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While many medical studies have dealt with the incidence, nature and treatment of polytrauma the injury-causing accident mechanisms are rarely discussed in detail, mostly due to the lack of documentation of the technical aspects. The present prospective study was started in late 2007 and collects data from traffic accidents with most severely injured in six south- German counties and two larger cities for the duration of one year. It is aimed at identifying and documenting all polytrauma cases (ISS ≥ 16) caused by traffic accidents and their crash circumstances. The data collection is based on an interdisciplinary concept to include both the police, emergency dispatch centers, hospitals and fire departments in the region and is completely anonymous. Potentially relevant cases where an emergency physician was called to the scene of a traffic accident are provided by the dispatch center. All three hospitals in the region suited for the treatment of polytraumatised patients record injuries, major diagnostic and surgery data. Data and images from the accident scene are provided by the police and by fire departments. The latter provide information which is usually not available from the police, like deployed airbags, vehicle extrication measures and detailed views of car interiors. The main objective of the study is to determine the structure of road users who sustain a polytrauma, their crash opponents and the injury patterns found in relation to the collision configuration and the protection by seat belts, air bags and other devices. With detailed documentation of vehicle damage and extrication measures the study is also intended to support the development of injury predictors for pre-hospital treatment and provide field data regarding further improvement of technical rescue.
The aim of this study is to investigate the differences in car occupant injury severity recorded in AIS 2005 compared to AIS 1990 and to outline the likely effects on future data analysis findings. Occupant injury data in the UK Cooperative Crash Injury Study Database (CCIS) were coded for the period February 2006 to November 2007 using both AIS 1990 and AIS 2005. Data for 1,994 occupants with over 6000 coded injuries were reviewed at the AIS and MAIS level of severities and body regions to determine changes between the two coding methodologies. Overall there was an apparent general trend for fewer injuries to be coded at the AIS 4+ severity and more injuries to be coded at the AIS 2 severity. When these injury trends were reviewed in more detail it was found that the body regions which contributed the most to these changes in severity were the head, thorax and extremities. This is one of the first studies to examine the implications for large databases when changing to an updated method for coding injuries.
Bicyclists are minimally or unprotected road users. Their vulnerability results in a high injury risk despite their relatively low own speed. However, the actual injury situation of bicyclists has not been investigated very well so far. The purpose of this study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. Technical and medical data were prospectively collected shortly after the accident at the accident scenes and medical institutions providing care for the injured. Data of injured bicyclists from 1985 to 2003 were analyzed for the following parameters: collision opponent, collision type, collision speed (km/h), Abbreviated Injury Scale (AIS), Maximum AIS (MAIS), incidence of polytrauma (Injury Severity Score >16), incidence of death (death before end of first hospital stay). 4,264 injured bicyclists were included. 55% were male and 45% female. The age was grouped to preschool age in 0.9%, 6 to 12 years in 10.8%, 13 to 17 years in 10.4%, 18 to 64 years in 64.7%, and over 64 years in 13.2%. The MAIS was 1 in 78.8%, 2 in 17.0%, 3 in 3.0%, 4 in 0.6%, 5 in 0.4%, and 6 in 0.2%. The incidence of polytrauma was 0.9%, and the incidence of death was 0.5%. The incidence of injuries to different body regions was as follows: head, 47.8%; neck, 5.2%, thorax, 21%; upper extremities, 46.3%; abdomen, 5.8%; pelvis, 11.5%, lower extremities, 62.1%. The accident location was urban in 95.2%, and rural in 4.8%. The accidents happened during daylight in 82.4%, during night in 12.2%, and during dawn/dusk in 5.3%. The road situation was as follows: straight, 27.3%; bend, 3.0%; junction, 32.0%; crossing, 26.4%; gate, 5.9%; others, 5.4%. The collision opponents were cars in 65.8%, trucks in 7.2%, bicycles in 7.4%, standing objects in 8.8%, multiple objects in 4.3%, and others in 6.5%. The collision speed was grouped <31 in 77.9%, 31-50 in 4.9%, 51-70 in 3.7%, and >70 in 1.5%. The helmet use rate was 1.5%. 68% of the registered head injuries were located in the effective helmet protection area. In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two thirds of the head injuries could have been prevented by helmets. Accidents are concentrated to crossings, junctions and gates. A significant lower mean injury severity was observed in victims using separate bicycle lanes. These results do strongly support the extension or addition of bicycle lanes and their consequent use. However, the lanes are frequently interrupted at crossings and junctions. This emphasizes also the important endangering of bicyclists coming from crossings, junctions and gates, i.e. all situations in which contact of bicyclists to motorized vehicles is possible. Redesigning junctions and bicycle traffic lanes to minimize the possibility of this dangerous contact would be preventive measures. A more consequent helmet use and use and an extension of bicycle paths for a better separation of bicyclists and motorized vehicle would be simple but very effective preventive measures.
While the number of fatal accidents is diminishing every year, there is still a need of improvement and action to prevent these deaths. Basis for this purpose has to be an analysis about the factors influencing the car crash mortality. There are various studies describing the univariate influence of several factors, but crash scenarios are too complex to be described by a single variable. The multivariate analysis respects the interference of the variables and gets so to more detailed and representative results. This multivariate analysis is based on about 2,600 cases (the data have been collected by the accident research units Hannover and Dresden (during the years 1999-2003). This paper presents a multivariate model (containing ten different variables) which detects 93% of these cases properly. This means it detects the cases as truly survived and truly death.
This study is aimed to investigate the correlations of impact conditions and dynamic responses with the injuries and injury severity of child pedestrians by accident reconstruction. For this purpose, the pedestrian accident cases were selected from Sweden and Germany with detailed information about injuries, accident cars, and accident environment. The selected accident cases were reconstructed using mathematical models of pedestrian and passenger car. The pedestrian models were generated based on the height, weight, and age of the pedestrian involved in accidents. The car models were built up based on the corresponding accident car. The impact speeds in simulations were defined based on the reported data. The calculated physical quantities were analyzed to find the correlation with injury outcomes registered in the accident database. The reconstruction approaches are discussed in terms of data collection, estimating vehicle impact speeds, pedestrian moving speeds and initial posture, secondary ground impact, validity of the mathematical models, as well as impact biomechanics.
The so-called "seat-belt injuries" or "seat-belt syndromes", described as 2-point seat-belt injuries, contain heavy inflection injuries of the lumbal spinal column, combined with heavy abdominal injuries as rupture of the upper intestinal bold or heavy injuries of the upper entrails. With "playing" children in the font of the car, with inappropriate plant of 3-point belts, identical injuries can occur.
Nowadays airbags are part of the standard equipment in almost all new cars. While airbags are saving an increasing number of people from severe injuries and death in moderate and high speed crashes, they do not completely prevent dashboard injuries. The most common mechanism in dashboard injuries is a posteriorly directed force to the proximal tibia with the knee flexed. This may occur during a motor vehicle frontal impact accident when a knee of the driver or the front-seat passenger strikes the dashboard. The posterior force can be combined with a abducting or rotational force leading to concomitant lateral or posterolateral injury. Car and airbag manufacturers therefore develop special inflatable systems to reduce the impact force in dashboard injuries. Every new inflatable system, however, has to be evaluated in out of position situations in which the system might cause injuries to certain body areas. Therefore, we investigated a new kneebag system in different critical seating positions of post mortem test subjects (PMTS). The tested knee airbag module is a folded airbag (18 litre volume) which is installed below the lower section of the instrument panel of a passenger car. Using four PMTS (2 male, 2 female, age 36"67) the following positions were tested: normal seating position, knee flexed >90 degrees and knee flexed <60 degrees in static deployment tests with direct contact. In addition a dynamic test (48.8kph, AAMA-pulse) was carried out with the PMTS belted in a normal seating position. The inflation phase and the impact of the system on the knee/lower leg were analysed by high speed videos. After the test the lower legs of the PMTS were examined by Xray and autopsy. All soft tissue injuries and bone fractures were recorded. All the tests could be evaluated. Except some superficial skin lesions in the impact area no fracture of the bones around the knee and no knee ligament and tendon injuries were observed. Neither video analysis nor autopsy of the PMTS showed any critical contact injuries caused by the inflation process of the bag. Therefore, it can be concluded that in the tested seating positions which are the most critical for the knee area the knee bag system is safe.
Pelvic fracture, cracking or breaking of a portion of the pelvis are extremely common injuries in the side impact collisions of motor vehicles. Due to both its shape and structural architecture, mechanics of the pelvic bone is complicated. There is a lack of knowledge regarding the dynamic behavior of the pelvis and its biomechanical tolerance under impact environment. Hence this study is aimed at the understanding of the mechanical response of the human pelvis with three-dimensional finite element (FE) models, under side impact load, applied through a structure, equivalent to a car door. The door structure was modeled, considering few layers, consisting of foam (Styrodur®, 3035 CS), plastic (UHMWPE), steel, glass and steel, putting them in series. A soft tissue layer (equivalent to fat) was also considered on the greater trochanter location. These FE models (with and without the car door structure) were analyzed with ANSYS-LS-DYNA-® dynamic finite element software to compare the effect of the car door padding system for shock absorption. It was observed that with proper combination of shock absorbing material (foam, etc.) and its thickness, the transmission of impact load to the body part (pelvis, etc.) from the outer surface of the car door could be reduced.
In order to improve the protection of children transported in cars, within the CHILD programme (GR3D-CT2002-00791) real world road accidents are thoroughly analysed and then reconstructed in laboratory. Prior to comparing injury severities of real victims to physical parameter values measured on the dummies, the quality of the reconstructions is evaluated by experts who use their experience based on the investigation of numerous and various accidents. This paper presents a new tool aiming at better evaluating and validating accident reconstructions. It is based on statistical evaluation of vehicle deformations which gives weighing factors for every part of the car body structure finally leading to a specific Reconstruction Quality Score (RQS indicator). Furthermore, the reliability of this score, depending on the number of measured points, can be established. This tool includes a function aiming at adjusting the speed for a further reconstruction and at defining the launching speed and the pulse shape for complementary sled tests. Finally, the functions of the RQS software and database are presented.
Detailed investigations and reconstructions of real accidents involving vulnerable road users
(2005)
The aim of this research is to improve knowledge about vulnerable road users accidents and more specifically pedestrians or cyclists. This work has been based on a complete analysis of real accidents. From accidents chosen from an in-depth multidisciplinary investigation (psychology, technical, medical), we have tried to identify the configuration of the impact: car speed, pedestrian or cyclist orientations. Then, we have made a numerical modelling of the same configuration with a multibody software. In particular, we have reproduced the anthropometry of the victim and the front shape of the car. A first simulation has been performed on this starting configuration. Next, effects of some parameters such as car velocity or victim position at impact have been numerically studied in order to find the best correlations with all indications produced by the in-depth analysis. Finally, the retained configuration was close to the presumed real accident conditions because it reproduces in particular the same impact points on the car, the same injuries, and is according to the driver statement. This double approach associating an in-depth accident analysis and a numerical simulation has been applied on pedestrian-to-car and bicyclist-tocar accidents. It has allowed us to better understand the real kinematics of such impacts. Even if this method is based on a case to case study, it underlines which parameters are relevant on a vulnerable road user accident investigation and reconstruction.
The improvement of passive car security devices led to a reduction of injuries, especially of the head, the neck and the torso mainly due to the airbag function. The passenger's foot and ankle could not profit from this development. Some investigators even reported a progression of leg injuries (1). In this study, we investigated a current collective of patients with foot and ankle fractures or severe soft tissue injuries in relation with defined crash parameters. Special interest was paid to the car's footwell.
Sedan type vehicles in which adult rear seat passengers were present and which were involved in frontal collisions were investigated, and the influence of unbelted rear seat passengers on the injuries of front seat occupants was studied. Unbelted rear seat passengers move forward during impact. It was observed that there were not only cases in which front seat occupants sustained injuries caused by direct contact with rear seat passengers, but also cases where front seat occupants received severe injuries due to additional force from rear seat passengers, either impacting directly or indirectly as a result of deformation of the front seat. Severe injuries of front seat occupants were observed in the latter cases. This research validates the importance of seat-belt use for rear seat passengers, not only to protect themselves but also to mitigate injuries of front seat occupants.
The incidence and treatment of sternal fractures among traffic accidents are of increasing importance to ensure best possible outcomes. Analysis of technical indicators of the collision, preclinical and clinical data of patients with sterna fractures from 1985-2004 among 42,055 injured patients were assessed by an Accident Research Unit. Two time groups were categorized: 1985-1994 (A) vs. 1995-2004 (B). 267/42,055 patients (0.64%) suffered a sterna fracture. Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251/31,183 pts), followed by 0.19% (5/2,633pts) driving motorbike, and 0.11% (4/3,258pts) driving a truck. 91% wore a safety belt. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33/255 car/trucks), with an airbag malfunction in 18%. The steering column was deformed in 39%, the steering wheel in 36%. Cars in the recent years were significantly older (7.67-±5 years (B) vs. 5.88-±5 years (A), p=0.003). Cervical spine injuries are frequent (23% vs. 22%), followed by multiple rib fractures (14% vs. 12%) and lung injuries (12% vs. 11%). We found 9/146 (6%) and 3/121 patients (3%) with heart contusion among the 267 sternal fractures. MAIS was 2.56-±1.3 vs. 2.62-±1.3 (A vs. B, p=0.349). 18% of patients were polytraumatized, with 11.2% dying at the scene, 2.3% in the hospital. Sternal fractures occur most often in old cars to seat-belted drivers often without any airbag. Severe multiple rib fractures and lung contusion are concomitant injuries in more than 10% each indicating the severity of the crash. Over a twentyyear period, the injury severity encountered was not different with 18% polytrauma patients suffering sternal fractures.
This study examines the severity and types of injuries sustained by child pedestrians aged 18 years and below in order to identify the body regions at greatest risk for injury in a pedestrian accident. Detailed medical diagnoses were reviewed retrospectively for 572 child pedestrians admitted to an urban pediatric trauma center with injuries during the time period from January 2001 to December 2005. Eighty percent of these children sustained AIS 2 or greater injuries, most commonly to the lower extremity (41%) and head (34%). Fortyfour percent of admitted children had more significant AIS 3 or greater injuries primarily to the head (58%), thorax (17%) and lower extremities (14%). Testing procedures to assess the child- interaction with the motor vehicle should include injury assessment for the pediatric head, thorax and lower extremities. This understanding of how child pedestrians interact with motor vehicles may provide insight into effective countermeasures with potential for implementation in vehicle designs world-wide.
The number of injuries sustained by car occupants involving the head, thorax, spine, pelvis and the upper limbs have been reduced significantly during recent years. This is probably due to better safety features in the cars, especially the availability and usage of safety belts, airbags etc. Therefore one can notice clinically a relative increase in survivors of severe frontal crashes, but many of them have injuries to the lower extremities. To verify this, we analyzed the foot and ankle injuries of front seat passengers.
The primary goal of this investigation was to determine the relative risk of traffic accidents in students. In a two year period, a survey amongst 2,325 students was carried out, and 3,645 injuries sustained by students treated at our hospital were analyzed. Moped-riding in adolescents were associated with a 23.75-fold increased risk for injury as compared to biking. Children who ride bicycles have a 2.2-fold increased risk for an injury sustained by traffic accidents compared to pedestrians. None of 50 injured bicycle riders with helmet had an AIS for head injuries of more than 2. 24 of 233 injured bicycle drivers without helmet had an AIS for head injuries of more than 2. The use of a protective helmet significantly reduced the severity of head injuries. The level of awareness towards danger and a history of previous accidents correlate with the likelihood of future accidents. Due to the severity of traffic accidents, more adequate prevention measures (wearing of bicycle helmets and better education for moped riders) are urgently needed.
Description of road traffic related knee injuries in published investigations is very heterogeneous. The purpose of this study was to estimate the risk of knee injuries in real world car impacts in Germany focusing vulnerable road users (pedestrians, bicyclists and motorcyclists) and restrained car drivers. The accident research unit analyses technical and medical data collected shortly after the accident at scene. Two different periods (years 1985-1993 and 1995-2003) were compared focusing on knee injuries (Abbreviated Injury Scale (AISKnee) 2/3). In order to determine the influences type of collision, direction and speed as well as the injury pattern and different injury scores (AIS, MAIS, ISS) were examined. 1.794 pedestrians, 742 motorcyclists, 2.728 bicyclists and 1.116 car drivers were extracted. 2% had serious ligamentous or bony injuries in relation to all injured. The risk of injury is higher for twowheelers than for pedestrians, but knee injury severity is higher for the latter group. Overall the current knee injury risk is low and significant reduced comparing both time periods (27%, p<0,0001). Severe injuries (AISKnee 2/3) were below 1%). Improved aerodynamic design of car fronts reduced the risk for severe knee injuries significantly (p=0,0015). Highest risk of injury is for motorcycle followed by pedestrians, respectively. Knee protectors could prevent injuries by reducing local forces. The classically described dashboard injury was rarely identified. The overall injury risk for knee injuries in road traffic is lower than estimated and reduced comparing both periods. The aerodynamic shape of current cars compared to older types reduced the incidence and severity of knee injuries. Further modification and optimization of the interior and exterior design could be a proper measurement. Classic described injury mechanisms were rarely identified. It seems that the AIS is still underestimating extremity injuries and their long term results.