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To date, the Trauma Registry (TraumaRegister DGU-® contains data of approximately 100.000 severely injured patients, 65% of which suffered from a road traffic crash. Thus, it is the world's largest data base for severely injured patients. The article describes the development of the registry and explains how it was rolled out over Germany using the established structure of the German Trauma Network (TraumaNetzwerk DGU-®). In addition, this article presents three typical use cases from the fields of quality management, policy making and system-wide interventions, clinical research and injury prevention. In conclusion, the TraumaRegister DGU-® is a well-established tool for various purposes related to the control and reduction of the burden of road injury. Its ongoing expansion to other countries will support the goal of international benchmarking of hospitals and trauma systems.
Every second counts when human lives are at stake. The increasingly safe design of vehicles presents rescuers with a serious challenge. Faced with high-strength steels and body reinforcements, even the most powerful cutters reach their limits. Therefore, incident commanders require information on the technical features and components installed, directly in the vehicle. Several tests have shown that such information helps to save valuable minutes. Therefore, a standardised A4 "rescue sheet" containing information on the location of cabin reinforcements, the tank, the battery, airbags, gas generators, control units etc. " and indicating adequate cutting points must be used throughout Europe. Hopefully, in a few years, the new eCall emergency call system will be in place everywhere in Europe. The system will transmit the relevant vehicle-specific data directly to the rescuers on-site. Until then, we need a simple and effective solution that saves lives.
Police records about traffic accidents like used by IRTAD (International Road Traffic and Accident Database) and CARE (Community Road Accident Database) do not represent all road injuries. For instance, road accidents of bicyclists without a counterpart are usually not reported. Furthermore, IRTAD-like data contains hardly any information on injury outcome and accident circumstances. This information gap leads to an under-representation of the safety concerns of the most vulnerable road users like children and the elderly both in accident research and safety promotion. Injury registration for the European Injury Database (IDB), in turn, combines details of accident causation with diagnostic information that can be used to assess injury severity and long term consequences. The IDB is collecting data from hospital emergency department patients and is being implemented in a growing number of countries. In this article IDB results on mode of transport and injury outcome are presented from a sample of nine EU member states.
A total survey of road traffic accidents involving most severely injured, defined as sustaining a polytrauma or severe monotrauma (ISS > 15) or being killed, was conducted over 14 months in a large study region in Germany. Data on injuries, pre-clinical and clinical care, crash circumstances and vehicle damage were obtained both prospectively and retrospectively from trauma centers, dispatch centers, police and fire departments. 149 patients with a polytrauma and eight with a severe monotrauma were recorded altogether. 22 patients died in hospital. Another 76 victims had deceased at the accident scene. In 2008, 49 % of patients treated with life-threatening injuries were car or van occupants, 21 % motorcyclists, 18 % cyclists and 10 % pedestrians. Among fatalities at the scene, vehicle occupants constituted an even larger portion. The number of road users with life-threatening trauma in the region was extrapolated to the German situation. It suggests that 10 % among the "seriously injured" as defined in national accident statistics are surviving accident victims with a polytrauma or severe monotrauma.
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.
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.
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.
To elucidate the risk of pedestrians, bicycle and motorbike users, data of two accident research units from 1999 to 2014 were analysed in regard to demographic data, collision details, preclinical and clinical data using SPSS. 14.295 injured vulnerable road users were included. 92 out of 3610 pedestrians ("P", 2.5%), 90 out of 8307 bicyclists ("B", 1.1%) and 115 out of 4094 motorcycle users ("M", 2.8%) were diagnosed with spinal fractures. Thoracic fractures were most frequent ahead of lumbar and cervical fractures. Car collisions were most frequent mechanism (68, 62 and 36%). MAIS was 3.8, 2.8 and 3.2 for P, B and A with ISS 32, 16 and 23. AIS-head was 2.2, 1.3 and 1.5). Vulnerable road users are at significant risk for spine fractures. These are often associated with severe additional injuries, e.g. the head and a very high overall trauma severity (polytrauma).
Introduction: Spine injuries pose a considerable risk to life and quality of life. The total number of road deaths in developed countries has markedly decreased, e.g. in Germany from over 20000 in 1970 to less than 4000 in 2010, but little is known how this is reflected in the burden of spine fractures of motor vehicle users. In this study, we aimed to show the actual incidence of spine injuries among drivers and front passengers and elucidate possible dependencies between crash mechanisms and types of injuries.
