cometadata/datacite-titles-descriptions-related-identifiers huggingface dataset:
DOI: 10.6084/m9.figshare.1568836
title: Mortality Risk in Pediatric Motor Vehicle Crash Occupants: Accounting for Developmental Stage and Challenging Abbreviated Injury Scale Metrics

description: <b>Objective:</b> Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity.<b>Methods:</b> The NASS-CDS 2000–2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0–4, 5–9, 10–14, and 15–18 years. Next, the National Trauma Databank 2002–2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MR<sub>MAIS</sub>) for each injury within 6 age groups: 0–4, 5–9, 10–14, 15–18, 0–18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated.<b>Results:</b> MR and MR<sub>MAIS</sub> distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all <i>P</i> MAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MR<sub>MAIS</sub> than such injuries among 5- to 9-year-olds and 10- to 14-year-olds (<i>P</i> =.04; <i>P</i> MAIS in 0- to 18-year-olds was 0.4% for an AIS 3 radius fracture versus 1.4% for an AIS 2 vault fracture.<b>Conclusions:</b> Trauma severity metrics are important for outcome prediction models and can be used in pediatric triage algorithms and other injury research. Trauma severity may vary for similar injuries based upon developmental stage, and this difference should be reflected in severity metrics. The MR-based data-driven determination of injury severity in pediatric occupants of different age cohorts provides a supplement or an alternative to AIS severity classification for pediatric occupants in MVCs.
DOI: 10.6084/m9.figshare.1568838.v2
title: Driver Injury Risk Variability in Finite Element Reconstructions of Crash Injury Research and Engineering Network (CIREN) Frontal Motor Vehicle Crashes

description: <b>Objective:</b> A 3-phase real-world motor vehicle crash (MVC) reconstruction method was developed to analyze injury variability as a function of precrash occupant position for 2 full-frontal Crash Injury Research and Engineering Network (CIREN) cases.<b>Method:</b> Phase I: A finite element (FE) simplified vehicle model (SVM) was developed and tuned to mimic the frontal crash characteristics of the CIREN case vehicle (Camry or Cobalt) using frontal New Car Assessment Program (NCAP) crash test data. Phase II: The Toyota HUman Model for Safety (THUMS) v4.01 was positioned in 120 precrash configurations per case within the SVM. Five occupant positioning variables were varied using a Latin hypercube design of experiments: seat track position, seat back angle, D-ring height, steering column angle, and steering column telescoping position. An additional baseline simulation was performed that aimed to match the precrash occupant position documented in CIREN for each case. Phase III: FE simulations were then performed using kinematic boundary conditions from each vehicle's event data recorder (EDR). HIC15, combined thoracic index (CTI), femur forces, and strain-based injury metrics in the lung and lumbar vertebrae were evaluated to predict injury.<b>Results:</b> Tuning the SVM to specific vehicle models resulted in close matches between simulated and test injury metric data, allowing the tuned SVM to be used in each case reconstruction with EDR-derived boundary conditions. Simulations with the most rearward seats and reclined seat backs had the greatest HIC15, head injury risk, CTI, and chest injury risk. Calculated injury risks for the head, chest, and femur closely correlated to the CIREN occupant injury patterns. CTI in the Camry case yielded a 54% probability of Abbreviated Injury Scale (AIS) 2+ chest injury in the baseline case simulation and ranged from 34 to 88% (mean = 61%) risk in the least and most dangerous occupant positions. The greater than 50% probability was consistent with the case occupant's AIS 2 hemomediastinum. Stress-based metrics were used to predict injury to the lower leg of the Camry case occupant. The regional-level injury metrics evaluated for the Cobalt case occupant indicated a low risk of injury; however, strain-based injury metrics better predicted pulmonary contusion. Approximately 49% of the Cobalt occupant's left lung was contused, though the baseline simulation predicted 40.5% of the lung to be injured.<b>Conclusions:</b> A method to compute injury metrics and risks as functions of precrash occupant position was developed and applied to 2 CIREN MVC FE reconstructions. The reconstruction process allows for quantification of the sensitivity and uncertainty of the injury risk predictions based on occupant position to further understand important factors that lead to more severe MVC injuries.
DOI: 10.6084/m9.figshare.1568835.v2
title: The Influence of Enhanced Side Impact Protection on Kinematics and Injury Measures of Far- or Center-Seated Children in Forward-Facing Child Restraints

