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This article was downloaded by: [TOBB Ekonomi Ve Teknoloji] On: 21 December 2014, At: 15:42 Publisher: Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Traffic Injury Prevention Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcpi20 Severe Injury to Near- and Far-Seated Occupants in Side Impacts by Crash Severity and Belt Use David C. Viano a & Chantal S. Parenteau a a ProBiomechanics LLC , Bloomfield Hills, Michigan Published online: 08 Feb 2010. To cite this article: David C. Viano & Chantal S. Parenteau (2010) Severe Injury to Near- and Far-Seated Occupants in Side Impacts by Crash Severity and Belt Use, Traffic Injury Prevention, 11:1, 69-78, DOI: 10.1080/15389580903479178 To link to this article: http://dx.doi.org/10.1080/15389580903479178 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions

Severe Injury to Near- and Far-Seated Occupants in Side Impacts by Crash Severity and Belt Use

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Page 1: Severe Injury to Near- and Far-Seated Occupants in Side Impacts by Crash Severity and Belt Use

This article was downloaded by: [TOBB Ekonomi Ve Teknoloji]On: 21 December 2014, At: 15:42Publisher: Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,37-41 Mortimer Street, London W1T 3JH, UK

Traffic Injury PreventionPublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/gcpi20

Severe Injury to Near- and Far-Seated Occupants inSide Impacts by Crash Severity and Belt UseDavid C. Viano a & Chantal S. Parenteau aa ProBiomechanics LLC , Bloomfield Hills, MichiganPublished online: 08 Feb 2010.

To cite this article: David C. Viano & Chantal S. Parenteau (2010) Severe Injury to Near- and Far-Seated Occupants in SideImpacts by Crash Severity and Belt Use, Traffic Injury Prevention, 11:1, 69-78, DOI: 10.1080/15389580903479178

To link to this article: http://dx.doi.org/10.1080/15389580903479178

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of theContent. Any opinions and views expressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon andshould be independently verified with primary sources of information. Taylor and Francis shall not be liable forany losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use ofthe Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in anyform to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Page 2: Severe Injury to Near- and Far-Seated Occupants in Side Impacts by Crash Severity and Belt Use

Traffic Injury Prevention, 11:69–78, 2010Copyright C©© 2010 Taylor & Francis Group, LLCISSN: 1538-9588 print / 1538-957X onlineDOI: 10.1080/15389580903479178

Severe In jury to Near- and Far -Seated Occupantsin Side Impacts by Crash Sever ity and Belt Use

DAVID C. VIANO and CHANTAL S. PARENTEAUProBiomechanics LLC, Bloomfield Hills, Michigan

Purpose: This study investigated the risk of severe-to-fatal injury (MAIS 4+F) to near- and far-seated front occupants inside impacts by belt use and crash severity (delta V).

Methods: 1993–2007 NASS-CDS was analyzed for front-seat occupants in side impacts while they were either the near-side or far-side occupant by belt use. Light vehicles were included with model year 1994+. Injury severity was subdividedinto MAIS 0–2, 3, and 4+F. The risk for MAIS 4+F injury was determined by dividing the number of MAIS 4+F by thenumber of exposed occupants with known injuries. Individual NASS-CDS cases were downloaded from the 1997–2007electronic data to evaluate injury patterns causing high relative risks.

Results: In 35+ mph side-impact delta Vs, the risk for MAIS 4+F injury was 75.4 ± 41.0% for unbelted near-side and48.1 ± 14.6% for unbelted far-side occupants. The risk was 51.8 ± 14.8% for belted near-side and 30.9 ± 8.2% for far-sideoccupants. Seat belt use was 81.4% effective in preventing MAIS 4+F injury for near-side occupants and 93.5% for far-sideoccupants. The relative risk (RR) for unbelted compared to belted occupants was 35.9 for far-side occupants in 10–15 mphdelta V crashes. The relative risk was 35.1 for near-side occupants in <10 mph delta V side impacts. The high relative riskswere associated with complex, high-speed multi-collision crashes often with occupant impacts on the windshield, steeringwheel, or other frontal components and ejection.

Conclusions: Seat belt use was more effective in preventing severe injury (MAIS 4+F) to far-side occupants than near-sideoccupants in <25 mph delta V impacts. High relative risk for unbelted occupants in low-speed side impacts was explainedby the fact that the accidents were high-speed, multi-impact collisions. Severe injury was caused by ejection, impact with theside interior, or impact with the frontal components where airbags sometimes deployed.

Keywords Side impacts; Seat belts; Restraint effectiveness; Motor vehicle crashes; Injury

INTRODUCTION

Side-impact crashes are second to frontal crashes in termsfrequency (Pintar et al. 2007) and account for about a third ofoccupant fatalities (National Highway Traffic Safety Adminis-tration [NHTSA] 2005). Figure 1 shows the risk for severe-to-fatal injury (MAIS 4+F) in model year 1994+ tow-away, planarcrashes using NASS-CDS data for calendar years 1993–2007.The data are plotted by crash type and delta V. Side impacts havethe greatest injury risks irrespective of crash severity. Diggeset al. (2005) reported that 67% of serious injury is to near-sideoccupants and 33% to the far-side occupants.