This study aims to analyze spine injuries in motor vehicle accidents. Between 1985 and 2004 the Hannover accident research unit documented 18353 accidents. We identified 161 front passengers (0.53%) with cervical spine injuries, 84 (0.28%) with thoracic and 95 (0.31%) with lumbar injuries. Technical and medical data was reviewed. Patients" records were retrieved. X-rays were evaluated and fractures were classified according to the Magerl classification. 68% and 57% of thoracic and lumbar fractures occurred in accidents with multiple impacts. Delta-v was 50, 40 and 40 kph in passengers with cervical, thoracic and lumbar spine, resp. Passengers with spinal fractures frequently showed numerous concomitant injuries, e.g. additional vertebral fractures. The influence of seat belts and airbags is discussed. Patient work-up has to include a thorough investigation for additional injuries.
With an ever rising human life expectancy the share of elderly people in society is constantly rising. This leads to the fact that at the same rate the share of people with age related diseases such as dementia and poor eyesight taking part in traffic will rise and therefore traffic accidents caused by this group of people due to the disease will play an ever greater role. This Situation will be among the future challenges of road safety work. At present this study displays specific characteristics of accidents caused by elderly car drivers (aged 65 or higher) based on the analysis of the German In-Depth Accident Study GIDAS. Herein almost 1000 elderly car drivers were identified as accident participants in the years 2008 to 2011. The focus of this study lies on identifying special types of accidents which are caused by elderly drivers and on characterizing these types with the information gathered on scene and by interviewing the participants. The main evidence analyzed is the knowledge about the accident locality, the trajectories of the participants as well as the reasons for the occurrence of the accidents. Furthermore personal information such as the personal condition before the accident and driving purposes is used to identify patterns of contributing circumstances for accidents caused by elderly traffic participants.
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.
In Germany averagely two million traffic accidents happen each year and emergency medical services are called to more than 400 000 patients. Even though this number is decreasing continuously (due to improvements in the fields of vehicle safety, road construction, and accident prevention) every case is yet a challenge for the rescuers and requires improvements in emergency medicine as well. Especially during diagnostics right at the accident scene, there are only limited instruments available to gain the necessary knowledge of the injuries suffered, to come to essential decisions about treatment or transport. To provide an additional diagnostic aid by scouting and estimating the situation, a software-tool calculating the likeliness of the most frequent severe injuries (AIS 3-6) of front occupants in passenger cars has been developed to deliver this necessary information about particular accident scenarios. To achieve this, logistic likelihood functions have been calculated in a multivariate regression analysis analysing all AIS 3+ injuries in the GIDAS database of the years 1999-2006 that happened more than four times
In most of developed countries, the progress made in passive safety during the last three decades allowed to drastically reduce the number of killed and severely injured especially for occupants of passenger cars. This reduction is mainly observed for frontal impacts for which the AIS3+ injuries has been reduced about 52% for drivers and 38% for front passengers. The stiffening of the cars' structure coupled with the generalization of airbags and the improvement of the seatbelt restraint (load limiter, pretension, etc.) allowed to protect vital body regions such as head, neck and thorax. However, the abdomen did not take advantage with so much success of this progress. The objective of this study is to draw up an inventory on the abdominal injuries of the belted car occupants involved in frontal impact, to present adapted counter-measures and to assess their potential effectiveness. In the first part the stakes corresponding to the abdominal injuries will be defined according to types of impact, seat location, occupants' age and type of injured organs. Then, we shall focus on the abdominal injury risk curves for adults involved in frontal impact and on the comparisons of the average risks according to the seat location. In the second part we will list counter-measures and we shall calculate their effectiveness. The method of case control will be used in order to estimate odds ratio, comparing two samples, given by occupants having or not having the studied safety system. For this study, two type of data sources are used: national road injured accident census and retrospective in-depth accident data collection. Abdominal injuries are mainly observed in frontal impact (52%). Fatal or severe abdominal occupant- injuries are observed at least in 27% of cases, ranking this body region as the most injured just after the thorax (51%). In spite of a twice lower occupation rate in the back seats compared to the front seats, the number of persons sustaining abdominal injuries at the rear place is higher than in the front place. In recent cars, the risk of having a serious or fatal abdominal injury in a frontal impact is 1.6% for the driver, 3.6% for the front passenger and 6.3% for the rear occupants. The most frequently hurt organs are the small intestine (17%), the spleen (16%) and the liver (13%). The most common countermeasures have a good efficiency in the reduction of the abdominal injuries for the adults: the stiffness of the structure of the seats allows decreasing the abdominal injury risk from 54% (driver) to 60% (front occupant), the seatbelt pretensioners decrease also this risk from 90% (driver) to 83% (front passenger).
