Abdominopelvic Injuries in Lateral Motor Vehicle Crashes with Side Airbags… · 2017-01-10 ·...

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Abdominopelvic Injuries in Lateral Abdominopelvic Injuries in Lateral Motor Vehicle Crashes with Side Motor Vehicle Crashes with Side Airbags: Another Bag? Airbags: Another Bag? October 8 October 8 th th , 2009 , 2009 CIREN 2009 Public Meeting CIREN 2009 Public Meeting Anne Rizzo, MD; Anne Rizzo, MD; Jeffrey Jenkins, BSME; Tayseer A Jeffrey Jenkins, BSME; Tayseer A Aldaghlas Aldaghlas , MD, MS; Christine Burke; Robyn , MD, MS; Christine Burke; Robyn Richmond, MD; Margaret Griffen, MD Richmond, MD; Margaret Griffen, MD

Transcript of Abdominopelvic Injuries in Lateral Motor Vehicle Crashes with Side Airbags… · 2017-01-10 ·...

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Abdominopelvic Injuries in Lateral Abdominopelvic Injuries in Lateral Motor Vehicle Crashes with Side Motor Vehicle Crashes with Side

Airbags: Another Bag?Airbags: Another Bag?

October 8October 8thth, 2009, 2009CIREN 2009 Public MeetingCIREN 2009 Public Meeting

Anne Rizzo, MD;Anne Rizzo, MD; Jeffrey Jenkins, BSME; Tayseer A Jeffrey Jenkins, BSME; Tayseer A AldaghlasAldaghlas, MD, MS; Christine Burke; Robyn , MD, MS; Christine Burke; Robyn

Richmond, MD; Margaret Griffen, MD Richmond, MD; Margaret Griffen, MD

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Inova Fairfax HospitalFalls Church, VA

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OutlineOutlineMorbidity and mortality of abdominal and pelvic Morbidity and mortality of abdominal and pelvic injuries:injuries:

Solid organsSolid organsHollow Viscus Injuries (HVI)Hollow Viscus Injuries (HVI)PelvisPelvis

Federal Motor Vehicle Safety Standards Federal Motor Vehicle Safety Standards (FMVSS 214)(FMVSS 214)Current side impact air bag coverageCurrent side impact air bag coverageAnalysis of side impact air bags in the CIREN Analysis of side impact air bags in the CIREN databasedatabase

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DisclosuresDisclosures

Nothing to DiscloseNothing to DiscloseDude, I was texting my girl Dude, I was texting my girl friendfriend…… I have my seatbelt onI have my seatbelt on……??

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Abstract Accepted For 2010 Eastern Association Abstract Accepted For 2010 Eastern Association for the Surgery of Trauma Annual Meeting,for the Surgery of Trauma Annual Meeting,

Phoenix, AZPhoenix, AZ

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BackgroundBackgroundSide impacts = 26% of all MVC’s32% have AIS 3+ injuriesThorax and pelvis most likely to be injured in near-side impacts Thorax and pelvic injuries are associated with door intrusion NHTSA estimated head and torso SIAB reduce fatality in near side crashes by 24%

Samaha 2003Lau 1991,Chung 1999,Samaha 2003Department of Transportation, National Highway Traffic Safety Administration, “Federal Motor Vehicle Safety Standards; Side Impact Protection; Side Impact Phase-In Reporting,” Federal Register, Vol. 72, No. 175, Tuesday, September 11, 2007.

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Injury Distribution in Near Side Crashes with AIS>3 Injuries

Head 38%

Pelvis 32%

Abdomen 25%

Chest 64%

N=726Aldaghlas 2009

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Abdominal Pelvic ContentsAbdominal Pelvic Contents

Peritoneal organsPeritoneal organs–– diaphragm, liver, spleen, stomach, small diaphragm, liver, spleen, stomach, small

bowel and transverse colon bowel and transverse colon RetroperitonealRetroperitoneal–– aorta, vena cava, pancreas, kidneys, ureters aorta, vena cava, pancreas, kidneys, ureters

and portions of duodenum and colon and portions of duodenum and colon PelvisPelvis–– rectum, bladder, iliac vessels, internal rectum, bladder, iliac vessels, internal

genitalia of women genitalia of women

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Abdominal AnatomyAbdominal Anatomy

Liver

Diaphragm

Spleen

Kidney

Stomach

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Solid Organ InjuriesSolid Organ Injuries

