INJURY PATTERNS CAUSED BY SEAT BELTS s. Behrens , Dr . med . E.G. Suren, Dr . med . L. Gotzen , Dr . med . Department of Surgery-Trauma Unit - Medical University Hannover G. Stürtz , Dipl . -Ing . Institute of Automot ive Engineering Technical University, Berl in SURVEY The ef fectivity in the use of passive restraint within the whole combine of safety devices , such as deformation areas , passenger compartments , seat construction , head-rest and steering uni t has been determined in several invest igat ions {8) (6) (10) . During the last years , however , together with an increasing use of safety belts , a frequency of injur ies was apparent , which - for the first t ime - was described in 1956, and to which in 1 962 the descr iption "Seat-belt - Syndrom" became attached (3) . Ever since a stead ily in- creasing tendency of spec if ic publicat ions could be ob- served , with a defin ite predom inat ion of spectacular single- case presentations in medical journals (2) ( 4 ) (5) (2) . Rather a large number of detailed sin gle case analyses is required for the def in ition of injury mechanism as well as injury model and injury cause , in order to make clear state- ments . In 1 97 5 , Mackay (8) reported about 82 passenger-car accidents , involving a total of 1 08 car occupants wearing seat belts . He worked out further aspects concerning type and frequency of heavy injur ies caused by safety belts (13). The task of this invest igation is the collection of typical injury models, without as well as w ith d isfunction of the systems passenger compartment/seat/restraint/occupant . +) numbers in parentheses designate references at end of paper (:
13
Embed
(4) - IRCOBI · 2016. 5. 26. · 4. Three-point automatic belt Three-point static belt (running through) Three-point static belt (single adjustment) Diagonal static belt Total Fig.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
INJURY PATTERNS CAUSED BY SEAT BELTS
s . Behren s , Dr . med .
E . G . Suren , Dr . med .
L . Gotzen , Dr . med .
Department of Surgery-Trauma
Unit - Med ical Univers ity
Hannover
G . Stürt z , Dipl . - Ing . Institute of Automotive Engineering
Technical Univer s i ty , Berl in
SURVEY
The ef fectivity in the use of pass ive restraint within the whole comb ine of sa fety devices , such as deformation areas , passenger compartment s , seat construct ion , head-rest and steering unit has been determined in several invest igations { 8 ) ( 6 ) ( 1 0) . During the last year s , however , together with an increasing use of safety belts , a frequency of in juries was apparent , which - for the first time - was described in 1 9 5 6 , and to which in 1 9 6 2 the descr ipt ion " Seat-be ltSyndrom " became attached ( 3 ) . Ever s ince a stead i ly increas ing tendency of specif ic pub l ication s could be observed , with a def inite predomination of spectacular singlecase presentat ions in med ical j ourn a l s ( 2 ) ( 4 ) ( 5 ) ( 2 ) .
Rather a large number of detai led s ingle case analyses is required for the def i n ition of i n j ury mechanism as we l l as inj ury mod e l and inj ury cause , in order to make c lear statement s . In 1 9 7 5 , Mackay ( 8 ) reported about 8 2 pas s enger-car acc idents , involving a total of 1 08 car occupants wearing seat be lts . He worked out further a spec t s concerning type and frequency of heavy injuries caused by safety belts ( 1 3 ) .
The task of thi s invest igation i s the collection of typical i n j ury model s , without as we l l as with d i s function of the systems passenger compartment/seat/restra int/occupant .
+ ) numbers in parentheses des ignate references at end of paper
(:
METHOD OF INVESTIGATION
S ince February , 1 97 3 the Med ical Univer s ity of Hanover i s - within+the framework o f a Traffic Accident Research Program ) col lecting data of real tra f f i c acc idents , in which people have been inj ured . At the scene of the accident , the documentation starts on average about 1 3 minutes a fter the accident happened . I t inc ludes main ly the medica l , technical and psycholog ical data of the pre-crash , crash and post-crash pha s e .
The technical documentation contains mainly a photogrammetric survey of acc ident traces , veh icle damage as we l l as techn ical particulars of the vehicle and cond ition of sa fety device ( the latter for instance , in order to c larify the usage of safety belts ) .
Deta i l s about traff ic area and i t s surrounding as we l l as weather condi t ions were also collected . The medical documentation contains personal data of the accident vict im , such as the type and severity of inj uries received , the steps taken for accident rescue , such as voluntary help from the publ i c or perhaps , med ical emergency treatment . The documentation is completed by supplementation of out-patient respectively hospital care , the course , inc luding epicr i s i s or , i f need be , the post mortem report .
