Radiographic detection of rib fractures: a restraint-based study of occupants in car crashes

wbldb

Kent, Richard W.¹; Crandall, Jeff¹; Patrie, James¹; Fertile, Jay¹

Radiographic detection of rib fractures: a restraint-based study of occupants in car crashes

Traffic Inj Prev. 2002;3(1):49-57

©2002 Taylor & Francis

Affiliations

¹Automobile Safety Laboratory, Impact Biomechanics Group, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia, USA
Abstract and keywords

Twenty-nine human cadavers were subjected to frontal impacts using two restraint conditions:: torso belt-only (14 tests), and torso belt-and-airbag (15 tests). Five radiologists independently evaluated post-test chest films, and their results were compared with detailed necropsy results. The radiologists' ability to identify rib fractures was influenced by the restraint system, rib number, aspect (right or left), circumferential location of the fracture, and the number of fractures on the rib. The probability of fracture detection (sensitivity) was significantly higher for the torso belt-only group (0.44) than for the belt-and-airbag group (0.24). Knowledge of fracture locations increased the overall (both restraint groups) sensitivity from 0.40 to 0.49. It is concluded that the sensitivity is dependent on the restraint system used. Since rib fractures are the injuries most commonly used to describe AIS 2+ thoracic injury severity, this dependence may bias field data-based comparative studies of restraint system effectiveness.

Keywords: Automobile Safety; Rib Fractures; Rib Fracture Detection; Restraint System Effectiveness; Blunt Thoracic Trauma; Radiology
Links

DOI: 10.1080/15389580210516
History

Received: 2001-02-09

Accepted: 2001-09-14

Online: 2010-09-15

Cited Works (15)

Year	Entry
1971	Nahum AM, Gadd CW, Schneider DC, Kroell CK. The biomechanical basis for chest impact protection: force-deflection characteristics of the thorax. J Trauma. October 1971;11(10):874-882.
1974	Schmidt G, Kallieris D, Barz J, Mattern R. Results of 49 cadaver tests simulating frontal collision of front seat passengers. In: Proceedings of the 18th Stapp Car Crash Conference. December 4-5, 1974; Ann Arbor, MI. Warrendale, PA: Society of Automotive Engineers:283-291. SAE 741182.
1986	Liang K-Y, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. April 1986;73(1):13-22.
1994	Morgan RM, Eppinger RH, Haffner MP, Yoganandan N, Pintar FA, Sances A, Crandall JR, Pilkey WD, Klopp GS, Kallieris D, Miltner E, Mattern R, Kuppa SM, Sharpless CL. Thoracic trauma assessment formulations for restrained drivers in simulated frontal impacts. In: Proceedings of the 38th Stapp Car Crash Conference. October 31–November 2, 1994; Fort Lauderdale, FL. Warrendale, PA: Society of Automotive Engineers:15-34. SAE 942206.
1998	Yoganandan N, Pintar FA. Biomechanics of human thoracic ribs. J Biomech Eng. February 1998;120(1):100-104.
1978	Foret-Bruno JY, Hartemann F, Thomas C, Fayon A, Tarrière C, Got C, Patel A. Correlation between thoracic lesions and force values measured at the shoulder of 92 belted occupants involved in real accidents. In: Proceedings of the 22nd Stapp Car Crash Conference. October 24-26, 1978; Ann Arobor, MI. Warrendale, PA: Society of Automotive Engineers:271-292. SAE 780892.
1985	Walfisch G, Chamouard F, Lestrelin D, Tarriere C, Brun Cassan F, Mack P, Got C, Guillon F, Patel A, Hureau J. Predictive functions for thoracic injuries to belt wearers in frontal collisions and their conversion into protection criteria. In: Proceedings of the 29th Stapp Car Crash Conference. October 9-11, 1985; Washington, DC. Warrendale, PA: Society of Automotive Engineers:49-68. SAE 851722.
1997	Crandall JR, Bass CR, Pilkey WD, Miller HJ, Sikorski J, Wilkins M. Thoracic response and injury with belt, driver side airbag, and force limited belt restraint systems. Int J Crashworthiness. 1997;2(1):119-132.
1990	The Abbreviated Injury Scale-1990 Revision. Des Plaines, IL: Association for the Advancement of Automotive Medicine (AAAM); 1990.
1994	Plank GR, Kleinberger M, Eppinger RH. Finite element modeling and analysis of thorax/restraint system interaction. In: Proceedings of the 14th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 23-26, 1994; Munich, Germany.210-219.
1974	Patrick LM, Bohlin N, Anderson A. Three-point harness accident and laboratory data comparison. In: Proceedings of the 18th Stapp Car Crash Conference. December 4-5, 1974; Ann Arbor, MI. Warrendale, PA: Society of Automotive Engineers:201-282. SAE 741181.
2000	Kent RW, Crandall JR, Bolton JR, Duma SM. Driver and right-front passenger restraint system interaction, injury potential, and thoracic injury prediction. In: 44th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 2-4, 2000; Chicago, IL.
1982	Kallieris D, Mellander H, Schmidt G, Barz J, Mattern R. Comparison between frontal impact tests with cadavers and dummies in a simulated true car restrained environment. In: Proceedings of the 26th Stapp Car Crash Conference. October 20-21, 1982; Ann Arbor, MI. Warrendale, PA: Society of Automotive Engineers:353-367. SAE 821170.
1998	Kallieris D, Del Conte-Zerial P, Rizzetti A, Mattern R. Prediction of thoracic injuries in frontal collisions. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1550-1563.
1992	Pattimore D, Thomas P, Dave SH. Torso injury patterns and mechanisms in car crashes: an additional diagnostic tool. Injury. 1992;23(2):123-126.

