Age Related Thresholds and Thoracic InjuryAge Related Thresholds and Thoracic Injury CIREN Public...

Age Related Thresholds and Age Related Thresholds and Thoracic InjuryThoracic Injury

CIREN Public MeetingCIREN Public MeetingMarch 25, 2008March 25, 2008

Toyota – Wake Forest UniversitySchool of Medicine

CIREN Center

Impact of Age on Thoracic InjuriesImpact of Age on Thoracic Injuries

Scope of the problemScope of the problemImpact of thoracic injuries on the elderlyImpact of thoracic injuries on the elderlyImpact of age on rib fractures and Impact of age on rib fractures and pulmonary contusion in CIRENpulmonary contusion in CIRENImpact of age on rib fractures and Impact of age on rib fractures and pulmonary contusion in NASS and NTDBpulmonary contusion in NASS and NTDBVolumetric assessment of pulmonary Volumetric assessment of pulmonary contusioncontusion

US Census, 2000US Census, 2000

Percent US Population Above 65 Years Old

0

5

10

15

20

25

2000 2010 2020 2030 2040 2050

Year

Per

cent

(%)

Aging in AmericaAging in America

Rib fractures are most common thoracic Rib fractures are most common thoracic injury in the elderlyinjury in the elderlyPulmonary contusion is the most common Pulmonary contusion is the most common soft tissue injury of the thorax in the soft tissue injury of the thorax in the elderlyelderly

Effect of Age on ThoraxEffect of Age on Thorax

Less deformation in response to loadingLess deformation in response to loadingRib cage morphology changes with ageRib cage morphology changes with age–– U of Michigan, 2006 CIREN meetingU of Michigan, 2006 CIREN meeting

Bone demonstrates thin cortical shell and Bone demonstrates thin cortical shell and ““brittlebrittle”” material propertiesmaterial properties

Database SelectionDatabase Selection

++++

++++

++++++

Crash Crash datadata

++++++++++++++++++++NTDBNTDB

++++++++++++++NASSNASS

++++++++++++++++++++CIRENCIREN

++++++++++++++++++++++Local Local CIRENCIREN

Physiologic Physiologic datadata

Image Image analysisanalysis

Outcome Outcome datadata

DetailDetail# of # of casescases

DatabaseDatabase

AgeAge--Related Mortality ThresholdsRelated Mortality Thresholds

National Trauma Databank / CIREN studyNational Trauma Databank / CIREN studyIdentification of isolated injuries in NTDBIdentification of isolated injuries in NTDBCreation of Receiver Operator Creation of Receiver Operator Characteristic curvesCharacteristic curves–– Serial assessment of each ageSerial assessment of each age

Identification of age that maximizes Identification of age that maximizes sensitivity and specificity for determining sensitivity and specificity for determining mortalitymortality

Thorax Injury ThresholdsThorax Injury ThresholdsAGEInjury

41RIB CAGE, FRACTURE, FLAIL CHEST (UNSTABLE CHEST WALL), WITH LUNG CONTUSION

450264.4

63RIB CAGE, FRACTURE, 1 RIB, WITH HEMO/PNEUMOTHORAX450214.3

56RIB CAGE, FRACTURE, FLAIL (UNSTABLE CHEST WALL), BILATERAL450266.5

40LUNG, CONTUSION, BILATERAL441410.4

40THORACIC CAVITY INJURY NFS WITH HEMO/PNEUMOTHORAX442202.3

40RIB CAGE, FRACTURE, > 3 RIBS ON EACH OF TWO SIDES, WITH STABLE CHEST OR NFS, WITH HEMO/PNEUMO THORAX

450242.5

42RIB CAGE, FRACTURE, 2-3 RIBS ANY LOCATION OR MULTIPLE FRACTURES OF SINGLE RIB, WITH STABLE CHEST OR NFS WITH HEMO/PNEUMOTHORAX

450222.3

40RIB CAGE, FRACTURE, > 3 RIBS ON ONE SIDE AND <= 3 RIBS ON OTHER SIDE, STABLE CHEST OR NFS

450230.3

68LUNG, CONTUSION, UNILATERAL441406.3

42RIB CAGE, FRACTURE, > 3 RIBS ON ONE SIDE AND <= 3 RIBS ON OTHER SIDE, STABLE CHEST OR NFS, WITH HEMO/PNEUMO THORAX

450232.4

NTDB Injury ThresholdsNTDB Injury Thresholds

Based on large databaseBased on large databaseAges appear young but represent Ages appear young but represent observed inflection pointobserved inflection pointIndicative of progressive processIndicative of progressive processImpact of injury likely dependent on Impact of injury likely dependent on physiologic reservephysiologic reserve