Side-impact protection has been assessed since the early1970s with Federal Motor Vehicle Safety Standard (FMVSS)214. FMVSS 214 initially consisted of a crush resistance stan-dard for passenger cars. NHTSA revised FMVSS 214 in 1990 to

Received 23 June 2009; accepted 2 November 2009.Address correspondence to: David C. Viano, ProBiomechanics LLC,

265 Warrington Rd., Bloomfield Hills, MI 48304-2952. E-mail: [email protected]

include a dynamic side-impact test with a crabbed deformablebarrier with a phase-in of 1994–1997 (NHTSA 2007). Side-impact field data showed that car-to-car collisions were mostcommon, near-side occupants were most at risk, and that seriouschest injuries were most common (Haland 1994). The revisedFMVSS 214 included performance criteria for the chest andpelvis in near-side front and rear occupants. Head injuries werethe most frequent cause of fatalities in side impacts, and theywere addressed by the upgrade to FMVSS 201, occupant protec-tion in interior impacts (Kahane and Tarbet 2006). FMVSS 214was amended in 2007 to include an oblique pole test and head re-sponse requirements for both front and rear near-side occupants.The crash tests are run with the dummies using the available re-straint systems (belts on, side airbags, and belt pretensioners).

There is currently no regulation to assess the risk of occu-pants seated on the far side of the impact. Many research groupshave assessed the injury risk to far-side occupants because of therelatively high involvement in serous-to-fatal injury (Digges andDalmotas 2001; Digges and Gabler 2006; Digges et al. 2005;Fildes et al. 2000; Frampton et al. 1998; Mackay et al. 1991).In early 2004, an international consortium of universities and

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70 VIANO AND PARENTEAU

23.2%

8.2%

18.1%

33.5%

45.0%

0.20% 0.39%

9.1%8.0%

2.4%1.2%

2.43%1.17%

3.6%0%

10%

20%

30%

40%

50%

<10 10-15 15-20 20-25 25-30 30-35 35

MAIS 4+F Risk

NASS-CDS 1993-2007MY 1994+

Front

Rear

Side

Side 0.096% 1.17% 2.43%Front 0.13% 0.084% 0.34%Rear 0.013% 0.099% 0.40%

Delta V (mph)

(Risk = # MAIS 4+F/ MAIS 0-6 F Occupants in delta V range)

Figure 1 Risk for severe (MAIS 4+F) injury with one standard error bars forNASS-CDS tow-away crashes.

crashworthiness research groups was formed to assess far-sideinjury risks by investigating crash and test data (Gabler et al.2005). The consortium also assessed the risk of occupant-to-occupant interaction in side impacts (Newland et al. 2008). Theyfound an increased risk for near-side occupants with far-side oc-cupancy. They also observed occupant-to-occupant interactionsin vehicle-to-pole side impacts and pointed out the risk of seri-ous head injury to both near- and far-side occupants under suchconditions.

Many studies have determined seat belt effectiveness in sidecrashes and in preventing ejection. Evans (1991) showed thatseat belts are 27 and 39% effective in reducing near- and far-side impact fatalities, respectively. Seat belt effectiveness was8 and 17% in preventing ejection. NHTSA reported that three-point belts reduced fatalities by 10–41% in near-side impactsand 39–58% in far-side impacts (Kanianthra 2005).

Side-impact crashes can be part of multiple impact collisions.Bahouth and Digges (2005) reported that one of the most harm-ful crashes was a side impact followed by another side impact.They described how injuries in the first impact can be exac-erbated in subsequent impacts. In some instances, the vehiclecrush zones were deformed during the first impact and may havelimited energy absorption during subsequent impacts.

The objective of this study was to examine the risk for severe-to-fatal injury (MAIS 4+F) to near- and far-side front-seatedoccupants in side crashes by belt use and crash severity. Indi-vidual NASS-CDS electronic cases were investigated to betterunderstand the cause of injury in some circumstances.

METHODOLOGY

NASS-CDS DataNASS-CDS (National Automotive Sampling System–Crashworthiness Data System) is a stratified sample of about5000 fatal, injury, and tow-away crashes without injury thatwere prospectively selected each year for in-depth investigation.Most of the vehicles were towed from the scene because of

damage. The data include information based on crash investiga-tion teams, vehicle registration, medical records, police reports,and interviews. The data were extrapolated to national estimatesusing weighting factors provided by NHTSA. In this study,NASS-CDS data for calendar years 1993–2007 were used tostudy near-seated (near-side) and far-seated (far-side) occupantinjury by belt use and crash severity. This study focused onside impacts where the greatest vehicle damage was on the sidewithout rollover (GAD1 = L/R and rollover ≤0). Front-seatoccupants were 13–104 years old. Only tow-away, light vehicles(body type 1–49) with model year 1994+ were included.

Belt UseBelt use was defined by the NASS-CDS investigator’s variablesMANUSE and ABELTUSE. Unbelted was defined as MANUSE≤1 and ABELTUSE <1 or = 2. Belted was defined as MANUSE= 4.