Cited By (11)

Year	Entry
2012	Forman JL, Kent RW, Mroz K, Pipkorn B, Bostrom O, Segui-Gomez M. Predicting rib fracture risk with whole-body finite element models: development and preliminary evaluation of a probabilistic analytical framework. In: 56th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 14-17, 2012; Seattle, WA.109-124.
2003	Kent R, Patrie J, Poteau F, Matsuoka F, Mullen C. Development of an age-dependent thoracic injury criterion for frontal. In: Proceedings of the 18th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 19-22, 2003; Nagoya, Japan.
2008	Subit D, Ogam E, Gabrielli F, Guillemain P, Kent R, Masson C. Rib failure detection using time-frequency analysis: a feasibility study. In: Proceedings of the 36th International Workshop on Human Subjects for Biomechanical Research. November 2, 2008; San Antonio, TX.
2012	Kerrigan JR, Arregui‐Dalmases C, Foster J, Crandall JR, Rizzo A. Pedestrian injury analysis: field data vs. laboratory experiments. In: Proceedings of the 2012 International IRCOBI Conference on the Biomechanics of Injury. September 12-14, 2012; Dublin, Ireland.672-689.
2013	Agnew AM, Kang Y-S, Moorhouse K, Herriott R, Bolte JH IV. Age-related changes in stiffness in human ribs. In: Proceedings of the 2013 International IRCOBI Conference on the Biomechanics of Injury. September 11-13, 2013; Gothenburg, Sweden.257-269.
2003	Kent R, Shaw G, Lessley D, Crandall J, Kallieris D, Svensson M. Comparison of belted Hybrid III, THOR, and cadaver thoracic responses in oblique frontal and full frontal sled tests. In: Proceedings of the SAE World Congress & Exhibition. March 3-6, 2003; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 2003-01-0160.
2002	Petitjean A, Lebarbe M, Potier P, Trosseille X, Lassau J-P. Laboratory reconstructions of real world frontal crash configurations using the Hybrid III and THOR dummies and PMHS. Stapp Car Crash J. 2002;46:27-54. SAE 2002-22-0002.
2005	Lebarbé M, Potier P, Baudrit P, Petit P, Trosseille X, Vallancien G. Thoracic injury investigation using PMHS in frontal airbag out-of-position situations. Stapp Car Crash J. 2005;49:323-342. SAE 2005-22-0015.
2009	Gabrielli F, Subit D, Ogam E, Guillemain P, Kent RW, Masson C. Time-frequency analysis to detect bone fracture in impact biomechanics. application to the thorax. Med Eng Phys. 2009;31(8):952-958.
2009	Kindig MM. Tolerance to Failure and Geometric Influences on the Stiffness of Human Ribs Under Anterior-Posterior Loading [Master's thesis]. Charlottesville, VA: University of Virginia; December 2009.
2008	Thor CP. Characteristics of Thoracic Organ Injuries in Frontal Crashes [Master's thesis]. Virginia Polytechnic Institute and State University; December 10, 2008.