New Jersey CIREN team PowerPoint presentation, september 2001

SLIDE 1:
FACTORS INFLUENCING THE PATTERNS OF INJURIES AND OUTCOMES IN SEDAN vs SEDAN CRASHES COMPARED TO SPORT UTILITY, VAN, OR PICK-UP TRUCK vs SEDAN CRASHES


SLIDE 2:
map of CIREN network teams in the United States


SLIDE 3:
NEW JERSEY MEDICAL SCHOOL - UMDNJ
DEPARTMENTS OF ANATOMY, CELL BIOLOGY AND INJURY SCIENCES AND OF SURGERY

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
 - Ahmed Mahmood, BS


SLIDE 4:
CRASH RECONSTRUCTION:
 - Frank Costanzo (ACA)
 - Robert Freeth (ACA)
 - Robert Schaar (Dynamic Science)

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


SLIDE 5:
ADDITIONAL CASES CONTRIBUTED BY:

Patricia C. Dischinger, PhD and Andrew Burgess, MD
(University of Maryland - Baltimore and Charles McC. Mathias National study Center for Trauma

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

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


SLIDE 6:
THE SUVT PROBLEM
The introduction into the U.S. fleet of a high percent of large, heavy and bulky vehicles as represented by sport utility vehicles, family vans, and light pick up trucks produces crash incompatibilities when these impact sedans. SUVTs represent a threat to the ability of the present set of safety devices to continue to maintain a low injury, low complication and reduced mortality profile in SUVT-sedan MVC's.


SLIDE 7:
STUDY INCLUSION CRITERIA
- driver or front seat passenger from frontal or lateral MVCs
- no rollovers, no rear end collisions
- no ejection of victim
- must be 16 years of age or older
- all cases obtained after informed consent with Certificate of Confidentiality


SLIDE 8:
RESULTS

449 patients were analyzed

 - 331 frontal crash occupants
	* 174 with airbags
	* 156 no airbags
	* 1 unknown airbag status
 - 118 lateral crash occupants

of the 257 two-car crash occupants
 - 87 frontal & 33 lateral - sedan vs sedan
 - 62 frontal & 37 lateral - sedan vs SUVT
 - 25 frontal & 2 lateral - SUVT vs sedan
 - 7 frontal & 4 lateral - SUVT vs SUVT


SLIDE 9:
TABLE IA: frontal vs lateral crashes
(by t-test or Fisher exact: P-value: 
'+' <0.05  
'++' < 0.01  
'+++'<0.001


SLIDE 10:
TABLE IB: Frontal Crashes: Airbags & Seatbelts


SLIDE 11:
(bar chart)
ALL FRONTAL CASES vs. ALL LATERAL CASES


SLIDE 12:
(bar chart)
ALL FRONTAL AIRBAG vs. ALL FRONTAL NO AIRBAG


SLIDE 13:
CASE PRESENTATION:
SEDAN vs SEDAN -  LEFT LATERAL CRASH


SLIDE 14:
LEFT LATERAL MOTOR VEHICLE CRASH

V1 = 1991 Toyota Corolla DX 4door sedan (1057kg), failed to observe stop sign and attempted left turn against traffic.

V2 = 1990 Lincoln Mark VII 2 door (1718 kg), travelling eastbound in travel lane.


SLIDE 15:
CASE OCCUPANT (V1)
 - 36 year old female restrained driver
 - weight = 45kg (100lb)
 - height = 155cm (5'1")



SLIDE 16:
CRASH SCENE
 - 4-lane divided urban roadway at its intersection with a commercial driveway
 - speed limit = 64kmh (40mph)
 - roadway dry, free of defects
 - positive 4% grade in eastbound direction
 - visibility for both V1 and V2 limited by stopped urban transit bus


SLIDE 17:
RECONSTRUCTION DATA (V1)
 - left lateral collision
 - CDC = 09LYEW2
 - PDOF = 270 degrees
 - Delta V = 29kph (16.3mph)
 - max crush = 14cm at C2
 - estimated speed V1 = 32-40kph (20-25mph)
 - estimated speed V2 = 64-72kph (38-44mph)


SLIDE 18:
scene diagram
(text commentary illegible)


SLIDE 19:
photo of roadway - crash path


SLIDE 20:
post-crash vehicle exterior photos


SLIDE 21:
LEFT LATERAL MOTOR VEHICLE CRASH VS. SEDAN - CASE OCCUPANT (V1) INJURY LIST

INJURY <SOURCE> INTRUSION(cm)
- loss of consciousness <1hr 	<left window/frame> 	0cm
- left forehead abrasion 	<left window/frame> 	0cm
- left forehead contusion	<left window/frame> 	0cm
- left pneumothorax		<left armrest/hardware>	18cm
- left inferior 
  pubi rami fracture		<left armrest/hardware>	18cm
- left anterior and posterior
  acetabular column fracture	<left armrest/hardware>	18cm
- left anterior and posterior
  acetabular wall fracture	<left armrest/hardware>	18cm
- left iliac wing fracture	<left armrest/hardware>	18cm
- obturator branch of left internal
  iliac artery laceration	<left armrest/hardware>	18cm
- retroperitoneal hematoma	<left armrest/hardware>	18cm\
- pubic symphysis diastasis	<left armrest/hardware>	18cm


SLIDE 22:
CASE PRESENTATION:
SEDAN VS. VAN
LEFT LATERAL CRASH


SLIDE 23:
LEFT LATERAL MOTOR VEHICLE CRASH
V1 = 1997 Ford Taurus 2door sedan (1497kg), entered intersection from roadway with a posted stop sign.

V2 - 1989 Ford Econolone van (2300kg), travelling northbound in travel lane.


SLIDE 24:
CASE OCCUPANT (V1)
 - 78 year old female unrestrained driver
 - weight = 70kg (154lb)
 - height = 163cm (5'4")


SLIDE 25:
CRASH SCENE
 - 2-lane urban intersection controlled by stop sign in one direction only
 - speed limit = 72km/h (45 mph)
 - roadway dry, straight, free of defects)
 - daylight conditions


SLIDE 26:
RECONSTRUCTION DATA (V1)
 - left lateral collision
 - CDC = 10LYAW3
 - PDOF = 305 degrees
 - Delta V = 22kph (13.8mph)
 - Max Crush = 28cm at C3
 - estimated speed V1 = 16-24kph (10-15mph)
 - estimated speed V2 = 72-81kph (45-51mph)


SLIDE 27:
crash scene diagram


SLIDE 28:
photos - crash path - roadway


SLIDES 29-30:
photos - post-crash vehicle interior


SLIDE 31:
LEFT LATERAL MOTOR VEHICLE CRASH vs VAN - CASE OCCUPANT (V1) INJURY LIST

INJURY 			<SOURCE> 	INTRUSION (cm)

INJURY <SOURCE> INTRUSION(cm)
- loss of consciousness <1hr 	<left A pillar> 	12cm
- left tempero-parietal 
   scalp laceration 		<left A pillar> 	12cm 	
- bilateral subdural hematomas
  (tempero-parietal 		<left A pillar> 	12cm
- bilateral subarachnoid 
  hemorrhages 			<left A pillar> 	12cm
- right lateral chest wall 
  abrasions			<airbag>		n/a
- left pneumothorax		<left door panel>	17cm
- left rib fractures (111-v11)	<left door panel>	17cm
- splenic laceration <3cm	<left door panel>	17cm
- sternum fracture		<airbag>		n/a
- bilateral ventricular wall
  contusions			<airbag>		n/a
- right lateral abdominal wall
  abrasions			<airbag>		n/a


SLIDE 32:
 skeletal diagram, indicating injuries (text illegible)


SLIDE 33:
 vehicle interior diagram, indicating points of contact for injuries (text illegible)


SLIDE 34:
CASE PRESENTATION 
SEDAN vs SUV - FRONTAL CRASH (VEHICLE 1)


SLIDE 35:
FRONTAL MOTOR VEHICLE CRASH

V1 = 1994 Nissan Sentra 4 door sedan (1114kg), crossed into oncoming traffic lanes

V2 = 1997 Jeep Grand Cherokee 4 door SUV (1850kg), travelling northbound in travel lane.


SLIDE 36:
CASE OCCUPANT (V1)
 - 27 year old male unrestrained driver
 - weight = 67kg (148lb)
 - height = 180cm (5'11")


SLIDE 37:
CRASH SCENE
 - 2 lane undivided urban roadway
 - speed limit = 56kph (35mph)
 - roadway dry, straight and level
 - daylight conditions
 - estimated coefficient of friction = 0.75


SLIDE 38:
RECONSTRUCTION DATA (V1)
 - frontal collision
 - CDC = 12FDEW3
 - PDOF = 350 degrees
 - Delta V = 38.3 kph (21.7mph)
 - max crush = 56cm at C1
 - estimated speed V1 = 72-80kph (45-50mph)
 - estimated speed V2 = 56-64kph (35-40mph)


SLIDE 39:
scene diagram for crash


SLIDES 40-42:
POST CRASH VEHICLE EXTERIOR PHOTOS


SLIDE 43:
FRONTAL MOTOR VEHICLE CRASH vs SUV - CASE OCCUPANT (V1) INJURY LIST

- left chin laceration 		<airbag> 		n/a
- liver laceration Grade IV	<steering wheel>	0cm
- left hepatic artery
  laceration			<steering wheel>	0cm
- left portal vein fistula	<steering wheel>	0cm
- left second metacarpal
   fracture			<steering wheel>	0cm			

SLIDE 44:
unidentified CT scans, appear to be liver?


