University of New Jersey CIREN team PowerPoint presentation - December 2001

SLIDE 1:
AGE, SEX AND MVCs: Achilles, ANthony and Cleopatra, and Sara and Abraham as Motor Vehicle Crash Victims


SLIDE 2:
CIREN TEAM:
 - John H. Siegel, MD, FACS
 - Joyce A. Smith, MS
 - Nadegda Tenenbaum, MD
 - Laurie McCammon
 - Ruth Ross, PhD
 - Philip Marsh, MS
 - Esther Leibovich, BS


SLIDE 3:
CRASH RECONSTRUCTION:
 - Frank Costanzo (ACA)
 - Robert Freeth (ACA)
 - Robert Schaar (Dynamic Science)

REGIONAL MEDICAL EXAMINER'S OFFICE:
 - Faruk Presswalla, MD


SLIDE 4:
ADDITIONAL CASES CONTRIBUTED BY:
 - Patricia C. Dischinger, PhD and Andrew Burgess, MD
(University of Marylnad-Baltimore and Charles McC. Mathias National Study Center for Trauma)

 - Stewart C. Wang, MD, PhD (Trauma-Burn Center, University of Michigan, and the University of Michigan Transportation Research Institute)

 - David Grossman, MD, MPH (University of Washington Harborview Medical Center and Harborview Injury Prevention and Research Center)


SLIDE 5:
OUR SAMPLE GROUP

MALES
 Ages: 16-44	Frontal crash: 111 / Lateral crash: 35
 Ages: 45-59	Frontal crash:  32 / Lateral crash:  9
 Ages: 60+   	Frontal crash:  31 / Lateral crash: 12

FEMALES
 Ages: 16-44	Frontal crash: 86 / Lateral crash: 37
 Ages: 45-59	Frontal crash: 28 / Lateral crash: 12
 Ages: 60+   	Frontal crash: 38 / Lateral crash:  6


SLIDES 6-7:
AGE DISTRIBUTION OF FRONTAL CRASH SAMPLE POPULATION


SLIDES 8-9:
ACHILLES
Vital young warrior, hero of the Greek victory over Troy
 - 17 year old male unrestrained driver
 - weight = 104kg (229lb)
 - height = 167cm (5'6")
 - airbag deployed
 - survivor
 	* our American adolescent road warrior....


SLIDE 10:
	...has a high speed chariot crash
V1 = 1994 Honda Accord (1342kg)
 - DeltaV = 51.7kph
 - energy dissipated = 170,056 joules
 - max crush = 81cm at C1

V2 = tractor-trailer (454545kg)


SLIDE 11:
Scene diagram


SLIDE 12:
scene photograph


SLIDE 13:
subject vehicle (post-crash photo)


SLIDE 14:
airbag deployment (post-crash photo)


SLIDE 15:
no seat belt use (post-crash photo)


SLIDE 16:
widened mediastinum (CT scan)


SLIDE 17:
CT of aortic disruption with left hemothorax


SLIDE 18:
CT reconstruction showing aortic pseudoaneurysm


SLIDE 18:
left femoral fracture due to axial loading (CT scan)


SLIDE 20:
INJURY LIST
- Right frontal ICH (source: windshield)
- multiple rib fractures (source: steering wheel rim)
- right pulmonary contusion with large left HTX (source: steering wheel rim)
- 2 descending aortic ruptures (source: steering wheel rim)
- liver, spleen and bilateral kidney laceration (source: steering wheel rim)
- left axillary nerve injury (source: left door panel)
- left midshaft femur fracture (source: left instrument panel)


SLIDE 21:
CLEOPATRA:
 Macedonian queen of Egypt; seductress of history

ANTHONY:
 Fatal lover ensnared in her "sweet coils of grace"


SLIDE 22:
YOUNG CLEOPATRA
 - 26-year-old female unrestrained driver
 - weight = 60kg (132lb)
 - height = 160cm (5'3")
 - airbag deployed
 - survivor
	* Our modern young Cleopatra hastens to her rendezvous....


SLIDE 23:
	... in her SUV

V1: 1998 Mitsubishi Montero Sport SUV (1930kg)
 - DeltaV = unknown
 - energy dissipated = unknown
 - max crush = 80cm at C1

V2: transit bus


SLIDE 24:
scene diagram


SLIDE 25:
scene photo


SLIDES 26-27:
subject vehicle (post-crash photo)


SLIDE 28:
airbag deployment (post-crash photo)


SLIDE 29:
no seat belt use (post-crash photo)


SLIDE 30:
interior view (post-crash photo)


SLIDE 31:
(photo) Steering wheel mark across upper abdomen


SLIDE 32:
(xray) left hip dislocation


SLIDE 33:
(xray) right femur fracture


SLIDE 34:
multiple rib fractures


SLIDE 35:
CT scan - lung contusion below rib fractures

SLIDE 36:
INJURY LIST
 - chest and breast contusions (source: airbag cover)
 - right multiple rib fractures (source: airbag & steering wheel)
 - right pulmonary contusion (source: airbag & steering wheel)
 - liver contusion (source: steering wheel rim)
 - left hip dislocation (source: instrument panel)
 - right midshaft femur fracture  (source: instrument panel)
 - right patella fracture (source: instrument panel)


SLIDE 37:
MATURE CLEOPATRA
 - 47 year old female
 - seatbelt-restrained driver
 - weight = 77kg (169lb)
 - height = 170cm (5'7")
 - airbag deployed
 - survivor
	* dragged along by fate...