While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTAs) involving trucks, little is known about RTA injury risk for truck drivers. The objective of this study is to analyze the injury severity in truck drivers following RTAs. Between 1999 and 2008 the Hannover Medical School Accident Research Unit prospectively documented 43,000 RTAs involving 582 trucks. Injury severity including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration. The results show that the safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.
Bone fracture patterns could be crucial in reconstructing the nature of loading, especially in the lower limb and upper limb kinematics in vehicle-pedestrian crashes. In addition, use of FE bone models can be a handy tool to predict vehicle impact velocity and the impact direction. The point of fracture initiation in bone loading has been predicted quite accurately earlier. A methodology that predicts bone crack initiation and its propagation pattern for the six known loading directions using a single material and failure model is presented.
Real world accident reconstruction with the Total Human Model for Safety (THUMS) in Pam-Crash
(2013)
Further improvement of vehicle safety needs detailed analysis of real world accidents. According to GIDAS (German In-Depth Accident Study) most car to car front accidents occur at mid-crash severity. In this range thoracic injuries already occur. In this study a real world frontal crash with mid-crash severity out of the AARU database was reconstructed. The selected car to car accident was reconstructed by AARU by means of pc-crash software in order to get the initial dynamic accident conditions. These initial conditions were used to reconstruct the complete accident in more detail using FE models for the car structure and the occupants. Occupant simulations were performed with FE HIII-dummy models and the THUMS using Pam-Crash code. An initial THUMS validation was performed in order to verify the model-´s biofidelity by means of table-top test simulations. THUMS bone stiffness values were modified to match the real word occupant age. A comparison between driver and passenger restraint system loading was done, as well as an injury prediction comparison between the HIII-dummy model and THUMS response for both cases. Detailed comparison between the HIII-dummy models and THUMS regarding thoracic loading are discussed.
The number of injured car occupants decreases constantly. Nevertheless, they account for nearly 50% of all fatalities and about 44% of all seriously injured persons in German traffic accidents. Further reductions of casualties require multiple efforts in all parts of traffic safety. In this paper a detailed analysis of the important pre-hospital rescue phase was done. The basis for future improvements is the knowledge about injury causation of car occupants in combination with other corresponding influence factors. For that reason more than 1.200 severe (AIS3+) injuries of frontal car occupants were analyzed. For the most relevant injuries of car occupants multivariate analysis models were created to predict the probability of these injuries in a real crash scenario. In addition to the collision severity different influence factors like impact direction, seat belt usage, age of the occupant, and gender were analyzed. Furthermore, the models were checked regarding the goodness of fit and all results all results were checked concerning their robustness. The prediction models were created on the basis of 5.000 car accidents. Afterwards, the models were validated using 4.000 different car accidents. The prediction of the probability of severe injuries could be used for different applications in the field of traffic safety. One possibility is the implementation of the models in a tool for the on-the-spot diagnosis. The background for the development of such applications is the fact, that there are only limited diagnostic possibilities available at the accident scene. Nevertheless, the rescue forces have to make essential decisions like the alerting of the necessary medical experts, appropriate treatment, the type of transportation and the choice of an adequate hospital. These decisions quite often decide between life and death or influence the long-term effects of injured persons. At this point, indications of expectable injuries could help enormously. To enable even persons with limited technical knowledge to use the tool, a procedure was developed that facilitates the assumption of the given crash severity. Another important possibility for the application of the prediction models is the use for the qualification of information sent by e-call systems.
Pedestrian accidents are one of the major concerns related with road accidents around the world. Portugal has one of the highest rates of pedestrian fatalities in Europe. In this paper an overview conditions were the pedestrian accidents occurred in Portugal is presented. In the last years, a project related with the pedestrian accidents has run in Portugal for the period 2004-2006 where 603 people died, 2097 have been severely injured and about 17000 slightly injured. Within this project all the pedestrian accidents in this period have been analysed providing global information about a wide range of aspects, since location, driver and pedestrian characteristics, weather and road conditions, among others. In addition, 50 in-depth accidents have been investigated and the data collected according the Pendant methodology. For this in-depth methodology detailed information about the accident has been collected, including injuries, vehicle damage, road conditions and road user- behaviour and actions. An accident reconstruction has been carried for each case including the determination of the speeds and driver actions, and the analysis of the contributing factors for the accident. Depending of the accident complexity, different methodologies have been used to analyse these accident, from the classical analytical equations such as Simms and Woods, to the use of detailed computational pedestrian models as those included in the commercial software- PC-Crash-® or Madymo-®. Also one of the goals of our investigation is the development of multibody models and methodologies for the reconstruction of pedestrian accidents. Some of these tools integrated in the commercial software Cosmos Motion-® are presented. The advantages of the different approaches are compared and discussed for some of the accidents investigated. With these tools the impact speed can be determined from the projection distance with analytical tools or PC-Crash-®, but more complex tools should be used to determine speed from the injuries, what is especially important for fatal accidents. The influence of the vehicle geometry and stiffness characteristics is another aspect analysed, where the influence of the vehicle stiffness has been determined using a combined multibody-finite elements approach within the software Madymo-®.
An analysis of NASS and FARS was conducted to determine crash conditions that involved injuries that are not currently being directly addressed by vehicle safety standards or by consumer information test protocols. Analysis of both field data and US NCAP tests were conducted to determine the relative safety provided by seating position and by vehicle model year. Opportunities for improvements were determined by crash categories with large populations of injuries that were not addressed by safety tests or smaller numbers that were increasing in frequency. Areas of opportunities include improved occupant restrain in rollovers, improved frontal protection for rear seat occupants and improved fire prevention in frontal and rollover crashes.
From an automotive safety occupant protection standpoint, effective occupant restraint requires a system capable of providing non-injurious occupant ride down of anticipated crash forces. This is not only the case for frontal collisions, where occupant restraint is provided primarily by seatbelts and airbags, but is also critical for other crash modes such as side impacts, rear impacts, rollovers, as well as multiple impact events. In the rear impact crash mode, occupant restraint is provided primarily by the seatbacks and to some extent the seatbelts. Foundationally, therefore, what becomes fundamental to the seatback's role in rear occupant protection is its ability to contain the occupant within the seat, preventing occupant ramping, as well as preventing the seat's, and/or its occupant's, dangerous intrusion into the rear occupant's survival space where contact with rear compartment components and/ or rear seated occupants can present a significant injury risk. An analysis is presented of a series of rear impact sled testing conducted by the authors that evaluates the timing, position and extent of the front seatback's reward displacement toward and into the rear occupant compartment as well as consideration of the front seat occupant' ramping potential and its injury potential relative to the rear compartment. Additionally, three other series of testing are presented which assess various seat designs occupant retention capabilities. Lastly, a matched-pair comparison test series is presented which evaluates occupant motion in rear impact with and without use of a typical vehicle body mounted 3-point seatbelt. Discussion of restraint system performance observed in all the testing is included along with ATD biofidelity and thigh-gap considerations. The data collected and presented includes accelerometer instrumentation and high speed video analysis.
Powered Two Wheeler (Motorcycle) crashes are overrepresented in EU, England, and United States casualty statistics for both fatal and serious injuries. While regional geographic differences are evident for motorcycle size, type, and engine displacement, the casualty statistics consistently indicate significantly higher injury rates for all motorcycle riders when compared to car occupants. Accident analysis and reconstruction of these motorcycle crashes is a necessary process to gain further understanding of potential injury mitigation strategies. This paper focuses on the analysis of the rider post impact trajectory in the immediate moments following a crash. The rider and motorcycle, while loosely coupled by seating position leading up to a crash, quickly decouple as the crash forces develop. As a result, the rider moves relative to the motorcycle and relative to the collision partner. This movement, or trajectory, is primarily influenced by the type and configuration of the impact, the type and configuration of the motorcycle and collision partner, and the speeds involved. Understanding the rider's post impact trajectory will assist in the development of injury mitigation strategies. Both the free flight trajectory of the rider and the rider's trajectory as influenced by interaction with the motorcycle and collision partner are examined. Rider trajectories in full scale crash testing and real world motorcycle crashes are both studied and presented. The resulting physical evidence that can be observed by an accident analyst is discussed. The application of projectile motion physics is analyzed and the necessary input parameters, such as initial launch angle, are studied. This study will assist in understanding the post-impact dynamics of a motorcyclist, and will provide useful information to analysts evaluating real world crashes.
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.
When assessing the consequences of accidents normally the injury severity and the damage costs are considered. The injury severity is either expressed within the police categories (slight injury, severe injury or fatal injury) or the AIS code that rates the fatality risk of a given injury. Both injury metrics are assessing the consequences of the accident directly after the accident. However, not all consequences of accidents are visible directly after the accident and the duration of the consequences are different. Besides a physiological reduction of functionality social and psychological implications such as reduced mobility options, problems to continue the original job etc. are happening. In order to assess long term consequences of accidents the MHH Accident Research Unit established a brief questionnaire that is distributed to accident involved people of the Hannover subset of the GIDAS data set approx. one year after the accident beginning with the accident year 2013. The basic idea of using a brief questionnaire (in fact only one page) is to obtain a relatively large return rate because the questionnaire appears to be simple and quickly answered. This appears to be important because it is believed that the majority of accident involved people will not report long term consequences. In order to allow a more detailed survey amongst those responders that are reporting long term consequences they are asked for a written consent for the additional questionnaire that will be distributed at a time that is not yet defined. Long term consequences are reported for all addressed areas, medical, physiological, psychological and sociological by people without injuries, with minor injuries and with severe injuries.
Pedestrian and cyclist are the most vulnerable road users in traffic crashes. One important aspect of this study was the comparable analysis of the exact impact configuration and the resulting injury patterns of pedestrians and cyclists in view of epidemiology. The secondary aim was assessment of head injury risks and kinematics of adult pedestrian and cyclists in primary and secondary impacts and to correlate the injuries related to physical parameters like HIC value, 3ms linear acceleration, and discuss the technical parameter with injuries observed in real-world accidents based documented real accidents of GIDAS and explains the head injuries by simulated load and impact conditions based on PC-Crash and MADYMO. A subsample of n=402 pedestrians and n=940 bicyclists from GIDAS database, Germany was used for preselection, from which 22 pedestrian and 18 cyclist accidents were selected for reconstruction by initially using PC-Crash to calculate impact conditions, such as vehicle impact velocity, vehicle kinematic sequence and throw out distance. The impact conditions then were employed to identify the initial conditions in simulation of MADYMO reconstruction. The results show that cyclists always suffer lower injury outcomes for the same accident severity. Differences in HIC, head relative impact velocity, 3ms linear contiguous acceleration, maximum angular velocity and acceleration, contact force, throwing distance and head contact timing are shown. The differences of landing conditions in secondary impacts of pedestrians and cyclists are also identified. Injury risk curves were generated by logistic regression model for each predicting physical parameters.
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.
Injury severity of e.g. pedestrians or bikers after crashes with cars that are reversing is almost unknown. However, crash victims of these injuries can frequently be seen in emergency departments and account for a large amount of patients every year. The objective of this study is to analyze injury severity of patients that were crashed into by reversing cars. The Hannover Medical School local accident research unit prospectively documented 43,000 road traffic accidents including 234 crashes involving reversing cars. Injury severity including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) was analyzed as well as the location of the accident. As a result 234 accidents were included into this study. Pedestrians were injured in 141 crashes followed by 70 accidents involving bikers. The mean age of all crash victims was 57 -± 23 years. Most injuries took place on straight stretches (n = 81) as well as parking areas (n = 59), entries (n = 36) or crossroads (n = 24). The AIS of the lower extremities was highest followed by the upper extremities. The AIS of the neck was lowest. The mean MAIS was 1.3 -± 0.6. The paper concludes that the lower extremities show the highest risk to become injured during accidents with reversing cars. However, the risk of severe injuries is likely low.
Injury probability functions for pedestrians and bicyclists based on real-world accident data
(2017)
The paper is focusing on the modelling of injury severity probabilities, often called as Injury Risk Functions (IRF). These are mathematical functions describing the probability for a defined population and for possible explanatory factors (variables) to sustain a certain injury severity. Injury risk functions are becoming more and more important as basis for the assessment of automotive safety systems. They contribute to the understanding of injury mechanisms, (prospective) evaluation of safety systems and definition of protection criteria or are used within regulation and/or consumer ratings. In all cases, knowledge about the correlation between mechanical behavior and injury severity is needed. IRFs are often based on biomechanical data. This paper is focusing on the derivation of injury probability models from real world accident data of the GIDAS database (German In-depth Accident Study). In contrast to most academic terms there is no explicit term definition or definition of creation processes existing for injury probability models based on empirical data. Different approaches are existing for such kind of models in the field of accident research. There is a need for harmonization in terms of the used methods and data as well as the handling with the existing challenges. These are preparation of the dataset, model assumptions, censored/unknown data, evaluation of model accuracy, definition of dependent and independent variable, and others. In the presented study, several empirical, statistical and phenomenological approaches were analyzed regarding their advantages and disadvantages and also their applicability. Furthermore, the identification of appropriate prediction parameters for the injury severity of pedestrians has been considered. Due to its main effect on injuries of pedestrians and bicyclists, the importance of the secondary impact has also been analyzed. Finally, the model accuracy, evaluated by several criteria, is the rating factor that gives the quality and reliability for application of the resulting models. After the investigation and evaluation of statistical approaches one method was chosen and appropriate prediction variables were examined. Finally, all findings were summarized and injury risk functions for pedestrians in real world accidents were created. Additionally, the paper gives instructions for the interpretation and usage of such functions. The presented results include IRFs for several injury severity levels and age groups. The presented models are based on a high amount of real world accidents and describe very well the injury severity probability of pedestrians and bicyclists in frontal collisions with current vehicles. The functions can serve as basis for the evaluation of effectiveness of systems like Pedestrian-AEB or Bicycle-AEB.