DATA
Basing on a number of 8 4 3 documented traff ic acc idents unti l Apr i l , 1 9 7 7 , 1 2 2 acc idents involving a total of 1 6 1 adu l t occupants o f pas senger c a r s wearing safety belts , have been included in this report . In order to e l iminate the inf luence of vary ing impact directions of trauma , only cases with fronta l d i rections ( 1 0 . 00 am to 2 . 00 pm) with solid
+ ) A research program f inanced by the Federal Author it ies of Road Systems , Cologne , FRG .
obstructions , such as motor car s , were cons idered .
12 11
Flg.:1 F ig. 1 Impact Types in Sample
01
02
The investigation mater i a l con s i s t s of 8 1 head-on impacts , involving 1 1 0 adult drivers , respect ive ly co-dr ivers wearing safety belts . S afety b e l t wearing adult passengers occupying the back seat , have up to now not been observed .
METHOD OF ANALYS I NG
The car occupants were by asse ssment of each s ingle case divided into the groups I (without system d i s function ) and I I (with system d i s function) . I t was rated as a d i s function i f one or several e lements within the j oint combine of
Q • i. V. !�
vehicle cornpartrnent , seat , be l t and car occupant v i s ibly lead to an intens i fication of the traurna . Those can be for exarnple intrusion , weak seat anchorage , s lack be lts as wel l as wrong use of bel t , respectively seating pos i tion . The traurna was estirnated by its severity and frequency . The inj ury severity was determined by the "Abbreviated I n j ury Scale " ( 1 4 ) for every body region (AI S ) as we l l as for the body a s a whole by the " Over a l l I n j ury S ever ity Degree " ' (OAI S ) •
With the obj ective of a quantitative and qua l i tative va luation of the trauma , the " Absolute traumatic degree " ( 1 3 ) of s ingle body regions , as the result of i n j ury frequency and medium sever ity , was made . The average i n j ury severity was calcu lated with reference to costs ar i s ing frorn inj ury sequence of s ingle degrees of i n j ury sever ity , with the help of an average valuation of S th degree ( 1 2 ) .
As a measure for the k inetic energy changing dur ing the crash phase to deformation , and as a measurement for the degree of deformation of the veh ic le , the "Vehicle Deformation Index " (VDI ) was est imated for every crash vehic le . Its degree of valuation resu lts from depth of de formation -veh icle length areas .
VDI = VEHICLE DEFORMATION INDEX CORRllLATION BllTWIUN DE»TH OF DU'ORMATION AND
LDIQTH OF VllHICU
•XAllPU: VDl=3
l"IV• •QUAL ARUS
i - -wu.öiCRDi -7 TWO •QUAL
ARUS
ov•R ...,.,._. °" ,,. VllHICU
F ig. 2 Veh icle Deformation I ndex
RESTRAINT WITH OR WITHOUT D I SFUNCTIONS
A division of car occupants lead to 7 7 persons in group I (without d i s function) and 3 3 people in group I I ( with d i s function) • A s cause o f d i s funct ion
l . lncorrect wearing of be l ts
2 . Intrusion i nto passengers compartment
3 . Seat yie l d i ng or torn out
4 . Combi nation between 2 and 3
5 . S l i pped loading
1 6 8
7
total 33
F i g . 3 Cause of m isfunction i n safety-be lt-system
the wrong be l t fasteninq i s predominating , followed by intrusion of the occupant department and s·eat secur ity . Up to now only the predorninating d i s function for each case was rnentioned .
A d i v i sion of a l l safety belt acc idents by the type of be lt systerns
1 .
2 .
3 .
4 .
Three-point automati c be l t
Three-point static be l t (running through)
Three-point stat i c be l t (si ngle ad j ustment)
D i agonal static be l t
Total
Fig . 4 Types of Seat-bel t-systems
59 38
l 1
2 1 1 0
(' l r ' )'
.
shows c learly the predominat ion of the three -po int-automatic be l t , in each case with pas s -through hardware .
A d ivis ion of a l l inj ured be lt users by in�ury s everity of body regions and various seating positions i s shown in
Fig . 5 Summary of i n juries of di ffe rent severities by body areas , separation between driver and co-driver
Dominating - after inj ury frequency - with the dr iver as we l l a s the co-driver - are the head injuries , f o l l owed by the trauma of the lower extremi t ies and the thorax . Concern ino the inj ury sever ity , the pos ition , however , i s changing . The most endangered body regions are f irst and foremost the abdominal and the thorax reqion . Every pa ssenger received on an average 3 inj ur ies .
