title: The cushion effect.
abstract: BACKGROUND
  The pattern and severity of crash injury depends on a complex interaction of biomechanical factors such as deceleration velocity at impact (delta-V), seat-belt and airbag use, and type of impact. Human body characteristics such as height and weight may play an important role. We hypothesized that body mass index (BMI) will influence crash injury patterns.
  
  
  METHODS
  The University of Michigan Program for Injury Research and Education database was queried. Three cohorts were analyzed, lean (BMI </= 25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI > 30 kg/m2)
  
  
  RESULTS
  There were 189 detailed crash cases, with 22 fatalities. There was an increased risk of fatal outcome associated with the obese cohort (adjusted odds ratio, 4.2 compared with lean; p = 0.04). Age, delta-V, seat-belt use, and type of impact were independent predictors of Injury Severity Score (ISS). After adjusting for other modifiers, being overweight was associated with decreased ISS (p = 0.03) and abdominal maximal Abbreviated Injury Scale (mAIS) score (p = 0.008) when compared with the lean cohort. However, the lower extremity mAIS score increased when overweight (p = 0.03) and obese cohorts (p = 0.001) were compared with the lean cohort.
  
  
  CONCLUSIONS
  Although no difference in ISS was identified between the lean and obese cohorts, there was an increase in mortality with the obese cohort. The severity of lower extremity injuries increased with increasing BMI. The overweight cohort was associated with lower ISS and abdominal mAIS score compared with the lean cohort. This protection may be attributable to an increase in insulating tissue, or a "cushion effect," without a significant increase in mass and momentum.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, USA. sarbabi@med.umich.edu
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Wahl
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hemmila
authors.forename: Carla
authors.initials: C
authors.lastname: Kohoyda-Inglis
authors.forename: Paul A
authors.initials: PA
authors.lastname: Taheri
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Wang
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D017278:Air Bags / Q000706:statistics & numerical data; D001336:Automobiles / Q000145:classification; D001696:Biomechanical Phenomena; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D018570:Risk Assessment / Q000379:methods; D012622:Seat Belts / Q000706:statistics & numerical data; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology*