title: Field investigation of child restraints in side impact crashes.
abstract: OBJECTIVE
  Various test procedures have been suggested for assessing the protection afforded by child restraints (CRS) in lateral collisions. Analyses of real world crashes can be used to identify relevant characteristics of the child, restraint, collision, and injury mechanisms that should be incorporated into the design of the test procedures as well as in the design of related ATDs and injury metrics. The objective of this work is to use in-depth crash investigations of children restrained in CRS in side impacts to elucidate specific sources and mechanisms of injuries and explore the role of crash severity variables such as magnitude and location of intrusion and specific impact angle.
  
  
  METHODS
  Real world crashes involving children restrained in forward facing CRS in side impacts were analyzed from Partners for Child Passenger Safety, an on-going child specific crash surveillance system in which insurance claims are used to identify cases. In-depth crash investigations using standardized protocols were used to calculate the crash severity and determine the mechanisms and sources of the injuries sustained.
  
  
  RESULTS
  Cases of 32 children restrained in CRS in 30 side impact crashes were examined. Twenty-five percent sustained AIS 2+ injuries. The most common injuries sustained by children restrained in CRS in side impact crashes were to the face, head, and lower extremity. Characteristics of the crashes that appeared related to injury were intrusion that entered the child's occupant space or caused an interior part of the vehicle to enter the child's occupant space, forward component of the crash, and the rotation of the CRS, restrained by a seat belt, towards the side of the impact.
  
  
  CONCLUSIONS
  The ability to assess the injury potential in a laboratory setting for the body regions of common injury, the head, face, and lower extremity, must be explored. Characteristics of a regulatory-based test procedure to assess injury risk should include a frontal component to the crash and intrusion into the occupant's seating position. Design enhancements of the CRS should address rotation during lateral impacts. These results provide guidance to current efforts to design and regulate these restraints for the safety of child passengers in side impacts.
authors.affiliation: TraumaLink, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, 3535 TraumaLink-10th floor, Pennsylvania 19104, USA. arbogast@email.chop.edu
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Yoganand
authors.initials: Y
authors.lastname: Ghati
authors.forename: Rajiv A
authors.initials: RA
authors.lastname: Menon
authors.forename: Suzanne
authors.initials: S
authors.lastname: Tylko
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tamborra
authors.forename: Richard M
authors.initials: RM
authors.lastname: Morgan
mesh_terms: D000063:Accidents, Traffic; D001696:Biomechanical Phenomena; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012622:Seat Belts; D015599:Trauma Severity Indices; D014481:United States; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology*