Occupant injuries in light passenger vehicles-A NASS study to enable priorities for development of injury prediction capabilities of human body models.

To prioritize how the development of mathematical human body models for injury prediction in crash safety analysis should be made, the most frequent injuries in the NASS CDS data from 2000 to 2015 were analyzed. The crashes were divided into seven types, from front to side. Non-minor injuries (AIS2+) were analyzed in two steps. In the first step, a grouping was made according to the AIS definition of body regions: head, face, neck, thorax, abdomen and pelvic contents, spine, upper extremities (including shoulder girdle) and lower extremities (including pelvis). In a second step, the body regions were divided in organs, parts of the spine, and parts of the extremities. The three most often injured anatomical structures of each body region were estimated for drivers and front seat passengers in each type of crash. For drivers, an injury risk greater than 2.4 % was found for the lower extremities (pelvis) and the head (concussion) in side oblique near side impacts, for the head in frontal oblique near side impacts (concussion) and for the lower extremities (ankle joint) in frontal impacts. For passengers, an injury risk greater than 2.4 % was found for the thorax (lungs) in side near side impacts, for the head (concussion) in front oblique near side impacts, and for the thorax (sternum) and the upper extremities (wrist, hand) in frontal impacts. Future development of human body models should focus on injuries to the head, thorax and the lower extremities. More specifically, it should focus on concussion in all impact directions and on rib and pelvic fractures in side near side impacts and in side oblique near side impacts.

Reliability of measuring the cervical sagittal translation mobility with a simple method in a clinical setting.

Introduction. The cervical sagittal translation mobility is related to neck pain. A practical method for measuring the specific cervical mobility is needed. The aim was to describe a simple method for measuring the cervical sagittal translation mobility and to evaluate its reliability in a clinical setting. Method. The head protraction and retraction ranges of thirty healthy seated subjects were measured from a dorsal reference plane by two physiotherapists utilizing a tape measure. A standard inclinometer/goniometer was used to minimize angular movements of the head during the translational movements. The measurements were made twice for each subject with a two-hours interval between each measurement. The inter-rater and intra-rater agreements were evaluated with intraclass correlation coefficients (ICCs) and with the distribution of the difference of the measurements. The systematic differences were analysed with the Wilcoxon signed rank test. Results. The intra-rater agreement was good. The inter-rater agreement was moderate in the first measurement and good in the second. A systematic difference was noted between raters in the first measurement but not in the second, possibly indicating a learning effect. Discussion. The method used in the study is simple and reliable and can be recommended for clinical use.

Children at risk of residual physical problems after public road traffic injuries--a 1-year follow-up study.

OBJECTIVES: To describe the residual physical problems 1 year after traffic injuries in children with respect to age, gender, extraction (Swedish or foreign), type of care, type of accident and use of protective equipment, type of injury, and the impact on daily living activities. METHODS: Hospital data were analysed for children, aged 15 or under, after road traffic accidents in the Gothenburg region in 2000. Age, gender, type of road user, counterpart, use of protective equipment, type and severity of each injury, and type of care were related to follow-up data obtained by a self-completed questionnaire answered 1 year after the accident. The AIS90 was used for injury classification. Residual physical problems were specified, graded, and mapped on anatomical pictures of the body by the respondents. Logistic regression was used to explore independent factors for residual problems. RESULTS: A total of 341 children (81%) fulfilled the study. Cyclists dominated, 60%, followed by moped users, car occupants and pedestrians. The mean age was 11 years, 61% were boys, 16% were of foreign extraction, 26% were treated as inpatients, and 11% had at least one serious (AIS3+) injury. Residual problems were reported for 16% of the study group (n=53), and of these 31% were located to the lower extremities (mostly knee problems), upper extremities in 20%, face in 14%, neck in 14%, upper trunk in 8%, lower trunk in 8%, and skull/brain in 3%. Significant permanent impairment was reported in one case. Cyclists reported problems significantly less frequently than others. Children reporting problems tended to be older and were most often injured as moped users. Problems to the neck and the upper trunk were reported to a higher rate than the injury rate in these regions. Children with residual problems reported limitations in daily living activities after the accident more often than those without residual physical problems. CONCLUSIONS: Residual physical problems were reported in about one sixth of the study group, few with serious problems. The risk of residual problems should be recognised in older children, especially after moped accidents, and also in children with neck problems.

Cervical status after neck sprains in frontal and rear-end car impacts.