Age Effect Controlling for AISAge Effect Controlling for AIS

To evaluate effects of age on thoracic To evaluate effects of age on thoracic injury severityinjury severityDatabase: NTDBDatabase: NTDBSeverity of injury score (AIS) for thoracic Severity of injury score (AIS) for thoracic injuries comparedinjuries compared–– Rib fractures, pulmonary contusionRib fractures, pulmonary contusionIsolated injuriesIsolated injuries–– Impact of multiple injuries not capturedImpact of multiple injuries not captured

Mortality by Thoracic Abbreviated Mortality by Thoracic Abbreviated Injury Scale (AIS)Injury Scale (AIS)

Mortality by Isolated Thoracic AIS in NTDB

05

101520253035404550

1 2 3 4 5

AIS

Perc

ent M

orta

lity

(%)

Mortality by Isolated Thoracic AIS in NTDB

05

101520253035404550

1 2 3 4 5

AIS

Perc

ent M

orta

lity

(%)

< 65 yo>= 65 yo

Mortality by Rib Fracture AISMortality by Rib Fracture AIS

Mortality by Isolated Rib Fracture AIS in NTDB

0

2

4

6

8

10

12

1 2 3 4 5

AIS

Per

cent

Mor

talit

y (%

)

Mortality by Isolated Rib Fracture AIS in NTDB

02468

101214161820

1 2 3 4 5

AIS

Perc

ent M

orta

lity

(%)

< 65 yo>= 65 yo

Mortality by Pulmonary Contusion Mortality by Pulmonary Contusion AISAIS

Mortality by Isolated Pulmonary Contusion AIS in NTDB

0

1

2

3

4

5

6

7

8

1 2 3 4 5

AIS

Perc

ent M

orta

lity

(%)

Mortality by Isolated Pulmonary Contusion AIS in NTDB

0

2

4

6

8

10

12

14

16

1 2 3 4 5

AIS

Per

cent

Mor

talit

y (%

)

< 65 yo>= 65 yo

Thoracic Injuries Thoracic Injuries ––T/WFU CIRENT/WFU CIREN

T/WFU CIREN Center cases were reviewed T/WFU CIREN Center cases were reviewed to characterize thoracic injuries with to characterize thoracic injuries with respect to agerespect to age96 total cases96 total casesDetermination of rib fracture number (Determination of rib fracture number (ααAIS) AIS) and presence of pulmonary contusionand presence of pulmonary contusion–– Relationship with ageRelationship with age

T/WFUT/WFU--CIRENCIRENPatient Age According to Number of Rib Fractures in Patients

that Sustained Rib Fractures

40

42

44

46

48

50

52

54

3 or Fewer Rib Fractures Between 4 and 8 Rib Fractures Greater than 8 Rib Fractures

Ave

rage

Pat

ient

Age

(yea

rs)

T/WFUT/WFU--CIRENCIREN

Thoracic Injuries According to Age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90

Patient Age (years)

Perc

ent o

f Pat

ient

s in

Eac

h Ag

e Ra

nge

% Patients with PulmonaryContusion in Each Age Range% Patients with Rib Fractures inEach Age Range


Thoracic Injury According to Age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90

Patient Age (years)

% o

f CIR

EN P

atie

nts

with

Tho

raci

c In

jury

Patients with PCPatients with Rib Fractures


Age Comparison of Thoracic Injury

0

10

20

30

40

50

60

Both Pulmonary Contusion andRib Fractures

ONLY Rib Fractures ONLY Pulmonary Contusion

Ave

rage

Pat

ient

Age

(yea

rs)

Thoracic Injuries in CIRENThoracic Injuries in CIREN

CIREN cases were evaluated to CIREN cases were evaluated to characterize thoracic injuries with respect characterize thoracic injuries with respect to ageto age1996 to 20061996 to 2006Rib fracture and pulmonary contusion Rib fracture and pulmonary contusion cases identifiedcases identified–– Relationship with ageRelationship with age–– Characterization of crash severityCharacterization of crash severity

Thoracic Injuries in CIRENThoracic Injuries in CIREN

Crash severity characterized by change in Crash severity characterized by change in velocity (Delta V)velocity (Delta V)–– Mild: Delta V Mild: Delta V 0 to 24.1 km/h0 to 24.1 km/h–– Moderate: Delta V Moderate: Delta V 24.2 to 48.2 km/h24.2 to 48.2 km/h–– Severe: Delta V Severe: Delta V ≥≥ 48.3 km/h48.3 km/h

Age Distribution in CIRENAge Distribution in CIREN

0

100

200

300

400

500

600

700

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Freq

uenc

y

Mean Age Mean Age --CIRENCIREN

Mean Age of Thoracic Injuries in CIREN

0

10

20

30

40

50

60

70

80

PC +, RibFX + PC +, RibFX - PC -, RibFX + PC -, RibFX -

Age

(yea

rs)

Mean Age of Thoracic Injuries in CIREN

0

10

20

30

40

50

60

70

80

PC +, RibFX + PC +, RibFX - PC -, RibFX + PC -, RibFX -

Age

(yea

rs)

Injury Distribution Injury Distribution --CIRENCIREN

Percent of Age Group with Rib Fractures and Pulmonary Contusion

0

10

20

30

40

50

60

70

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f Age

Gro

up (%

)

PC +, RibFX +PC +, RibFX -PC -, RibFX +PC -, RibFX -

Injury Distribution Injury Distribution ––CIRENCIRENby Crash Severityby Crash Severity

Percent of Age Group with Rib Fractures and Pulmonary Contusion in Low Severity Crashes

0

10

20

30

40

50

60

70

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f age

gro

up (%

)



Percent of Age Group with Rib Fractures and Pulmonary Contusion in Moderate Severity Crashes

0

10

20

30

40

50

60

70

80

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f age

gro

up (%

)



Percent of Age Group with Rib Fractures and Pulmonary Contusion in High Severity Crashes

0

10

20

30

40

50

60

70

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f age

gro

up (%

)


Pulmonary Contusion Pulmonary Contusion --CIRENCIREN

Percent Pulmonary Contusion by Age Among Total Study Group and Rib Fracture Patients

0

5

10

15

20

25

30

35

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f stu

dy g

roup

(%)

Percent of total sample populationPercent of patients with rib fractures

Thoracic Injuries in NASSThoracic Injuries in NASS

NASS cases were evaluated to NASS cases were evaluated to characterize thoracic injuries with respect characterize thoracic injuries with respect to ageto age2000 2000 –– 2006 cases reviewed2006 cases reviewedRib fracture and pulmonary contusion Rib fracture and pulmonary contusion cases identifiedcases identified–– Relationship with ageRelationship with age–– Characterization of crash severityCharacterization of crash severity–– Impact of restraint systemsImpact of restraint systems

Injury Distribution Injury Distribution --NASSNASS

Percent of Age Group with Rib Fractures and Pulmonary Contusion

0

10

20

30

40

50

60

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f Age

Gro

up (%

)


Injury Distribution Injury Distribution ––NASSNASSby Crash Severityby Crash Severity

Percent of Age Group with Rib Fractures and Pulmonary Contusion in Low Severity Crashes

0

10

20

30

40

50

60

70

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f Age

Gro

up (%

)



Percent of Age Group with Rib Fractures and Pulmonary Contusion in Moderate Severity Crashes

0

10

20

30

40

50

60

70

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent o

f Age

Gro

up (%

)



Percent of Age Group with Rib Fractures and Pulmonary Contusion in High Severity Crashes

0

10

20

30

40

50

60

70

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (Years)

Perc

ent o

f Age

Gro

up (%

)


Pulmonary Contusion Pulmonary Contusion ––NASSNASS

Percent Pulmonary Contusion by Age Among Total Study Group and Rib Fracture Patients

0

5

10

15

20

25

30

35

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Age (years)

Perc

ent s

tudy

pop

ulat

ion

(%)

Percent of total sample populationPercent of patients with rib fractures

Rib Fractures Rib Fractures --NASSNASS

n = 9987, 4822, 1779

Percent Rib Fractures by Age and Delta V

0

5

10

15

20

25

30

35

40

45

50

55

60

65

Low Moderate High

Crash Severity

Perc

ent R

ib F

ract

ure

(%)

Age < 40

Age 40 - 64

Age >= 65

Percent Rib Fractures by Age and Delta V

0

5

10

15

20

25

30

35

40

45

50

55

60

65

Low Moderate High

Crash Severity

Perc

ent R

ib F

ract

ure

(%)

