Article, Traumatology

Severe upper extremity injuries in frontal automobile crashes: the effects of depowered airbags

Original Contributions

Severe upper extremity injuries in frontal automobile crashes: the effects of depowered airbags

M. Virginia Jernigan MS, Amber L. Rath BS, Stefan M. Duma PhD*

Virginia Tech-Wake Forest, Center for Injury Biomechanics, Blacksburg, Virginia, VA 24061, USA

Received 5 February 2004; accepted 5 February 2004

Abstract

Background: The purpose of this study was to determine the effects of depowered frontal airbags on the incidence of severe upper extremity injuries.

Methods: The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 2,413,347 occupants who were exposed to an Airbag deployment in the United States.

Results: Occupants exposed to a depowered airbag deployment were significantly more likely to sustain a severe upper extremity injury (3.9%) than those occupants exposed to a full-powered airbag deployment (2.5%) ( P = .01). Full-powered systems resulted in an injury distribution of 89.2% fractures and 7.9% dislocations compared with depowered systems with 55.3% fractures and 44.3% dislocations. Conclusions: Although depowered airbags were designed to reduce the risk of injuries, they appear to have increased the overall incidence of severe upper extremity injuries through a shift from long bone fractures to Joint dislocations.

D 2005

Introduction

Although airbags have reduced the incidence of fatal and severe injuries in automobile collisions, they have been shown to increase the risk of other injuries [1]. These associated minor injuries include corneal abrasions, skin contusions or lacerations, and upper extremity injuries [2-20]. In particular, upper extremity injuries have been identified through case reports that present a wide range of upper extremity injuries, from a minor abrasion to a more severe avulsion or fracture [21-35]. Although upper extremity injuries were observed before airbag implementation, it is

* Corresponding author. Tel.: +1 540 231 3945; fax: +1 540 231 9100.

E-mail address: [email protected] (S.M. Duma).

suggested that the risk of serious upper extremity injury to restrained occupants with airbags is higher when compared with those without airbags [22,36,37]. Upper extremity injuries have been estimated as nearly a quarter of all injuries to the whole body in motor vehicle crashes [33,38].

To investigate the interaction between the upper extrem- ity and a deploying frontal airbag, experimental testing has been done using Hybrid III and Research Arm Injury Device upper limbs [36,39- 41]. In addition, numerous cadaver studies have aimed to estimate dynamic injury tolerance and to reproduce fractures similar to those observed in real- world case studies [42- 46]. As identified in case studies, injuries to the upper extremity can occur because of contact with the airbag during or after deployment, and are likely caused by various combinations of axial and bending moments applied to the arm [25].

0735-6757/$ – see front matter D 2005 doi:10.1016/j.ajem.2004.02.045

injury types and “>To reduce the incidence of airbag-induced fatal and severe injuries to small females and children, the National Highway Traffic Safety Association submitted a change in safety standards [37]. The new safety regulations, effective in 1998 model vehicles, allowed automobile manufactures to reduce the power of the deploying airbag and still meet the safety standards by passing a standardized sled test rather than a full-vehicle crash test. The new depowered airbags could be less aggressive than the pre-1998 full- powered airbags.

Several recent studies have shown that depowered airbags did reduce the risk of Serious injuries as well as changing the overall injury patterns [47-50]. Fewer injuries occurred to drivers of the later models vehicles. The depowered airbags could be responsible for these improve- ments. Although previous studies have provided insight into the interaction between an airbag and the upper extremity, the national rate of incidence of severe upper extremity injuries is unknown for occupants exposed to full-powered and depowered airbags. The purpose of this paper is to determine the effects of depowered airbags on the overall risk and severity of upper extremity injuries in frontal automobile crashes.

Methods

This study uses the National Automotive Sampling System (NASS) to eliminate the inaccuracies associated with small case study projections [51]. The primary advantage of using the NASS is that the database includes an analysis of approximately 5000 cases per year and it allows for national incidence estimates. The injuries are coded by Trained nurses using the Abbreviated Injury Scale [52]. This coding allows for a consistent and accurate distinction and identification of upper extremity injuries. The NASS database has been used for national injury projection studies to analyze injury severity and crash characteristics for things such as lower extremity injury patterns and restraint effectiveness in motor vehicle crashes [1,5,53-59]. Every crash investigated for the NASS database is assigned a weighted value, which scales the incidence of the particular crash investigated to a number that represents actual occurrence of similar non-investigat- ed crashes that occur in the United States each year. Unweighted numbers reflect actual values counted from the cases that appear in the NASS database. The AIS scale classifies injuries by body region on a 6-point scale ranging from low severity (AIS1) to fatal (AIS6). The AIS values are assigned for each injury sustained and do not include combined effects from multiple injuries to the same patient.

For this study, cases in the NASS with an airbag deployment were selected from an 8-year span, years 1993 through 2000, that included drivers and front seat occupants only, and excluded ejected occupants and rollovers. In

addition, only frontal impacts were considered, which are defined as having a primary direction of force of 11, 12, or 1 o’clock. Only severe upper extremity injuries were analyzed, identified as AIS level 2 severity and higher. Such injuries include amputation, avulsion, burn, crush, dislocation, fracture, and laceration. The upper extremity was defined to include the acromium, clavicle, scapula, humerus, elbow, radius, ulna, wrist, hand, and fingers. The injuries and specific body region were identified in the NASS database using the current AIS injury codes. Injuries to the fingers, hand, and wrist were all grouped together and termed hand injuries. Frequencies of occupants with injuries and total injuries to occupants were analyzed. This study is divided into 3 parts.

Depowered and full-powered airbag deployment

For all occupants who were exposed to a full-powered airbag deployment, the number of occupants that sustained a severe upper extremity injury was compared with the total number of occupants who did not sustain a severe upper extremity injury. Next, an analogous search was performed for crashes with a depowered airbag deploy- ment. For all occupants who were exposed to a depowered airbag deployment, the number of occupants that sustained a severe upper extremity injury was compared with the total number of occupants who did not sustain a severe upper extremity injury. Frequencies of occupants and injuries were analyzed. The top 3 sources of injury were identified for occupants exposed to full-powered and depowered airbag deployments.

Severe upper extremity injury types and locations

Severe upper extremity injuries were further examined to compare injury types and locations, depending on which type of airbag the occupant was exposed to and whether or not the airbag was the source of the injury. Specific severe upper extremity injury types were compared as percentages of total upper extremity injuries in similar crashes, depend- ing on the injury source. To further analyze injuries by location, upper extremity fractures were broken down by specific body region to compare resulting fracture location by airbag type and injury source.

Occupant and crash characteristics

Various occupant and crash characteristics were exam- ined to identify trends that correlate with incidence of severe upper extremity injury for occupants exposed to airbag deployment. The first study involved a comparison between the types of occupants exposed to each type of airbag deployment. This part identified differences between the population exposed to full-powered airbags and those exposed to depowered airbags. Group 1 was the group of

occupants exposed to a full-powered airbag deployment, whereas group 2 was the group of occupants exposed to a depowered airbag deployment. Average values and standard deviations were calculated for occupant height, weight, age, sex, seat position, seatbelt use, and change in velocity (DV ). Next, a similar investigation was performed for occupants with airbag-induced severe upper extremity injuries– depending on whether the airbag was full-powered or depowered. Group 1-A was the group with an airbag- induced injury from a full-powered airbag, whereas group 2-A was the group of occupants with an airbag-induced injury from a depowered airbag. Average values and standard deviations were calculated for occupant height, weight, age, sex, seat position, seatbelt use, and DV.

Results

Depowered and full-powered airbag deployment

A total of 2,413,347 occupants from 6,091 cases were exposed to an airbag deployment between the years 1993 and 2000. Because the proportion of airbag-equipped vehicles in the fleet is increasing, more occupants are exposed to airbag deployments each year. Accordingly, the number of occupants who sustained a severe upper extremity injury in a crash with airbag deployment has also increased. In addition, every year there have been more occupants who sustained a severe upper extremity injury when exposed to a full-powered airbag deployment than when exposed to a depowered airbag deployment (Fig. 1). Occupants were significantly more likely to sustain a severe upper extremity injury when exposed to a depowered airbag than when exposed to a full-powered airbag ( P = .01) (Fig. 2). In particular, 2.5% of occupants exposed to a full-powered airbag deployment sustained a severe upper extremity injury compared with 3.90% of occupants exposed to a depowered airbag. In

Fig. 2 Incidence of severe upper extremity injury for occupants in frontal crashes that were exposed to a full-powered or depowered airbag deployment.

addition, 0.7% of occupants who were exposed to a full- powered airbag deployment sustained a severe upper extremity injury specifically from the airbag compared with 0.8% of those occupants exposed to a depowered airbag ( P = .67).

There were 88,324 total severe upper extremity injuries to occupants, 68,691 of which were to occupants exposed to a full-powered airbag deployment (77.8%), whereas 19,633 occurred to occupants who were exposed to a depowered airbag deployment (22.2%) (Fig. 3). The top 3 injury sources for occupants who sustained a severe upper extremity injury when exposed to a full-powered airbag deployment were the airbag (30.4%), the steering wheel (17.9%), and the instrument panel or glove box (14.0%). If the occupants were exposed to a depowered airbag

Fig. 1 Occupants with severe upper extremity injuries in frontal crashes that were exposed to a full-powered or depowered airbag deployment by crash year.

Fig. 3 Number of severe upper extremity injuries that occurred to occupants in frontal crashes.

Table 1 Comparison of severe (AIS2 and AIS3) upper extremity injury types for occupants exposed to a full-powered or depowered airbag deployment

Full-powered airbag deployment Source: airbag Source:

n % n

other

%

Depowered airbag deployment

Source:

airbag

Source:

other

n

%

n

%

Amputation

0

0.0

675

1.4

0

0.0

0

0.0

Avulsion

19

0.1

16

0.0

0

0.0

0

0.0

Burn

499

2.4

0

0.0

15

0.4

0

0.0

Crush

0

0.0

796

1.7

0

0.0

0

0.0

Dislocation

1,645

7.9

3,146

6.6

1,594

44.3

476

3.0

Fracture

18,600

89.2

41,858

87.5

1,993

55.3

15,473

96.5

Laceration

90

0.4

879

1.8

0

0.0

82

0.5

Unknown

0

0.0

468

1.0

0

0.0

0

0.0

Totals

20,853

100.0

47,838

100.0

3,602

100.0

16,031

100.0

deployment, the leading source for the injuries was the instrument panel or glove box (41.8%), followed by the airbag (18.3%) and the steering wheel (17.3%).

Severe upper extremity injury types and locations

Severe upper extremity injuries rated as AIS2 and AIS3 were grouped together for this analysis. For occupants who sustained severe upper extremity injuries from sources other than the airbag, the majority were fractures for both occupants exposed to a full-powered airbag deployment (87.5%) and occupants exposed to a depowered airbag deployment (96.5%) (Table 1). Howev- er, there was a shift in severe upper extremity type for injuries that were induced specifically by the airbag. For occupants with airbag-induced injuries from a full- powered airbag, 89.2% were fractures, whereas occupants who sustained airbag-induced injuries from a depowered bag sustained only 55.3% as fractures, whereas 44.3% were dislocations. Of these, 91.7% were shoulder dis- locations, whereas 8.3% were dislocations of the wrist or

fingers. There were no airbag-induced elbow dislocations from a depowered airbag.

There was a shift in the fracture location depending on whether the occupant was exposed to a full-powered or depowered airbag deployment, and whether the airbag was the source of the fracture (Table 2). For injuries that were airbag induced, occupants exposed to a full-powered airbag sustained the majority to the radius (54.2%), followed by the ulna (35.7%). There were no airbag-induced fractures to the scapula from a full-powered airbag. In contrast, occupants who were exposed to a depowered airbag sustained most of the airbag-induced injuries to the humerus (30.6%), and the radius (30.5), followed by the scapula (19.9%). There were no airbag-induced fractures to the ulna from a depowered airbag.

