title: Head impact contact points for restrained child occupants.
abstract: OBJECTIVE
  Head injuries are the most common injuries sustained by children in motor vehicle crashes regardless of age, restraint, and crash direction. For rear seat occupants, the interaction of the subject with the seat back and the vehicle side interior structures has been previously highlighted. In order to advance this knowledge to the development of countermeasures, a summary of vehicle components that contributed to these injuries is needed. Therefore, the objective of this study was to create a contact map of the vehicle interior for head and face injuries to rear-seated restrained children in front crashes.
  
  
  METHODS
  The Crash Injury Research and Engineering Network (CIREN) was queried for rear-seated, restrained child occupants (age 0-15 years) in forward-facing child restraints, booster seats, or lap and shoulder belts who sustained an AIS2+ head and/or face injury in a frontal motor vehicle crash. Cases were analyzed to describe injury patterns and injury causation scenarios. A contact point map was developed to summarize the vehicle components related to injury causation of the head/face injury.
  
  
  RESULTS
  Twenty-one cases met the combined inclusion and exclusion criteria. Seven of the child occupants were restrained in forward-facing child restraints, 2 in belt-positioning booster seats, and 12 in lap and shoulder belts. There were 28 head and 17 facial injuries. For left rear occupants, the most common contact point was the pillar in front of the occupant's seat row; that is, B-pillar for second-row occupants, indicating a leftward kinematics. For right rear occupants, due to differences in crash dynamics, the most common contact point location was the passenger's seat back, suggesting that these occupants moved predominantly forward.
  
  
  CONCLUSIONS
  Contact points associated with head/face injury for restrained children 0 to 15 years in frontal crashes have been delineated. In a majority of the cases, the head/face injury was the most severe injury and severe injuries to other body regions were uncommon, suggesting that efforts to mitigate head injuries for these occupants would greatly improve their overall safety. The majority of the head/face contact points were to the first row seat back and B-pillar. In these frontal crashes, the importance of head/face contact with the vehicle side structure suggests that deploying a curtain air bag in frontal impacts may help manage the energy of impact. These data advance the current understanding of injury patterns and causation in frontal crashes involving restrained rear-row occupants and can be used to develop solutions to mitigate the injuries sustained.
authors.affiliation: Center for Injury Research and Prevention at The Children’sHospital of Philadelphia, 34th and CivicCenter Blvd, Suite 1150, Philadelphia, PA 19104, USA. arbogast@email.chop.edu
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Samantha
authors.initials: S
authors.lastname: Wozniak
authors.forename: Caitlin M
authors.initials: CM
authors.lastname: Locey
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D001336:Automobiles; D002648:Child; D057207:Child Restraint Systems; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000209:etiology*; D016208:Databases, Factual; D004867:Equipment Design; D005151:Facial Injuries / Q000209:etiology; D006801:Humans; D007223:Infant; D011187:Posture; D014481:United States