The purpose of this work is to investigate the association between the injuries in motorcycle accident and the main accident configurations. The data were provided by a multicentric case-control study MAIDS regarding the risk of crash and injuries of motorcyclists. Chi-square test was used to evaluate the relationship between the variables and a logistic regression was performed to evaluate the association of injury severity with some variables supposed to be predictive factors. Lesive patterns characterized by internal haemorrhages are mainly associated with fronto-lateral crashes, above all in urban areas. Lacerations or abrasions, mainly reported in torso and lower extremities, are mostly associated with single crashes or accidents in queue also for crashes occurred to low speed (< 50 km/h). The severity of injuries is highly associated with impact speed, regardless of the crash configuration. Fractures and haemorrhages play an important role in determining the severity of injuries. The upper extremities are the most frequently traumatised anatomic areas.
Recently, EuroNCAP updated the upper legform test protocols. The main objective of this study is to establish the upper legform test in KIDAS (Korean In-depth Accident Study) taking into account domestic pedestrian accident data as well as anthropometric data to protect elderly pedestrians whose average height and weight is much smaller and lighter than other age groups, especially compared to Europeans. Therefore 230 cases of pedestrian accidents from KIDAS were investigated to explore the injury severity of body regions as well as age related injury patterns. Injuries of all body regions were examined, with a special focus on injuries of abdomen and pelvic area. On the other hand, in order to explore Korea's pedestrian accident environment, national police data and KIDAS (Korean In-depth Accident Study) data were compared. The results should be taken into account in future analyses and possible improvements, such as regulations and KNCAP test protocols, of the pedestrian safety policy in Korea.
This study aimed at developing an injury estimation algorithm for AACN technologies for Germany and compared them to findings based on Japanese data. The data to build and to verify the algorithm was obtained from the German in-depth Accident Database (GIDAS) and split into a training and a validation dataset. Significant input variables and the generalized linear regression model to predict severe injuries (ISS>15) were selected to maximize area under the receiver operating characteristic curve (AUC). Probit regression with the input parameter multiple impact, delta v, seatbelt use and impact direction gave the largest AUC of 0.91. Sensitivity of the algorithm was validated at 90% and specificity at 76% for an injury risk threshold of 2%. It appears that no major differences between Japan and Germany exist for injury estimation based on delta v and impact direction. However, far side impact and multiple crash events appear to be associated with a larger risk increase in the German data.
The number of road accidents in Portugal has decreased significantly in the last decades, however, this tendency is not similar in all types of transportation. In the most recent years and by European standards, Portugal is still one of the leading countries concerning the number of fatalities in Powered Two Wheelers (PTW) accidents. To this effect, the in-depth investigation of PTW accidents is crucial and so, a thorough statistical analysis concerning the main factors influencing PTW riders injury severity accidents was undertaken regarding the 2007-2010 period in the National Road Safety Authority (ANSR) injured riders database using the software SPSS. In addition, to determine the importance of absent factors in the database analysis, such as velocity, a set of 53 real accidents involving PTW were also investigated and computationally reconstructed using the software PC-Crash. Lateral collisions between a motorcycle, its rider and the side of three different passenger cars were also simulated, varying the motorcycle impact angle and velocity in order to estimate the PTW deformation energy and the rider- injuries, as this accident configuration stands out in terms of frequency and even severity. The results of this detailed study are presented.
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.
Injuries in motorbike accidents in correlation with protective clothes and mechanism of the accident
(2013)
This study deals with a possible connection between safety clothing / accident mechanism and injury severity in a state-wide traffic accident investigation with focus on light and small motorbike-involvement for accidents in the area of the Saarland in which the persons riding the bike have been injured or killed. An interdisciplinary team of medical scientists and engineers collected the medical and technical data as well as all the relevant traces of the accident on scene and in time. During twenty months of data collection a total of 401 cases could be gathered. Grave injuries were more common for the group of heavier motorcycles (>125 ccm). Motorcyclists had been polytraumatized only in the group where the accident was connected with a collision. Significant correlation between protective clothes and injury severity could only be found for protective gloves and protective trousers. The knowledge about mechanism of the accident, protective clothes and severity of injuries can be helpful for the improvement of road and motorcyclists' safety.