Spleen most commonly injured (60%), Spleen most commonly injured (60%), mortality 6mortality 6--10%10%Liver second most commonly injured, Liver second most commonly injured, mortality 8mortality 8--10%10%Mechanism: direct compression, rate of Mechanism: direct compression, rate of compression, rib fractures, accelerationcompression, rib fractures, acceleration

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Hollow Viscus Injuries (HVI)Hollow Viscus Injuries (HVI)

Small bowel injury relatively uncommon (<1% of all trauma admissions)Intestine = 3rd most commonly injured abdominal organ in blunt trauma (5-15%)Mechanism: sudden rise in intraluminal pressure, compression, acceleration

East, J Trauma 2003

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Pelvic Organ InjuriesPelvic Organ Injuries

Pelvic structure protects various organsPelvic structure protects various organsPelvic fractures : GU, GI and vascular Pelvic fractures : GU, GI and vascular injuriesinjuriesMechanism: direct compression, Mechanism: direct compression, acceleration, laceration from bone acceleration, laceration from bone fragmentsfragments

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Pelvic FracturesPelvic Fractures

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Mechanism of Pelvic Ring Fractures

Thornton 2009Thornton 2009

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Pelvic Fracture ClassificationPelvic Fracture Classification

Tile and YoungTile and Young--Burgess:Burgess:Both based on direction of injurious forceBoth based on direction of injurious forceRelates to type of treatment required and Relates to type of treatment required and

prognosisprognosis

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YoungYoung--Burgess (YB)Burgess (YB)

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Injury Types Based on YB Injury Types Based on YB ClassificationClassification

AP compressionAP compressionBBased on direction of injurious forceased on direction of injurious force

Pubic diastasis with or without SI joint disruptionPubic diastasis with or without SI joint disruptionCauses external rotation of Causes external rotation of

either hemipelvis or both either hemipelvis or both External rotation increasedExternal rotation increased

volume: increased bleedingvolume: increased bleeding

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Injury Types Based on YB Injury Types Based on YB ClassificationClassification

Lateral compressionLateral compressionSacral buckle and Sacral buckle and horizontal pubic rami horizontal pubic rami fractures fractures Causes internal rotation of Causes internal rotation of either hemipelvis or both either hemipelvis or both Internal rotation creates Internal rotation creates decreased volume: less decreased volume: less bleedingbleeding

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Injury Types Based on YB Injury Types Based on YB ClassificationClassification

Vertical shear injury Vertical shear injury A vertical force to hemipelvis (by femur)A vertical force to hemipelvis (by femur)HemipelvisHemipelvis is displaced in a cranial direction is displaced in a cranial direction

Complex fractureComplex fractureForces applied > one primary vectorForces applied > one primary vector

Most MORBID injuryMost MORBID injury

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Pelvic FracturesPelvic FracturesMortalityMortality

Associated with high mortalityAssociated with high mortalityOverall mortality 16%Overall mortality 16%Uncontrolled pelvic hemorrhage 39%Uncontrolled pelvic hemorrhage 39%Open fractures 45%Open fractures 45%

Grotz 2005

Dente 2005

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Pelvic FracturesPelvic FracturesMorbidityMorbidity

Infection, pain, nerve damage (10Infection, pain, nerve damage (10--15%), 15%), malunionmalunion or nonunion, or nonunion, DVTsDVTs and and PEsPEsComplications in women: urinary tract (21%), Complications in women: urinary tract (21%), lower GI symptoms (8%)lower GI symptoms (8%)Long term disability: <50% of patients who are Long term disability: <50% of patients who are operated return to their operated return to their preinjurypreinjury level of functionlevel of functionMechanism: direct compression, tension, Mechanism: direct compression, tension, bending, shearbending, shear

Huittinen 1972

Weis 1984

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Timeline of Federal Safety RulesTimeline of Federal Safety Rules

19661966 DOT createdDOT created

19681968 Front seat shoulder beltsFront seat shoulder belts

19951995 Passive restraints in all carsPassive restraints in all cars

19971997 Dual frontal AB in all carsDual frontal AB in all cars

2000s2000s Performance requirements added Performance requirements added to decrease injuries in side impact to decrease injuries in side impact crashescrashes

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FMVSS No. 214FMVSS No. 214Protect occupants in near side crashesSide impact requirements for passenger cars: October of 1990Defined minimum requirements for thoracic and pelvic protectionNew requirements in 2010: criteria for abdominal and pelvic regions

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Current Testing for Side ImpactCurrent Testing for Side Impact

