Wide vs. Narrow Frontal Crashes - NHTSA · ¾Irrigation & debridement w/splinting open heel injury...
Transcript of Wide vs. Narrow Frontal Crashes - NHTSA · ¾Irrigation & debridement w/splinting open heel injury...
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Wide vs. Narrow Frontal Crashes:Do Injury Patterns Differ?
Presenters:Gail T. Tominaga, MD, FACS (Co-PI)
Steve Erwin (Crash Investigator)
September 2006
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Presentation ObjectivesDiscuss differences between wide and narrow impacts
Present examples of wide and narrow impacts investigated by San Diego CIREN
Compare injury experience of occupants in wide vs. narrow impacts using CIREN database
Discuss implications for injury prevention comparing wide vs. narrow impacts
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Why Study Wide vs. Narrow Impacts Using CIREN Data?
NHTSA frontal crash test: “head on” into fixed barrier to assess safety system effectiveness
Not tested on narrow impacts
Delta T differs for wide and narrow impacts
Real world experience provides information on safety system effectiveness during narrow impacts
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DefinitionsNarrow impact
6th column of CDC=“N”Damage distribution across frontal plane < 41 cm
Wide impact6th column of CDC=“W” and 4th column of CDC=“D”Wide damage distribution across 66% of frontal plane
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WID
E
Nar
row
Delta V (velocity change)0 1/10th sec.
Wide impact (evenly distributed force)
Significant speed change begins immediately
peak
35 mph
Narrow impact (focalized force)
Significant speed change is delayed until enough resistance is built up
peak
Delta V (velocity change)0 1/10th sec.
35 mph
Deceleration pulses Wide vs. Narrow Impacts (Delta V / Delta T)
@ 50ms
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Subject – driver (solo)
2003 Mitsubishi Lancer
This case involves a belted, male driver responding to a frontalThis case involves a belted, male driver responding to a frontal (this vehicle) (this vehicle) collision with the back of a slow moving, heavy truck.collision with the back of a slow moving, heavy truck.
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Driver – sole occupant21yo male, 6’2”, 205 lbs
Pretensioner equipped belt used, frontal impact air bag(s) deployment. Bucket seat between mid & rear, slightly reclined. Cushion twisted to right, seat back twisted to left due to remote buckling
• Mesenteric arterial avulsion• Small bowel avulsion• Sigmoid colon “degloving” injury• Left testicular artery and vein laceration• Right rectus muscle partial transection
21
1
12:00 PDOF
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Crash: 1 event• Frontal to Vehicle – Back plane full end plane impact
• Case vehicle 2003 Mitsubishi Lancer4-door sedan, 2697 lbs. 12:00 PDOF (Zero-degrees) 54 kmph BES DV (34 mph)
• Opposing vehicle (V2) 2003 Peterbilt 3-axle “cement truck” nfs. Heavy Truck, full load, > 10,000 lbs GVWR
• 6:40 am, Saturday, cloudy, dry, daylight
NNot To Scale
04-024
12
21
1
1
FRP V1(est.)
V12003 Mitsubishi Lancer
2697 lbs
V22003 Peterbilt cement truck
full load, approximated 25 mph
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2002 Mitsubishi Lancer / 54 cm Max. crush / 34 mph DV / 12:00 PDOF
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Direction of travel
POI
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Transfer on bag (skin?)