Injury SeverityInjury severity of the occupant was assessed using the Maxi-mum Abbreviated Injury Scale (MAIS) and the TREATMNTvariable. MAIS represents the assessment of life-threatening in-juries at the time of first medical evaluation and not long-termconsequences. It ranges from MAIS 0 to 9. MAIS 4–6 repre-sents a severe-to-unsurvivable injury. Fatality was also used todetermine whether the occupant died of injuries in the accident.The variable TREATMNT was used to define fatality, which isTREATMNT = 1. Because fatalities can occur at any MAISlevel, severely injured occupants were defined as those withMAIS 4–6 or fatality. The shorthand notation for this is MAIS4+F.

Side ImpactVehicles were involved in impacts where the greatest damagewas to the left or right side (GAD1 = L or R). Collisionsin which a rollover occurred were excluded from the sample(rollover ≤0).

Weighted DataNational estimates for the number of occupants and injuries ineach category were made using the ratio weight (ratwgt) variablein the NASS-CDS. All calculations were based on weightedvalues.

Statistical AnalysesThe risk for severe injury (MAIS 4+F) was determined by thenumber of MAIS 4+F occupant injuries divided by the numberof occupants with known injuries (MAIS 0–6 or F). Occupantswith unknown injuries were removed from the exposure groupused to determine risk. Standard errors for MAIS 4+F weredetermined in SAS.

Individual NASS-CDS Electronic Case ReviewElectronic cases were downloaded from the 1997–2007 NASS-CDS online files for severely injured far-side occupants with aspinal injury in 10–20 mph delta V side impacts and for severelyinjured near- and far-side occupants in <10 mph delta V side

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INJURY SEVERITY AND BELT USE 71

0.34% 3.3%6.6%

28.6%

42.4%

21.8%

75.4%

0.01% 0.7%2.7%

12.0%

22.1%

45.7%

51.8%

0%10%20%30%40%50%60%70%80%90%

100%

Ris

k M

AI 4

+F

<10 10-15 15-20 20-25 25-30 30-35 35+

Delta V (mph)

0.26%

10.3%5.0%

10.5%

22.0%

47.0%

48.1%

0.03% 0.3% 0.4% 1.5%

10.5% 11.1%

30.9%

0%

10%

20%

30%

40%

50%

60%

Ris

k M

AIS

4+

F

<10 10-15 15-20 20-25 25-30 30-35 35+

Delta V (mph)

Unbelted

Belted

Near Side

Unbelted

Belted

Far Side

Figure 2 Risk for severe-to-fatal injury (MAIS 4+F) for near-side (top) andfar-side (bottom) occupants in side impacts by belt use and crash delta V.

impacts. The cases were reviewed to gain an understanding ofthe crashes associated with the severe injury in relatively low-speed side impacts.

RESULTS

Figure 2 shows the risk of severe-to-fatal injury (MAIS4+F) for near-side (top) and far-side (bottom) occupants inside impacts by belt use. The injury risk is shown for delta Vcategories from <10 mph to more than 35 mph. The largest riskis 75.4 ± 41.0% for unbelted, near-side occupants in 35+ mphside impact delta V crashes. The risk for belted near-sideoccupants starts to rise for crashes above 20 mph and variesfrom 12.0 to 51.8% by delta V. The overall risk for MAIS 4+Finjury is 6.91 ± 0.61% for unbelted and 1.29 ± 0.12% forbelted near-side occupants. Seat belt effectiveness is 81.4% fornear-side occupants in preventing MAIS 4+F injury.

For unbelted, far-side occupants, the highest risks are 47.0–48.1% for MAIS 4+F injuries in crashes above 30 mph delta V.The risk is reasonably high at 10.3 ± 7.1% for crashes of 10–15 mph delta V for an unbelted far-side occupant. For belted, far-side occupants, the risk is relatively low until the crash severityis over 25 mph. The data show that belt use is effective inpreventing MAIS 4+F injury ranging from 0.3 to 1.5% forcrashes of 10–25 mph delta V. The risk is high at 30.9 ± 8.2%in the most severe crashes. The overall risk for MAIS 4+F injuryis 6.13 ± 1.13% for unbelted and 0.40 ± 0.04% for belted far-

side occupants. Seat belt effectiveness was 93.5% for far-sideoccupants in preventing MAIS 4+F injury.

Table I provides the weighted counts for the exposed front-seat occupants and those near-side and far-side by seat beltuse. The maximum AIS (MAIS) injury for each occupant wasgrouped by MAIS 0–2, 3, and 4+F. Unknown injury severityis included, but risk was determined using only occupants withknown injury severity (i.e., occupants with unknown injury wereremoved from the exposure group). For the 15 years of NASS-CDS data, 2,840,198 near-side occupants and 2,738,423 far-sideoccupants were involved in side impacts. There were 53,764(1.89%) near-side and 25,480 (0.93%) far-side occupants whowere severely to fatally injured (MAIS 4+F).

