Pediatric Injuries in Mismatched Crashes

Martin R. Eichelberger, MDg ,Kelly Orzechowski, MPH, Patrick McLaughlin, BS

Children’s National Medical Center

United Sates Vehicle FleetUnited Sates Vehicle Fleet

Fatality RatesFatality Rates

Vehicle-to-Vehicle IncompatibilityVehicle to Vehicle Incompatibility

• Larger striking vehicles over-ride side impact barriers

• Increased risk of head & chest injury to near side occupant

• Head & chest injuries are more life th t ithreatening

Pediatric Anatomy

Pediatric Head Injury in Side Impact Crashes

• Large Heads = More S f A A il blSurface Area Available for ContactH d t D P l L l• Head at Door Panel Level Increases Risk of Injury

Pediatric Head Injury in Side Impact Crashes

Case A Frontal Impact Sedan Vs SUVCase A. Frontal Impact Sedan Vs. SUV

• Frontal Impact

• 7 year old female• 7 year-old female

• 57 pounds

• Right Front Passenger

• Lap portion of a 3 point restraint• Lap portion of a 3-point restraint

Case A. Scene DiagramCase A. Scene Diagram

Case A. Case VehicleCase A. Case Vehicle

• V1: 1989 Mercury Tracer• V2: 1985 Nissan Pickup• Max Crush: 14.2 inches• Delta V: 19 mph

PDOF 10 d• PDOF: 10 degrees

Case A. Seating Positiong

Right Front Seat Instrument Panel Contact

Case A. External InjuriesCase A. External Injuries

Left Upper Thigh Contusion

Abdominal Ecchymosis

Left Upper Thigh Contusion

Right Arm Abrasion

Injury Severity in Mismatched Frontal Impacts

16Compatible (N=141)

Mismatched (N=30)

10

12

14

6

8

10

Mea

n

2

4

0LOS ISS GCS

Injury Severity in Mismatched Frontal Impacts

70

80

Compatible (N=141)

50

60

ases

(%)

Mismatched (N=30)

20

30

40

Perc

ent o

f Ca

0

10

20

AIS2+ AIS3+ AIS4+

Injury Patterns in Mismatched Frontal Impacts

16

18Compatible Mismatched

10

12

14

ases

(%)

6

8

10

Perc

ent o

f Ca

0

2

4

AIS3+Head AIS3+Chest AIS3+Abd/Pel AIS3+Extremity

Case B: Side Impact Sedan Vs. SUVCase B: Side Impact Sedan Vs. SUV

• Lateral Impact

8 ld l• 8 year-old male

• 79 lbs.

• Right Front Passenger

3 t B lt & Ai b• 3-pt. Belt & Air bag

Case B. Scene DiagramCase B. Scene Diagram

DYNAMIC SCIENCE, INC.CASE NUMBER 233

NOT TO SCALE

dsi an Exodyne Company

NS

E

W

V3V3 POI #2, V1 vs. V3

V1

V1

V1V1

V2

V1

V1 V2

V1

V2 V2V

POI #1, V1 vs. V2

V2

1999 CHEVROLET LUMINA

V1

V1

V1

V2

V3

1995 CHEVROLET BLAZER

1999 TOYOTA CAMRY

Case B. Case VehicleCase B. Case Vehicle

• V1: 1999 Chevy Luminay• V2: 1995 Chevy Blazer• Max Crush: 18.1 in.• Delta V: 23 mph• PDOF: 050