Occupant and crash characteristics

The next analysis was made by examining occupant and crash characteristics for the 2,413,347 occupants who were exposed to an airbag deployment. There was no significant difference in the continuous variables between those

Table 2 Comparison of severe (AIS2 and AIS3) upper extremity fracture locations for occupants exposed to a full-powered or depowered airbag deployment

Full-powered airbag deployment Source: airbag Source:

n % n

other

%

Depowered airbag deployment

Source:

airbag

Source:

other

n

%

n

%

Acromium

0

0.0

26

0.1

0

0.0

0

0.0

Arm NFS

90

0.5

1,719

4.1

28

1.4

6,026

38.9

Clavicle

206

1.1

6,667

15.9

5

0.3

586

3.8

Forearm NFS

10

0.1

0

0.0

147

7.4

0

0.0

Hand

1,238

6.7

11,233

26.8

200

10.0

2,331

15.1

Humerus

332

1.8

3,625

8.7

609

30.6

708

4.6

Radius

10,089

54.2

9,010

21.5

607

30.5

3,564

23.0

Scapula

0

0.0

171

0.4

397

19.9

11

0.1

Ulna

6,635

35.7

9,407

22.5

0

0.0

2,247

14.5

Totals

18,600

100.0

41,858

100.0

1,993

100.0

15,473

100.0

NFS indicates not further specified.

occupants exposed to a full-powered or depowered airbag deployment (Table 3). However, drivers were significantly more likely to be exposed to a full-powered airbag than were passengers ( P = .01). In particular, 88.1% of drivers exposed to an airbag were exposed to a full-powered airbag deployment, compared with 81.8% of passengers exposed to airbags. In addition, of all occupants exposed to a full- powered airbag, 85.5% were drivers, compared with 78.1% drivers for those occupants exposed to a depowered airbag. Females were 49.1% of the population exposed to full- powered airbags, compared with 51.5% of the occupants exposed to depowered airbag deployments. In addition, for all occupants exposed to an airbag deployment, 86.7% of females were exposed to full-powered airbags, compared with 87.7% of males who were exposed to airbags. This difference was not found to be significant ( P = .67). Finally, there was no difference in the use of seatbelts for occupants exposed to depowered or full-powered airbags ( P = .87). In particular, for all occupants exposed to airbags, 87.8% of unbelted occupants and 87.2% of belted occupants were exposed to full-powered airbags. In addition, 85.4% of occupants were belted when exposed to a full-powered airbag, whereas 86.1% were belted when exposed to a

depowered airbag deployment.

The next analysis involved a comparison between the occupants that sustained a severe airbag-induced upper extremity injury when exposed to a full-powered or depowered airbag (Table 4). Within a 95% confidence interval, occupant height, weight, age, and crash DV were all not significant factors correlating with incidence of airbag-induced injury based on airbag type.

There was no significant difference in incidence of airbag-induced severe upper extremity injury for occupants exposed to depowered or full-powered airbag deployment based on the occupant seat position ( P = .66), sex ( P = .13), or use of seatbelts ( P = .78). In particular, 85.9% of drivers with airbag-induced severe upper extremity injuries were exposed to a full-powered airbag deployment, compared with 81.1% of passengers with airbag-induced severe upper extremity injuries. In addition, of all occupants with airbag- induced severe upper extremity injuries from full-powered airbags, 65.9% were drivers, compared with 57.6% of those occupants with airbag-induced severe upper extremity

Table 3 Comparison of occupant and crash characteristics for occupants exposed to a full-powered or depowered airbag

Group 1: exposed to full-powered airbag deployment

Mean SD

Group 2: exposed to depowered airbag

deployment

Mean

SD

Occupant height (in) 66.99

0.27

67.11

0.48

Occupant weight (lb) 159.83

2.27

162.77

4.47

Occupant age (y) 33.73

0.89

33.98

2.23

DV (mph) 13.55

0.32

15.08

0.47

Table 4 Comparison of continuous valued occupant and crash characteristics for occupants with airbag-induced severe upper extremity injuries from a full-powered or depowered airbag

Group 1-A: airbag- induced severe upper extremity injury from a full-powered airbag

Mean SD

Group 2-A: airbag- induced severe upper extremity injury from

a depowered airbag

Mean

SD

Occupant Height

66.88

0.78

64.47

1.26

(in)

Occupant Weight

142.93

5.60

158.35

19.91

(lb)

Occupant age

35.95

4.49

30.81

6.49

(y)

DV (mph)