SLIDE 38:
	...in a more conservative chariot
V1 = 1996 Ford Explorer (1631kg)
 - DeltaV = 53.7kph
 - energy dissipated = unknown
 - max crush = 61cm at C3

V3 = 1994 Hyundai Elantra (1122kg)
 - driver fatality in V3


SLIDE 39:
scene diagram


SLIDE 40:
scene photo


SLIDE 41:
subject vehicle (post-crash photo)


SLIDE 42:
airbag deployment (post-crash photo)


SLIDE 43:
head and facial injuries (post-crash photo - sanitized)


SLIDE 44:
seat belt marks (post-crash photo)


SLIDE 45:
right 7th rib fracture (xray)


SLIDE 46:
right kidney laceration from seat belt (CT scan)


SLIDE 47:
left 4th lumbar burst fracture from seat belt (CT scan)


SLIDE 48:
left 4th lumbar burst fracture from seat belt (xray)


SLIDE 49:
left 4th lumbar burst fracture from seat belt (CT scan)


SLIDE :
INJURY LIST:
 - left internal capsule hemorrhage (source: airbag)
 - r parietal, L midbrain contusion (source: airbag)
 - right 7th rib fracture (source: seatbelt restraint)
 - right lower abdominal contusion (source: seatbelt restraint)
 - right kidney laceration (grIV) (source: seatbelt restraint)
 - L4 burst body fracture (source: loading from restraint)
 - L4 facet fracture (source: loading from restraint)


SLIDE 51:
YOUNG ANTHONY
 - 42 year old male unrestrained driver
 - weight = 78kg (172lb)
 - height = 170cm (5'7")
 - airbag deployed
 - survivor
	** racing heedlessly to love...


SLIDE 52:
	...his small chariot collided with an elephant at high speed

V1= 1999 Hyundai Accent (953kg)
 - DeltaV = 46kph
 - Energy dissipated = 74,186 joules
 - max crush = 45cm at C6

V2 = 1999 Chrysler Town and Country minivan (1643kg)


SLIDE 53:
scene diagram


SLIDE 54:
scene photo


SLIDE 55:
subject vehicle (post-crash photo)


SLIDE 56:
airbag deployment (post-crash photo)


SLIDE 57:
facial contact with airbag (post-crash vehicle interior photo)


SLIDE 58:
toe pan intrusion (post-crash vehicle interior photo)


SLIDE 59:
right hip fracture and dislocation (xray)


SLIDE 60:
head of femur fracture (CT scan)


SLIDE 61:
head of femur fracture (CT scan)


SLIDE 70:
repair of femoral head


SLIDE 71:
right tibial plateau fracture


SLIDE 72:
INJURY LIST

 - right cheek laceration (source: airbag cover)
 - right wrist laerations (source: instrument panel)
 - right knee abrasions (source: instrument panel)
 - right hip posterior dislocation (source: instrument panel)
 - right femoral head fracture with intra-articular fragment (source: instrument panel)
 - right acetabulum fracture (source: instrument panel)
 - right tibial plateau fracture (source: instrument panel)


SLIDE 65:
MATURE ANTHONY
 - 53 year old male unrestrained driver
 - weight = 70kg (154lb)
 - height = 170cm (5'7")
 - airbag deployed
 - survivor
	* the battle lost: love is at an end...


SLIDE 66:
	...high-speed desperation in a better chariot
V1 = 1997 Honda Civic (1064kg)
 - DeltaV = 63.4kph
 - energy dissipated = 178,365 joules
 - max crus = 45cm at C1

V2 = 1992 Ford Taurus (1430kg)
 - DeltaV = 47kph
 - energy dissipated = 125,071 joules

SLIDE 67:
scene diagram

SLIDE 68:
scene photo


SLIDE 69:
subject vehicle (post crash photo)


SLIDE 70:
airbag deployment - no seat belts (post-crash photo)


SLIDE 71:
bent steering wheel (post-crash photo)


SLIDE 72:
impact sites with instrument panel (post-crash photo)


SLIDE 73:
widened mediastinum (CT scan)


SLIDE 74:
aortic arch pseudoaneurysm (CT scan)


SLIDE 75:
CT reconstruction of aortic arch pseudoaneurysm


SLIDE 76:
axial loading fractures of left femur and left patella


SLIDE 77:
INJURY LIST
 - massive chest contusion (source: airbag)
 - sternum fracture (source: steering wheel)
 - bilateral rib fractures (inc.1&2) (source: steering wheel)
 - aortic arch laceration (source: steering wheel)
 - liver laceration (source: steering wheel)
 - right clavicle fracture (source: steering wheel)
 - left open midshaft femur fracture (source: steering column)
 - left intertrochanteric femur fracture (source: instrument panel)
 - left cominuted patella fracture (source: instrument panel)
 - right open tibia/fibula fracture (source: toe pan)
 - left foot fractures  (source: toe pan)


SLIDE 78:
ABRAHAM - aged patriarch
and
SARAH - aged mother


SLIDE 79:
ABRAHAM:
 - 71 year old male unrestrained driver
 - weight 85k (187lb)
 - height = 170cm (5'7")
 - airbag deployed
 - survivor
	* contemplating eternal truth, falls asleep at the wheel....


