title: Implications of Functional Capacity Loss and Fatality for Vehicle Safety Prioritization.
abstract: OBJECTIVE
  We investigate the use of the Functional Capacity Index (FCI) as a tool for establishing vehicle safety priorities by comparing the life year burden of injuries to the burden of fatality in frontal and side automotive crashes. We demonstrate FCI's utility by investigating in detail the resulting disabling injuries and their life year costs.
  
  
  METHODS
  We selected occupants in the 2000-2013 NASS-CDS database involved in frontal and side crashes, merged their injuries with FCI, and then used the merged data to estimate each occupant's overall functional loss. Lifetime functional loss was assessed by combining this measure of impairment with the occupants' expected future life spans, estimated from the Social Security Administration's Actuarial Life Table.
  
  
  RESULTS
  Frontal crashes produce a large number of disabling injuries, particularly to the lower extremities. In our population, these crashes are estimated to account for approximately 400,000 life years lost to disability in comparison with 500,000 life years lost to fatality. Victims of side crashes experienced a higher rate of fatality but a significantly lower rate of disabling injury (0.3 vs. 1.0%), resulting in approximately 370,000 life years lost to fatality versus 50,000 life years lost to disability.
  
  
  CONCLUSIONS
  The burden of disabling injuries to car crash survivors should be considered when setting vehicle safety design priorities. In frontal crashes this burden in life years is similar to the burden attributable to fatality.
authors.affiliation: a Department of Public Health Sciences , University of Virginia , Charlottesville , Virginia.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: McMurry
authors.affiliation: b Biocore, LLC , Charlottesville , Virginia.
authors.forename: Chris
authors.initials: C
authors.lastname: Sherwood
authors.affiliation: c University of Virginia Center for Applied Biomechanics , Charlottesville , Virginia.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Poplin
authors.affiliation: d Dirección General de Tráfico Madrid , Madrid , Spain.
authors.forename: María
authors.initials: M
authors.lastname: Seguí-Gómez
authors.affiliation: c University of Virginia Center for Applied Biomechanics , Charlottesville , Virginia.
authors.forename: Jeff
authors.initials: J
authors.lastname: Crandall
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data*; D017281:Cost of Illness; D016208:Databases, Factual; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D035002:Lower Extremity / Q000293:injuries; D018986:Motor Vehicles / Q000592:standards*; D012449:Safety / Q000592:standards*; D017741:Survivors / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000209:etiology*
keywords: NASS-CDS; disability; impairment; injury burden; societal cost