The risk for MAIS 4+F injury to belted near-side occupantswas 1.29 ± 0.11% and it was 0.40 ± 0.04% for belted far-sideoccupants. In contrast, unbelted near-side occupants had a 6.91± 0.61% risk of MAIS 4+F and unbelted far-side occupantshad a 6.13 ± 1.13% risk of MAIS 4+F. The difference in riskfor belted and unbelted occupants with MAIS 4+F injury wasstatistically significant (p < 0.001). The difference in risk be-tween near- and far-side belted occupants was also significantlydifferent (p < 0.001). The differences in risk in Figure 2 by deltaV category were not statistically significant due to the smallersample size. Nonetheless, the trends represent the best nationalestimate of risk by delta V category.

Figure 3 shows the relative risk of severe-to-fatal in-jury (MAIS 4+F) for unbelted compared to belted (top) and

35.1

4.92.4 2.4 1.9

0.5 1.5

8.4

35.9

12.1

7.04.3

2.1 1.6

0

5

10

15

20

25

30

35

40

<10 10-15 15-20 20-25 25-30 30-35 35+

Rel

ativ

e R

isk

-M

AIS

4+

F

0.3

2.3

6.5

8.0

2.1

4.1

1.3

0.3

1.3

2.7

0.5

1.71.9 1.6

012

3456

789

<10 10-15 15-20 20-25 25-30 30-35 35+Delta V (mph)

Near

Far

Unbelted/Belted

Belted

Unbelted

Near/Far

Rel

ativ

e R

isk

-M

AIS

4+

F

Figure 3 Relative risk of severe-to-fatal injury (MAIS 4+F) for unbeltedcompared to belted (top) and near- compared to far-side (bottom) occupants inside impacts by delta V.

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72 VIANO AND PARENTEAU

Table I NASS-CDS data for side impacts by near- and far-side front occupants, either belted or unbelted

Side impact (GAD1 = ‘L/R’ and Rollover <= 0) Delta V (mph)

Other <10 10–15 15–20 20–25 25–30 30–35 35+ All

Exposed Near 1,132,754 898,091 527,775 175,314 67,616 23,902 9,536 5,210 2,840,198MAIS unk 39,627 29,229 24,257 8,970 1,256 563 23 26 103,951MAIS 0–2 1,059,251 862,839 492,734 147,192 49,186 12,433 4,351 1,075 2,629,060MAIS 3 15,659 5,784 6,108 12,735 7,665 5,094 1,662 959 55,665MAIS 4+F 18,217 238 4,677 6,416 9,510 5,813 3,500 3,150 51,522

SE MAIS 4+F 102 1,191 815 2,465 872 768 830 3,226

Exposed Far 970,166 948,668 467,058 238,601 75,954 22,314 6,490 9,172 2,738,423MAIS unk 46,833 28,475 28,460 7,806 2,498 531 69 115 114,786MAIS 0–2 906,695 919,055 428,147 225,728 67,579 17,674 3,849 4,426 2,573,153MAIS 3 8,980 718 5,401 2,828 3,449 1,485 1,021 1,125 25,005MAIS 4+F 7,658 420 5,051 2,239 2,428 2,625 1,552 3,506 25,480

SE MAIS 4+F 273 2,781 553 533 531 314 660 2,985

Belted Near 952,150 815,911 447,847 127,182 54,777 18,344 4,059 3,400 2,423,671MAIS unk 33,623 23,512 19,779 7,644 1,121 506 13 0 86,197MAIS 0–2 898,501 787,016 420,691 105,495 41,573 10,439 1,222 1,055 2,265,991MAIS 3 10,081 5,307 4,537 10,805 5,668 3,461 977 586 41,421MAIS 4+F 9,943 76 2,840 3,238 6,416 3,938 1,848 1,760 30,059

SE MAIS 4+F 55 948 450 2,201 792 430 504 2,680

Belted Far 833,168 863,701 406,557 199,480 61,593 14,690 3,527 5,549 2,388,265MAIS unk 43,967 26,242 25,758 6,042 2,263 279 15 87 104,652MAIS 0–2 780,357 837,134 378,212 190,904 56,209 12,252 2,476 3,246 2,260,789MAIS 3 6,380 66 1,492 1,733 2,231 642 649 525 13,717MAIS 4+F 2,465 259 1,096 801 891 1,517 389 1,690 9,108

SE MAIS 4+F 259 584 325 307 474 121 447 900

Unbelted Near 121,494 53,557 55,228 42,454 10,043 4,157 4,244 1,625 292,802MAIS unk 5,690 5,711 3,426 1,262 135 57 10 26 16,317MAIS 0–2 103,175 47,207 48,608 37,135 5,516 1,020 2,847 20 245,529MAIS 3 4,789 477 1,500 1,345 1,557 1,340 464 374 11,845MAIS 4+F 7,841 162 1,694 2,711 2,833 1,739 923 1,206 19,109

SE MAIS 4+F 86 719 550 1,106 360 286 656 1,678

Unbelted Far 103,635 63,146 40,588 30,491 10,269 4,602 2,304 3,274 258,309MAIS unk 2,712 1,372 2,325 1,764 206 21 28 20 8,448MAIS 0–2 93,399 60,963 30,893 26,217 7,805 2,748 833 1,179 224,038MAIS 3 2,468 652 3,413 1,072 1,201 825 372 508 10,512MAIS 4+F 5,056 160 3,955 1,438 1,057 1,008 1,071 1,566 15,312

SE MAIS 4+F 86 2,720 447 313 226 280 474 2,833

near-compared to far-side (bottom) occupants in side impacts.The relative risks are shown for delta V categories from <10mph to more than 35 mph. The highest relative risk for near-side occupants is in <10 mph side impacts. Unbelted, near-sideoccupants are 35.1 times more likely to experience MAIS 4+Fthan belted occupants. The relative risk for all crashes is 5.37for near-side occupants. The highest relative risk for far-sideoccupants is 35.9 for unbelted compared to belted occupantsin 10–15 mph side delta V crashes. For all side impacts, therelative risk is 15.36 for far-side unbelted compared to beltedoccupants.

