title: Analysis of crash parameters and driver characteristics associated with lower limb injury.
abstract: This study aims to investigate changes in frequency, risk, and patterns of lower limb injuries due to vehicle and occupant parameters as a function of vehicle model year. From the National Automotive Sampling System-Crashworthiness Data System, 10,988 observations were sampled and analyzed, representing 4.7 million belted drivers involved in frontal crashes for the years 1998-2010. A logistic regression model was developed to understand the association of sustaining knee and below knee lower limb injuries of moderate or greater severity with motor vehicle crash characteristics such as vehicle type and model years, toepan and instrument panel intrusions in addition to the occupant's age, gender, height and weight. Toepan intrusion greater than 2cm was significantly associated with an increased likelihood of injury (odds ratio: 9.10, 95% confidence interval 1.82-45.42). Females sustained a higher likelihood of distal lower limb injuries (OR: 6.83, 1.56-29.93) as compared to males. Increased mass of the driver was also found to have a positive association with injury (OR: 1.04, 1.02-1.06), while age and height were not associated with injury likelihood. Relative to passenger cars, vans exhibited a protective effect against sustaining lower limb injury (OR: 0.24, 0.07-0.78), whereas no association was shown for light trucks (OR: 1.31, 0.69-2.49) or SUVs (OR: 0.76, 0.28-2.02). To examine whether current crash testing results are representative of real-world NASS-CDS findings, data from frontal offset crash tests performed by the Insurance Institute for Highway Safety (IIHS) were examined. IIHS data indicated a decreasing trend in vehicle foot well and toepan intrusion, foot accelerations, tibia axial forces and tibia index in relation to increasing vehicle model year between the year 1995 and 2013. Over 90% of vehicles received the highest IIHS rating, with steady improvement from the upper and lower tibia index, tibia axial force and the resultant foot acceleration considering both left and right extremities. Passenger cars received the highest rating followed by SUVs and light trucks, while vans attained the lowest rating. These results demonstrate that while there has been steady improvement in vehicle crash test performance, below-knee lower extremity injuries remain the most common AIS 2+ injury in real-world frontal crashes.
authors.affiliation: Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA. Electronic address: xy3vp@virginia.edu.
authors.forename: Xin
authors.initials: X
authors.lastname: Ye
authors.affiliation: Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA. Electronic address: gsp3j@virginia.edu.
authors.forename: Gerald
authors.initials: G
authors.lastname: Poplin
authors.affiliation: Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA. Electronic address: dipan.bose@gmail.com.
authors.forename: Dipan
authors.initials: D
authors.lastname: Bose
authors.affiliation: School of Medicine, University of North Carolina, Chapel Hill, NC, USA. Electronic address: aaronlforbes@gmail.com.
authors.forename: Aaron
authors.initials: A
authors.lastname: Forbes
authors.affiliation: School of Medicine, University of North Carolina, Chapel Hill, NC, USA. Electronic address: shurwitz@abos.org.
authors.forename: Shepard
authors.initials: S
authors.lastname: Hurwitz
authors.affiliation: Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA. Electronic address: cgs5w@virginia.edu.
authors.forename: Greg
authors.initials: G
authors.lastname: Shaw
authors.affiliation: Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA. Electronic address: jrc2h@virginia.edu.
authors.forename: Jeff
authors.initials: J
authors.lastname: Crandall
mesh_terms: D015998:Abbreviated Injury Scale; D000054:Acceleration; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001835:Body Weight; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000453:epidemiology* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D015995:Prevalence; D011336:Probability; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Logistic regression; Lower extremity injury; NASS-CDS