SLIDE 45:
 skeletal diagram, indicating injuries (text illegible)


SLIDE 46:
CASE PRESENTATION: SEDAN vs SUV, FRONTAL CRASH (VEHICLE2)


SLIDE 47:
CASE OCCUPANT (V2)
 - 38 year old male restrained driver
 - weight = 82kg (180lb)
 - height = 178cm (5'10")


SLIDE 48:
RECONSTRUCTION DATA (V2)
 - frontal collision
 - CDC = 12 FLEE7
 - PDOF = 355 degrees
 - Delta V = 23.0 kph (14.3mph)
 - Max crush = 128 cm at C1
 - estimated speed V1 = 56-64 kph (35-40 mph)
 - estimated speed V2 = 72-80 kph (45-50 mph)


SLIDE 49:
post-crash vehicle exterior photos


SLIDE 50:
post-crash vehicle interior photos


SLIDE 51:
FRONTAL MOTOR VEHICLE CRASH - CASE OCCUPANT (V2) INJURY LIST
- loss of consciousness <1hr	<airbag>	n/a
- forehead abrasions		<airbag>	n/a
- right distal 1/3 
  fibula fracture		<brake pedal>	15cm displ.
- dright distal 1/3
  tibial fracture		<brake pedal>	15cm displ.
- left bimalleolar
  fibula fracture		<toe pan>	22cm


SLIDE 52:
x rays - tibia & fibula fractures


SLIDE 53:
skeletal diagram, indicating injuries (text illegible)



SLIDE 54:
ME CASE PRESENTATION
SEDAN vs SUV - RIGHT LATERAL CRASH


SLIDE 55:
RIGHT LATERAL MOTOR VEHICLE CRASH

V1 = 1991 Buick Skylark 4 door sedan (1299kg), passing through intersection after reportedly failing to stop at red light

V2 = 1996 Ford Explorer SUV (1775kg), passed through intersection on green traffic signal


SLIDE 56:
 - 46 year old male unrestrained driver
 - weight = 116kg (256lb)
 - height = 188cm (6'2")


SLIDE 57:
CRASH SCENE
 - 4 lane urban intersection controlled by a lighted traffic signal
 - speed limit = 64kph (40mph)
 - roadway = wet, dark


SLIDE 58:
RECONSTRUCTION DATA (V1)
 - right lateral collision
 - CDC = 03RYAW6
 - PDOF = 080 degrees
 - DeltaV = 58.8 kph (36.6mph)
 - max crush = 92 cm (12.2in) located 31cm forward of C3
 - estimated speed V1 = 64-72 kph (40-45mph)
 - estimated speed V2 = 81-88 kph (50-55mph)


SLIDE 59:
crash scene diagram - text illegible


SLIDE 60:
crash scene photo


SLIDEs 61-62:
post-crash vehicle photos - exterior

SLIDEs 63-64:
post-crash vehicle photos - interior


SLIDES 65-66:
RIGHT LATERAL MOTOR VEHICLE CRASH vs SUV - CASE OCCUPANT (V1) INJURY LIST
- subarachnoid hemorrhage
  (cerebellum)			<R front upper window frame> 70cm
- right jaw lacerations (2)	<R front window> 70cm
- right comminuted mandibular
  body fractures		<R front door panel> 70cm

- Atlanto-occipital dislocation <R front upper window frame> 70cm
- C-spine C1 complete cord
  trasnection 			<R front upper window frame> 70cm
- R rib fractures (II-V)	<R front door panel>  70 cm
- thoracic aorta transection (100%, 
  3cm distal to the LSA)	<R front door panel>  70cm
- left hemothorax (750cc)	<R front door panel>  70cm
- R vertebral artery laceration	<R front door panel>  70cm
- R upper extremity abrasions	<R front door panel>  70cm
- multiple liver lacerations	<R front door panel>  70cm
- bilateral pelvic abrasions
  bilateral (aspects)		<unknown>		n/a


SLIDE 67:
photos - liver laceration


SLIDE 68:
photos - rib fractures


SLIDES 69-71:
skeletal diagrams, indicating injuries (text illegible)