description: <b>Objective:</b> To evaluate the influence of forward-facing child restraint systems’ (FFCRSs) side impact structure, such as side wings, on the head kinematics and response of a restrained, far- or center-seated 3-year-old anthropomorphic test device (ATD) in oblique sled tests.<b>Methods:</b> Sled tests were conducted utilizing an FFCRS with large side wings and with the side wings removed. The CRS were attached via LATCH on 2 different vehicle seat fixtures—a small SUV rear bench seat and minivan rear bucket seat—secured to the sled carriage at 20° from lateral. Four tests were conducted on each vehicle seat fixture, 2 for each FFCRS configuration. A Q3s dummy was positioned in FFCRS according to the CRS owner's manual and FMVSS 213 procedures. The tests were conducted using the proposed FMVSS 213 side impact pulse. Three-dimensional motion cameras collected head excursion data. Relevant data collected during testing included the ATD head excursions, head accelerations, LATCH belt loads, and neck loads.<b>Results:</b> Results indicate that side wings have little influence on head excursions and ATD response. The median lateral head excursion was 435 mm with side wings and 443 mm without side wings. The primary differences in head response were observed between the 2 vehicle seat fixtures due to the vehicle seat head restraint design. The bench seat integrated head restraint forced a tether routing path over the head restraint. Due to the lateral crash forces, the tether moved laterally off the head restraint reducing tension and increasing head excursion (477 mm median). In contrast, when the tether was routed through the bucket seat's adjustable head restraint, it maintained a tight attachment and helped control head excursion (393 mm median).<b>Conclusion:</b> This testing illustrated relevant side impact crash circumstances where side wings do not provide the desired head containment for a 3-year-old ATD seated far-side or center in FFCRS. The head appears to roll out of the FFCRS even in the presence of side wings, which may expose the occupant to potential head impact injuries. We postulate that in a center or far-side seating configuration, the absence of door structure immediately adjacent to the CRS facilitates the rotation and tipping of the FFCRS toward the impact side and the roll-out of the head around the side wing structure. Results suggest that other prevention measures, in the form of alternative side impact structure design, FFCRS vehicle attachment, or shared protection between the FFCRS and the vehicle, may be necessary to protect children in oblique side impact crashes.
DOI: 10.6084/m9.figshare.1568836.v2
title: Mortality Risk in Pediatric Motor Vehicle Crash Occupants: Accounting for Developmental Stage and Challenging Abbreviated Injury Scale Metrics

description: <b>Objective:</b> Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity.<b>Methods:</b> The NASS-CDS 2000–2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0–4, 5–9, 10–14, and 15–18 years. Next, the National Trauma Databank 2002–2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MR<sub>MAIS</sub>) for each injury within 6 age groups: 0–4, 5–9, 10–14, 15–18, 0–18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated.<b>Results:</b> MR and MR<sub>MAIS</sub> distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all <i>P</i> MAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MR<sub>MAIS</sub> than such injuries among 5- to 9-year-olds and 10- to 14-year-olds (<i>P</i> =.04; <i>P</i> MAIS in 0- to 18-year-olds was 0.4% for an AIS 3 radius fracture versus 1.4% for an AIS 2 vault fracture.<b>Conclusions:</b> Trauma severity metrics are important for outcome prediction models and can be used in pediatric triage algorithms and other injury research. Trauma severity may vary for similar injuries based upon developmental stage, and this difference should be reflected in severity metrics. The MR-based data-driven determination of injury severity in pediatric occupants of different age cohorts provides a supplement or an alternative to AIS severity classification for pediatric occupants in MVCs.
DOI: 10.6084/m9.figshare.1568838.v1
title: Driver Injury Risk Variability in Finite Element Reconstructions of Crash Injury Research and Engineering Network (CIREN) Frontal Motor Vehicle Crashes