HIC (Head Injury Criterion)HIC (Head Injury Criterion)TTI (Thoracic Trauma Index)TTI (Thoracic Trauma Index)Maximum Pelvic Acceleration Criteria Maximum Pelvic Acceleration Criteria (130g)(130g)No current abdominal criteriaNo current abdominal criteria

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Air Bag Deployment ReviewAir Bag Deployment Review726 near side crashes reviewed726 near side crashes reviewed586 near side crashes without SIAB586 near side crashes without SIABinstalledinstalled28 SIAB did not deploy28 SIAB did not deploy

112 vehicles with SIAB deployment112 vehicles with SIAB deployment61 deployments with head coverage61 deployments with head coverage111 deployments with thorax/abdomen111 deployments with thorax/abdomencoveragecoverage4 deployments with pelvic coverage4 deployments with pelvic coverage

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Torso and head: Roof rail and door mounted

Types of Side Impact Air BagsTypes of Side Impact Air Bags

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Types of Side Impact Air BagsTypes of Side Impact Air BagsTorso and head: roof rail and seat mounted

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Head Injuries Head Injuries

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Types of Side Impact Air BagsTypes of Side Impact Air BagsTorso: seat and door mounted

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Chest InjuriesChest Injuries

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Abdominal InjuriesAbdominal Injuries

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Torso and pelvis: seat mountedTypes of Side Impact Air BagsTypes of Side Impact Air Bags

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Pelvic InjuriesPelvic Injuries

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Head injury vs. SIAB coverageHead injury vs. SIAB coverage

Minor Injury = At least one AIS ≤ 2 for HeadSevere Injury = At least one AIS ≥ 3 for Head

SIAB with Head Coverage

SIAB without Head Coverage

No SIAB

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Chest injury vs. SIAB coverageChest injury vs. SIAB coverage

Minor Injury = At least one AIS ≤ 2 for ChestSevere Injury = At least one AIS ≥ 3 for Chest

SIAB with Chest Coverage

SIAB without Chest Coverage

No SIAB

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Abdominal injury vs. SIAB coverageAbdominal injury vs. SIAB coverage

Minor Injury = At least one AIS ≤ 2 for AbdomenSevere Injury = At least one AIS ≥ 3 for Abdomen

SIAB with Abdomen Coverage

SIAB without Abdomen Coverage

No SIAB

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Pelvic injury vs. SIAB coveragePelvic injury vs. SIAB coverage

Minor Injury = At least one AIS ≤ 2 for PelvisSevere Injury = At least one AIS ≥ 3 for Pelvis

SIAB with Pelvis Coverage

SIAB without Pelvis Coverage

No SIAB

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Injury Distribution in Severe Near Side Crashes with AIS>3 Injuries

47%

38%

21%

66%

N=726

<1%

2%

6%

4%

With Air Bags Without Air Bags

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ConclusionConclusionCurrent side air bag coverage focuses on Current side air bag coverage focuses on the head and torsothe head and torsoSIAB (head, chest, abdomen) extend SIAB (head, chest, abdomen) extend protective benefits to other body regions: protective benefits to other body regions: EXCEPTION EXCEPTION

PelvisPelvisLesser extent abdominal organsLesser extent abdominal organs

Few SIAB extend to the pelvic region, Few SIAB extend to the pelvic region, leaving pelvis unprotected in a majority of leaving pelvis unprotected in a majority of crashes crashes

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ConclusionConclusionFuture HorizonsFuture Horizons

Additional data variables describing side Additional data variables describing side air bag coverage zones in crash research air bag coverage zones in crash research databases would enable researchers to databases would enable researchers to focus more specifically on reduction in focus more specifically on reduction in injuries to the AP region injuries to the AP region

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ConclusionConclusionFuture HorizonsFuture Horizons

The new injury criteria for FMVSS 214 in The new injury criteria for FMVSS 214 in 2010 for the protection of AP regions will 2010 for the protection of AP regions will reduce injuries and disabilities from side reduce injuries and disabilities from side impact crashesimpact crashesRecommendations: Pelvic AB coverageRecommendations: Pelvic AB coverage

Structural Integrity ChangeStructural Integrity Change

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LimitationsLimitations

Limited details on SIAB coverage area Limited details on SIAB coverage area available for researchavailable for researchSmall sample size of current pelvic SIABSmall sample size of current pelvic SIABAbdominal organ mechanisms of injury Abdominal organ mechanisms of injury need more studyneed more study

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Questions?Questions?