Sheared completely
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Contact: lower dash/bolster, belt, air bag, steering assembly
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Friction burns @ ‘D’ ring
Pretensioner locked
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Wide Impact CIREN Case
Right lower abdominal abrasion Left lower abdominal abrasion
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Toe pan intrusion 5 cm
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Wide Impact CIREN Case21 year old male, 6’2”, 205 lbsMAIS 4, ISS 17Ground transport to ED with complaint of painUS and DPL positive OR ½ hour after arrivalMultiple operative procedures
Exploratory laparotomy, repair of partial transection of right rectus muscleLigation of mesenteric arterial bleeds, left testicular artery, and left testicular veinSmall bowel resection with primary anastomosisSigmoid colon resection with primary anastomosis
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Wide Impact Case: Injury Sources
AbdomenAIS 3-4 Major lac of arteries and veins (safety belt)
AIS 4 Massive (OIS Grade IV/V) jejunum-ileum lac (safety belt)
AIS 4 Massive (OIS Grade IV/V) colon laceration (safety belt)
AIS 1 Contusions and abrasions
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This case involves a belted driver responding to a narrow frontaThis case involves a belted driver responding to a narrow frontal l impact into a rigid object with frontal impact air bag deploymenimpact into a rigid object with frontal impact air bag deploymentt
Subject – Driver
1996 Nissan Sentra
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Crash: 1 event
• Narrow front to rigid object 30cm steel, non-breakaway utility pole, not damaged
• Case vehicle 1996 Nissan Sentra4-door sedan, 2315 lbs., 100” wheelbase 12 o’clock PDOF WinSmash dV = 66 mph
•1:54 am, Saturday, clear, dry dark-street lights
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12:00 PDOFSubject Subject –– Driver (sole occupant)Driver (sole occupant)3030--yearyear--old male, 5old male, 5’’1010””, 200 lbs. Belt used, , 200 lbs. Belt used, frontal impact air bag(s) deployed.frontal impact air bag(s) deployed.
•R - internal pudenal artery laceration
• R - acetabulum fracture
• R - posterior tibial artery and vein transection
• Multiple R - foot fractures and soft tissue injury
• R - fibula mid shaft fracture, nondisplaced, minimal angulation
• L - hand laceration w/ extensor tendon lacerations
• L - extensive diastasis sacroiliac joint and pubic symphysis w/ retroperitoneal hematoma
• L - iliolumbar artery laceration
• L - distal tibia/fibula• L - medial malleolus• L - calcaneous fracture
•Concussion w/ LOC < 1 hour (CT negative)
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1996 Nissan Sentra / Max. crush = 135 cm / 12:00 PDOF / 66mph dV (stvz 45mph)
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Left: dash (32), toe pan (86), steering assembly (31), A-pillar, floor pan (15) intrusion.
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Contacts:knee bolster (L & R), steering assembly, belt, floorboard (pedals)
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Right Foot
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Left medial malleolus fracture
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Right Calcaneous Fracture
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L - Sacroiliac Joint Diastasis
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Narrow Impact CIREN Case30 year old male, 5’11”, 201 lb, MAIS 4, ISS 3445 minute extrication helicopter transportation Multiple operative procedures
Pelvic angioembolization: gelfoam embolism R-internal pudenal artery, coil embolism L-iliolumbar branchesExploratory laparotomyORIF symphysis pubisIrrigation & debridement w/splinting open heel injuryVascular grafting L-tibial artery transectionExternal fixation R-foot and ankleIrrigation & debridement L-hand w/repair of 3rd & 4th digit extensor tendons Closed reduction L-pilon fracture w/ internal and external fixationClosed reduction, percutaneous screw fixation L-sacroiliac joint dislocation
Hospital length of stay 24 days, discharged to extended care facility
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Narrow Impact Case: Injury SourcesHead
AIS 2 LOC < 1 hour (Air bag)
Upper extremityAIS 1 Multiple hand tendon lacerations (IP)
AbdomenAIS 4 Major laceration iliac artery (Steering wheel)AIS 3 Minor laceration other named arteries (IP)
Lower extremitiesAIS 3 Skin laceration w/ blood loss >20% volume (IP)AIS 3 Symphysis pubis diastasis (Floor/toe pan)AIS 3 Open, displaced, comminuted tibia shaft fx (Floor/toe pan)AIS 3 Laceration arteries/veins (IP)AIS 2 Closed pelvic fractures (Floor/toe pan)AIS 2 Calcaneal fracture (Floor/toe pan)AIS 2 Talus, Metatarsal/Tarsal fracture and traumatic arthrotomy (Floor/toe pan)AIS 2 Fibula fracture (head/neck/shaft) (Floor/toe pan)AIS 2 Medial malleolus tibia fracture (IP)
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CIREN DatabaseUsed to compare injury patterns for wide vs. narrow impacts
Regions injured
Within regions, compare severity and sources
Specific injuries for selected regions
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Study Criteria
Frontal impact PDOF=12 o’clock and GAD=F
Ranked #1 impact by Crash Investigator
Wide: damage distribution > 66% of frontal plane
Narrow: damage distribution < 41 cm
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Study CriteriaInclusion criteria
Safety belt useFrontal air bag deployment during impactAIS > 2 injury severity
Exclusions criteriaChildren (<13 yrs) Passengers Open cases
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CIREN CasesWide Impacts: N =141
Mean age=43, Median age=41 (range: 16-80 yrs)Mean ISS=19, Median ISS=14 (range: 5-75)Mean delta V=49, Median=47 (range: 14-92 kmph)
Narrow Impacts: N = 35 Mean age= 46, Median age=47 (range:17-86 yrs)Mean ISS= 17, Median=14 (range: 5-43)Mean Delta V=52, Median= 47 (range: 22-113 kmph)
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Occupant Injury Regions
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Head
Face
Neck
Thorax
Abdomen
Spine
Up Ext
Low Ext
Percentage of injuries
NarrowWide
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WIDE vs. NARROW FRONTAL CRASHES
Injury Severity by Body Region
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Wid
e
Nar
row
Wid
e
Nar
row
Wid
e
Nar
row
Wid
e
Nar
row
Head Spine Thorax Abdomen
Body Region
Per
cent
age
of In
juri
es
AIS 6AIS 5AIS 4AIS 3AIS 2
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WIDE vs. NARROW FRONTAL CRASHES
Injury Sources
0%10%20%30%40%50%60%70%80%90%
100%
Head Spine Thorax Abdomen
Body Region
Perc
enta
ge o
f Inj
urie
s OtherNon-contactInteriorInst PanelAir BagSteering WheelSafety Belt
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WIDE vs. NARROW FRONTAL CRASHES
Injury PatternsHeadThoraxAbdomen*
Wide impact Solid organ injuryNarrow impact Hollow viscus injury
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Abdomen injuries
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Wide Narrow
Other
Solid organ
Hollow viscus
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Narrow Impact Injury Sources
0%10%20%30%40%50%60%70%80%90%
100%
Solid HVI Other
Safety belt Steering wheel
Wide Impact Injury Sources
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Solid HVI Other
Safety belt Steering wheel Other
Source of Injuries
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WIDE vs. NARROW FRONTAL CRASHES
Differences in Abdominal Injury
Hollow viscusSolid organAbdominal injury
Focalized Evenly distributedDelta T
89% pole or tree78% moving autoObject hit
74%77%Type of Auto = Car
3%11%Death
Mean 17, Median 14Mean 19, Median 14ISS
Mean 46, Median 37Mean 43, Median 41Age (years)
100%100% Seatbelt use & air bags
NarrowWide
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SummaryDifferent injury patterns observed for some regions
Wide impacts have more head and upper extremity injuriesNarrow impacts have more abdomen and thoracic injuriesWide impacts have more solid organ abdominal injuries compared to narrow impacts with more hollow viscus injuries
Wide impacts result in greater injury severity for each region except the abdomen
Different patterns of injury sources observed for some regions comparing wide vs. narrow impacts
Implications for vehicle and safety system design to prevent injury
Needs further study as more CIREN cases become available
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San Diego CIREN TeamPrincipal Investigators
Raul Coimbra, MD, FACS (UCDS)Gail T. Tominaga, MD, FACS (Scripps Memorial La Jolla)
TeamSharon Pacyna, RN, BSN, MPH
Steve ErwinCarol Conroy, MPH, PhDMarSue May, RN, BSN
Barbara Frasier