SLIDE 80:
	...and has aserious impact with the Tree of Life....

V1 = 1993 Chevrolet Caprice (1839kg)
 - DeltaV = 66kph
 - energy dissipated = 324,351 joules
 - max crush = 115cm at C3

V2 = tree


SLIDE 81:
scene diagram


SLIDE 82:
scene photo


SLIDE 83:
unfortunate tree (photo)


SLIDE 84:
subject vehicle (post-crash photo)


SLIDE 85:
driver compartment intrusion (post-crash photo)


SLIDE 86:airbag deployment (no seat belt) 
seat far forward on impact


SLIDE 87:
seat belt inactivated by driver


SLIDE 88:
brake and gas pedals deformed


SLIDE 89: 
post-crash photo: airbag cover injury to chin and jaw, with brain contusion


SLIDES 9091:
left bimalleolar fractures


SLIDE 92: 
INJURY LIST
 - left parietal SAH (source: airbag cover)
 - left frontal lobe contusion (source: airbag cover)
 - chin contusion (source: airbag cover)
 - upper neck, chest abrasion (source: airbag cover)
 - left knee, ankle abrasion (source: instrument panel)
 - left bimalleolar fracture (source: toe pan)



SLIDE 93:
SARAH
 - 73 year old female restrained driver
 - weight = 79kg (174lb)
 - height = 160cm (5'3")
 - airbag deployed
 - survivor
	* revered mother daydreaming of beloved children and grandchildren....


SLIDE 94: 
	...awakens to find pole bearing down on vehicle..

V1 = 1999Oldsmobile Intrigue (1594kg)
 - DeltaV = 51,3kph
 - energy dissipated = 168,226 joules
 - max crush = 82cm at C4

V2 = pole


SLIDE 95:
scene diagram


SLIDE 96: 
scene photo


SLIDE 97:
subject vehicle (post-crash photo)


SLIDE 98: 
pole impact (post-crash photo)


SLIDES 99-100:
airbag deployment (seat belt restrained) (post-crash photo)


SLIDE 101: 
pulmonary contusions


SLIDE 102:
(CT scan) sternal fracture


SLIDES 103-104: 
(CT scan) (multiple) rib fractures


SLIDE :
INJURY LIST
 - left chest wall contusion (source: airbag)
 - sternum abrasion (source: airbag/cover)
 - bilateral rib fractures (source: airbag/cover)
 - sternum comminuted fracture (source: airbag/cover)
 - bilateral knee abrasions (source: instrument panel)
 - bilateral lower leg contusions (source: foot pedals)


SLIDE 106: 
MALES AGE 16-44 vs. AGE 45-59 IN FRONTAL CRASHES


SLIDE 107:
MALES AGE 45-59 vs. AGE 60+ IN FRONTAL CRASHES


SLIDE 108: 
MALES AGE 16-44 vs.AGE 60+ IN FRONTAL CRASHES


SLIDE 109:
FEMALES AGE 16-44 vs. AGE 45-59 IN FRONTAL CRASHES


SLIDE 110: 
FEMALES AGE 16-44 vs.AGE 60+ IN FRONTAL CRASHES


SLIDE 111:
FEMALES AGE 16-44 vs.AGE 60+ IN FRONTAL CRASHES


SLIDE 112: 
AGE 16-44 MALES vs. FEMALES IN FRONTAL CRASHES


SLIDE 113:
AGE 45-59 MALES vs. FEMALES IN FRONTAL CRASHES


SLIDE 114
AGE 60+ MALES vs. FEMALES IN FRONTAL CRASHES


SLIDES 115-116:
CONCLUSIONS:
* women tend to be shorter and lighter than men in general. However, there is no difference within gender by age groups.

* Females and males over age 60 tend to have crashes with lower deltaV's, spend more time in the hospital, have more intensive care days and asignificantly lower survival rate than younger individuals of the same gender. This is especially true for females.

* Thorax and rib injuries are the major difference between young and aged females, with elderly women having a significantly greater incidence of both. Cardiac injury and shock are also increased in elderly women.

* A comparison between men aged 60 and over and women aged 60 and over reveals that the increased susceptibility of elderly women to thorax and spine injuries is not simply due to age, and may be due to increased loss of bone mass in elderly women as opposed to elderly men.

SLIDE 117:
RECOMMENDATIONS:
Given the fact that the population is aging and larger numbers of persons, especially women, survive into the eighth and ninth decade, specific modifications in restraint and iarbag aggressivity may have to be provided for this group of patients

There may also have to be modifications in foot pedal lengths as well as adjustments in seat and steering whieel location so older females, who tend to be shorter, can be seated effectively further form the steering wheel, without compromising their ability to see the road.