Case B. Vehicles

Case Occupant Seat Opposing Vehicle

Case B. Vehicle IntrusionCase B. Vehicle Intrusion

Case Occupant Seat Seat Intrusion

Case B. External InjuriesCase B. External Injuries

Right Knee Contusion

Case B. Brain InjuriesCase B. Brain Injuries

C b ll I h i• Cerebellar Ischemia

• Hydrocephalus

• Petechial Cerebellar• Petechial Cerebellar Hemorrhage

• Tentorial Subdurals

Case B. Skull Fractures

Multiple Occipital FracturesMultiple Occipital Fractures

Case B. Abdominal Injuriesj

Liver LacerationAdrenal Hemorrhage

Case B Internal InjuriesCase B. Internal Injuries

L C t i

Blood in Morrison’s Pouch

Lung Contusions

Side Impact Syndrome

Ri k f I j f Child i Sid I t C h

Odds Ratio 95% CI P-valueAIS2+ 2 5 1 1 5 5 020

Risk of Injury for Children in Side Impact Crashes

AIS2+ 2.5 1.1, 5.5 .020AIS3+ 2.3 1.3, 4.0 .006AIS4+ 2.8 1.4, 5.2 .002AIS5+ 2 7 1 1 6 2 020AIS5+ 2.7 1.1, 6.2 .020AIS2+ Head 2.5 1.4, 4.4 .003AIS3+ Head 2.8 1.5, 5.3 .001AIS4+ Head 3.4 1.6, 7.0 .001AIS4 Head 3.4 1.6, 7.0 .001AIS2+ Chest 4.0 2.0, 8.0 .000AIS3+ Chest 4.8 2.3, 9.9 .000AIS4+ Chest 4.3 1.5, 12.6 .008AIS2+ Cervical 3.7 1.2, 11.3 .018GCS <9 4.9 2.2, 10.6 .000ISS > 15 3.1 1.7, 5.8 .000

Side Impact SyndromeSide Impact Syndrome

p < .01

80

90

100

Frontal (N=166)

50

60

70

80

of C

ases

(%)

Lateral (N=65)

10

20

30

40

Perc

ent

0

10

AIS 2+ Head

AIS 2+ Chest

AIS 2+ Cervical

AIS 2+Abdomen

AIS 2+Lumbar

All Frontal Impacts Vs. All Lateral Impacts

Injury Contact Points for Seriously Injured Children

70

50

60

(%)

FrontalLateral

30

40

nt o

f Cas

es

10

20Perc

e

0Door Panel Non-

ContactA,B,C Pillar Seatback Car Seat Seatbelt Instrument

Panel

All frontal cases with ISS>15 compared to all lateral cases with ISS>15.

Injury Severity in Mismatched Near Side Impacts

25Compatible (N=27)

Mismatched (N=20)

15

20

Mismatched (N 20)

10

15

0

5

LOS GCS ISS

Injury Severity in Mismatched Near Side Impacts

100

Compatible (N=27)

Mismatched (N=20)

70

80

90

100

s (%

)

Mismatched (N=20)

40

50

60

cent

of C

ases

0

10

20

30

Perc

0AIS2+ AIS3+ AIS4+

Injury Severity in Mismatched Near Side Impacts

90

100 Compatible

Mismatched

60

70

80

ases

(%)

30

40

50

rcen

t of C

a

0

10

20

30

Pe

0AIS 2+Head AIS 3+Head AIS4+Head AIS 2+Chest AIS 3+Chest AIS4+Chest

ConclusionsConclusions

• Side Impact Syndrome - Head Neck ChestSide Impact Syndrome Head, Neck, Chest

Mi h d Sid C h ISS (T d)• Mismatched Side Crashes ISS (Trend)

Potential Injury Reduction MethodsPotential Injury Reduction Methods

• Improved Child Safety Seat Designs– More Head PaddingMore Head Padding– Increased Depth of Head Wings

• Improved Child Seat Installation Technology – LATCH: Rigid versus Flexibleg– Some Sled Test Show that Rigid LATCH

anchorage systems prevent occupant contact ith d lwith door panel

Potential Injury Reduction MethodsPotential Injury Reduction Methods

• Increase Booster Seat Use• Head Wings• Head Wings• Improve Side Impact Protection Technology• Develop Crash Test Dummy for Side Impact Tests• Develop Crash Test Dummy for Side Impact Tests• Crash Testing of Mismatched Vehicles