OBJECTIVE: To compare the cervical status after neck sprains in frontal and rear-end car impacts with respect to earlier proposed neck-sprain injury mechanisms, rotated head at impact, and the seat-belt geometry. METHODS: A prospective, multidisciplinary, in-depth study was made based on 23 car occupants injured in frontal impacts and 108 injured in rear-end impacts. The active neck mobility was measured in protraction-retraction, flexion-extension, side bending right-left, and rotation right-left. This was done in the acute phase and then three and twelve months later. The maximum range, increase in pain, and level of pain were recorded for each movement. A subgroup with increased pain during movements towards the impact direction, but not in the opposite one, so-called isolated contra-directional pain (ICP), was further analysed. The side bending and rotation mobility were studied in another subgroup, in which the head was rotated inwards or outwards relative the car, i.e. away from or towards the diagonal part of the seat belt. RESULTS: Rear-end impacts more often than frontal impacts caused greater restrictions of the cervical mobility and more frequently increased pain at the three different times that measurements were recorded, but, with few exceptions, the differences for each movement were not statistically significant. Increased pain during extension was more often noted after rear-end impacts. ICP during pro-/retraction was also more often noted after rear-end impacts. Head-inward rotation in rear-end impacts caused a more restricted mobility in the same direction at the primary examination than head-outward rotation. CONCLUSIONS: The cervical status after neck sprains in frontal and rear-end car impacts is very similar, and the cervical range of movement in different directions and increased pain during cervical motions do not reveal any specific isolated injury mechanisms. Combined injury mechanisms should be considered, and further studies are recommended to investigate asymmetric loading during impact.

Jaw symptoms and signs and the connection to cranial cervical symptoms and post-traumatic stress during the first year after a whiplash trauma.

PURPOSE: To estimate the prevalence of jaw symptoms and signs during the first year after a neck sprain in a car collision. Further, to determine their relationships to the localisation and grade of the initial neck symptoms and signs, headache, post-traumatic stress and crash characteristics. METHODS: One hundred and forty-six adult subjects and crash characteristics were prospectively investigated in an in-depth study during 1997-2001. Head, neck, and jaw symptoms and signs were recorded within 5 weeks and after 1 year. Acute post-traumatic stress was estimated with the Impact of Event Scale-Revised (IES-R). RESULTS: Jaw symptoms were initially reported by three men (5%) and three women (4%), and subsequently developed in eight women (10%) during the following year. Jaw signs were noted initially in 53 subjects (37%) and in 28 subjects (24%) after 1 year, without difference between sexes, and more often after low-speed impacts. Headache in females, cranial cervical symptoms, pronounced neck problems, post-traumatic stress and whiplash-associated disorders (WAD) grade II-III after rear-end impacts were related to jaw signs during the acute phase. After 1 year, jaw signs were related to residual neck problems, headache and post-traumatic stress. CONCLUSIONS: Jaw symptoms are seldom reported during the acute phase after a whiplash trauma. Women more often than men develop jaw symptoms during the first year. Jaw symptoms and signs may develop also after low-speed impacts, especially after rear-end collisions. Jaw symptoms and signs should be observed after whiplash trauma, especially in those with headache, pronounced neck problems, cranial neck symptoms and post-traumatic stress.

Children and adolescents injured in traffic--associated psychological consequences: a literature review.

AIM: To identify the prevalence of post-traumatic stress disorder (PTSD) and PTSD symptoms (PTSS) among children and adolescents injured in traffic, and to assess predictors of such post-traumatic stress. METHODS: Studies identified from electronic databases were reviewed. RESULTS: Based on a review of 12 studies, fulfilling specified criteria, the prevalence of PTSS was estimated at 30% within 1 month and 13% at 3-6 months. The prevalence of PTSD was almost 30% at 1-2 months and decreased to the same level as PTSS at 3-6 months. Perceived threat and high levels of distress, anxiety symptoms and being female were significantly associated with PTSD and PTSS. Injury severity was positively related to the number of PTSD symptoms in one of eight studies. Types of accident, age and socioeconomic status were not related to the development of PTSD/PTSS. CONCLUSION: Any child will be at risk of PTSD/PTSS, not just those with severe injuries. Trauma care should include procedures that could identify and prevent stress reactions in order to minimize the risk of associated psychological consequences.

Psychosocial aspects of road traffic trauma--benefits of an early intervention?