Age < 40

Age 40 - 64

Age >= 65

Rib Fractures Rib Fractures --NASSNASS

Percent Rib Fractures by Delta Vand Restraint Category: Age >= 65

0

10

20

30

40

50

60

70

80

90

Low Moderate High

Crash Severity

Perc

ent R

ib F

ract

ure

(%)

Unrestrained

Seatbelt

Airbag

Both Restraints

Percent Rib Fractures by Delta Vand Restraint Category: Age < 40

0

10

20

30

40

50

60

70

80

90

Low Moderate High

Crash Severity

Perc

ent R

ib F

ract

ure

(%)

Unrestrained

Seatbelt

Airbag

Both Restraints

Pulmonary Contusion Pulmonary Contusion --NASSNASS

n = 9987, 4822, 1779

Percent Pulmonary Contusion by Age and Delta V

0

5

10

15

20

Low Moderate High

Crash Severity

Per

cent

Pul

mon

ary

Cont

usio

n (%

)

Age < 40

Age 40 - 64

Age >= 65


Percent Pulmonary Contusion by Delta Vand Restraint Category: Age < 40

0

5

10

15

20

Low Moderate High

Crash Severity

Perc

ent P

ulm

onar

y C

ontu

sion

(%)

Unrestrained

SeatbeltAirbag

Both Restraints

Percent Pulmonary Contusion by Delta Vand Restraint Category: Age >= 65

0

5

10

15

20

Low Moderate High

Crash Severity

Per

cent

Pul

mon

ary

Con

tusi

on (%

)

Unrestrained

Seatbelt

Airbag

Both Restraints


n = 623, 695, 423

Percent Pulmonary Contusion Per Rib Fracture by Age and Delta V

0

5

10

15

20

25

30

35

40

Low Moderate High

Crash Severity

Per

cent

Pul

mon

ary

Con

tusi

on (%

)

Age < 40

Age 40 - 64

Age >= 65


This needs further investigation

Percent Pulmonary Contusion per Rib Fracture by Delta V and Restraint Category: Age >= 65

0

5

10

15

20

25

30

35

40

45

Low Moderate High

Crash Severity

Perc

ent P

ulm

onar

y C

ontu

sion

(%)

Unrestrained

Seatbelt

Airbag

Both Restraints

Percent Pulmonary Contusion per Rib Fracture by Delta Vand Restraint Category: Age < 40

0

5

10

15

20

25

30

35

40

45

Low Moderate High

Crash Severity

Perc

ent P

ulm

onar

y C

ontu

sion

(%)

Unrestrained

SeatbeltAirbag

Both Restraints

Incidence within Thoracic Injury Cohort Incidence within Thoracic Injury Cohort --NTDBNTDB

Incidence of PC and Rib FX Among Patients Who Sustained At Least One of These

01020304050607080

15 25 35 45 55 65 75 85

Age Midpoint

Perc

ent W

ithin

Gro

up

PC+RIB+PC+RIB-PC-RIB+

Injury Incidence Injury Incidence --NTDBNTDB

Incidence of PC and Rib FX Among All MVC Patients

0

20

40

60

80

100

15 25 35 45 55 65 75 85Age Midpoint

Per

cent

With

in

Gro

up

PC+RIB+

PC+RIB-

PC-RIB+

PC-RIB-

Mortality of Chest Injuries Mortality of Chest Injuries --NTDBNTDB

Mortality Rate by Injury Combination and Age

05

10152025303540

15 25 35 45 55 65 75 85

Age Midpoint

Mor

talit

y R

ate PC+RIB+

PC+RIB-

PC-RIB+

PC-RIB-

Logistic Regression Logistic Regression --NASSNASS

Determination of independent effect of Determination of independent effect of variables on rib fractures and pulmonary variables on rib fractures and pulmonary contusioncontusionUnivariateUnivariate assessment to determine assessment to determine inclusion variablesinclusion variablesStepwise multivariate logistic regressionStepwise multivariate logistic regression–– Significance: p < 0.05Significance: p < 0.05

