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Pediatric Injuries in Mismatched Crashes
Martin R. Eichelberger, MDg ,Kelly Orzechowski, MPH, Patrick McLaughlin, BS
Children’s National Medical Center
United Sates Vehicle FleetUnited Sates Vehicle Fleet
Fatality RatesFatality Rates
Vehicle-to-Vehicle IncompatibilityVehicle to Vehicle Incompatibility
• Larger striking vehicles over-ride side impact barriers
• Increased risk of head & chest injury to near side occupant
• Head & chest injuries are more life th t ithreatening
Pediatric Anatomy
Pediatric Head Injury in Side Impact Crashes
• Large Heads = More S f A A il blSurface Area Available for ContactH d t D P l L l• Head at Door Panel Level Increases Risk of Injury
Pediatric Head Injury in Side Impact Crashes
Case A Frontal Impact Sedan Vs SUVCase A. Frontal Impact Sedan Vs. SUV
• Frontal Impact
• 7 year old female• 7 year-old female
• 57 pounds
• Right Front Passenger
• Lap portion of a 3 point restraint• Lap portion of a 3-point restraint
Case A. Scene DiagramCase A. Scene Diagram
Case A. Case VehicleCase A. Case Vehicle
• V1: 1989 Mercury Tracer• V2: 1985 Nissan Pickup• Max Crush: 14.2 inches• Delta V: 19 mph
PDOF 10 d• PDOF: 10 degrees
Case A. Seating Positiong
Right Front Seat Instrument Panel Contact
Case A. External InjuriesCase A. External Injuries
Left Upper Thigh Contusion
Abdominal Ecchymosis
Left Upper Thigh Contusion
Right Arm Abrasion
Injury Severity in Mismatched Frontal Impacts
16Compatible (N=141)
Mismatched (N=30)
10
12
14
6
8
10
Mea
n
2
4
0LOS ISS GCS
Injury Severity in Mismatched Frontal Impacts
70
80
Compatible (N=141)
50
60
ases
(%)
Mismatched (N=30)
20
30
40
Perc
ent o
f Ca
0
10
20
AIS2+ AIS3+ AIS4+
Injury Patterns in Mismatched Frontal Impacts
16
18Compatible Mismatched
10
12
14
ases
(%)
6
8
10
Perc
ent o
f Ca
0
2
4
AIS3+Head AIS3+Chest AIS3+Abd/Pel AIS3+Extremity
Case B: Side Impact Sedan Vs. SUVCase B: Side Impact Sedan Vs. SUV
• Lateral Impact
8 ld l• 8 year-old male
• 79 lbs.
• Right Front Passenger
3 t B lt & Ai b• 3-pt. Belt & Air bag
Case B. Scene DiagramCase B. Scene Diagram
DYNAMIC SCIENCE, INC.CASE NUMBER 233
NOT TO SCALE
dsi an Exodyne Company
NS
E
W
V3V3 POI #2, V1 vs. V3
V1
V1
V1V1
V2
V1
V1 V2
V1
V2 V2V
POI #1, V1 vs. V2
V2
1999 CHEVROLET LUMINA
V1
V1
V1
V2
V3
1995 CHEVROLET BLAZER
1999 TOYOTA CAMRY
Case B. Case VehicleCase B. Case Vehicle
• V1: 1999 Chevy Luminay• V2: 1995 Chevy Blazer• Max Crush: 18.1 in.• Delta V: 23 mph• PDOF: 050
Case B. Vehicles
Case Occupant Seat Opposing Vehicle
Case B. Vehicle IntrusionCase B. Vehicle Intrusion
Case Occupant Seat Seat Intrusion
Case B. External InjuriesCase B. External Injuries
Right Knee Contusion
Case B. Brain InjuriesCase B. Brain Injuries
C b ll I h i• Cerebellar Ischemia
• Hydrocephalus
• Petechial Cerebellar• Petechial Cerebellar Hemorrhage
• Tentorial Subdurals
Case B. Skull Fractures
Multiple Occipital FracturesMultiple Occipital Fractures
Case B. Abdominal Injuriesj
Liver LacerationAdrenal Hemorrhage
Case B Internal InjuriesCase B. Internal Injuries
L C t i
Blood in Morrison’s Pouch
Lung Contusions
Side Impact Syndrome
Ri k f I j f Child i Sid I t C h
Odds Ratio 95% CI P-valueAIS2+ 2 5 1 1 5 5 020
Risk of Injury for Children in Side Impact Crashes
AIS2+ 2.5 1.1, 5.5 .020AIS3+ 2.3 1.3, 4.0 .006AIS4+ 2.8 1.4, 5.2 .002AIS5+ 2 7 1 1 6 2 020AIS5+ 2.7 1.1, 6.2 .020AIS2+ Head 2.5 1.4, 4.4 .003AIS3+ Head 2.8 1.5, 5.3 .001AIS4+ Head 3.4 1.6, 7.0 .001AIS4 Head 3.4 1.6, 7.0 .001AIS2+ Chest 4.0 2.0, 8.0 .000AIS3+ Chest 4.8 2.3, 9.9 .000AIS4+ Chest 4.3 1.5, 12.6 .008AIS2+ Cervical 3.7 1.2, 11.3 .018GCS <9 4.9 2.2, 10.6 .000ISS > 15 3.1 1.7, 5.8 .000
Side Impact SyndromeSide Impact Syndrome
p < .01
80
90
100
Frontal (N=166)
50
60
70
80
of C
ases
(%)
Lateral (N=65)
10
20
30
40
Perc
ent
0
10
AIS 2+ Head
AIS 2+ Chest
AIS 2+ Cervical
AIS 2+Abdomen
AIS 2+Lumbar
All Frontal Impacts Vs. All Lateral Impacts
Injury Contact Points for Seriously Injured Children
70
50
60
(%)
FrontalLateral
30
40
nt o
f Cas
es
10
20Perc
e
0Door Panel Non-
ContactA,B,C Pillar Seatback Car Seat Seatbelt Instrument
Panel
All frontal cases with ISS>15 compared to all lateral cases with ISS>15.
Injury Severity in Mismatched Near Side Impacts
25Compatible (N=27)
Mismatched (N=20)
15
20
Mismatched (N 20)
10
15
0
5
LOS GCS ISS
Injury Severity in Mismatched Near Side Impacts
100
Compatible (N=27)
Mismatched (N=20)
70
80
90
100
s (%
)
Mismatched (N=20)
40
50
60
cent
of C
ases
0
10
20
30
Perc
0AIS2+ AIS3+ AIS4+
Injury Severity in Mismatched Near Side Impacts
90
100 Compatible
Mismatched
60
70
80
ases
(%)
30
40
50
rcen
t of C
a
0
10
20
30
Pe
0AIS 2+Head AIS 3+Head AIS4+Head AIS 2+Chest AIS 3+Chest AIS4+Chest
ConclusionsConclusions
• Side Impact Syndrome - Head Neck ChestSide Impact Syndrome Head, Neck, Chest
Mi h d Sid C h ISS (T d)• Mismatched Side Crashes ISS (Trend)
Potential Injury Reduction MethodsPotential Injury Reduction Methods
• Improved Child Safety Seat Designs– More Head PaddingMore Head Padding– Increased Depth of Head Wings
• Improved Child Seat Installation Technology – LATCH: Rigid versus Flexibleg– Some Sled Test Show that Rigid LATCH
anchorage systems prevent occupant contact ith d lwith door panel
Potential Injury Reduction MethodsPotential Injury Reduction Methods
• Increase Booster Seat Use• Head Wings• Head Wings• Improve Side Impact Protection Technology• Develop Crash Test Dummy for Side Impact Tests• Develop Crash Test Dummy for Side Impact Tests• Crash Testing of Mismatched Vehicles