SLIDE 72:
ME CASE PRESENTATION: SEDAN vs SUV - LEFT LATERAL CRASH


SLIDE 73:
LEFT LATERAL MOTOR VEHICLE CRASH

V1 =  1985 Oldsmobile Cutlass Ciera 4door sedan (1257kg), passing through intersection on green light

V2 = 1994 Nissan Pathfinder SUV (1762kg), passed through intersection on red traffic signal


SLIDE 74:
CASE OCCUPANT (V1)
 - 35 year old female unrestrained driver
 - weight = 99kg (218lb)
 - height = 178cm (5'10")


SLIDE 75:
CRASH SCENE
 - 4-lane urban intersection controlled by a lighted traffic signal
 - roadway level and straight
 - speed limit = 56 kph (35mph)
 - roadway - asphalt, dry, free of defects
 - coefficient of friction - 0.70


SLIDE 76:
RECONSTRUCTION DATA (V1)
- left lateral collision
 - CDC = 09LYAW5
 - PDOF = 260 degrees
 - delta V = 47kph (20mph)
 - max crush = 89cm at C3
 - estimated speed V1 = 32-40kph (20-25mph)
 - estimated speed V2 = 48-56kph (30-35mph)


SLIDE 77:
crash scene diagram


SLIDES 78-79:
photos - crash scene, both invovled vehicles (post-crash)


SLIDES 80-81:
photos - post-crash vehicle exterior (V1)


SLIDE 82:
photos - post-crash vehicle interior (V1)


SLIDE 83:
photos - post-crash vehicle exterior (V2)


SLIDE 84:
LEFT LATERAL MOTOR VEHICLE CRASH vs SUV - CASE OCCUPANT (V1) INJURY LIST

- bilateran subarachnoid 
  hemorrhages			<B pillar> 38cm
- bilateral rib fractures	<door panel> 29cm
- bilateral pulmonary
  contusions			<door panel> 29cm
- bilateral pulmonary
  lacerations			<door panel> 29cm
- thoracic aorta transection	<door panel> 29cm
- splenic lacerations		<door panel> 29cm
- hemoperitoneum		<door panel> 29cm
- left shoulder lacerations	<door panel> 29cm
- left knee lacerations		<lower door panel> 29cm
- left lower leg abrasions	<lower door panel> 29cm


SLIDE 85:
photos - splenic lacerations


SLIDE 86:
photo - thoracic aorta transection


SLIDES 87-88:
skeletal/internal organ diagram, indicating injuries (text illegible)



SLIDEs 89-91:
bar charts (no numerical values provided)

FRONTAL SEDAN/MID-SIZE SUVT vs SEDAN/FULL-SIZE SUVT
LATERAL SEDAN/SEDAN vs SEDAN/FULL-SIZE SUVT
SUV INJURY COMPARISON: Patient in SUV vs patient struct by FSUVT (frontal or lateral)


SLIDE 92:
TABLE II: COMPARISON OF VEHICLE STRUCTURAL PARAMETERS IN FRONTAL CRASHES: STRIKING V2 vs OCCUPANT V1


SLIDE 93:
TABLE III: COMPARISON OF VEHICLE STRUCTURAL PARAMETERS IN LATERAL CRASHES: STRIKING V2 vs OCCUPANT V1


SLIDE 94:
TABLE IV: COMPARISON BETWEEN CATEGORIES OF VEHICLE CRASHES BY STRIKING V2 vs OCCUPANT V1 CATEGORIES


SLIDE 95:
TABLE V: EFFECT OF CRASH TYPE ON INCIDENCE OF INJURY PRODUCTING OCCUPANT COMPARMENT CONTACTS


SLIDE 96:
CONCLUSIONS:
* In two-vehicle MVCs, SUVT occupants are better protected agains serious and face injuries than occupants of the sedans that they hit.

* full size SUVTs striking sedans shift the pattern of injuries in a cephalad direction, increasing the incidence of brain, thorax, lung and liver injuries and decreasing the incidence of pelvic fractures and lower extremity injuries, compared to sedan vs. sedan crash injuries.


SLIDE 97:
FACTORS INDUCING INJURIES IN SUVT vs SEDAN CRASHES
- increase in mass ratio SUVT vs sedan
- increase in bumper height SUVT vs sedan
- increase in hood height SUVT vs. sedan
- increase in strike width of SUVT


SLIDE 98:
SUGGESTIONS FOR VEHICLE MODIFICATIONS TO REDUCE INJURY INCIDENCE AND SEVERITY
- uniform bumper height of sedans and SUVTs to match sedan frame support
- increase side impact standards to reduce intrusion of side door components into vehicle
- greater crush force dissipation in frontal structure of SUVTs
- side airbags at head and thorax/pelvis level in sedans


SLIDE 99:
NEW JERSEY STATE REGIONAL MEDICAL EXAMINER'S OFFICE - 
EDWIN H. ALBANO INSTITUTE OF FORENSIC SCIENCES
 - Faruk Presswalla, MD
 - Phito Pierre-Louis, MD
 - John Krolikowski, MD
 - Lila Perez, MD
 - A.Wayne Williams, MD
 - Kenneth Hutchins, MD
 - J. Shaikh, MD
 - Joan Burriello


SLIDES 100-102:
SPECIAL THANKS TO:
University of Maryland, Baltimore and the Charles McC> Mathias National Study Center for Trauma
 - Patricia C. Dischinger, PhD
 - Andrew R. Burgess, MD
 - Timothy Kearns

Trauma-Burn Center, University of Michigan, and the University of Michigan Transportation Research Institute
 - Stewart C. Wang, MD, PhD
 - Lawrence W. Schneider, PhD
 - Joel B. MacWilliams

University of Washington Harborview Medical Center and Harborview Injury Prevention and Research Center
 - David Grossman, MD, MPH
 - Fred Rivara, MD
 - Charles Mock, MD



SLIDE 103:
ADDITIONAL DISCUSSION
 - ME case with brush guards
 - Tabular results - airbag effects


SLIDE 104:
ME Case Presentation: SEDAN vs SUV - RIGHT LATERAL CRASH


SLIDE 105:
RIGHT LATERAL MOTOR VEHICLE CRASH

V1 = 1996 Plymouth Neon 4-door sedan (1096kg), attempting to make left turn on green. This vehicle DID meet the 1997 side protection standards

V2 = 2000 Mercedes-Benz ML430 SUV (2714kg), passed through intersection on red traffic signal


SLIDE 106:
CASE OCCUPANT (V1)
 - 51 year old white female restrained front seat passenger
 - weight = 67kg (149lb)
 - height = 168cm (5'6")



SLIDE 107:
CRASH SCENE	
- 4-lane urban intersetction controled by a lighted traffic signal
- 2 left lanes marked for left turn in both directions
- speed limit = 80kph (50mph)
- roadway = dry, free of defects
- coefficient of friction = .075
- curbs were covered by snow


SLIDE 108:
crash scene diagram


SLIDE 109:
photo of crash scene (intersection)


SLIDE 110:
post-crash photo of V1 - exterior


SLIDE 111:
RECONSTRUCTION  DATA
- right lateral collision
- CDC = 02RYEW4
- PDOF = 060 degrees
- delta V = 58.8kph (36.6mph)
- max crush = 61cm (24.4in) at C2
- estimated speed V1 = 19kph (12mph)
- estimated speed V2 = 80kph (50mph)


SLIDES 112-115:
photos - post-crash V1, exterior (various angles)


SLIDEs 116-117:
photos - post-crash V1, interior (various angles)


SLIDEs 118-119:
photos - post-crash V2, exterior (various angles)


SLIDES 120-121:
RIGHT LATERAL MOTOR VEHICLE CRASH vs SUV- CASE OCCUPANT INJURY LIST

- unconsciousness at scene 		<B-pillar> 34cm
- right parietal scalp abrasion		<B-pillar> 34cm
- right subgleal hemorrhage		<B-pillar> 34cm
- right forehead, eyelid abrasions	<B-pillar> 34cm
- bilateral posterior rib fractures
  (right II-IX; left V, VI)		<right door panel> 39cm
- posterior thoracic aorta lacerations
  (4cm distal to ostium of LSA)		<right door panel> 39cm
- bilateral hemothoraces (3500cc)	<right door panel> 39cm
- bilateral diaphragmatic laceration at the
  crura / T-spine junction		<right door panel> 39cm
- 3 linear liverlacerations (Grade II)	<right door panel> 39cm
- spleen laceration (grade I)		<center console>  none
- bladder mucosal laceration		<right door panel> 39cm
- right knee abrasion			<lower door panel> 32cm
- left pubic rami fracture		<center console>  none
- right sacroiliac joint fracture
  dislocation				<right door panel> 39cm



SLIDES 122-125:
ME photos internal organs, thoracic cavity (unlabeled)


SLIDE 126:
TABLE II: Effect of increased mass ratios - frontal airbag and frontal no-airbag crashes

SLIDE 127: TABLE III: EFFECT OF INCREASED MASS RATIOS (LATERAL CRASHES)