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  • 1.
    Ahlm, Kristin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Eriksson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Driver's alcohol and passenger's death in motor vehicle crashes2006Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 7, nr 3, s. 219-223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated.

    METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests.

    RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers.

    CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.

  • 2.
    Albertsson, Pontus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för tillämpad utbildningsvetenskap, Beteendevetenskapliga mätningar (BVM).
    Evaluation of Insight Training of Ambulance Drivers in Sweden Using DART: a New E-learning Tool2011Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 12, nr 6, s. 621-629Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of the study was to evaluate whether a new e-learning tool for insight training of ambulance drivers can have an effect on drivers’ driving behaviors, perceived driving competence, competence to assess risks, self-reflection, and safety attitudes.

    Methods: A quasi-experimental study design, with participants nonrandomly assigned into a control and intervention group, was used. The intervention group participated in the insight-training course and the control group did not. Both groups completed a self- and peer assessment online questionnaire before and after the training.

    Results: The main finding is that the ambulance drivers assessed themselves through the instruments after the training, with the e-learning tool Driver Access Recording Tool (DART), as safer drivers in the areas of speed adaptation, closing up, and overtaking. In the answers from the group-based evaluation, the ambulance drivers responded that they were more reflective/analytical, had increased their risk awareness, and had changed their driving behaviors.

    Conclusions: After insight training, the ambulance drivers in this study assessed themselves as safer drivers in several important areas, including speed adaptation, closing up, and overtaking. In future training of ambulance drivers there should be more focus on insight training instead of previous training focusing on maneuvering capabilities.

  • 3. Bohman, Katarina
    et al.
    Stigson, Helena
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Folksam Research , Stockholm .
    Long-Term Medical Consequences for Child Occupants 0 to 12 Years Injured in Car Crashes2014Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, nr 4, s. 370-378Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: There is limited knowledge of the long-term medical consequences for children injured in car crashes. Thus, in the event of injury, the aim of the study was to specify patterns and risks of injuries resulting in permanent medical impairment of children (0-12years) for different body regions and injury severity levels, according to Abbreviated Injury Scale (AIS). The aim was also to compare the impairment outcome with adults. Methods: Data were obtained from the Folksam insurance company, including reported car crashes from 1998 to 2010 with at least one injured child 0-12years of age. In all, 2619 injured children with 3704 reported medical diagnoses were identified. All injuries were classified according to the AIS 2005 revision. If the child had not recovered within 1 year postinjury an assessment of permanent medical impairment (PMI) was made by one or several medical specialists. Results: In all, 55 children sustained 59 injuries resulting in PMI of which 75 percent were at AIS 1 or AIS 2. The head and cervical spine were the body regions sustaining the most injuries resulting in PMI. Sixty-eight percent of all injuries resulting in PMI were AIS 1 injuries to the cervical spine, with the majority occurring in frontal or rear impacts. Given an injury to the cervical spine, the risk of injuries resulting in PMI was 3 percent, and older children (6years) had a significantly higher risk (3% versus 1%) than younger children. The head was the second most commonly injured body region with injuries resulting in PMI (12/59), which were predominantly AIS 2+. In addition, mild traumatic brain injuries at AIS 1 were found to lead to PMI. Whereas for children the injuries leading to PMI were primarily limited to the head and cervical spine, adults sustained injuries that led to PMI from a more diverse distribution of body regions. Conclusion: The pattern of injuries resulting in permanent medical impairment is different for children and adults; therefore, safety priorities for children need to be based on child data. The majority of those injuries leading to PMI were at lower AIS levels. Furthermore, AIS 1 cervical spine and AIS 1+ head injuries should be given priority concerning mitigation of long-term consequences for children.

