BioTab—A New Method for Analyzing and Documenting Injury Causation in Motor-Vehicle Crashes

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Objective Motor vehicle crash (MVC)-related spinal injuries result in significant morbidity and mortality in children. The objective was to identify MVC-related injury causation scenarios for spinal injuries in restrained children. Methods This was a case series of occupants in MVCs from the Crash Injury Research and Engineering Network (CIREN) data set. Occupants aged 0–17 years old with at least one Abbreviated Injury Scale (AIS) 2+ severity spinal injury in vehicles model year 1990+ that did not experience a rollover were included. Unrestrained occupants, those not using the shoulder portion of the belt restraint, and those with child restraint gross misuse were excluded. Occupants with preexisting comorbidities contributing to spinal injury and occupants with limited injury information were also excluded. A multidisciplinary team retrospectively reviewed each case to determine injury causation scenarios (ICSs). Crash conditions, occupant and restraint characteristics, and injuries were qualitatively summarized. Results Fifty-nine cases met the study inclusion criteria and 17 were excluded. The 42 occupants included sustained 97 distinct AIS 2+ spinal injuries (27 cervical, 22 thoracic, and 48 lumbar; 80 AIS-2, 15 AIS-3, 1 AIS-5, and 1 AIS-6), with fracture as the most common injury type (80%). Spinal-injured occupants were most frequently in passenger cars (64%), and crash direction was most often frontal (62%). Mean delta-V was 51.3 km/h ± 19.4 km/h. The average occupant age was 12.4 ± 5.3 years old, and 48% were 16- to 17-year-olds. Thirty-six percent were right front passengers and 26% were drivers. Most occupants were lap and shoulder belt restrained (88%). Non-spinal AIS 2+ injuries included those of the lower extremity and pelvis (n = 56), head (n = 43), abdomen (n = 39), and thorax (n = 36). Spinal injury causation was typically due to flexion or lateral bending over the lap and or shoulder belt or child restraint harness, compression by occupant’s own seat back, or axial loading through the seat pan. Nearly all injuries in children <12 years occurred by flexion over a restraint, whereas teenage passengers had flexion, direct contact, and other ICS mechanisms. All of the occupants with frontal flexion mechanism had injuries to the lumbar spine, and most (78%) had associated hollow or solid organ abdominal injuries. Conclusions Restrained children in nonrollover MVCs with spinal injuries in the CIREN database are most frequently in high-speed frontal crashes, of teenage age, and have vertebral fractures. There are age-specific mechanism patterns that should be further explored. Because even moderate spinal trauma can result in measurable morbidity, future efforts should focus on mitigating these injuries.

Section: Methodsmentioning

confidence: 99%

Motor Vehicle Crash–Related Injury Causation Scenarios for Spinal Injuries in Restrained Children and Adolescents

Zonfrillo

Locey

Scarfone

et al. 2014

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“…However, to prevent injuries within one body region, it is always necessary to look at the specific injury, its severity, and its individual injury mechanism. Though the PIONEERS definition appears useful for providing a good overview of protective needs by body region for PTW riders, ultimately more detailed body region information like that defined for the Crash Injury Research database (Schneider et al 2011) may be more favorable. In the interim, this analysis highlights the need to encourage researchers to carefully choose the appropriate sample for analysis and always include a definition of body regions used in their publications.…”

Section: Discussionmentioning

confidence: 99%

Comparing consequences of using two different definitions for body regions for the improvement of personal protective equipment for powered two-wheelers

Schick

Piantini

Wisch

et al. 2019

Objective: Various definitions and uses of the term body region can be found in the literature. A definition of body regions using the Abbreviated Injury Scale (AIS) codes not strictly aligned with AIS chapters was developed for use in the European Commission-funded PIONEERS project (Protective Innovations of New Equipment for Enhanced Rider Safety). This work aims to examine the consequences of differently defined body regions on injury priority ranking using the percentage of patients showing at least moderate injury severity (AIS 2þ) per regarded body region. Methods: Three different crash investigation data sets of injured riders and/or pillion riders of powered 2-wheelers (PTWs) were used for this analysis. The first contained data for 143 fatalities, the second contained data for 58 severely injured, and the last for contained data for 982 patients from a sample that was close to national representativeness. Frequency of injury was examined using body regions based on the AIS chapters (and first digit of the AIS Unique Identifier) and based on the PIONEERS definition. Results: Though different body region definitions did not result in different top-ranked body regions in terms of injury frequency, different definitions did provide different levels of information that impact priority within AIS chapter-defined regions. For PTW riders, cervical injuries are the highest priority spinal injuries. Thoracic and lumbar spinal injuries seem to occur together with other injuries in the thorax and abdominal region. Severe lower extremity injuries frequently involve the pelvis and the leg. Conclusions: Body regions need to be defined carefully to avoid misinterpretations. Publications that use body regions for their analysis to present injury frequencies should clearly define what they include in each region.

“…In this study, 27 cases were analyzed and the AIS2+ head injuries were coded using the CIREN BioTab method developed by Schneider et al (2011). The BioTab approach to analyzing occupant injuries in a crash allows the researcher to attribute one or more injury causation scenarios (ICS) to each injury.…”

Section: Methodsmentioning

confidence: 99%

Head Injury Causation Scenarios for Belted, Rear-Seated Children in Frontal Impacts

Bohman

Arbogast

Boström

2011

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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.