description: <b>Objective:</b> A 3-phase real-world motor vehicle crash (MVC) reconstruction method was developed to analyze injury variability as a function of precrash occupant position for 2 full-frontal Crash Injury Research and Engineering Network (CIREN) cases.<b>Method:</b> Phase I: A finite element (FE) simplified vehicle model (SVM) was developed and tuned to mimic the frontal crash characteristics of the CIREN case vehicle (Camry or Cobalt) using frontal New Car Assessment Program (NCAP) crash test data. Phase II: The Toyota HUman Model for Safety (THUMS) v4.01 was positioned in 120 precrash configurations per case within the SVM. Five occupant positioning variables were varied using a Latin hypercube design of experiments: seat track position, seat back angle, D-ring height, steering column angle, and steering column telescoping position. An additional baseline simulation was performed that aimed to match the precrash occupant position documented in CIREN for each case. Phase III: FE simulations were then performed using kinematic boundary conditions from each vehicle's event data recorder (EDR). HIC15, combined thoracic index (CTI), femur forces, and strain-based injury metrics in the lung and lumbar vertebrae were evaluated to predict injury.<b>Results:</b> Tuning the SVM to specific vehicle models resulted in close matches between simulated and test injury metric data, allowing the tuned SVM to be used in each case reconstruction with EDR-derived boundary conditions. Simulations with the most rearward seats and reclined seat backs had the greatest HIC15, head injury risk, CTI, and chest injury risk. Calculated injury risks for the head, chest, and femur closely correlated to the CIREN occupant injury patterns. CTI in the Camry case yielded a 54% probability of Abbreviated Injury Scale (AIS) 2+ chest injury in the baseline case simulation and ranged from 34 to 88% (mean = 61%) risk in the least and most dangerous occupant positions. The greater than 50% probability was consistent with the case occupant's AIS 2 hemomediastinum. Stress-based metrics were used to predict injury to the lower leg of the Camry case occupant. The regional-level injury metrics evaluated for the Cobalt case occupant indicated a low risk of injury; however, strain-based injury metrics better predicted pulmonary contusion. Approximately 49% of the Cobalt occupant's left lung was contused, though the baseline simulation predicted 40.5% of the lung to be injured.<b>Conclusions:</b> A method to compute injury metrics and risks as functions of precrash occupant position was developed and applied to 2 CIREN MVC FE reconstructions. The reconstruction process allows for quantification of the sensitivity and uncertainty of the injury risk predictions based on occupant position to further understand important factors that lead to more severe MVC injuries.
DOI: 10.6084/m9.figshare.1568835.v1
title: The Influence of Enhanced Side Impact Protection on Kinematics and Injury Measures of Far- or Center-Seated Children in Forward-Facing Child Restraints

description: <b>Objective:</b> To evaluate the influence of forward-facing child restraint systems’ (FFCRSs) side impact structure, such as side wings, on the head kinematics and response of a restrained, far- or center-seated 3-year-old anthropomorphic test device (ATD) in oblique sled tests.<b>Methods:</b> Sled tests were conducted utilizing an FFCRS with large side wings and with the side wings removed. The CRS were attached via LATCH on 2 different vehicle seat fixtures—a small SUV rear bench seat and minivan rear bucket seat—secured to the sled carriage at 20° from lateral. Four tests were conducted on each vehicle seat fixture, 2 for each FFCRS configuration. A Q3s dummy was positioned in FFCRS according to the CRS owner's manual and FMVSS 213 procedures. The tests were conducted using the proposed FMVSS 213 side impact pulse. Three-dimensional motion cameras collected head excursion data. Relevant data collected during testing included the ATD head excursions, head accelerations, LATCH belt loads, and neck loads.<b>Results:</b> Results indicate that side wings have little influence on head excursions and ATD response. The median lateral head excursion was 435 mm with side wings and 443 mm without side wings. The primary differences in head response were observed between the 2 vehicle seat fixtures due to the vehicle seat head restraint design. The bench seat integrated head restraint forced a tether routing path over the head restraint. Due to the lateral crash forces, the tether moved laterally off the head restraint reducing tension and increasing head excursion (477 mm median). In contrast, when the tether was routed through the bucket seat's adjustable head restraint, it maintained a tight attachment and helped control head excursion (393 mm median).<b>Conclusion:</b> This testing illustrated relevant side impact crash circumstances where side wings do not provide the desired head containment for a 3-year-old ATD seated far-side or center in FFCRS. The head appears to roll out of the FFCRS even in the presence of side wings, which may expose the occupant to potential head impact injuries. We postulate that in a center or far-side seating configuration, the absence of door structure immediately adjacent to the CRS facilitates the rotation and tipping of the FFCRS toward the impact side and the roll-out of the head around the side wing structure. Results suggest that other prevention measures, in the form of alternative side impact structure design, FFCRS vehicle attachment, or shared protection between the FFCRS and the vehicle, may be necessary to protect children in oblique side impact crashes.
DOI: 10.6084/m9.figshare.1568837.v2
title: Analysis of Driver Evasive Maneuvering Prior to Intersection Crashes Using Event Data Recorders