Logistic Regression Logistic Regression ––Rib FracturesRib Fractures

0.040.040.71 0.71 –– 0.990.990.840.84SeatbeltSeatbelt0.010.010.69 0.69 –– 0.960.960.810.81AirbagAirbagNSNSRolloverRollover< 0.0001< 0.00011.14 1.14 –– 1.291.291.221.22IntrusionIntrusion0.00010.00011.004 1.004 –– 1.0141.0141.011.01Delta VDelta V< 0.0001< 0.00010.992 0.992 –– 0.9970.9970.990.99Vehicle weightVehicle weightNSNSGCSGCS< 0.0001< 0.00011.005 1.005 –– 1.0131.0131.011.01Pt WeightPt WeightNSNSPt HeightPt Height< 0.0001< 0.00011.08 1.08 –– 2.02.01.091.09ISSISS< 0.0001< 0.00011.04 1.04 –– 1.051.051.051.05AgeAge

pp--valuevalue95 % Confidence 95 % Confidence IntervalInterval

Odds RatioOdds RatioVariableVariable

ROC = 0.90, GOF = < 0.0001

Logistic Regression Logistic Regression ––Pulmonary ContusionPulmonary Contusion

NSNSSeatbeltSeatbeltNSNSAirbagAirbagNSNSRolloverRollover< 0.0001< 0.00011.13 1.13 –– 1.321.321.221.22IntrusionIntrusionNSNSDelta VDelta V0.020.020.994 0.994 –– 0.9990.9990.9960.996Vehicle weightVehicle weightNSNSGCSGCSNSNSPt WeightPt WeightNSNSPt HeightPt Height< 0.0001< 0.00011.06 1.06 –– 1.071.071.061.06ISSISSNSNSAgeAge

pp--valuevalue95 % Confidence 95 % Confidence IntervalInterval

Odds RatioOdds RatioVariableVariable

ROC = 0.90, GOF = < 0.0001

T/WFU CIREN PC DataT/WFU CIREN PC Data

5656Air bag deployment Air bag deployment (%)(%)8.48.4Mean CT scan time Mean CT scan time

postpost-- crash (hrs)crash (hrs)

6161Seat belt usage (%)Seat belt usage (%)50, 1750, 17Incidence of Incidence of pneumothorax, pneumothorax, hemothoraxhemothorax (%)(%)

7878Occupant position, Occupant position, driver (%)driver (%)7272Incidence of rib Incidence of rib

fractures (%)fractures (%)

3939±±1717Average patient age Average patient age (yrs)(yrs)28, 33, 3928, 33, 39Percent left, right, Percent left, right,

bilateral contusion (%)bilateral contusion (%)

1.3:11.3:1Male: Female ratioMale: Female ratio14.614.6Mean percent high Mean percent high radiopacity lung tissue radiopacity lung tissue (%)(%)

Distribution of components contacted Distribution of components contacted by PC+ cases T/WFU CIRENby PC+ cases T/WFU CIREN

0

3

6

9

Airbag

Center

cons

oleIns

trumen

t Pan

elNea

r side

B-pi

llar

Near s

ide do

or

Seat b

eltStee

ring w

heel

Num

ber o

f Pat

ient

s

Delta V, MPH

PDOF, Degrees

PDOF and DeltaPDOF and Delta--V V in T/WFU CIREN in T/WFU CIREN

PC+ casesPC+ cases

Distribution of the impact mode for Distribution of the impact mode for PC+ cases T/WFU CIRENPC+ cases T/WFU CIREN

11%

28%

50%

11%Far side impactFrontal impactNear side impactRollover

Motivation for future researchMotivation for future research

Strategies for mitigation &/or prevention Strategies for mitigation &/or prevention of PC require knowledge about PC Volume of PC require knowledge about PC Volume (outcome data)(outcome data)–– Volume, spatial distributionVolume, spatial distribution

Also require knowledge about exposure Also require knowledge about exposure (crash data)(crash data)CIREN is the place to get these togetherCIREN is the place to get these together

CT Segmentation Algorithm

Categories of Lung Tissue for Segmentation Algorithm

Damaged lung, not aerated

Contusion, atelectasis, aspiration, etc

350 HU to 3071 HU*

High attenuation

Aerated lung, uninvolved in trauma

Functional lung tissue

-1024 HU to 351 HU*

Lung attenuation

This is not lung tissue, it is trapped air

Pneumothorax-1024 HU*Low attenuation

AssumptionMedical Description

HU Description

Term Used

M. Daly et al., Clinical Imaging, 2007 (in press)


1. Original CT scan

2. Select all pixels with in 200 HU of selected pixel



3. Edit until the entire chest cavity is selected, the resulting mask is the Total Chest Cavity mask

Lung Attenuation-1024 < HU ≤ -351

Algorithm Continued

Partition Total Chest Cavity into:• Low Attenuation Pixel set• Lung Attenuation Pixel set• High Attenuation Pixel set