16.28

2.39

18.05

3.25

injuries from depowered airbags. Of all females with airbag- induced severe upper extremity injuries, 93.5% were exposed to full-powered airbags, compared with 64.5% of males. In addition, of all the occupants with airbag-induced severe upper extremity injuries from full-powered airbags, 75.5% were female, compared with 28.1% of occupants with airbag-induced severe upper extremity injuries from depowered airbags. In addition, there was no difference in the use of seatbelts for occupants with airbag-induced severe upper extremity injuries from depowered or full-powered airbags. In particular, 88.1% of unbelted occupants with airbag-induced severe upper extremity injuries were ex- posed to full-powered airbags, compared with 83.5% of belted occupants. Finally, of those occupants with airbag- induced severe upper extremity injuries from full-powered airbags, 85.9% were belted, compared with 89.9% of occupants with airbag-induced severe upper extremity injuries from depowered airbag deployment.

Discussion

This paper presents the most comprehensive upper extremity injury study to date concerning the comparison between depowered and full-powered airbags. It investi- gates 25464 individual cases over 8 years to identify the effects of depowered frontal airbags on the incidence of upper extremity injuries for occupants exposed to a frontal airbag deployment.

In contrast to previous experimental research with human cadaver arms, this study found the risk of severe injury increases from 2.5% to 3.9% with exposure to depowered airbags [36,42,44,45]. This is likely because the previous research focused on radius and ulna fracture prediction as the risk of joint dislocation was unknown. It is suggested that future experimental studies be performed to investigate the injury biomechanics of upper extremity joint disloca- tions. These data would be useful for designing future airbags to reduce the risk of both fractures and dislocations.

Acknowledgment

The authors thank JP Research for their assistance with the case selection and statistical analysis.

