Pressure-based abdominal injury criteria using isolated liver and full-body post-mortem human subject impact tests

Liver trauma research suggests that rapidly increasing internal pressure plays a role in liver injury. Previous work has shown a correlation between pressure and liver injury in pressurized ex vivo human livers when subjected to blunt impacts. The purpose of this study was to extend the investigation of this relationship between pressure and liver injury by testing full-body post-mortem human surrogates (PMHS). Pressure-related variables were compared with one another and also to previously proposed biomechanical predictors of abdominal injury. Ten PMHS were tested. The abdominal vessels were pressurized to physiological levels using saline, and a pneumatic ram impacted the right side of the specimen ribcage at a nominal velocity of 7.0 m/s. Specimens were subjected to either lateral (n = 5) or oblique (n = 5) impacts, and the impact- induced pressures were measured by transducers inserted into the hepatic veins and inferior vena cava. The liver injuries observed were similar to those documented in the Crash Injury Research Engineering Network (CIREN) trauma database. Using binary logistic regression to develop injury risk functions, it was determined the peak rate of pressure change (Ṗmax) was a statistically significant predictor of AIS ≥ 3 liver injury for both the PMHS and ex vivo testing. This suggests that Ṗmax is a good predictor of liver injury regardless of the impact boundary conditions.