PURPOSE: To assess the psychosocial consequences of traffic accidents, and to evaluate the effect of an intervention programme to reduce the occurrence and extent of psychosocial residual states. MATERIAL AND METHODS: A telephone interview was conducted with 314 individuals, 1(1/2)-2 years after the accident in 1994-1995. The effect of the intervention programme was studied for inpatients, 68 in the study group, and 89 in the control group. The structured follow-up form included the Impact of Event Scale (IES). RESULTS: Half of those injured had residual physical complaints with negative effects on their work- and economic-situation. An influence on housing or the need for practical assistance was reported by 1-7%. Mental effects were reported by 4/5. IES demonstrated that 1/5 suffered a high degree of intrusion, and this occurred twice as often among females as among males. Situational anxiety occurred more often in the intervention group than in the control group, p=0.02. More individuals in the intervention group than in the control group were satisfied with the medical certificate to the insurance company, p=0.058. CONCLUSIONS: Females were afflicted by mental effects considerably more than males. The intervention programme did not appear to reduce the psychosocial sequelae. The methods within this area need to be further developed.

Whiplash-associated disorders in frontal impacts: influencing factors and consequences.

This multidisciplinary in-depth investigation of accidents using 24 occupants with neck symptoms shows the complexity of whiplash-associated disorders (WAD) in frontal impacts with respect to factors that influence occurrence as well as duration of symptoms. Several different occupant kinematics have been identified, all resulting in symptoms classified as WAD. Compared to occupants restrained only by a seat belt, occupants with arm resistance influence showed a greater representation of symmetrical neck symptoms. Two cases of unbelted occupants with a neck compression mechanism far from conventional "whiplash" motion were found. Posture as well as physical and psychosocial factors such as strong negative reactions, bad prognosis expectation, and stressed daily activities influenced the duration of symptoms. Occupant characteristics and sitting posture and behavior at the time of impact are important factors when analyzing and understanding WAD.

Cycling and alcohol.

PURPOSE: To compare the accident and the psychosocial circumstances and the consequences of the injuries sustained by intoxicated (alcohol) and sober cyclists in road traffic accidents. MATERIAL AND METHODS: A telephone interview was conducted with 207 adults injured 3 years earlier. The group was selected from the list of 1278 cyclists registered at the hospitals in Göteborg in 1995 and 1996. Ninety-five of the 207 had been registered as under the influence of alcohol and 112, registered as sober, constituted a matched group. RESULTS: Compared with the sober group, the intoxicated cyclists more often sustained their injuries at night time (P<0.001), at the weekend (P<0.001), on their way to or from a party or a pub/restaurant (P<0.001) and in single accidents (P<0.001) with a greater risk of injury to the head or face (P<0.001). They cycled less during the year (P<0.001), were not so familiar with the route (P=0.045) or bicycle (P<0.001), had bicycles without a hand-brake or gears (P=0.045) and less often wore a helmet (P=0.003). Driving licences had been revoked only in the intoxicated group (P=0.02) and nine out of ten who were divorced were from this group (P=0.004). CONCLUSIONS: Injury prevention for cyclists should aim at altering the attitude towards cycling intoxicated and increasing the use of a helmet. The alternative is a change in the law in both cases.

Prediction of outcome in whiplash-associated disorders using West Haven-Yale Multidimensional Pain Inventory.

OBJECTIVE: To investigate the predictive capacity of the West Haven-Yale Multidimensional Pain Inventory (MPI) with regard to prolonged pain, using car occupants who had sustained a neck sprain in a traffic accident. DESIGN: A prospective cohort study including a one-year follow-up. PATIENTS: One hundred thirty adults were examined by a specialized neck-injury team after a first visit to an accident and emergency department. The subjects answered the MPI questionnaire within one month of the accident. OUTCOME MEASURES: One year later, the patients answered a questionnaire about residual neck pain. The main outcome was determined by the question, "Do you have residual pain which you relate to the accident?" RESULTS: One hundred twenty-three (95%) of the subjects completed the study. Ninety-seven reported pain of some degree that they related to the accident. All but one of the MPI variables differed significantly between the group with residual pain and the group without pain. The variable interference had the strongest correlation with the outcome. Its discriminative capacity was 81% for those with pain and 94% for those without pain one year later. CONCLUSIONS: The MPI may be used at an early stage to identify patients who may develop chronic neck-pain after a traffic accident, at least in those who want a follow-up session after an initial visit to an accident and emergency department.