The share of high-tensile steel in car bodies has increased over the last years. While occupant safety has generally benefited from this measure, there is a potential risk that, as a result, rescue time may increase considerably. In more than 60% of all car occupant fatalities a technical rescue has been necessary. These are in particular those cases where occupants die immediately at the accident scene. Therefore, in these cases "rescue time" is a very sensitive parameter. In addition to the general analysis of the need of technical rescue and the actual rescue time depending on model years, the injury pattern of occupants requiring technical rescue will be analysed to provide advice for rescue teams. Furthermore, a detailed analysis of rescue measures for the most popular car models depending on the safety cell design is given.
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 main objective of EC CASPER research project is to reduce fatalities and injuries of children travelling in cars. Accidents involving children were investigated, modelling of human being and tools for dummies were advanced, a survey for the diagnosis of child safety was carried out and demands and applications were analysed. From the many research tasks of the CASPER project, the intention of this paper is to address the following: • In-depth investigation of accidents and accident reconstruction. These will provide important points for the injury risk curve, in order to improve it. Different accident investigation teams collected data from real road accidents, involving child car passengers, in five different European countries. Then, a selection of the most appropriate cases for the injury risk curve and the purposes of the project was made for an in-depth analysis. The final stage of this analysis was to conduct an accident reconstruction to validate the results obtained. The in-depth analysis included on-scene accident investigation, creating virtual simulations of the accident/possible reconstruction, and conducting the reconstruction. In the cases of successful reconstructions, new points were introduced to the injury risk curves. Accident reconstructions of selected cases were carried out in test laboratories as the next step following in-depth road accident investigation. These cases were reconstructed using similar child restraint systems (CRS) and the same type make and model as in the real accidents. Reconstructing real cases has several limitations, such as crash angle, cars" approximation paths and crash speed. However, a few changes and applications on the testing conditions were applied to reduce the limitations and improved the representations of the real accidents. After conducting the reconstructions, a comparison between the deformations of the cars on the real accident and the vehicles from the reconstructions was made. Additionally, a correlation between the data captured from the dummies and the injury data from the real accident was sought. This finalises an in-depth analysis of the accident, which will provide new relevant points to the injury risk curve. The CASPER project conducted a large research programme on child safety. On technical points, a promising research area is the developing injury risk curves as a result of in-depth accident investigations and reconstructions. This abstract was written whilst the project was not yet finished and final results are not yet known, but they will be available by the time of the conference. All the works and findings will not necessarily be integrated in the industrial versions of evaluation tools as the CASPER project is a research program.
In the course of the EUROPEAN PROJECT TRACE all fatally injured pedestrians autopsied at the Institute for Legal Medicine in Munich in 2004 had been analysed by using the "Human Functional Failure (HFF) analysis" method. It was possible to apply this method although some restrictions have to be taken into account. The results derived from this analysis comprise first the failures the pedestrians (most often "impairment of sensorimotor and cognitive abilities") and the opponents (most often " Non-detection in visibility constraints conditions") faced in the accident, second the conflicts and tasks (pedestrian crossing the street conflicting with a vehicle from the side (which was going ahead on a straight road), the degree of accident involvement (pedestrians often the primary active part), and further the contributing factors to the accident (pedestrians most often "alcohol (> 0.05% BAC)", opponents most often "visibility constraints").
Despite the steadily declining number of pedestrian fatalities and injuries in most European countries during recent decades, pedestrian protection is still of great importance in the European Union as well as in Germany. This is because they still constitute a large proportion of road user casualties and are more likely to suffer serious and fatal injuries than most other road users. In 1999 only car occupants suffered more fatal injuries than pedestrians in Germany. In December 1998, EEVC WG 17 completed their review and updating of the EEVC WG 10 pedestrian test procedure that made it possible to evaluate the protection afforded to pedestrians by the front of passenger cars in an accident. Within the scope of this procedure, four different impactors are used representing those parts of the body which are injured very often and/or very seriously in vehicle-pedestrian-collisions. In a project executed by IKA and BASt, a small family car was tested according to the EEVC WG 17 test procedure. Afterwards modifications to the car were carried out in order to improve the pedestrian protection provided by the vehicle design. There were certain restrictions placed on the level of modifications undertaken, e.g. only minor modifications to vehicle styling and to the vehicle structures, which provide passenger protection. The redesigned vehicle was tested again using the WG 17 test procedure. The test results of the modified vehicle were compared with those of the standard vehicle and evaluated. The results show that considered measures for pedestrian protection in many areas of the vehicle front structure and the use of innovative techniques can lead to a significant reduction of the loads of pedestrians at an acceptable expense.