Subdivided into the qroups I and I I , it i s evident OA IS Group 1 Group I I 0 37
l + 2 39 1 7
3 + 4 9
5 + 6 7
Fig . 6 Corre l ation between Overal 1 l n j ury Seele and both G roups Wearing Seat-be l ts
that the car occupants in group I were not at a l l , or only s l ightly i n j ured . Those in group I I were a l l i n j ured , 9 of them fata l ly .
A compar ison between both groups , as far as the Absolute Traumatic Degree is concerned , und e r lines the d i f ference in the endangering degree . Thi s app l i e s also to inj ury frequency and inj ury severity
-�• 1r'n1 ..,.. '""--"-..!
tOO tTO,O
.......... , • . „,
1,1
" "-
-
....
,_.,_ ... ,_._.
-" r·a ...,.. '""- " -..!
F ig. 7 The Absolute Trauma t i s inq Degree
Al l 3 3 occupants in group I I rece ived head i n j ur ies . The head , next to the Absolute Traumatic Degree , appears to be the most endangered region , fo l l owed by the thorax and abdominal reg ion .
Group I , however , shows substanti a l ly lower Absolute Traumatic Degrees . Owing to the der ivation of inerti a l force of the passenger over the belt sys tem , the thorax i n j uries are consequent l y predominating .
A subd ivis ion of the fatal be l t acc idents
U FO D i agnosis OA IS VD I Misfunction of Cause of Death (Hannover) Safety Be 1 ts
No . 724/2 Lung rupture , 5 4 s l i pped loadi ng ehest trauma serious r i p fract . f lai l chest , u p-per arm fract . , bra i n contusion , tibi a l fract .
No . 61/2 severe brain 6 2 be l ts worn s l ack brain i n jury i n jury, forearm wounds
No . 572 le fort l , ruptur 5 5 seat tearing out trauma of the of sma l l i ntesti- abdomen ne , rod i a 1 fract . ,
wound of k ne e , both t ib ia
No . 51 9/2 rupture of smal 1 5 5 seat broken trauma of the i ntest i ne , hemor- abdomen rhage from art . mesent .
No . 5 1 1/1 le fort 1 1 , d i s l oc . 5 5 i n trusion i nto trauma of the of h i p joi n t , fem . the passe ngers abdomen , shock fract . , t ib ia l compartment head fract . , pate l . fract . , c lavi c . fract . , contusion of sma 1 1 i ntesti ne , rupture mesent .
No . 505 serious r ip fract . , 5 5 ree 1 broke up trauma of the spien and l i ver abdomen , ehest rupture , wounds of trauma both knees
No . 348 severe brain i n j u- 5 6 i ntrus i on i nto trauma of the ry, wou nd of the the passengers abdomen , brai n face , serious ri p compartment i n j u ry fract . , sp i e n-l i ver-ki dney rup-ture fern . neck frac t .
Fig . 8 Fatal Traffic Accidents Passengers Wearing Seat Be l ts
.1� '�) .
a l l of which belong to group I I , leads with regard to the med ical cause of death to the predominating f actor of severe trauma of the abdomen , to be followed by trauma of the thorax .
The important part the degree of vehicle damage is playing concerning the trauma of belt-wearing occupants , is to be seen in f igures 9 - 1 2 .
OAIS 6 n• 110
,P /
4 p" OAISm
I /
3 / „
2 O' „ ...0- - -<:/' all occupants
1
2 3 4 5 6 VDI
F ig. 9 Correlat ion between OAISm and Vehicle
Deformation Index for a l l occupants
According to f igure 9 a compari son between Vehicle Deformation Index (VDI ) and Overall I n j ury Sever ity Degree ( OAI S ) shows an increase of inj ury sever i t y , with a ris ing
VDI f?r a l l 1 1 0 occupants .
The increase in i n j ury severity for group I i s evidently less than the one in group I I , with an upward trend in
8 8
veh ic le def ormation
OAIS 6 n• 110
4
3
2
1
, " "
o- - -,
a' e> .. „ „ . . . o . „„
0- - - -0 OAISm mlsfunctto?/
I
I I I
..& - - -d
. . . „ . . . „„ „ „0 O " „ · "correct functlon
· · o ·
�-.....--2-.,...--3-..,r--4
--r--5-r--�6__, VDI
Fig. 1 0 Correlation between OAI S and VDI for the d i f ferent Groups
The compar ison of i n j ury severity for d i f ferent occupant pos itions shows for dr iver and co-driver an increase with ris ing VDI , with more per i l to group II for dr iver s
OAIS
8 n•77 alldrtvers
3 -, '
p- - - . O OAISm m11ruMt '°"
I p I
I
I
2 (§}- _ <f . . o �·"'' . . ' " oco�rect tunctlon
2 3 4 s 6 VDI
OAIS n•33 8 811 co-drivers
4
3
, J:> - - � - - -0 OAISm ,am'iotunctlon
2 3 4 s 6 VDI
F ig. 1 1 + 1 2 The Dif ference between Dr iver and Co-Driver in the two groups
SUMMARY
The analys i s of accidents in which 1 1 0 car occupants were inj ured , c learly stresses the urgency for action , in order to reduce inj ury r i s k s , not only as far as the s afety be lt i t � e l f i s concerned but also in view of the in j ury model with s afety belt usage .
