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Differences in thoracic injury causation patterns between seat belt restrained children and adults
Kristy B Arbogast1, Caitlin M Locey, Mark R Zonfrillo
1Center for Injury Research and Prevention, Children's Hospital of Philadelphia Department of Pediatrics, University of Pennsylvania Perelman School of Medicine.
Insights
Seat belt use in rear seats causes thoracic injuries differently across age groups. Younger occupants experience more lung injuries, while older individuals sustain more severe rib fractures from belt loading.
Area of Science:
- Biomechanics
- Injury Prevention
- Traffic Safety
Background:
- Rear seat occupants are increasingly common, necessitating a better understanding of their injury risks.
- Seat belt effectiveness is well-established, but injury patterns can vary by occupant age and restraint type.
Purpose of the Study:
- To analyze age-based differences in thoracic injuries among rear seat occupants restrained by lap and shoulder belts.
- To identify the causation of these injuries, focusing on how seat belt forces transfer to occupants of varying sizes.
- To inform the development of age-specific thoracic injury criteria.
Main Methods:
- Review of 20 frontal crash cases from the Crash Investigation Research and Engineering Network (CIREN).
- Inclusion criteria: rear seat, lap and shoulder belt restrained occupants with AIS 2+ thoracic injuries.
- Categorization of occupants into age groups: 8-15 years, 16-24 years, 25-54 years, and 55+ years.
Main Results:
- Younger occupants (8-15 years) predominantly suffered lung injuries (contusions, pneumothorax) with fewer skeletal fractures.
- Older occupants (16-24 years and 25+ years) experienced more frequent and severe rib fractures, often multiple and bilateral.
- Belt compression from shoulder or lap belts was identified as the primary injury mechanism, evidenced by contusions and abrasions.
Conclusions:
- Thoracic injury patterns from seat belt loading differ significantly between pediatric and adult rear seat occupants.
- Current thoracic injury criteria may not adequately address age-related variations in injury response.
- Further research is needed to refine age-specific injury assessment for rear seat occupants.
Abstract:
The objective of this research was to delineate age-based differences in specific thoracic injury diagnoses for seat belt restrained rear seat occupants and describe the associated injury causation in order to provide insight into how the load of the seat belt is transferred to occupants of various sizes. Using data from the Crash Investigation Research and Engineering Network (CIREN), 20 cases of rear seated, lap and shoulder belt restrained occupants with AIS2+ thoracic injuries in frontal crashes were reviewed. Seven were children and adolescents age 8-15 years, 5 were 16-24 years, 3 were 25-54 years, and 5 were 55+ years. Six of the seven 8-15 year olds sustained injuries to the lung in the form of pulmonary contusion or pneumothorax. Only three of the seven sustained a skeletal (sternum or rib) fracture; only one of these three involved multiple ribs bilaterally. In contrast, four of the five 16-24 year olds sustained at least one rib fracture - often multiple and bilateral. The adult cohort (25+ years) was involved in predominantly more minor crashes; however they all sustained complex rib fractures - seven of the eight involved multiple ribs, four of the eight were also bilateral. Belt compression - either from the shoulder belt or the lap belt - was identified as the primary cause of the thoracic injuries. Often, there was clear evidence of the location of belt loading from AIS 1 chest contusions or abrasions. These findings have implications for age-based thoracic injury criteria suggesting that that different metrics may be needed for different age groups.
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