description: <b>Objective:</b> Intersection crashes account for over 4,500 fatalities in the United States each year. Intersection Advanced Driver Assistance Systems (I-ADAS) are emerging vehicle-based active safety systems that have the potential to help drivers safely navigate across intersections and prevent intersection crashes and injuries. The performance of an I-ADAS is expected to be highly dependent upon driver evasive maneuvering prior to an intersection crash. Little has been published, however, on the detailed evasive kinematics followed by drivers prior to real-world intersection crashes. The objective of this study was to characterize the frequency, timing, and kinematics of driver evasive maneuvers prior to intersection crashes.<b>Methods:</b> Event data recorders (EDRs) downloaded from vehicles involved in intersection crashes were investigated as part of NASS-CDS years 2001 to 2013. A total of 135 EDRs with precrash vehicle speed and braking application were downloaded to investigate evasive braking. A smaller subset of 59 EDRs that collected vehicle yaw rate was additionally analyzed to investigate evasive steering. Each vehicle was assigned to one of 3 precrash movement classifiers (traveling through the intersection, completely stopped, or rolling stop) based on the vehicle's calculated acceleration and observed velocity profile. To ensure that any significant steering input observed was an attempted evasive maneuver, the analysis excluded vehicles at intersections that were turning, driving on a curved road, or performing a lane change. Braking application at the last EDR-recorded time point was assumed to indicate evasive braking. A vehicle yaw rate greater than 4° per second was assumed to indicate an evasive steering maneuver.<b>Results:</b> Drivers executed crash avoidance maneuvers in four-fifths of intersection crashes. A more detailed analysis of evasive braking frequency by precrash maneuver revealed that drivers performing complete or rolling stops (61.3%) braked less often than drivers traveling through the intersection without yielding (79.0%). After accounting for uncertainty in the timing of braking and steering data, the median evasive braking time was found to be between 0.5 to 1.5 s prior to impact, and the median initial evasive steering time was found to occur between 0.5 and 0.9 s prior to impact. The median average evasive braking deceleration for all cases was found to be 0.58 g. The median of the maximum evasive vehicle yaw rates was found to be 8.2° per second. Evasive steering direction was found to be most frequently in the direction of travel of the approaching vehicle.<b>Conclusions:</b> The majority of drivers involved in intersection crashes were alert enough to perform an evasive action. Most drivers used a combination of steering and braking to avoid a crash. The average driver attempted to steer and brake at approximately the same time prior to the crash.
DOI: 10.6084/m9.figshare.1568836.v1
title: Mortality Risk in Pediatric Motor Vehicle Crash Occupants: Accounting for Developmental Stage and Challenging Abbreviated Injury Scale Metrics

description: <b>Objective:</b> Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity.<b>Methods:</b> The NASS-CDS 2000–2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0–4, 5–9, 10–14, and 15–18 years. Next, the National Trauma Databank 2002–2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MR<sub>MAIS</sub>) for each injury within 6 age groups: 0–4, 5–9, 10–14, 15–18, 0–18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated.<b>Results:</b> MR and MR<sub>MAIS</sub> distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all <i>P</i> MAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MR<sub>MAIS</sub> than such injuries among 5- to 9-year-olds and 10- to 14-year-olds (<i>P</i> =.04; <i>P</i> MAIS in 0- to 18-year-olds was 0.4% for an AIS 3 radius fracture versus 1.4% for an AIS 2 vault fracture.<b>Conclusions:</b> Trauma severity metrics are important for outcome prediction models and can be used in pediatric triage algorithms and other injury research. Trauma severity may vary for similar injuries based upon developmental stage, and this difference should be reflected in severity metrics. The MR-based data-driven determination of injury severity in pediatric occupants of different age cohorts provides a supplement or an alternative to AIS severity classification for pediatric occupants in MVCs.