  • 4. Carlsson, Anna
    et al.
    Lundälv, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Acute Injuries Resulting from Accidents Involving Powered Mobility Devices (PMDs) – Development and Outcomes of PMD Related Accidents in Sweden2019Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957XArtikel i tidskrift (Refereegranskat)
  • 5.
    Carlsson, Anna
    et al.
    Chalmersa Commercial R&D, Chalmers Industrial Technology, Gothenburg, Sweden.
    Lundälv, Jörgen
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Acute injuries resulting from accidents involving powered mobility devices (PMDs): Development and outcomes of PMD-related accidents in Sweden2019Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 20, nr 5, s. 484-491Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Powered mobility devices (PMDs) are commonly used as aids for older people andpeople with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in trafficsafety contexts. However, the problem of accidents involving PMD drivers has been reported inmany countries where these vehicles have become increasingly popular.The aim of this study is to extract and analyze national PMD-related accident and injury datareported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will providevaluable insight into the risks and obstacles that PMD drivers are exposed to in the trafficenvironment and may contribute to improving the mobility of this group in the long term.

    Methods: The current study is based on data from 743 accidents and 998 persons. An analysiswas performed on a subset of data (N¼301) in order to investigate the development of accidentsover a period of 10 years. Thereafter, each accident in the whole data set was registered as eithersingle (N¼427) or collision (N¼315).

    Results: The results show that there was a 3-fold increase in the number of PMD-related accidentsreported to STRADA during the period 2007–2016.With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominatedby males. Single accidents were more common than collisions (N¼427 and N¼316, respectively)and the level of injury sustained in each type of accident is on par.The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), dueto either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many ofthe single accidents was a difference in ground level (34%, typically a curb).Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly atjunctions or intersections (70%).Abbreviated Injury Scale (AIS) 3þ injuries were dominated by hip and head injuries in both singleaccidents and collision events.

    Conclusions: The present study shows that further research on PMD accidents is required, withregard to both single accidents and collision events. To ensure that appropriate decisions aremade, future work should follow up on injury trends and further improve the quality of PDMrelatedaccident data. Improved vehicle stability and design, increased usage of safety equipment,proper training programs, effective maintenance services, and development of a supporting infrastructurewould contribute to increased safety for PMD drivers.

  • 6.
    Gustafsson, Markus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Stigson, Helena
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kullgren, Anders
    Risk of Permanent Medical Impairment (RPMI) in Car Crashes Correlated to Age and Gender2015Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 16, nr 4, s. 353-361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:

    As fatalities from car crashes decrease, focus on medical impairment following car crashes becomes more essential. This study assessed the risk of permanent medical impairment based on car occupant injuries. The aim was to study whether the risk of permanent medical impairment differs depending on age and gender.

    Methods:

    In total, 36,744 injured occupants in car crashes that occurred between 1995 and 2010 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. If a car occupant still had residual symptoms 3years after a crash, the case was classed as a permanent medical impairment. In total, 5,144 injuries led to permanent medical impairment. The data were divided into different groups according to age and gender as well as levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to the AIS.

    Results:

    The cervical spine was the body region that had the highest number of diagnoses, and occupants who sustained injuries to the upper and lower extremities had the highest risk of medical impairment for both genders. Females aged 60 and above had a higher risk of permanent medical impairment from fractures in the extremities compared to males in the same age group and younger females. Females aged 44 or younger had a higher risk of permanent medical impairment from whiplash-associated disorders (WAD) than males in the same age group. Minor and moderate injuries (AIS 1-2) had a higher risk of permanent medical impairment among older car occupants compared to younger ones.

    Conclusions:

    Differences in long-term outcome were dependent on both gender and age. Differences between age groups were generally greater than between genders. The vast majority of permanent medical impairments resulted from diagnoses with a low risk of fatality. The results emphasize the impact of age and gender in long-term consequences from car crashes. They could be used when designing safety technology in cars as well as to improve health care by contributing to better allocation of rehabilitation resources following trauma.

