Associations between upper extremity injury patterns in side impact motor vehicle collisions with occupant and crash characteristics. (January 2019)

• Record Type: Journal Article
• Authors: Kelley, Mireille E.; Talton, Jennifer W.; Weaver, Ashley A.; Usoro, Andrew O.; Barnard, Eric R.; Miller, Anna N.
• Is Part Of: Accident analysis and prevention. Volume 122(2019)
• Page Start: 1
• Page End: 7
• Publication Date: 2019-01
• Subjects: Motor vehicle collision -- Upper extremity -- Side impact -- Injury source -- Injury mechanism; Accidents -- Prevention -- Periodicals; Accident Prevention -- Periodicals; Accidents -- Prévention -- Périodiques; 363.106
• DOI: 10.1016/j.aap.2018.09.029
• Languages: English
• ISSNs: 0001-4575

Abstract

Highlights: The clavicle was the most common fracture location in side impacts. Odds of scapula fracture significantly increased with rearward seat track position. Contact with the door resulted in the highest number of UE injuries in side impacts. Contact with the B-pillar resulted in the highest ratio of AIS 2 + UE injuries in side impacts. Abstract: Introduction: Side impact motor vehicle collisions (MVC) represent a significant burden of mortality and morbidity caused by automotive injury within the United States. The objective of this study was to evaluate the relationship between upper extremity (UE) injury patterns and contact sources in side impact MVC with occupant and crash variables. Methods: Crash Injury Research and Engineering Network data obtained from 1998 to 2012 were used to evaluate UE injuries in side impact crashes. First row drivers and passengers that were at least 16 years old with complete crash information were included. Side impact crashes were defined to have an area of deformation to the side of the vehicle and a principal direction of force between 60° and 120° or 240° and 300°. Injuries were stratified by type, anatomic location, and Abbreviated Injury Scale (AIS) severity. Occupant variables included age, sex, height, weight, body mass index, and Injury Severity Score. Vehicle and crash variables included in the analysis were change in vehicle velocity at the time of impact, maximum door intrusion, maximum B-pillar intrusion, seat track position, belt use, vehicle type, impact type, and injury source. Statistical analysis of the UE injury data included descriptive statistics, linear regression analyses with occupant variables, and logistic regression analyses with vehicle and crash variables. Results: There were 903 UE injuries among 408 case occupants. The most common injury type was soft tissue injury (72.5%). The majority of fractures were proximal to and including the humerus (70.3%) with the clavicle being the most common fracture location (N = 89). AIS 2+ UE injuries were associated with a significantly higher mean occupant Injury Severity Score than AIS 1 UE injuries (p = 0.01). Contact with the door was the leading cause of UE injury (34.2%). The odds (OR [95% confidence interval], p-value) of an AIS 2+ UE injury due to contact with the B-pillar (5.3 [3.1, 9.1], <0.0001), door (1.9 [1.3, 2.7], 0.0006), and steering wheel/assembly (2.7 [1.1, 6.3], 0.03) were significantly higher than all other injury sources combined. Scapula fractures were significantly associated with rearward seat track positions (1.46 [1.04, 2.05], 0.03). Conclusions: This study provides insight into UE injury patterns in side impact MVC. The clavicle was the most common UE fracture location. Contact with the door resulted in the highest number of UE injuries and the B-pillar resulted in the most severe injuries. Additionally, exposure to greater B-pillar intrusion was associated with increased odds of scapula and clavicle fractures in side impacts.