The cushion effect

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Arbabi, Saman¹; Wahl, Wendy L.¹; Hemmila, Mark R.¹; Kohoyda-Inglis, Carla¹; Taheri, Paul A.¹; Wang, Stewart C.¹

The cushion effect

J Trauma. June 2003;54(6):1090-1093

©2003 Lippincott Williams & Wilkins, Inc.

Affiliations

¹Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
Abstract and keywords

Background: The pattern and severity of crash injury depends on a complex interaction of biomechanical factors such as deceleration velocity at impact (delta-V), seat-belt and airbag use, and type of impact. Human body characteristics such as height and weight may play an important role. We hypothesized that body mass index (BMI) will influence crash injury patterns.

Methods: The University of Michigan Program for Injury Research and Education database was queried. Three cohorts were analyzed, lean (BMI ≤ 25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI > 30 kg/m2)

Results: There were 189 detailed crash cases, with 22 fatalities. There was an increased risk of fatal outcome associated with the obese cohort (adjusted odds ratio, 4.2 compared with lean; p = 0.04). Age, delta-V, seat-belt use, and type of impact were independent predictors of Injury Severity Score (ISS). After adjusting for other modifiers, being overweight was associated with decreased ISS (p = 0.03) and abdominal maximal Abbreviated Injury Scale (mAIS) score (p = 0.008) when compared with the lean cohort. However, the lower extremity mAIS score increased when overweight (p = 0.03) and obese cohorts (p = 0.001) were compared with the lean cohort.

Conclusion: Although no difference in ISS was identified between the lean and obese cohorts, there was an increase in mortality with the obese cohort. The severity of lower extremity injuries increased with increasing BMI. The overweight cohort was associated with lower ISS and abdominal mAIS score compared with the lean cohort. This protection may be attributable to an increase in insulating tissue, or a “cushion effect,” without a significant increase in mass and momentum.

Keywords: Trauma, Body mass index, Injury, Motor vehicle crash, Weight, Height
Links

DOI: 10.1097/01.TA.0000064449.11809.48

PubMed: 12813327

WoS: 000183727400011

Ovid: 00005373-200306000-00007
History

Received: 2002-10-29

Accepted: 2003-02-12

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Cited By (25)

Year	Entry
2003	Wang SC, Bednarski B, Patel S, Yan A, Kohoyda-Inglis C, Kennedy T, Link E, Rowe S, Sochor M, Arbab S. Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions. In: 47th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 22-24, 2003; Lisbon, Portugal.545-559.
2011	Yoganandan N, Fitzharris M, Pintar FA, Stemper BD, Rinaldi J, Maiman DJ, Fildes BN. Demographics, velocity distributions, and impact type as predictors of AIS 4+ head injuries in motor vehicle crashes. In: 55th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 3-5, 2011; Paris, France.267-280.
2017	Ejima S, Kohoyada-Inglis C, Holcombe S, Derstrin B, Zhang P, Goulson R, MacWilliams J, Wang S. Lower extrimity fracture in patients with obessity in real-world crash data. In: Proceedings of the 25th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 5-8, 2017; Detroit, MI.
2017	Hu J, Zhang K, Fanta A, Hwang E, Reed MP. Effects of male stature and body shape on thoracic impact response using parametric finite element human modeling. In: Proceedings of the 25th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 5-8, 2017; Detroit, MI.
2004	Etheridge BS, Beason DP, Eberhardt AW. Bone density and trochanteric tissue thickness affect fracture of the female pelvis in side impact experiments. In: Proceedings of the 32nd International Workshop on Human Subjects for Biomechanical Research. 2004.127-143.
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2015	Joodaki H, Forman J, Forghani A, Overby B, Kent R, Crandall J, Beahlen B, Beebe M, Bostrom O. Comparison of kinematic behaviour of a first generation obese dummy and obese PMHS in frontal sled tests. In: Proceedings of the 2015 International IRCOBI Conference on the Biomechanics of Injury. September 9-11, 2015; Lyon, France.454-466.
2017	Wang SC. Treat the patient, not just their disease. In: Proceedings of the 2017 International IRCOBI Conference on the Biomechanics of Injury. September 13-15, 2017; Antwerp, Belgium.xxii-xxxvii.
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2023	Schäuble A, Zippel F, Rücker P, Kinsky T. Impact kinematics and dynamics of an obese ATD in comparison with an elderly female, the HIII 50th male and the HIII 5th female ATDs as drivers and front passengers in full-width frontal impacts. In: Proceedings of the 2023 International IRCOBI Conference on the Biomechanics of Injury. September 13-15, 2023; Cambridge, United Kingdom.285-30.
2023	Zouzias D, Fokylidis A, Lioras A, Rorris L. Assessment of abdominal and skeletal loadings and kinematics during frontal impacts through a novel tool for HBM variants generation based on the occupant’s BMI. In: Proceedings of the 2023 International IRCOBI Conference on the Biomechanics of Injury. September 13-15, 2023; Cambridge, United Kingdom.398-410.
2015	Joodaki H, Forman J, Forghani A, Overby B, Kent R, Crandall J, Beahlen B, Beebe M, Bostrom O. Comparison of kinematic and dynamic behavior of a first generation obese dummy and obese PMHS in frontal sled tests. In: Proceedings of the 11th Ohio State University Injury Biomechanics Symposium. May 17-19, 2015; Columbus, OH.
2012	Yoganandan N, Humm JR, Pintar FA, Brasel KH, Rudd RW, Ridella SA. Thoraco-abdominal deflection responses of post mortem human surrogates in side impacts. Stapp Car Crash J. October 2012;56:49-64.
2008	Cormier JM. The influence of body mass index on thoracic injuries in frontal impacts. Accid Anal Prev. March 2008;40(2):610-615.
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2014	Kim J-E, Kim IH, Shum PC, Shih AM, Pintar F, Shen W, Ma X, Laud PW, Heymsfield SB, Allison DB, Zhu S. A computational study of injury severity and pattern sustained by overweight drivers in frontal motor vehicle crashes. Comput Methods Biomech Biomed Eng. July 2014;17(9):965-977.
2015	Shi X, Cao L, Reed MP, Rupp JD, Hu J. Effects of obesity on occupant responses in frontal crashes: a simulation analysis using human body models. Comput Methods Biomech Biomed Eng. 2015;18(12):1280-1292.
2007	Li Z, Kim J-E, Davidson JS, Etheridge BS, Alonso JE, Eberhardt AW. Biomechanical response of the pubic symphysis in lateral pelvic impacts: a finite element study. J Biomech. 2007;40(12):2758-2766.
2007	Chong M, Sochor M, Ipaktchi K, Brede C, Poster C, Wang S. The interaction of “occupant factors” on the lower extremity fractures in frontal collision of motor vehicle crashes based on a level I trauma center. J Trauma. March 2007;62(3):720-729.
2010	Kent RW, Forman JL, Bostrom O. Is there really a “cushion effect”? a biomechanical investigation of crash injury mechanisms in the obese. Obesity. 2010;18(4):749-753.
2013	Rupp JD, Flannagan CAC, Leslie AJ, Hoff CN, Reed MP, Cunningham RM. Effects of BMI on the risk and frequency of AIS 3+ injuries in motor‐vehicle crashes. Obesity. January 2013;21(1):E88-E97.
2023	Baker C. AutoTriage: A Feasibility Assessment of Using in-Vehicle Sensors to Predict Traumatic Brain Injury in Road Traffic Collisions [PhD thesis]. Imperial College London; March 23, 2023.
2018	Cristino DM. Lower Extremity Biomechanical Response of Female and Male Post-Mortem Human Surrogates to High-Rate Vertical Loading During Simulated Under-Body Blast Events [PhD thesis]. Virginia Polytechnic Institute and State University; December 13, 2018.