The fol lowing facts are evident :
1 . The cruc ial point for inj ury severity - after the Absolute Traumatic Degree through system d i s function - is the head reg ion , fol lowed by the thorax and pe lvis /abdomen .
2 . Typica l injur ies owing to d i s function are ruptures of the intestines , the l iver and spleen , as wel l as thorax l e s ion s .
3 . The severe trauma of the abdomen i s predominat ing with lethal i n j ur ies .
4 . Together with increas ing veh icle deformation the inj ury sever ity for drivers as we l l as co-driver s , espec ially in connection with sys tem d i sfunctions , i s r i s ing .
5 . S evere injuries spe c i fic for belts and without system d i s function on ly are inf l icted i n connection with a High Veh i c l e Deformation I ndex .
6 . Wrong usage of safety be lt , weak seat ing anchorage respectively rigidnes s , and intrus ion of the passenger compartment are caus ing an increase of i n j ury sever ity .
Here · inj uries already occur with low veh i c l e deformation degrees (VDI ) .
Q � �' ""'
Ref erences
1 . Behrens , s . u . H . Tscherne :
2 . Bierwag , K . :
Verkehrsunfa l lfor schung
Fortschr . Med . 94 , 1 5 8 3 , 1 97 6
Dekapitation durch unzweckmäßigen S i c herhe itsgurt Mschr . Unfallhe i l k . 7 3 , 4 2 1 , 1 9 7 0
3 . Garrett , J . W . a . P . W . Braunstein :
The Seat Belt Syndrom
J . Trauma 2 , 2 2 0 , 1 9 6 2
4 . Hartung , R . u . B . Egger :
Schwere isolierte N ierenruptur durch S icherheitsgurttrauma
Unfallhe i lk . 7 9 , 1 1 7 , 1 9 7 6
5 . Kurock , W . u . M . Nage l :
Strangulation des Halses durch S icherhe itsgurt
Münchn . med . Wschr . 1 1 4 , 1 4 1 3 , 1 9 7 2
6 . Langwiede� , K . : Ver letzungsfolgen bei Unfäl len m i t angelegtem Sicherheitsgurt
Hrg s . : HUK - Verband , Köln , 1 9 7 5
7 . Mackay , G . M . , P . F . Gloyns , H . R . M . Hayes , D . K . Gri f f iths a . S . J . Rattenbury :
Serious Trauma to Car Occupants Wearing Seat Belts
Proc . 2 nd I RCOBI - Conf . , 20 , 1 9 7 5
8 . Mackay , G . M . : Sorne Cos t Benefit Cons iderations of Car Occupants Restraint System
C I DITVA 59 , Sept . , 1 9 74
9 . Myer s , J . W . , c . Schmidt a. R . O . Kraft :
An Unusual Seat Belt I n j ury : Case Report
J . Trauma 1 2 , 5 2 9 , 1 9 7 2
1 0 . Rüter , G . u . M . Hofmann :
Beanspruchunqsqren zen des �enschen be im inneren Aufpra l l
Forschung sber icht des Bate lle-Insti tutes e . V . Frankfurt , zur Kra f t fahr zeuqforschunq F 2 8 7 , 1 9 7 5
o t , J t ...... I
1 1 . S türtz , G . a . E . G . Suren :
K inemat i c of Rea l Pedestrian and Two-Whee l Rider Acc idents and S pecial Aspects of the Pedestr ian Acc idents
Proc . I RCOBI - Amsterdam - Sept . , 1 9 7 6
.1 2 . S türtz , G . , Appe l , H . u . E . G . Suren :
Gefährdungsgrade von PKW-Au ßentei len be i Fußgängerunf ä l len , Ergebnisse kasuist ischer Untersuchungen .
Entwicklungs l inien in der Kra f t f ahrzeugtechnik Ver lag : TUV Rhe in land GmbH , Köln , FRG , 1 9 7 7
1 3 . Suren , E . G . , G . S türtz , H . Tscherne , s . Behrens u . L . Gotzen :
Untersuchungen zu Verletzungsmuster und -ur sache gurtgeschützter PKW- Insassen