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Kent R, Cormier J, McMurry TL, Johan Ivarsson B, Funk J, Hartka T, Sochor M. Spinal injury rates and specific causation in motor vehicle collisions. ACCIDENT; ANALYSIS AND PREVENTION 2023; 186:107047. [PMID: 37003164 DOI: 10.1016/j.aap.2023.107047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
Motor vehicle collisions (MVCs) are a leading cause of acute spinal injuries. Chronic spinal pathologies are common in the population. Thus, determining the incidence of different types of spinal injuries due to MVCs and understanding biomechanical mechanism of these injuries is important for distinguishing acute injuries from chronic degenerative disease. This paper describes methods for determining causation of spinal pathologies from MVCs based on rates of injury and analysis of the biomechanics require to produce these injuries. Rates of spinal injuries in MVCs were determined using two distinct methodologies and interpreted using a focused review of salient biomechanical literature. One methodology used incidence data from the Nationwide Emergency Department Sample and exposure data from the Crash Report Sample System supplemented with a telephone survey to estimate total national exposure to MVC. The other used incidence and exposure data from the Crash Investigation Sampling System. Linking the clinical and biomechanical findings yielded several conclusions. First, spinal injuries caused by an MVC are relatively rare (511 injured occupants per 10,000 exposed to an MVC), which is consistent with the biomechanical forces required to generate injury. Second, spinal injury rates increase as impact severity increases, and fractures are more common in higher-severity exposures. Third, the rate of sprain/strain in the cervical spine is greater than in the lumbar spine. Fourth, spinal disc injuries are extremely rare in MVCs (0.01 occupants per 10,000 exposed) and typically occur with concomitant trauma, which is consistent with the biomechanical findings 1) that disc herniations are fatigue injuries caused by cyclic loading, 2) the disc is almost never the first structure to be injured in impact loading unless it is highly flexed and compressed, and 3) that most crashes involve predominantly tensile loading in the spine, which does not cause isolated disc herniations. These biomechanical findings illustrate that determining causation when an MVC occupant presents with disc pathology must be based on the specifics of that presentation and the crash circumstances and, more broadly, that any causation determination must be informed by competent biomechanical analysis.
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Affiliation(s)
- Richard Kent
- Center for Applied Biomechanics, Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA; Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA; Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA; Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | - Joseph Cormier
- Biomechanics Consulting and Research, Charlottesville, VA, USA
| | - Timothy L McMurry
- Center for Applied Biomechanics, Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - B Johan Ivarsson
- Biomechanics Consulting and Research, Charlottesville, VA, USA; Forensic Failure Engineering (FFE), LLC, Tempe, AZ, USA
| | - James Funk
- Center for Applied Biomechanics, Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA; Biomechanics Consulting and Research, Charlottesville, VA, USA
| | - Thomas Hartka
- Center for Applied Biomechanics, Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA; Emergency Medicine, University of Virginia, Charlottesville, VA, USA; Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Mark Sochor
- Center for Applied Biomechanics, Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA; Emergency Medicine, University of Virginia, Charlottesville, VA, USA; Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
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Kohles SS, McClaren JW. A stochastic model validated with human test data causally associating target vehicle Delta V, occupant cervicocranial biomechanics, and injury during rear-impact crashes. J Forensic Leg Med 2022; 91:102431. [PMID: 36137410 PMCID: PMC9583887 DOI: 10.1016/j.jflm.2022.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/04/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
Abstract
Even at low to moderate-speeds, rear-end motor vehicle crashes have been strongly associated with occupant cervicocranial biomechanics that lead to head and neck injury. In this paper, we present the development of an analytic mechanics model of occupant head and neck motion as associated with modeled target vehicle Delta V during rear-end vehicular crashes. The inclusion of stochastic mechanical input variables further developed the model beyond the deterministic framework by reflecting aspects of the random nature of real-world crashes and the resulting injuries. This approach led to the characterization of 1000 crash simulations, quantifying Delta V and the resulting probabilistic occupant biomechanics. The model was validated through the direct comparison with 86 published human subject crash tests. Overall, the model slightly underestimated by -2.6% the magnitude of peak head accelerations identified in the literature. The utility of the model allows a forensic biomechanical investigator to customize some of the fundamental input crash parameters and appropriately explore the resulting vehicular mechanics and their direct influence on injury biomechanics.
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Affiliation(s)
- Sean S Kohles
- Kohles Bioengineering, 1731 SE 37th Avenue, Portland, OR, 97214, USA; Division of Biomaterials & Biomechanics, School of Dentistry, and Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA; Department of Human Physiology and Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA.
| | - Jonathan W McClaren
- Cascade Spine & Injury Center, 5253 NE Sandy Boulevard, Portland, Oregon, 97213, USA.
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