The relative risk for near-side compared to far-side occu-pants is highest for belted occupants in 15–25 mph side delta Vcrashes. For all side impacts, the relative risk is 3.22 for beltednear- compared to far-side occupants. For unbelted occupants,the relative risk for near-side compared to far-side occupantsvaries from 0.3 to 2.7 with an overall relative risk of 1.13 for allside impacts.

Relative Risk of Unbelted-to-Belted Near-Side Occupants in<10 mph Delta V Side ImpactsFor low delta V side impacts, the relative risk for MAIS 4+Finjury was 35.1 for an unbelted compared to a belted near-sideoccupant. The reason for such a high relative risk was investi-gated by analyzing NASS-CDS electronic case files. Thirteencases were available with near- and far-seated occupants. Therewere two severely injured belted, near-side and one belted,far-side case.

Table II shows that the majority of the six available cases withan unbelted, near-side occupant involved a young to middle-aged male. The crashes involved high initial speeds and a seriesof events (impacts) in the collision sequence. The average num-ber of events (impacts) was 4 with a range of 1–7 where the<10 mph side impact was judged the most significant in thesequence. The front airbag deployed in five cases and two oc-cupants were ejected. One of the electronic cases provides anexample of these crashes.

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INJURY SEVERITY AND BELT USE 73

Table II NASS-CDS electronic cases of severely injured near-side and far-side occupants in <10 mph delta V side impacts

Delta Height Weight Max# Case MY Vehicle CDC V (mph) Age Gender (cm) (kg) Restraint AIS Region Source

Near-Side Belted1 2007-50-76C 2005 Hyundai

XG300/35011LYAW299R999999F9999

8.7 83 F 155 54 L-S + SAB 4 Thorax Side Airbag

2 2003-45-22J 2002 Toyota Camry 03RYEW2 8.7 63 F 160 61 L-S 4 Head Belt restraintB-pillar ordoor frame

Near-Side Unbelted3 2007-72-45B 2003 GMC Yukon 12LPAW3

03RBLW104BREE1

8.7 32 M 168 86 Airbag∗ 4 Thorax Left interior

4 2006-49-92B 1996 VW Passat 11LZEW2 9.3 41 M 193 118 Airbag 5 F Thorax Ext. object∗∗5 2005-74-194K 2001 Ford F-series 99L9999

11LYAW39.3 28 M 183 88 None 4 Head Other object

6 2003-9-232A 2001 LincolnNavigator

12RZHS201F999901F999912FREW300UYDW901RPAS211LYAW3

5.6 36 M 183 64 Airbag 6 F Heart Avulsion Left interior

7 2001-8-101B 1995 Ford Mustang 12FREN112FLEN199LBEW210LBEW312F999912FZEW112FRES9

5.6 37 M 173 Unk Airbag F Unk Unknown

8 1997-12-156J 1994 PontiacFirebird

03RFWN112L999912L999912RZES189LBEW2

8.7 25 M 173 75 Airbag 4 Thorax Ground∗∗

Far-Side Belted1 2006-4-4E 2003 BMW 3 Series 10LFEW2

09LZEW16.8 54 F Unk Unk L-S 4 Head Other occupant

Far-Side Unbelted2 2004-74-201K 1998 Buick Park

Avenue10LFEE409LZEW2

8.7 86 F 157 45 Airbag 4 Head Center IP

3 2003-73-21K 1997 FordExplorer∗∗∗

09LBEW400TDDO300RPAN300RPAN3

7.4 35 F 157 64 Airbag 4 Thorax Right interior

4 1997-41-103C 1995 Isuzu Rodeo 82RFEW3 8.1 39 M 188 93 None 5 Head Mirror5 1997-9-40A 1994 Chevrolet

C-series PU999999901RBEW201RYEW2

9.3 26 M 180 66 None 4 F Head Ground∗∗

6 1997-12-156J 1994 PontiacFirebird

03RFWN112L999912L999912RZES189LBEW2

8.7 24 M 190 79 Airbag 4 Head Ground∗∗

∗L-S (lap-shoulder belt use) in NASS-CDS vehicle inspection notes, manuse = 0 in NASS-CDS database, ∗∗Complete ejection.∗∗∗Rollover , SAB: Side airbag, Airbag: Frontal airbag.The underlined CDC was the principal impact in the collision sequence.