The misuse of CRS (child restraint system) is one of the most urgent problems in connection of child safety in cars. Numerous field studies show that more than two thirds of all CRS are used in a wrong way. This misuse could lead to serious injuries for the children. Surprisingly the quality of CRS use is coded much better in accident data (e.g. GIDAS) than the results of observatory field studies show. It is expected that misuse of CRS was not detected by the accident teams in a large number of the cases. An essential part in improving child seats and their usability is the knowledge of the relation between misuse and resulting injuries. For that the analysis and experimental reconstruction of accidents is an important part. For allowing an exact experimental accident reconstruction, it is necessary to have detailed information about the securing situation of the child and about the installation of the CRS in the car.
[Introduction:] A large number of road users involved in road traffic crashes recover from their injuries, but some of them never recover fully and suffer from some kind of permanent disability. In addition to loss of life or reduced quality of life, road accidents carry many and diverse consequences to the survivors such as legal implications, economic burden, job absences, need of care from a third person, home and vehicle adaptations as well as psychological consequences. Within an EU funded project MOVE/C4/SUB/2011-294/SI2.628846 (REHABIL AID) these consequences were analyzed more detailed.
In North America, frontal crash tests in both the regulatory environment and consumer-based safety rating schemes have historically been based on full-width and moderate-overlap (40%) vehicle to barrier impacts. The combination of improved seat-belt technologies, notably belt tensioning and load limiting systems, together with advanced airbags, has proven very effective in providing occupant protection in these crash modes. Recently, however, concern has been raised over the contribution of narrower frontal impacts, involving primarily the vehicle corners, to the incidence of fatality and serious injury as a result of the potential for increased occupant compartment intrusion and performance limitations of current restraint systems. Drawing on data documented in the National Automotive Sampling System (NASS)/ Crashworthiness Data System (CDS) for calendar years 1999 to 2012, the present study examines the characteristics of existing and proposed corner crash test configurations, and the nature of real-world collisions that approximate the test environments. In this analysis, particular emphasis is placed on crash pulse information extracted from vehicle-based event data recorders (EDR's).
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.
Aim of the study was to evaluate the protective effect of bicycle helmets particularly considering injuries to the head and to the face. Accidents with the participation of bicyclists which occurred from 2000 to 2007 were chosen from GIDAS. We observed that injuries to the head and face were more severe in the group of non-helmeted riders. There seems to be no significant difference in injuries with AIS 3-6. Altogether 26 cyclists were killed. 2 of them wore a helmet (1% of helmeted cyclists), 24 did not (1% of non-helmeted cyclists). Only one killed rider (without helmet) did not suffer from polytrauma (only head injuries recorded). The findings seem to support the thesis of a preventive effect of the bicycle helmet, however the two groups are different in their characteristics related to riding speed. Necessarily we need a multivariate model to evaluate the effect of helmets.
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.
A change emerges in hospital landscape due to health political measures, which in consequence also influences the pre-clinical medical care of emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data of Bavarian emergency medical services. In Bavaria, in 2006 it was necessary to call an emergency doctor in the case of 14.261 traffic accidents. Predominantly the patients were provided by land-based life saving appliances, air rescue services were only applied in 19.1 % of the cases. 47.6 % of patients being involved in a traffic accident were transported into a primary health care hospital. A prehospital interval of more than 60 minutes was calculated in 20 % of emergency care. 96.2 % of the patients were transported to hospitals of tertiary or maximum supply by air rescue services. The life saving appliances" readiness for action is however restricted to daylight. A further limitation appeared for routine office hours in hospitals: Only 36.7 % of accidents occurred in this time frame. An increase of hospitalizations in clinics of maximum supply appeared from 2002 until 2006 while simultaneously the prehospital period was extended. To assure a sufficient medical care of seriously injured persons further on, a fulltime and area-wide expostulation of efficient facilities is necessary. For this purpose it is necessary to establish regional trauma networks as well as emergency medical service at night time. Beyond that, a cost efficient compensation of the structural, personnel and logistic expenses has to be assured.
Mechanical properties of tibial bone at compressive strain rates of 50-200 s-1 are obtained through Split Hopkinson pressure bar. Cylindrical specimens of 12-15 mm diameter and 2-5 mm thickness were used. The Young- moduli are calculated from linear portion of stress-strain curves. For both cortical and cancellous part of the bones, the Young- modulus was found to increase with the increasing strain rates. Also for both cancellous and cortical bones the Young- modulus increases consistently with increase in densities.
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.