially increase risk of injury. Younger subjects were significantly more likely to adopt non-nominal sitting. Shorter subjects adopted non-nominal foot position more often, while taller subjects' knees were significantly closer to the dash. Participants opted not to wear their seat belt in the rear seat more than the front seat.

Paediatric Burns From Deployment of a Concealed Aviation Seatbelt Airbag

The advantages of airbags in reducing the rate of severe injuries and fatalities in motor vehicle crashes are well known but the physical act of airbag deployment can lead to injury to the passenger and the spectrum of airbag trauma resulting from deployment of vehicle airbags has been extensively reported. We present the first reported case of a pediatric burn injury resulting from the accidental deployment of an airbag in an aircraft. A four-year-old female child sustained injuries to the left side of her face and body while she was aboard a stationary airplane and the airbag concealed within the seat belt of her airplane seat unexpectedly and inexplicably deployed just before departure. We are presenting the case to increase awareness of the possibility of this injury in aircraft and to enable minimization of such accidents as well as help establish protocols for dealing with such mishaps if there were to happen.

Airbag Burns: An Unfortunate Consequence of Motor Vehicle Safety

Thousands of people are injured in motor vehicle collisions daily and the mandated installation of airbags protects passengers but can also cause injuries from deployment including cutaneous burns. We sought to characterize the patterns and outcomes of burns resulting from airbag deployment by performing a retrospective review of all patients evaluated by the burn service from May 1, 2015 to April 30, 2019. Inclusion criteria were patients of all ages with burn injuries related to airbag deployment. Demographic data, burn characteristics, and outcomes were reviewed. Seventeen patients met the inclusion criteria: 82.4% female and 17.6% male. The average age was 40.4 years. Fifteen patients had second-degree and two had third-degree burns. The average TBSA was 0.45%. The hands or upper extremity (88%) were most often injured, but there were two chest, one neck, and one anterior thigh burns. Eight patients suffered multiple burns. Burn etiology (chemical vs thermal) was often not specified. No patients required hospitalization or surgical intervention, and all wounds healed with wound care. The average time to re-epithelialization was 11 days. Although airbags prevent mortality and serious injury, the exothermic chemical reaction that inflates the airbag is responsible for deployment-related burns. Since there is a chemical and thermal component, all airbag-related burns should undergo chemical decontamination on the initial presentation. Burns related to airbag deployment tend to be small and do not require grafting; however, patients suffer from associated pain, scarring, and burn management can be a financial and time burden to the patient.

Fatal automobile accident due to airbag misdeployment

The purpose of this case report was to demonstrate a fatal motor vehicle accident in which a 33-year-old man died at the scene immediately after his car collided with the roadside curbstone at a normal speed. The autopsy of the deceased body revealed a penetrating injury on the neck as he was struck by the deployed airbag. Pathological examination showed the offending material to be a fractured cylinder-shaped metal piece, which had settled within the fourth cervical vertebral body. Further forensic engineering investigation of the airbag unit found that the metal fragment originated from a defective airbag gas generator, which had exploded upon deployment. These findings reflect on the increasing popularity of airbag-associated trauma across the globe in recent years. We suggest an effective management plan for the evaluation and mitigation of the complications associated with airbag-related incidents.

Injuries, death and vehicle airbag deployment

Airbags are impact-activated safety devices which deploy from the interior of vehicles to protect occupants from trauma during crashes. Although airbags effectively reduce the risk of death and injury, this it is not without issues. For example, high-impact unbelted rigid-barrier testing in the USA led to the adoption of powerful, large airbags that were associated with numerous airbag-related deaths and injuries. In contrast, European designs were tested and certified in conjunction with the use of three-point restraint systems, meaning that the airbags could be smaller with reduced ‘punch-out’ power. An overview is provided of the mechanism of action of airbags and the associated non-lethal and lethal injuries that may be sustained by vehicle occupants.