Case: 2003–9-232A. A Lincoln Navigator was travelingsouth in the right lane of a two-lane divided roadway negotiatinga curve as it went through an intersection. Figure 4 shows thatit departed the roadway to the right and struck a tree with the

right rear (event 1, CDC = 12RZHS2). The vehicle continuedsouth and struck two signs with the front (events 2 [01F9999]and 3 [01F9999]). It traveled back onto the roadway, overcor-rected, and traveled off the roadway to the right. It struck a

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74 VIANO AND PARENTEAU

Figure 4 NASS-CDS case 2003-9-232A with a Lincoln Navigator involved in a seven-event collision. The driver’s door was removed to extricate the fatallyinjured driver. Interior contacts were noted on the side interior (chest) and A-pillar (head).

tree with the right front, shearing it off at the base (event 4,12FREW3). The vehicle became airborne as it traveled overa drainage ditch. When it landed, the undercarriage struck theground (event 5, 00UYDW9), the right A-pillar struck a tree(event 6, 01RPAS2), and the left side struck another tree (event7). Event 7 was the principal impact with an 11:00 o’clock prin-cipal direction of force (PDOF) on the left side; the CDC was11LYAW3.

The Navigator was equipped with dual front airbags (de-ployed), dual side airbags (nondeployed), and three-point activerestraints with pretensioners (activated) in all occupied positions(belt not in use). The vehicle contained a driver and no otheroccupant. He was 36 years old, 6′ tall, and weighed 141 lb. Thefront airbags deployed but impact with the door trim causedheart avulsion (AIS 6) and lung laceration with pneumothorax(AIS 4) and head impact on the A-pillar caused minor injury.He was pronounced dead on the scene and not transported fortreatment.

In contrast, Table II shows that there were two cases witha belted near-side occupant with MAIS 4+F injury in a <10mph side impact. The cases involved females 63 and 83 yearsold. For completeness, the table also shows the <10 mph sideimpacts with MAIS 4+F belted and unbelted, far-side occu-pants. The five unbelted occupants were typically involved inmulti-impact collisions with two airbag deployments and twoejections. The belted, far-side occupant case involved a 54-year-

old female with an AIS 4 head injury from occupant-to-occupantcontact.

Relative Risk of Unbelted-to-Belted Far-Side Occupants in10–20 mph Delta V Side ImpactsFor side impacts of 10–15 mph delta V, the relative risk was35.9 for an unbelted compared to belted occupant. For crashesof 15–20 mph delta V, it was 12.1. The reason for such a high rel-ative risk was investigated by analyzing NASS-CDS electroniccase files for crashes of 10–20 mph delta V. Table III shows thatthe majority of the unbelted far-side occupants were involvedin oblique frontal impacts to the side of the vehicle. Five of the12 cases (41.7%) were at 1 o’clock and 4 were at 2 o’clock(33.3%). The relatively large frontal component of the PDOFcaused the unbelted occupants to move forward and contact thewindshield, steering wheel, or other frontal components. In 8of the cases, the front airbag deployed, but the occupant experi-enced severe head injury. One of the electronic cases providesan example of these crashes.

Case: 1997–12-169J. A Honda Accord was southbound anda Dodge Daytona was eastbound on a multilane roadway enter-ing the same intersection. Figure 5 shows that the two vehiclescontacted with the front of the Daytona striking the right side ofthe Accord; the CDC was 01RYAW2. The delta V was 17.5 mphand caused the Accord to yaw. It had two additional minorimpacts with the Daytona (CDC 03RPEW1, <3 mph delta

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INJURY SEVERITY AND BELT USE 75

Table III NASS-CDS electronic cases of far-side, front-seat occupant in 10–20 mph delta V side impacts with MAIS 4+F and spinal injury (region 90 = 6)

Delta Height Weight Max Spine MaxCase MY Vehicle CDC V (mph) Age Gender (cm) (kg) Restraint AIS Region Source Location AIS intrusion

Belted1999-11-193J 1999 Chevrolet

Lumina01RYEW302RBEW2

16.3 61 M UNK UNK L-S + airbag 5 F Head IP C-spine 3 1′3′′

2001-13-89D 1995 Chevy S-10Blazer

01RYEW303RZEW2

13.1 47 F 175 84 L-S 4 T-spine Non contact L-spine 2 8′′

2002-4-70K 2000 HyundaiElantra

02RFEW303RBEE1

13.1 83 M UNK UNK L-S + airbag 3 F UX S/W L-spine 2 0

2002-11-53E 2002 PontiacGrand Prix

01RYAW399F999999L9999

15.6 24 M 188 86 L-S + airbag 4 Head Non contact C-spine 2 1′5′′

2005-11-127K 2000 ChevroletPrizm

02RFEW102RPAW304RZAW2

18.1 21 F 157 58 L-S 5 Head Non contact C7 3 1′2′′

2006-48-68E 2003 Ford Focus 09LPEW3 13.8 90 M 170 79 L-S 4 Thorax Belt C-spine 1 7′′

