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Objective: There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction.Methods: In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3 years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS.Results: It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions.Conclusions: Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.

Objectives:The objective of this study was to determine the potential chest injury benefits and influence on occupant kinematics of a belt system with independent control of the shoulder and lap portions.Methods: This article investigates the kinematics and dynamics of human surrogates in 35 km/h impacts with 2 different restraints: a pretensioning (PT), force-limiting (FL) seat belt, a reference belt system, and a concept design with a split buckle consisting (SB) of 2 separate shoulder and lap belt bands. The study combines mathematical simulations with the THOR dummy and THUMS human body model, and mechanical tests with the THOR dummy and 2 postmortem human surrogate (PMHS) tests of similar age (39 and 42 years) and anthropometry (62 kg, 181 cm vs. 60 kg, 171.5 cm). The test setup consisted of a rigid metallic frame representing a standard seating position of a right front passenger. The THOR dummy model predictions were compared to the mechanical THOR dummy test results. The THUMS-predicted number of fractured ribs were compared to the number of fractured ribs in the PMHS. Results: THOR sled tests showed that the SB seat belt system decreased chest deflection significantly without increasing the forward displacement of the head. The THOR model and the THOR physical dummy predicted a 13-and 7-mm reduction in peak chest deflection, respectively. Peak diagonal belt force in the mechanical test with the reference belt was 5,582 N and the predicted force was 4,770 N. The THOR model also predicted lower belt forces with the SB system than observed in the tests (5,606 vs. 6,085 N). THUMS predicted somewhat increased head displacement for the SB system compared to the reference system. Peak diagonal force with the reference belt was 4,000 N and for the SB system it was 5,200 N. The PMHS test with the SB belt resulted in improved kinematics and a smaller number of rib fractures (2 vs. 5 fractures) compared to the reference belt. Conclusion:Concepts for a belt system that can reduce the load on the chest of the occupant in a crash and thereby reduce the number of injured occupants, in particular the elderly, was proposed.