body changes with aging - savona emergenza of michigan... · 2012-02-08 · body changes with aging...
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Body Changes With Aging
University of Michigan Program for
Injury Research and Education
Automotive Safety
• Vehicles are safer than they have ever been.
• Laboratory testing using idealized occupants and standardized crashes has led to great improvements in safety.
• The body is relatively stable during early and middle adulthood - not so during early childhood or advanced age.
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Child Small Adult
A Child’s Neck is Under-developed
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Upper vertebrae joints are more horizontal in children:
Less resistance to translation
The Head Bone is Connected to the Neck Bone...
• Partial rupture of ligaments between bottom of skull and first vertebrae presents as bleeding in lower skull. • Total rupture of these ligaments results in rupture of the spinal cord, a fatal injury.
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A child’s ligaments are loose to accommodate growth:
• An infant’s neck column can stretch up to 2 inches with traction.
• If stretched more than 1/4 inch, spinal cord rupture may occur.
The Head Bone is Connected tothe Neck Bone...
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Crash Scenario
• 1994 Ford Tempo vs tree
• Driver of V1 fell asleep, V1 crosses the center line and strikes a tree on the left side of the road
• Driver and center rear passenger are the only occupants of case vehicle
• Daylight with clear weather
• Dry asphalt roadway
Crash Scene Path of Case Vehicle
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Case Vehicle - 1994 Ford Tempo Crush Profile
CDC: 12-FYEW-3 PDOF: 360 degrees
47 cm of direct damage 77 cm of maximum crush
Impact Severity:
38 mph total delta V
all longitudinal
Case Vehicle - 1994 Ford Tempo
Center-rear passenger 18-month-old female 32 in tall, 28 lb In forward-facing child safety seat secured by manual vehicle lap belt
Photos Prior to Removal of Seat from Vehicle by Police 41-01
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Case Vehicle - 1994 Ford Tempo Child Safety Seat
Century 3000 STE convertible child safety seat
Manufactured 12/99
CSS being used in forward-facing mode
Shoulder harness set for use in rear-facing position
Tether equipped but not used
Case Vehicle - 1994 Ford Tempo Child Safety Seat Harness Slots
Front View
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Case Vehicle - 1994 Ford Tempo Child Safety Seat Harness Slots
Rear View
Center hit, 12 o’clock PDOF
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C1C1
}
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Result: Quadriplegia
Summary
• 18 month old, 28 lb female, front facing in CSS with improper belt placement.
• A small child’s neck is not yet fully developed and less able to withstand deforming forces.
• A heavy head and weak neck structure make small children extremely vulnerable in a frontal car crash.
• Preserving the normal structural integrity, alignment and spacing of the structures from the skull base down to the chest is critical to avoid injury to the spinal cord.
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Observations• The optimal solution would be to provide firm support
behind the child’s head, neck and spine in a rearward-facing child seat - already done for infants.
• Spreading the crash forces in this manner prevents excessive flexion, extension and traction movements that are may result in permanent neurological disability or death.
SWEDEN - children kept rear-facing until age 3.
There is little anatomic and tissue information available regarding young children--Can imaging technology help??
Child Small Adult
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Not all adults are the same.
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Aging of Population
Involvement, Injury, and Fatality Rates (rates per vehicle miles of travel)
0
10
20
30
40
16-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Involvement Rate Serious Injury Rate Fatality Rate
Rate
Age Group
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Life Span Changes in Bone Density
0
1
2
3
4
5
6
7
0 10 20 30 40 50 60 70 80
Male
Female
Age
Bo
ne
Den
sity
(ar
bit
rary
un
its)
Kraenzlin et al: McGraw-Hill, 1990 In Principles of Geriatric Medicine and Gerontology 2d ed.