Low AttenuationHU = -1024

High AttenuationHU ≥ -350

Calculation of Percent Pulmonary Contusion

Percent PC =

High Attenuation Volume

Total Lung Volume

Three Dimensional Reconstruction, Mimics

High AttenuationVolume

Lung AttenuationVolume

+

Contusion Characterization and CT-FEA Registration Method

• Segmented Lung showing PC and normal tissue•Determine spatial distribution of PC from radiology in A-P, M-L, H-F

Gayzik et al., Stapp Car Crash Journal, 2007

CT Reconstruction FEA model showing predicted contusion

Spatial distribution of PC from segmentation

can be used in determining FEA-

based injury metrics

• Lung model and PC threshold developed from CT

T/WFU CIREN Elderly Pulmonary T/WFU CIREN Elderly Pulmonary Contusion Contusion –– Case 85Case 85

75 yr old female75 yr old femaleDriver (belted, airbag Driver (belted, airbag deployed)deployed)Frontal impact with Frontal impact with another vehicleanother vehiclePDOF = 350 degreesPDOF = 350 degreesDelta V= 42.3 mphDelta V= 42.3 mph

MAIS= 4MAIS= 4ISS= 18ISS= 18IPC for thoracic IPC for thoracic injuries listed as injuries listed as steering wheelsteering wheelInjuries Included:Injuries Included:–– Right pulmonary Right pulmonary

contusioncontusion–– Bilateral Rib Fractures Bilateral Rib Fractures

(R2(R2--8, L28, L2--3)3)

PDOF CIREN 085PDOF CIREN 085

-1

1

-1 1

PDOF350°

-1

1

-1 1

PDOF350°

Radiological investigation of interaction between rib fractures

and pulmonary contusion

For WFU CIREN patients with Rib Fx and PC in nearside and frontal

crash

Lung Contusion

Rib Fractures

Pneumothorax

• Case occupant: Driver, 60, male

• Thorax Loads B-Pillar

• Crush = 33cm, PDOF = 290, Delta V = 19.4 kph

• Restraint = Seat belt

• PC by Vol = 6%

Case 1: Nearside impact

Area of detail:Load pathL

R

F

B

Lung Contusion

Rib Fractures (Right side 6th -10th)

• Case occupant: Driver, female, 79

• Thorax Loads Seat Belt

• Crush = 27 cm, PDOF = 0, Delta V = 37.2 kph

• Restraint = Seat belt

• PC by vol = 33%

Case 2: Frontal impact

Area of detail:

LR

ConclusionsConclusionsIncidence of rib fracture is greater with Incidence of rib fracture is greater with ageageAge not a factor in incidence of PCAge not a factor in incidence of PCMortality higher despite lower incidence of Mortality higher despite lower incidence of PCPCClear effect of airbag / seatbelt in Clear effect of airbag / seatbelt in mitigating Rib mitigating Rib FxFxHigher crash severity result in increased Higher crash severity result in increased rib rib fxfx & pc independent of age& pc independent of age

Future DirectionFuture Direction

Chest wall injuries in the elderly are a Chest wall injuries in the elderly are a substantial problem with much substantial problem with much opportunity for improvementopportunity for improvementFurther characterization of the mechanism Further characterization of the mechanism of chest wall injuriesof chest wall injuriesIdentification of the involvement of Identification of the involvement of restraint systems on chest wall injuriesrestraint systems on chest wall injuries

AcknowledgementsAcknowledgementsToyota Motor North America for sponsorship of our Toyota Motor North America for sponsorship of our CIREN centerCIREN centerWork was performed for the Crash Injury Research and Work was performed for the Crash Injury Research and Engineering Network (CIREN) Project at Wake Forest Engineering Network (CIREN) Project at Wake Forest University School of Medicine in cooperation with the University School of Medicine in cooperation with the United States Department of Transportation/National United States Department of Transportation/National Highway Traffic Safety Administration Highway Traffic Safety Administration (USDOT/NHTSA).(USDOT/NHTSA). Funding has been provided by Toyota Funding has been provided by Toyota Motor North America Inc. under Cooperative Agreement Motor North America Inc. under Cooperative Agreement Number DTNH22Number DTNH22--0505--HH--61001.61001. Views expressed are Views expressed are those of the authors and do not represent the views of those of the authors and do not represent the views of any of the sponsors or NHTSA.any of the sponsors or NHTSA.

Toyota – Wake Forest UniversitySchool of Medicine

CIREN Center

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