References

  1. Deery HA, Morris AP, Fildes BN, Newstead SV. Airbag technology in Australian passenger cars: preliminary results from real world crash investigations. Crash Prev Inj Control 1999;1(2):121 – 8.
  2. Campbell JK. Automobile air bag eye injuries. Nebr Med J 1993;306:7.
  3. Driver PJ, Cashwell R, Yeatts P. Airbag-associated bilateral hyphemas and angle recession. Am J Ophthalmol 1994;118(2):250 – 1.
  4. Dubois J, Stewart E. ocular injuries from air bag deployment. J Ophthalmic Nurs Technol 1998;17(4):147 – 50.
  5. Duma SM, Kress TA, Porta DJ, et al. Air bag induced eye injuries: a report of 25 cases. J Trauma 1996;41(1):114 – 9.
  6. Duma SM, Jernigan MV, Stitzel JD, Herring IP, Crowley JS, Brozoski FT, et al. The effect of frontal airbags on eye injury patterns in automobile crashes. Arch Ophthalmol 2002;120(Nov):1517 – 22.
  7. Gault JA, Vichnin MC, Jaeger EA, Jeffers JB. Ocular injuries associated with eyeglass wear and airbag inflation. J Trauma 1995;38(4):494 – 7.
  8. Ghafouri A, Burgess SK, Hrdlicka ZK, Zagelbaum BM. Air bag related Ocular trauma. Am J Emerg Med 1997;15(4):389 – 92.
  9. Huelke DF, Moore JL, Ostrom M. Airbag injuries and occupant protection. J Trauma 1992;33(6):894 – 8.
  10. Larkin GL. Airbag mediated corneal injury. Am J Emerg Med 1991;9:444 – 6.
  11. Lee WB, O’Halloran HS, Pearson PA, et al. Airbags and bilateral eye injury: five case reports and a review of the literature. J Emerg Med 2001;20(2):129 – 34.
  12. Lemley HL, Chodosh J, Wolf TC, et al. Partial dislocation of laser in situ keratomileusis flap by air bag injury. J Refract Surg 2000;16:373 – 4.
  13. Lesher MP, Durrie DS, Stiles MC. Corneal edema, hyphema, and angle recession after air bag inflation. Arch Ophthalmol 1993;111: 1320 – 2.
  14. Lueder GT. Air bag-associated ocular trauma in children. Ophthal- mology 2000;107(8):1472 – 5.
  15. Mishler KE. Hyphema caused by airbag. Arch Ophthalmol 1991; 109:1635.
  16. Steinmann R. A 40-year-old woman with an air bag-mediated injury. J Emerg Nurs 1992;18(4):308 – 10.
  17. Vichnin MC, Jaeger EA, Gault JA, Jeffers JB. Ocular injuries related to air bag inflation. Ophthalmic Surg 1995;26(6):542 – 8.
  18. Walter DP, James MR. An unusual mechanism of airbag injury. Injury 1996;27(7):523 – 4.
  19. Weinman SA. Automobile air bag-mediated injury: a case presenta- tion. J Emerg Nurs 1995;21(1):84 – 5.
  20. White JE, McClafferty K, Orton RB, et al. Ocular alkali burn associated with automobile air-bag activation. CMAJ 1995;153(7):933 – 4.
  21. Zabriskie NA, Hwang IP, Ramsey JF, Crandall AS. Anterior lens capsule rupture caused by air bag trauma. Am J Ophthalmol 1997; 123(6):832 – 3.
  22. Dalmotas DJ, German A, Hendrick BE, Hurley RM. Airbag deploy- ments: the Canadian experience. J Trauma 1995;38(4):476 – 81.
  23. Freedman EL, Safran MR, Meals RA. Automotive airbag-related upper extremity injuries: a report of three cases. J Trauma 1995;38(4): 577 – 81.
  24. Huebner CJ, Reed MP. Airbag-induced fracture in a patient with osteoporosis. J Trauma 1998;45(2):416 – 8.
  25. Huelke DF, Moore JL, Compton TW, et al. Upper extremity injuries related to airbag deployments. SAE Paper 940716, 1994.
  26. Huelke DF, Moore JL, Compton TW, et al. Upper extremity injuries related to airbag deployments. J Trauma 1995;38(4):482 – 8.
  27. Kirchhoff R, Rasmussen SW. Forearm fracture due to the release of an automobile air bag. Acta Orthop Scand 1995;55(5):483.
  28. Lundy DW, Lourie GM. Two open forearm fractures after airbag deployment during low speed accidents. Clin Orthop 1998;351:191 – 5.
  29. Marco F, Garcia-Lopez A, Leon C, Lopez-Duran L. Bilateral Smith fracture of the radius caused by airbag deployment. J Trauma 1996;40(4):663 – 4.
  30. Molia LM, Stroh E. Airbag injury during low impact collision. Br J Ophthalmol 1996;80(5):487 – 8.
  31. Michaeli-Cohen A, Neufeld M, Lazar M, et al. Bilateral corneal contusion and angle recession caused by an airbag. [letter]. Br J Ophthalmol 1996;80(5):487.
  32. Richter M, Otte D, Ing D, et al. Upper extremity fractures in restrained front-seat occupants. J Trauma 2000;48(5):907 – 12.
  33. Roth T, Meridity P. Hand injuries from inflation of an air bag security system. J Hand Surg 1993;18B:520 – 2.
  34. Sances A, Kumaresan S, Carlin F, Friedman K. Airbag protection in low and moderate impact. Ann Biomed Eng 2000;28(Suppl 1):S-51.
  35. Smock WS, Nichols GR. Airbag module cover injuries. J Trauma 1995;38(4):489 – 93.
  36. Kuppa SM, Olson MB, Yeiser CW, et al. RAID– an investigative tool to study air bag/upper extremity interactions. SAE Paper, vol. 970399. Detroit, Michigan7 SAE International Congress and Expo- sition; 1997.
  37. National Highway Traffic Safety Administration (NHTSA). Third report to Congress: effectiveness of occupant protection systems and their use, US Department of Transportation, DOT-HS-808-019, December 1996.
  38. Kulowski J. Injuries of the extremities: the most common among motoring casualties. South Med J 1956;49(2):1650 – 69.
  39. Johnston KL, Klinich KD, Rhule DA, Saul RA. Assessing arm injury potential from deploying Air bags. SAE International Congress and Exposition, Detroit, Michigan 1997;1231: 259 – 73.
  40. Kallieris D, Rizzetti A, Mattern R, Jost S, Primer P, Unger M. Response and vulnerability of the upper arm through side air bag deployment SAE Paper 973323. 41st Stapp International car crash Conference, Orlando, Florida; 1997.
  41. Saul RA, Backaitis SH, Beebe MS, Ore L. Hybrid III dummy instrumentation and assessment of arm injuries during air bag deployment SAE Paper 962417, 40th Stapp Car Crash Conference Albuquerque, New Mexico; 1996.
  42. Bass RC, Duma SM, Crandall JR, et al. The interaction of air bags with upper extremities SAE Paper 973324, 41st Stapp International Car Crash Conference, Orlando, Florida; 1997.
  43. Duma SM, Crandall JR, Hurwitz SR, Pilkey WD. Small female upper extremity interaction with a deploying side air bag SAE Paper 983148.. 42nd Stapp International Car Crash Conference Tempe, Arizona; 1998.
  44. Duma SM, Schreiber PH, McMaster JD, et al. Dynamic injury tolerance for long bones in the female upper extremity. J Anat 1999;194(3):463 – 71.
  45. Hardy WN, Schneider LW, Reed MP, Ricci LL. Biomechanical investigation of airbag-induced upper extremity injuries. 41st Stapp Car Crash Conference, Orlando, Florida; 1997.
  46. Pintar FA, Yoganandan N, Eppinger RH. Response and tolerance of the human forearm to impact loading SAE Paper 983149, SAE International Congress and Exposition, Detroit, Michigan; 1998.
  47. Jernigan MV, Duma SM. The effects of depowered airbags on severe upper extremity injuries in frontal automobile crashes. 47th Annual Proceedings of Association for the Advancement of Automotive Medicine Lisbon, Portugal; 2003. p. 601 – 3.
  48. Schneider L. Comparison of frontal crash protection for front seat occupants in pre-1998 and 1998 and newer model vehicles. 47th Annual Proceedings of Association for the Advancement of Automo- tive Medicine, Lisbon, Portugal; 2003. p. 81 – 3.
  49. Segui-Gomez M, Baker SP. Changes in injury patterns in frontal crashes: preliminary comparisons of drivers of vehicle model years 1993-1997 to drivers of vehicles 1998-2001. 46th Annual Proceedings of Association for the Advancement of Automotive Medicine Temple, Arizona; 2002. p. 1 – 9.
  50. Segui-Gomez M. Changes in injury patterns in frontal crashes: injuries to drivers of vehicles model year 1993-1997 vs. drivers of vehicles 1998-2002–an analysis of NASS/CDS Data. 47th Annual Proceed- ings of Association for the Advancement of Automotive Medicine, Lisbon, Portugal; 2003. p. 84.
  51. National Highway Traffic Safety Administration (NHTSA). National Automotive Sampling System (NASS), Crashworthiness data system, 1993-1999, Department of Transportation (DOT) HS 808985, 8,