Die traumatische Aortenruptur

Verkehrsunfälle sind für den größten Teil der traumatischen Aortenrupturen verantwortlich, meist zusammen mit weiteren schweren Begleitverletzungen. Die prähospitale Sterblichkeit ist hoch. Bei Verdacht auf eine beteiligte Aortenverletzung, aufgrund eines hohen traumatic aortic injury scores, ist eine Computertomographie durchzuführen. Es erfolgt eine Triage der Verletzungen, und die Versorgungspriorität der Aorta richtet sich nach dem Schweregrad der Aorten- und Begleitverletzungen sowie dem Zustand des Patienten. Bis zur definitiven Versorgung der aortalen Läsion muss der Blutdruck konsequent gesenkt werden. Grad I und II können in Einzelfällen unter enger Kontrolle inital konservativ gemanagt werden. Grad III (gedeckte Ruptur) und Grad IV (freie Ruptur) benötigen eine raschestmögliche Versorgung (interventionell, chirurgisch). In ausgesuchten Fällen kann auch eine verzögerte Versorgung günstig sein.

Als bevorzugte Versorgungsform hat sich die interventionelle Stentgrafttherapie etabliert.

Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

Rib fractures represent the most common bone fracture, occurring in 10-20% of all blunt trauma patients and leading to concomitant injuries of the inner organs in severe cases. The purpose of this study was to identify specific serial rib fracture patterns after blunt chest trauma. 380 serial rib fracture cases were investigated. Fractures were assigned to five different locations within the transverse plane. Rib level, fracture type, and dislocation grades were recorded and related to the cause of accident. In total, 3735 rib fractures were identified (9.8 per patient). 54% of the rib fractures were detected on the left thorax. Rib fracture distribution exhibited a hotspot at rib levels 4 to 7 in the lateral and posterolateral segments. On average, most rib fractures occurred in crush/burying injuries (15.8, n = 13) and pedestrian accidents (12.8, n = 13), least in car/truck accidents (8.9, n = 75). In the car/truck accident group, 47% of all rib fractures were in the lateral segment, in case of frontal collision (n = 24) even 60%. Fall injuries (n = 141) entailed mostly posterolateral rib fractures (35%). In case of falls >3 m (n = 45), 48% more rib fractures were detected on the left thorax. In cardiopulmonary resuscitation related serial rib fractures (n = 33), 70% of all rib fractures were located anterolaterally. Infractions were the most observed fracture type (44%), followed by oblique (25%) and transverse (18%) fractures, while 46% of all rib fractures were dislocated (15% ≥ rib width). Serial rib fractures showed distinct fracture patterns depending on the cause of accident. When developing a serial rib fracture classification system, data regarding patterns, fracture types, dislocation grades, and associated fractures should be included.

Airbag deployment: Infrared thermography and evaluation of thermal damage

The performance of airbag and its deployment are based on a fast exothermic-chemical reaction. The hot gas resulting from the chemical reaction which results in airbag deployment can cause thermal damage and skin burning for the car passenger. The thermal burns due to airbags are of two types: burns due to direct contact with the airbag surface and burns resulting from exposure to the hot gas leaving the deflation vents of the airbag. In this research, for experimental study of the burns resulting from exposure of the skin to airbag, using infrared thermography, the extent of temperature rise of the airbag surface was detected and measured from the zero moment of its inflation. Next, using Henriques equation, the extent of thermal damage caused by airbag deployment and its resulting burn degree was calculated. The results indicated that during the inflation of airbag, the maximum temperature of its surface can be 92 °C ± 2 °C. Furthermore, if the vehicle's safety system functions within the predicted time intervals, the risk of thermal damage is virtually zero. However, if even a slight delay occurs in detachment of the passenger's head and face off the airbag, second- and third-degree burns could develop.

Wrong-way driving crashes: A random-parameters ordered probit analysis of injury severity

In the context of traffic safety, whenever a motorized road user moves against the proper flow of vehicle movement on physically divided highways or access ramps, this is referred to as wrong-way driving (WWD). WWD is notorious for its severity rather than frequency. Based on data from the U.S. National Highway Traffic Safety Administration, an average of 355 deaths occur in the U.S. each year due to WWD. This total translates to 1.34 fatalities per fatal WWD crashes, whereas the same rate for other crash types is 1.10. Given these sobering statistics, WWD crashes, and specifically their severity, must be meticulously analyzed using the appropriate tools to develop sound and effective countermeasures. The objectives of this study were to use a random-parameters ordered probit model to determine the features that best describe WWD crashes and to evaluate the severity of injuries in WWD crashes. This approach takes into account unobserved effects that may be associated with roadway, environmental, vehicle, crash, and driver characteristics. To that end and given the rareness of WWD events, 15 years of crash data from the states of Alabama and Illinois were obtained and compiled. Based on this data, a series of contributing factors including responsible driver characteristics, temporal variables, vehicle characteristics, and crash variables are determined, and their impacts on the severity of injuries are explored. An elasticity analysis was also performed to accurately quantify the effect of significant variables on injury severity outcomes. According to the obtained results, factors such as driver age, driver condition, roadway surface conditions, and lighting conditions significantly contribute to the injury severity of WWD crashes.

Initial analysis of archived non-human primate frontal and rear impact data from the biodynamics data resource

OBJECTIVE

The research objective was to conduct an initial analysis of non-human primate (NHP) data from frontal and rear impact events archived in the Biodynamics Data Resource (BDR) records of the Naval Biodynamics Laboratory (NBDL). These rare data, collected between 1973 and 1989, will inform the safety community of upper-end tolerance limits of NHP and may be related to severe crash scenarios.

METHODS

Data from frontal and rear acceleration tests to 93 macaque NHP were examined. Each NHP was fully torso restrained, whereas the head-neck complex was unrestrained. Each NHP underwent between 1 and 21 total runs; 2 total runs was most common-a low-level run and then a high-level run. Following each impact exposure, the NHP was evaluated using a series of medical examinations. Now part of the legacy collection in the BDR, these evaluations were used to assess NHP exposures to be in one of 3 categories: noninjurious, injurious, or fatal. Using reported peak sled acceleration values, data were amenable to survival analysis statistical methodology to derive injury probability curves (IPCs). IPCs were derived for injury and fatality outcomes.

RESULTS

Fatal injuries for both frontal and rear impacts were mostly at the cranio-vertebral junction. In addition to hemorrhage, fatal frontal and rear impact tests both produced predominantly atlanto-occipital dislocations, with and without spinal cord transection. After exclusions, IPCs were derived for frontal and rear impact for both (1) fatal outcome and (2) injurious outcome (any injury including fatal injury). For frontal impact, 53 NHP qualified with 5, 25, and 50% risk for fatality at 89, 105, and 114 peak sled Gs, respectively, and for injurious outcome at 70, 92, and 106 Gs, respectively. For rear impact, 34 NHP qualified with 5, 25, and 50% risk for fatality at 96, 122, 138 peak sled Gs, respectively, and for injurious outcome at 75, 99, and 115 Gs, respectively.

CONCLUSIONS

The majority of injuries were at the cranio-vertebral junction, indicating that the inertial head mass caused a tensile loading mechanism to the cervical spine. These data may be used in conjunction with finite element modeling to estimate risks to the human population. The most direct application in the automotive environment could be to the well-restrained child. The N_ij neck injury criteria, currently based on data from piglet studies, could also benefit because the NHP is a more accurate human surrogate. These types of tests are likely to never be repeated and will form an upper bound of tolerance information valuable to safety system designers.

Seat belt-related injuries: A surgical perspective

Introduction:

Legislation making seatbelt use mandatory is considered to have reduced fatal and serious injuries by 25%, with UK government estimates predicting more than 50,000 lives saved since its introduction. However, whilst the widespread use of seatbelts has reduced the incidence of major traumatic injury and death from road-traffic collisions (RTCs), their use has also heralded a range of different injuries. The first ever seatbelt related injury was described in 1956, and since then clear patterns of seatbelt-related injuries have been recognised.

Methodology and Findings:

This review of the published literature demonstrates that the combination of airbags and three-point seatbelts renders no part of the body free from injury. Serious injuries can, and do, occur even when passengers are properly restrained and attending clinicians should have a high index of suspicion for overt or covert intra-abdominal injuries when patients involved in RTCs attend the Emergency Department. Bruising to the trunk and abdomen in a seatbelt distribution is an obvious sign that suggests an increased risk of abdominal and thoracic injury, but bruising may not be apparent and its absence should not be falsely reassuring. A high index of suspicion should be retained for other subtler signs of injury. Children and pregnant women represent high-risk groups who are particularly vulnerable to injuries.

Conclusion:

In this review we highlight the common patterns of seatbelt-related injuries. A greater awareness of the type of injuries caused by seatbelt use will help clinicians to identify and treat overt and covert injuries earlier, and help reduce the rates of morbidity and mortality following RTCs.

Analysis of driver injury severity in wrong-way driving crashes on controlled-access highways

For more than five decades, wrong-way driving (WWD) has been notorious as a traffic safety issue for controlled-access highways. Numerous studies and efforts have tried to identify factors that contribute to WWD occurrences at these sites in order to delineate between WWD and non-WWD crashes. However, none of the studies investigate the effect of various confounding variables on the injury severity being sustained by the at-fault drivers in a WWD crash. This study tries to fill this gap in the existing literature by considering possible variables and taking into account the ordinal nature of injury severity using three different ordered-response models: ordered logit or proportional odds (PO), generalized ordered logit (GOL), and partial proportional odds (PPO) model. The findings of this study reveal that a set of variables, including driver's age, condition (i.e., intoxication), seatbelt use, time of day, airbag deployment, type of setting, surface condition, lighting condition, and type of crash, has a significant effect on the severity of a WWD crash. Additionally, a comparison was made between the three proposed methods. The results corroborate that the PPO model outperforms the other two models in terms of modeling injury severity using our database. Based on the findings, several countermeasures at the engineering, education, and enforcement levels are recommended.

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.

Are bilateral femoral fractures no longer a marker for death?

OBJECTIVES

To determine whether previously reported high mortality rates associated with bilateral femoral fractures have decreased over time.

DESIGN

Retrospective review.

SETTING

Urban academic trauma center.

STUDY GROUP

54 adults with bilateral femoral fractures treated at our center from 2000 to 2006. The 108 fractures were initially treated with external fixation (11%), reamed antegrade nailing (23%), and reamed retrograde nailing (67%). Unilateral control group: 461 patients with unilateral femoral fractures treated at our center from 2002 to 2005.

INTERVENTION

Univariate analysis compared our results with those of a published historical control group from the same center approximately 15 years ago (study period, 1984-1990).

MAIN OUTCOME MEASUREMENTS

Mortality rates.

RESULTS

We noted marked differences between the current mortality rate associated with bilateral femoral fractures and that of the historical control group. The mortality rate decreased over time at our center for both bilateral (26%-7%, P = 0.002) and unilateral (12%-2%, P = 0.0001) fractures. Mortality rates were still significantly higher (P = 0.037) for bilateral (7%) than for unilateral (2%) fractures.

CONCLUSIONS

Mortality rates and Injury Severity Scores were reduced for bilateral and unilateral femoral fractures compared with data reported 15 years ago from the same center. The improved outcome might be related in part to changes in resuscitation, triage, intensive care, and orthopaedic management of the patients. However, considering that the Injury Severity Score also significantly decreased, the improvement might have occurred because of changes in injury patterns, perhaps secondary to improved safety features in motor vehicles.

LEVEL OF EVIDENCE

Prognostic level III. See instructions for authors for a complete description of levels of evidence.

Airbag-induced chemical eye injury

Chemical injuries of the eye are a rare complication of airbag deployment and result from seepage of the chemical, causing inflation through vents in the airbag. We describe a severe case of bilateral alkali eye injury upon airbag contact in a road traffic accident. Delayed recognition and irrigation of the eyes exacerbated the injury with a resultant poor healing response of the left eye. Consequently, a left amniotic membrane graft was performed to promote corneal epithelial healing. The use of an amniotic membrane graft in the acute period after a chemical keratitis is unusual and reflects the severity of the corneal injuries sustained by this patient. This case illustrates the vision-threatening risk of alkali keratitis secondary to airbag deployment and highlights the importance of early recognition and management.

Airbag-related chest wall burn as a marker of underlying injury: a case report

Introduction

This case of a man who sustained an airbag-induced thoracic injury and burn, highlights the potential harm that can be caused by airbags. It also serves to illustrate that a surface burn which looks small and benign can actually be a surface marker of a more serious injury. Staff working in emergency departments need to be aware of the risk of possible airbag-associated injuries.

Case presentation

A 65-year-old man was the driver in a frontal collision. He was wearing a seatbelt. The airbag was activated and caused a superficial chest wall burn. Initial chest x-rays were unremarkable but following deterioration in his condition, a computed tomography scan revealed a serious sternal fracture. The location of the fracture was marked on the surface by the burn.

Conclusion

Airbags can cause significant chest wall injuries and burns. Surface burns at the point of impact should not be dismissed as trivial as the forces involved can cause significant injury. We recommend that all people with chest wall injuries and/or burns due to airbags should have more detailed chest imaging as initial emergency radiographs can be falsely reassuring.

Airbag pneumonitis: a report and discussion of a new clinical entity

This report describes the occurrence of pneumonitis in a young male immediately after inhalation of aerosolized chemicals subsequent to motor vehicle airbag deployment. The clinical presentation was one of mild shortness of breath associated with bilateral alveolar infiltrates on chest radiology. Not previously described, this diagnosis should be considered in the differential of pulmonary infiltrates in motor vehicle crash patients.

Upper extremity fracture patterns following motor vehicle crashes differ for drivers and passengers

PURPOSE

Injury patterns of occupants in motor vehicle crashes are changing, with upper extremity injury becoming more common in patients treated at trauma centres. Although not life threatening, upper extremity injuries may result in long-term disability, including chronic deformity, neurovascular compromise and degenerative arthritis. The purpose of this study was to compare upper extremity injury in drivers and passengers using the Crash Injury Research Engineering Network (CIREN) database.

METHODS

CIREN data were used to compare upper extremity skeletal injury patterns and sources for drivers and passengers in frontal and side impacts. Occupant variables (age, gender, co-morbidity, avoidance maneuvers and restraint use) and crash variables (direction of impact, delta V and vehicle crush) were considered in the analysis.

RESULTS

Only 24.8% of all occupants in the CIREN database had upper extremity injuries. One-half of upper extremity injuries to drivers were forearm fractures compared to one-third for passengers. Occupants in side impacts were more likely (OR=5.05) to have clavicle fractures, even while controlling for driver versus passenger status and safety belt use. Air bags were more likely to be a source of forearm fracture (OR=2.31) when controlling for driver versus passenger status, direction of force, sex and age compared to other sources. Only 10% of driver fractures with air bag deployment in frontal impacts were associated with air bag fling.

CONCLUSIONS

This study found that drivers and passengers have different upper extremity injury patterns but the direction of impact also plays an important role.

Ocular injuries in patients with major trauma

AIM

To study the epidemiology of ocular injuries in patients with major trauma in the UK, determining the incidence and causes of ocular injuries, and their association with facial fractures.

METHODS

A retrospective analysis of the Trauma Audit Research Network database from 1989 to 2004, looking at data from 39,073 patients with major trauma.

RESULTS

Of the 39,073 patients with major trauma, 905 (2.3%) patients had associated ocular injuries and 4082 (10.4%) patients had a facial fracture (zygoma, orbit or maxilla). The risk of an eye injury for a patient with a facial fracture is 6.7 times as that for a patient with no facial fracture (95%, confidence interval 5.9 to 7.6). Of the patients with major trauma and an eye injury, 75.1% were men, and the median age was 31 years. 57.3% of ocular injuries were due to road traffic accidents (RTAs).

CONCLUSION

The incidence of ocular injuries in patients with major trauma is low, but considerable association was found between eye injuries and facial fractures. Young adults have the highest incidence of ocular injury. RTAs are the leading cause of ocular injuries in patients with major trauma. It is vital that all patients with major trauma are examined specifically for an ocular injury.

Modeling thermal burns due to airbag deployment

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

Air bags and the skin

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