title: Severe soft tissue injuries of the upper extremity in motor vehicle crashes involving partial ejection: the protective role of side curtain airbags.
abstract: BACKGROUND
  Partial ejection (PE) of the upper extremity (UE) can occur in a motor vehicle crash (MVC) resulting in complex and severe soft tissue injuries (SSTI). This study evaluated the relationship between partial ejection and UE injuries, notably SSTIs, in MVCs focusing on crash types and characteristics, and further examined the role of side curtain airbags (SCABs) in the prevention of partial ejection and reducing SSTI of the UE.
  
  
  METHODS
  Weighted data was analyzed from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) from 1993 to 2012. Logistic regression models were used to assess the relationship of PE with SSTI of the UE and the effect of SCABs in both nearside impacts and rollover collisions. Crash Injury Research and Engineering Network (CIREN) case studies illustrated PE involving SSTI of the UE, and long term treatment.
  
  
  RESULTS
  Rollover and nearside impact collisions had the highest percentages of partial ejection, with over half occurring in rollover collisions. Annually over 800 SSTIs of the UE occurred in all MVCs. For nearside lateral force impacts, a multivariable analysis adjusting for belt use and delta V showed a 15 times (OR 15.35, 95% CI 4.30, 54.79) greater odds of PE for occupants without SCABs compared to those with a SCAB deployment. No occupants (0 of 51,000) sustained a SSTI of the UE when a SCAB deployed in nearside impacts, compared to 0.01% (114 of 430,000) when SCABs were unavailable or did not deploy. In rollover collisions, a multivariable analysis adjusted for number of quarter turns and belt use showed 3 times the odds (OR 3.02, 95% CI 1.22, 7.47) of PE for occupants without SCABs compared to those with a SCAB deployment. Just 0.17% (32 of 19,000) of the occupants sustained a SSTI of the UE in rollovers with a SCAB deployment, compared to 0.53% (2294 of 431,000) of the occupants when SCABs were unavailable or did not deploy. CIREN case studies illustrated the injury causation of SSTI of the UE due to partial ejection, and the long term treatment and medical costs associated with a SSTI to the UE.
  
  
  CONCLUSIONS
  The majority of severe soft tissue injuries (SSTI) of the upper extremity (UE) involved partial ejection out the nearside window of outboard seated occupants in nearside impacts and rollover collisions. Real world case studies showed that SSTIs of the upper extremity require extensive treatment, extended hospitalization and are costly. Occupants without a side curtain airbag (SCAB) deployment had an increase in the odds of partial ejection. SCAB deployments provided protection against partial ejection and prevented SSTIs of the UE, with none occurring in nearside impacts, and a small percentage and reduction occurring in rollover collisions compared to those where SCABs were unavailable or did not deploy.
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, P.O. Box 359960, 325 Ninth Avenue, Seattle, WA 98104, United States. Electronic address: rkaufman@uw.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Kaufman
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, P.O. Box 359960, 325 Ninth Avenue, Seattle, WA 98104, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Fraade-Blanar
authors.affiliation: Department of Plastic Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States.
authors.forename: Angelo
authors.initials: A
authors.lastname: Lipira
authors.affiliation: Department of Plastic Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Friedrich
authors.affiliation: Department of Trauma Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States.
authors.forename: Eileen
authors.initials: E
authors.lastname: Bulger
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D017278:Air Bags; D001134:Arm Injuries / Q000209:etiology / Q000517:prevention & control*; D004738:Engineering; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D012622:Seat Belts; D017695:Soft Tissue Injuries / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
keywords: Degloving; Partial ejection; Severe soft tissue injury; Side curtain airbags; Upper extremity