2007-41-174J 2005 HyundaiAccent

02RYEW311LBEU1

16.9 79 M 157 UNK L-S 4 Head B-pillar C-spine 3 6′′

Unbelted1997-12-169J 1994 Honda

Accord01RYAW203RPEW112RBMS111FDEN112BREE1

17.5 23 M 185 77 Airbag 4 Head Windshield C-spine 3 1′1′′

1997-41-22J 1994 MercuryMarquis

03RYEW2 13.1 80 M 173 91 None 5 Head Interior C-spine 2 9′′

2000-11-20J 1999 GMCSuburban

02RYEW4 14.4 36 F 168 61 Airbag 4 Head Interior C-spine 3 2 1′8′′

T-spine2001-12-21B 1996 Buick

Century02RYEW303RZEW212FLEN1

14.3 69 F 175 75 Airbag 4 F Thorax S/W rim C-spine 2 None

2002-43-139E 2002 PontiacGrand Am

02RFEW303RBEW2

17.5 28 M UNK UNK Airbag 5 C-spine Roof 3′′

2003-41-27K 1998 Ford Escort 02RYEW3 17.5 22 F 163 47 Airbag 5 Head B-pillar C-spine 3 3′′

2003-75-94K 1994 OldsmobileCutlass

01RYEW2 13.1 33 M 175 82 Airbag 5 Head Wind/ header C-spine 3 1′7′′

2004-74-37K 1997 FordExplorer

12FRWN101RYAW312FLEN1

13.8 52 M 191 77 Airbag 5 C-spine Wind/ header 8′′

2005-75-175J 2005 DodgeCaravan

70LFEW5 16.2 50 M UNK UNK Airbag 5 Head Column lever C1 4 6′′

2005-76-47A 2004 ToyotaCamry

04RBEE5 16.9 72 F 163 68 None 3 F Head Interior C-spine 2 2′′

2006-48-213K 1997 ChevroletC PU

02RZEW401RYAW412FDEW2

15.6 29 M 191 67 None 5 Head Interior T6 3 1′4′′

2007-13-71A 2007 NissanSentra

01RZEW205RYES1

15.0 58 M 173 113 None 6 F Head Ground∗ T-spine 2 2′′

∗Complete ejection through the right front door.The underlined CDC was the principal impact in the collision sequence.

V and 12RBMS1, minor) and two minor impacts with poles(11FDEN1 and 12BREE1).

The 23-year-old driver of the Accord was unbelted; he was6′1′′ tall and weighed 170 lb. The front airbags deployed. Hemoved forward and to the right, impacting the windshieldwith his head, causing brain hemorrhaging (AIS 4), cervicalspine fracture (AIS 3), scalp laceration (AIS 1), and abrasion(AIS 1).

For the belted far-side occupants, there was a similar involve-ment of a frontal PDOF with 3 out of 7 cases (42.9%) involving

1 o’clock and another three 2 o’clock (42.9%) impacts to theside of the vehicle. Three of the 7 cases involved occupants>75 years old. Two cases involved airbag deployments.

DISCUSSION

Near-Side Occupants in <10 mph Side ImpactsThe highest relative risk for near-side occupants is in <10 mphside impacts. Unbelted, near-side occupants are 35.1 times morelikely to experience MAIS 4+F injury than belted occupants.

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Figure 5 NASS-CDS case 1997-012-169J with a Honda Accord involved in a right-side intersection collision by a Dodge Daytona. The driver was unbeltedand moved forward and to the right, experiencing head impact on the windshield. Both front airbags deployed.

The reason for the high relative risk is shown by the NASS-CDS electronic cases. Most of the unbelted near-side occupantswere young to middle-aged males who were involved in high-speed accidents with several impacts in the overall collision. Theaverage number of impacts was four and the most significantwas a side impact with less <10 mph delta V. The collisionsoften involved a frontal component with airbag deployment andejection was a factor with yaw and spinout of the vehicles.In contrast, there were only two cases with a belted near-sideoccupants with severe injury in <10 mph side impacts; bothinvolved older women.

Digges and Bahouth (2003) found high risks for serious in-jury with multiple impacts in comparison to single-impact colli-sions. For unbelted occupants, the risk for serious injury (MAIS3+) was 1.89% for a single impact, 8.36% for two impacts,and 16.69% for three-impact collisions. The comparable risksfor belted occupants were 0.34, 2.08, and 3.52%, respectively.The relative risks are rather similar in single (5.6), double (4.0),or triple (4.7) impacts in a collision. The data and other stud-ies show a significant progression in risk for serious injury inmultiple-impact collisions (Fay et al. 2001; Temming and Zobel1999). Bahouth and Digges (2005) found that one of the mostharmful crashes was a side impact followed by another impact.

The NASS-CDS cases reflect an injury mechanism with com-plex vehicle kinematics in multiple impacts from high speed.

The unbelted near-side occupant moves within the vehicle andcan experience interior impacts and ejection in the collision se-quence. The complex vehicle and occupant movements in thereal-world crashes are not covered by the type of side impacttesting of vehicles currently conducted. In the crash tests, thevehicle is at rest and is impacted by a moving deformable bar-rier or is brought into contact with a stationary pole. The timingof an airbag deployment is not addressed with respect to com-plex occupant and vehicle movement in the real-world crashesas shown in Tables II and III. These factors can influence thesafety performance.

Far-Side Occupants in 10–20 mph Delta V Side ImpactsFor these side crashes, the relative risk was 35.9 for an unbeltedcompared to a belted far-side occupant for crashes of 10–15mph delta V and 12.1 for crashes of 15–20 mph. The reasonfor the high relative risk was seen in the NASS-CDS electroniccases. The majority of unbelted, far-side occupants were in-volved in oblique frontal impacts to the side of their vehicle.The frontal component of the PDOF caused the unbelted occu-pant to move forward and contact front interior components eventhough the airbag deployed in some cases. In contrast, the caseswith belted far-side occupants involved older occupants withcontact injuries or younger occupants with noncontact (inertial)injuries.

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Unbelted, far-side occupants move across the interior in a sideimpact and can strike the far-side or adjacent occupant at nearlythe impact speed of the collision. In these cases, a 10–15 mphimpact of the occupant on the interior can result in severe injury,so delta V may not fully explain the crash severity. When the far-side occupant is belted, there can be injuries by inertial forcesor impacts with the interior as the vehicle rotates and spins inthe collision sequence. Again, these kinds of complex vehicleand occupant movements cannot be studied in the typical crashtesting done during vehicle development and consumer testing.

Occupant ProtectionBoth low-speed, side-impact situations require consideration ofways to improve occupant safety. Obviously, use of the availablesafety belt is the best means to reduce injury risks in side im-pacts for unbelted occupants. In many of the cases, movementof the unbelted occupant in the vehicle resulted in impacts orejection, causing injury. In these cases, the lap belt would pro-vide the essential means of remaining in the seat. Other meansof improving occupant containment may be beneficial by useof inflatable restraints with relatively long inflation hold times.The use of inflatable side curtains for rollover protection involveinflation hold times up to 5 s or more, which makes them poten-tially important means of reducing injury risks and preventingejection in low-speed side impacts, if inflation of the curtains istriggered. The main issue would be whether the sensing algo-rithm and decision logic for the triggering can detect and inflatethe curtain and belt pretensioning system. There are a number ofoptions based on vehicle travel speed, dynamics, and recordedacceleration in a multi-impact collision sequence.

Most modern seat belts limit load in the shoulder belt toimprove occupant protection in severe frontal crashes (Formanet al. 2006; Miller 1996; Petitjean et al. 2002). In these cases, theshoulder belt and airbag share restraint of the upper torso andbalancing the load in the belt with that in the airbag is a designconsideration. However, in far-side and oblique frontal impacts,the shoulder belt can allow excursion and load-limiting shoul-der belts can further increase the excursion of the occupant’shead and upper body (Horsch et al. 1984; Kallieris and Schmidt1990). A deleterious effect has been seen with the load-limitingrecommendation for 2.5 kN (Mertz and Dalmotas 2007; Mertzet al. 1995). The low load limit can allow too much excursionin some real-world crashes. An increase in excursion can leadto higher speed impacts with the interior and partial or com-plete ejection in some circumstances. However, in some cases,load limiting can increase excursion with beneficial effects inlowering risks for inertial or noncontact injury. Clearly, under-standing the benefits and risks of occupant excursion requiresconsideration beyond the kind of current crash testing used bythe government and industry.

The need for more crash test conditions and occupant seatingpositions has been considered. Mackay et al. (1991), Framptonet al. (1999), Fildes et al. (1994, 2000), Digges and Dalmotas(2001), and Gabler et al. (2005) have assessed the risk of in-jury to far-side occupants because of their relatively high risks

for severe injury. Any testing of far-side occupants would bebeneficial in gaining an understanding of occupant restraint andcontainment in side impacts. Currently, there are no regulationsor consumer tests to assess risks to far-seated occupants. Suchtesting could also address the potential for occupant-to-occupantloading in side impacts (Newland et al. 2008).

LimitationsThere are a number of limitations to the field accident dataanalysis using NHTSA’s stratified sample of motor vehicle ac-cidents in the United States. The sample size for the 15 yearsof NASS-CDS data can be small when the study is limited tothe most severe injury and small ranges in delta V for beltedand unbelted occupants. Though the weighted data provide thebest national estimate of the occurrence of field accident injury,the standard errors can be large. This makes statistical analysisdifficult. These results should be seen as the best estimate ofinjury risks in crashes of different delta V.

Our practice is to use NASS-CDS data analysis to raise ques-tions that are best answered by in-depth review of electroniccases. This style of research balances the limitations of the ac-cident data with factual information about real-world crasheswith essentially similar circumstances, such as injury severity,crash direction, and belt use. The combination of approachesis a powerful way to study traffic accident injury, particularlywhen the in-depth cases answer the question of why there is anunusually high risk of injury in a particular situation.

In this study, a ratio of risk for unbelted compared to beltedoccupants was calculated by taking the risk for severe injury withunbelted occupants and dividing by the risk for severe injury tobelted occupants by crash severity category. The accuracy of theratio depends on the sample size and the reader should be awareof the standard errors and potential limitations of the NASS-CDS data. For example, the trend in injury risks for near-sideoccupants in 30–35 mph crashes is reversed from that of otherdelta V ranges. The standard errors show that the difference issignificant with a higher risk for belted than unbelted occupants.An explanation is not obvious but may be based on some biasin the determination of delta V.

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