Head injury causation scenarios for belted, rear-seated children in frontal impacts

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Bohman, Katarina^1,2; Arbogast, Kristy B.^3,4; Boström, Ola¹

Head injury causation scenarios for belted, rear-seated children in frontal impacts

Traffic Inj Prev. February 2011;12(1):62-70

©2011 Taylor & Francis Group, LLC

Affiliations

¹Autoliv Research, Vargårda, Sweden

²Karolinska Institutet, Department of Public Health Science, Stockholm, Sweden

³The Center for Injury Research and Prevention, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

⁴The Department of Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Abstract and keywords

Objectives: Head injuries are the most common serious injuries sustained by children in motor vehicle crashes and are of critical importance with regard to long-term disability. There is a lack of understanding of how seat belt–restrained children sustain head injuries in frontal impacts. The aim of the study was to identify the AIS2+ head injury causation scenarios for rear-seated, belt-restrained children in frontal impacts, including the set of parameters contributing to the injury.

Method: In-depth crash investigations from two National Highway Traffic Safety Administration (NHTSA) databases, the National Automotive Sampling System–Crashworthiness Data System (NASS-CDS; 1997–2008) and the Crash Injury Research and Engineering Network (CIREN; 1996–2009), were collected and analyzed in detail. Selection criteria were all frontal impacts with principal direction of force (PDOF) of 11, 12, and 1 o’clock involving rear-seated, three-point belt-restrained, with or without booster cushion, children from 3 to 13 years with an AIS2+ head injury. Cases were analyzed using the BioTab method of injury causation assessment in order to systematically analyze the injury causation scenario for each case.

Results: There were 27 cases meeting the inclusion criteria, 19 cases with MAIS2 head injuries and 8 cases with MAIS3+ head injuries, including 2 fatalities. Three major injury causation scenarios were identified, including head contact with seatback (10 cases), head contact with side interior (7 cases,) and no evidence of head contact (9 cases).

Conclusions: Head injuries with seatback or side interior contact typically included a PDOF greater than 10 degree (similar to the Insurance Institute for Highway Safety [IIHS] and EuroNCAP offset frontal testing) and vehicle maneuvers. For seatback contact, the vehicle's movements contributed to occupant kinematics inboard the vehicle, causing a less than optimal restraint of the torso and/or torso roll out of the shoulder belt. For side interior contact, the PDOF and/or maneuvers forced the occupant toward the side interior. The cases without evidence of head/face contact were characterized by high crash severity and accompanied by severe injuries to the thorax and spine. These data lead to increased understanding of the injury patterns and causation in this crash restraint scenario so that interventions to mitigate the burden of injury can be advanced.

Keywords: Head injury, Rear seat, Frontal impact, Child
Links

DOI: 10.1080/15389588.2010.526159

PubMed: 21259175

WoS: 000287044500009
History

Received: 2010-07-16

Accepted: 2010-09-20

Cited Works (13)

Year	Entry
2005	Tylko S, Dalmotas D. Protection of rear seat occupants in frontal crashes. In: Proceedings of the 19th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 6-9, 2005; Washington, DC.
2008	Bostrom O, Gabler HC, Digges K, Fildes B, Sunnevang C. Injury reduction opportunities of far side impact countermeasures. In: 52nd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 6-8, 2008; San Diego, CA.289-299.
2006	Huang S, Reed MP. Comparison of child body dimensions with rear seat geometry. In: Proceedings of the SAE World Congress & Exhibition. April 3-6, 2006; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 2006-01-1142.
2003	Swanson J, Rockwell T, Beuse N, Summers L, Summers S, Park B. Evaluation of stiffness measures from the U.S. new car assessment program. In: Proceedings of the 18th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 19-22, 2003; Nagoya, Japan.
2006	Sherwood CP, Abdelilah Y, Crandall JR. Quantifying the relationship between vehicle interior geometry and child restraint systems. In: 50th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 16-18, 2006; Chicago, IL.381-396.
2004	Howard A, Rothman L, McKeag AM, Pazmino-Canizares J, Monk B, Comeau JL, Mills D, Blazeski SB, Hale I, German A. Children in side-impact motor vehicle crashes: seating positions and injury mechanisms. J Trauma. June 2004;56(6):1276-1285.
2005	Arbogast KB, Jermakian JS, Ghati Y, Smith R, Maltese MR, Menon RA. Predictors and patterns of pediatric head injury in motor vehicle crashes. In: Proceedings of the 2005 International IRCOBI Conference on the Biomechanics of Impact. September 21-23, 2005; Prague, Czech Republic.15-27.
2008	Bose D, Crandall JR. Influence of active muscle contribution on the injury response of restrained car occupants. In: 52nd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 6-8, 2008; San Diego, CA.61-71.
2007	Maltese MR, Locey CM, Jermakian JS, Nance ML, Arbogast KB. Injury causation scenarios in belt-restrained nearside child occupants. Stapp Car Crash J. 2007;51:299-311. SAE 2007-22-0013.
2010	Andersson M, Bohman K, Osvalder A-L. Effect of booster seat design on children’s choice of seating positions during naturalistic riding. In: 54th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 17-20, 2010; Las Vegas, NV.117-126.
2009	Lopez-Valdes F, Forman J, Ash J, Kindig M, Lamp J, Kent R, Bohman K, Bostrom O. The frontal-impact response of a booster-seated child-size PMHS. In: Proceedings of the 2009 International IRCOBI Conference on the Biomechanics of Impact. September 9-11, 2009; York, UK.177-188.
2007	Kent R, Forman J, Parent DP, Kuppa S. Rear seat occupant protection in frontal crashes and its feasibility. In: Proceedings of the 20th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 18-21, 2007; Lyon, France.
2007	Bohman K, Boström O, Osvalder A-L, Eriksson M. Rear seat frontal impact protection for children seated on booster cushions: an attitude, handling and safety approach. In: Proceedings of the 20th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 18-21, 2007; Lyon, France.

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2012	Arbogast KB, Locey CM, Zonfrillo MR. Differences in thoracic injury causation patterns between seat belt restrained children and adults. In: 56th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 14-17, 2012; Seattle, WA.213-220.
2012	Stammen JA, Herriott R, Kang Y-S, Bolte J, Dupaix R. Sequential biomechanics of the human upper thoracic spine and pectoral girdle. In: 56th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 14-17, 2012; Seattle, WA.151-162.
2013	Arbogast KB, Locey CM, Hammond R, Belwadi A. Injury risk for rear-seated occupants in small overlap crashes. In: 57th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 22-25, 2013; Quebec City, QC.267-279.
2013	Lopez-Valdes FJ, Forman JL, Ash JH, Kent R, Alba JJ, Segui-Gomez M. Assessment of a head support system to prevent pediatric out-of-position: an observational study. In: 57th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 22-25, 2013; Quebec City, QC.297-310.
2011	Jakobsson L, Bohman K, Andersson M, Stockman I, Boström O, Svensson M, Svanberg H, Wimmerstedt M, Arbogast KB. Rear seat safety in frontal to side impacts: focusing on occupants from 3yrs to small adults. In: Proceedings of the 22nd International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 13-16, 2011; Washington, DC.
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2013	Lopez‐Valdes FJ, Lorente OJ, Alba JJ. Preventing pediatric out‐of‐position in frontal crashes: impact assessment of a head support system. In: Proceedings of the 2013 International IRCOBI Conference on the Biomechanics of Injury. September 11-13, 2013; Gothenburg, Sweden.394-411.
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2021	Baker GH, Mansfield JA, Hunter RL, Bolte JH IV. Comparison of child and ATD static belt fit and belt torso contact on belt-positioning booster seats. In: Proceedings of the 2021 International IRCOBI Conference on the Biomechanics of Injury. September 8-10, 2021; Online.556-580.
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2017	Holt C, Seacrist T, Arbogast KB, Balasubramanian S, Kerrigan J, Kent R. Evaluating occupant kinematic responses to low acceleration time-extended evasive swerving events. In: Proceedings of the 13th Ohio State University Injury Biomechanics Symposium. May 21-23, 2017; Columbus, OH.
2012	Stammen JA, Herriott R, Kang Y-S, Dupaix R, Bolte J IV. Dynamic properties of the upper thoracic spine-pectoral girdle (UTS-PG) system and corresponding kinematics in PMHS sled tests. Stapp Car Crash J. October 2012;56:65-104.
2011	Skjerven-Martinsen M, Naess PA, Hansen TB, Rognum TO, Lereim I, Stray-Pedersen A. In-depth evaluation of real-world car collisions: fatal and severe injuries in children are predominantly caused by restraint errors and unstrapped cargo. Traffic Inj Prev. 2011;12(5):491-499.
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2019	Mansfield JA. Investigation of Child Restraint System (CRS) Misuse: Passive and Active Educational Interventions [PhD thesis]. The Ohio State University; 2019.
2012	Beck B. Optimising Protection for Motor Vehicle Rear Seat Occupants [PhD thesis]. University of New South Wales; 2012.
2013	Lopez-Valdes FJ. Mechanics of the Pediatric Thoracic Spine and Its Role in the Kinematics of the Head in Automotive Frontal Impacts [PhD thesis]. Charlottesville, VA: University of Virginia; May 2013.
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