Washington, DC; 1999.

  1. Association for the Advancement of Automotive Medicine (AAAM). The Abbreviated Injury Scale ; 1998. [Revision, Des Plains, Ill].
  2. Atkinson T, Atkinson P. Knee injuries in Motor vehicle collisions: a study of the National Accident Sampling System database for the years 1979-1995. Accid Anal Prev 2000;32(6):779 – 86.
  3. Farmer CM, Braver ER, Mitter EL. Two-vehicle side impact crashes: the relationship of vehicle and crash characteristics to injury severity. Accid Anal Prev 1997;29(3):399 – 406.
  4. Miller TR, Pindus NM, Douglass JB. Medically related motor vehicle injury costs by body region and severity. J Trauma 1993;34(2):270 – 5.
  5. Reiff DA, McGwin G, Rue LW. Splenic injury in side impact motor vehicle collisions: effect of occupant restraints. J Trauma 2001; 51(2):340 – 5.
  6. Segui-Gomez M. Driver air bag effectiveness by severity of the crash. Am J Public Health 2000;90(10):1575 – 81.
  7. Viano DC, Culver CC, Evans L, et al. Involvement of older drivers in multivehicle side-impact crashes. Accid Anal Prev 1990;22(2): 177 – 88.
  8. Zuby DS, Ferguson SA. Analysis of driver fatalities in frontal crashes of airbag-equipped vehicles in 1990-98 NASS/CDS. SAE Technical Paper Series 2001-01-0156. Warrendale, PA7 Society of Automotive Engineers; 2001.

Leave a Reply

Your email address will not be published. Required fields are marked *