Effect of Aging on Cardiac Output
0 2 4 6 8
10 12 14 16 18 20
20 40 60 80
Maximal Exercise
Rest
Car
dia
c O
utp
ut
(L/m
in)
Age M Branfronbrener, Circulation 12:557, 1955 Julius, et al: Influence of age, Circulation 36:222, 1967
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Preexisting Diseases and Outcomes
0
5
10
15
20
25 P
erce
nt
0 1 2 > 3 Preexisting Diseases
Mortality
Milzman, et al: Pre-existing Diseases in Trauma Patients. J Trauma 32-236, 1992
Age Fragility Relationship
0
1
2
3
4
5
6
7
8
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85+
Age
Fat
alit
ies
per
1,0
00 c
rash
es
Source TRB report “Transportation in an Aging Society” 1988
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ISS Scores UM CIREN 1997 - 1998
0
10
20
30
40
50
60
70
80
0 20 40 60 80
> 60 20 - 40 Fatalities
Delta V (mph)
ISS
University of Michigan CIREN Center, 1997 - 1998
Age Incidence of Rib Fractures UM CIREN 1997 - 1998
0 10 20 30 40 50 60 70 80 90
100
< 39 40 - 59 60 - 70 > 70
University of Michigan CIREN Center, 1997 - 1998
Age
Per
cen
t
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Injury Patterns in Elderly Fatalities CIREN (Maryland, NJ, Michigan)
Head Injury
Chest Injury (all with rib fractures)
38%
86%*
*Chest Injury a major cause of death in 71% of fatality cases
Elderly Fatalities CIREN 1997-1998
18 of 21 fatalities had Chest Injuries (86%)
All 18 had rib fractures
• 8-rib fractures
• 5-heart injuries
• 2-major vessel only
• 1-heart and major vessel
• 1-lung and major vessel
• 1-lung
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Frontal Crash
0%
5%
10%
15%
20%
25%
30%
35%
40%
20-29 30-39 40-49 50-59 60-69 70-79
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
20-29 30-39 40-49 50-59 60-69 70-79
Occupant Age Distribution
Fatality Rate by Age
NASS 1993-1996
Side Crash Cases
0%
5%
10%
15%
20%
25%
30%
35%
20-29 30-39 40-49 50-59 60-69 70-79
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
20-29 30-39 40-49 50-59 60-69 70-79
Occupant Age Distribution
Fatality Rate by Age
1993-1996 NASS
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Frontal Crash
0%
5%
10%
15%
20%
25%
30%
35%
40%
20-29 30-39 40-49 50-59 60-69 70-79
0%
5%
10%
15%
20%
25%
30%
35%
40%
20-29 30-39 40-49 50-59 60-69 70-79
Occupant Age Distribution
Femur Fracture Rate by Age
NASS 1993-1996
Frontal Crash
0%
5%
10%
15%
20%
25%
30%
35%
40%
20-29 30-39 40-49 50-59 60-69 70-79
0%
5%
10%
15%
20%
25%
30%
35%
20-29 30-39 40-49 50-59 60-69 70-79
Occupant Age Distribution
Tibia Fracture Rate by Age
NASS 1993-1996
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Age Distribution of Rib Fracture Patterns Frontal Crashes
0%
5%
10%
15%
20%
25%
30%
20-29 30-39 40-49 50-59 60-69 70-79
Single rib > 5 ribs > 8 ribs
0%
5%
10%
15%
20%
25%
30%
35%
40%
20-29 30-39 40-49 50-59 60-69 70-79
1993-1996 NASS
Odds Ratio for Rib FracturesElderly vs. YoungNASS 1993-1996
FRONT SIDE
Single rib 3.4 4
2-3 ribs 3.8 7
> 5 ribs 13 20
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Why??
Decreased Cortical Bone Bone Density Muscle
Increased AP diameter Cartilage ossification
ADULT ELDERLY
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7A/B • Male, 183 cm, 86 kg • Male, 183 cm, 80 kg • Age = 38 years • Age = 79 years
7A/B • Male, 183 cm, 86 kg • Male, 183 cm, 80 kg • Age = 38 years • Age = 79 years
Bone Geometry Muscle Mass/Quality
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• Male, 183 cm, 86 kg
• Age = 38 years
7A/B
• Male, 183 cm, 80 kg
• Age = 79 years
Bone DensityMuscle Mass/QualityFat Mass/Distribution
4 A/B
• Female, 168 cm, 50 kg • Female, 165 cm, 49 kg • Age = 18 years • Age = 72 years
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4 A/B
• Female, 168 cm, 50 kg • Female, 165 cm, 49 kg • Age = 18 years • Age = 72 years
Bone Density/Quality Muscle Mass/Quality
4 A/B
• Female, 168 cm, 50 kg • Female, 165 cm, 49 kg • Age = 18 years • Age = 72 years
Bone Density/Quality Muscle Mass/Quality
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3A/B
• Female, 165 cm, 77 kg • Female, 165 cm, 78 kg
• Age = 27 years • Age = 78 years
Body Habitus
3A/B
• Female, 165 cm, 77 kg • Female, 165 cm, 78 kg
• Age = 27 years • Age = 78 years
Bone density/quality Fat distribution
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The Body Changes With Aging
• These changes affect the body’s tolerance to injurious forces.
• People at the extremes of age are particularly vulnerable to injury.
• Little is known about changes in anthropometry and body composition with aging.
• Little is known about the response of very young or very old tissues to high energy trauma.
• Development and validation of dummies representative of individuals at the extremes of age is difficult?
How many different dummies can be built and validated?
• CIREN subjects are volunteer real-life crash dummies - (living ones at that!).
• Changes in body dimensions and composition with aging affect injury tolerance.
• Injury data is being collected by computer (CT) -Body dimension and composition data also.
Can this data be used as a surrogate fortissue properties and for the determination ofbody injury tolerance?If so, what needs to be done?
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