  • 7.
    Iraeus, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. ÅF Industry , Gothenburg.
    Lindquist, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Analysis of Delta Velocity and PDOF by Means of Collision Partner and Structural Involvement in Real-Life Crash Pulses With Modern Passenger Cars2014Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, nr 1, s. 56-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: In the widely used National Automotive Sampling System (NASS)-Crashworthiness Data System (CDS) database, summary metrics that describe crashes are available. Crash angle or principal direction of force (PDOF) is estimated by the crash examiner and velocity changes (V) in the x- and y-directions are calculated by the WinSMASH computer program using PDOF and results from rigid barrier crash testing combined with deformations of the crashed car. In recent years, results from event data recorders (EDRs) have been added to the database. The aim of this study is to compare both PDOF and V between EDR measurements and WinSMASH calculations. Methods: NASS-CDS inclusion criteria were model-year 2000 through 2010 automobiles, frontal crashes with V higher than 16km/h, and the pulse entirely recorded in the EDR module. This resulted in 649 cases. The subject vehicles were further examined and characterized with regard to frontal structure engagement (large or small overlap) as well as collision properties of the partner (impact location; front, side, or back) or object. The EDR crash angle was calculated as the angle between the lateral and longitudinal V at the time of peak longitudinal V. This angle was compared to the NASS-CDS investigator's estimated PDOF with regard to structural engagement and the collision partner or object. Multiple linear regression was used to establish adjustment factors on V and crash angle between the results calculated based on EDR recorded data and that estimated in NASS-CDS. Results: According to this study, simulation in the newest WinSMASH version (2008) underestimates EDR V by 11 percent for large overlap crashes and 17 percent for small overlap impacts. The older WinSMASH version, used prior to 2008, underestimated each one of these two groups by an additional 7 percentage points. Another significant variable to enhance the prediction was whether the crash examiner had reported the WinSMASH estimated V as low or high. In this study, none of the collision partner groups was significantly different compared to front-to-front impacts. However, with a larger data set a couple of configurations may very well be significantly different. In this study, the crash angle denoted by PDOF in the NASS database underestimates the crash angle calculated from recent EDR modules by 35 percent. Conclusion: On average the V and crash angle are underestimated in NASS-CDS when analyzing the data based on collision partner/object and structural engagement. The largest difference is found in small overlap crashes and the least difference in collision scenarios similar to barrier tests. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

  • 8.
    Iraeus, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. ÅF Industry, Gothenburg, Sweden.
    Lindquist, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Influence of Vehicle Kinematic Components on Chest Injury in Frontal-Offset Impacts2014Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, nr Supplement 1, s. S88-S95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Frontal crashes in which the vehicle has poor structural engagement, such as small-overlap and oblique crashes, account for a large number of fatalities. These crash modes are characterized by large intrusion and vehicle yaw rotation. Results from previous studies have shown mixed results regarding the importance and effects of these parameters. The aim of this study was to evaluate how vehicle yaw rotation, instrument panel intrusion, and the time history of the pulse angle influence chest injury outcomes.

    Method: This study was conducted using kinematic boundary conditions derived from physical crash tests, which were applied on a finite element simulation model of a vehicle interior including a finite element human model. By performing simulations with different levels of simplified boundary conditions and comparing the results to a simulation with a full set of boundary conditions, the influence of the simplifications was evaluated. The injury outcome measure compared between the simulations was the expected number of fractured ribs. The 3 simplifications simulated were (1) removal of vehicle yaw rotation, (2) removal of vehicle yaw rotation plus an assumption of a constant pulse angle between the x- and y-acceleration, and (3) removal of instrument panel intrusion.

    The kinematic boundary conditions were collected from 120 physical tests performed at the Insurance Institute of Highway Safety; 77 were small-overlap tests, and 43 were moderate overlap tests. For each test, the full set of boundary conditions plus the 3 simplifications were simulated. Thus, a total of 480 simulations were performed.

    Results: The yaw rotation influences occupant interaction with the frontal airbag. For the approximation without this kinematic boundary component, there was an average error in injury outcome of approximately 13% for the moderate overlap cases. Large instrument panel intrusion increases the risk of rib fracture in nearside small-overlap crashes. The mechanism underlying this increased fracture risk is a combination of increased airbag load and a more severe secondary impact to the side structure. Without the intrusion component, the injury risk was underestimated by 8% for the small-overlap crashes.

    Conclusion: The approximation with least error was version 2; that is, a model assuming a constant pulse angle, including instrument panel intrusion but no vehicle yaw rotation. This approximation simulates a sled test with a buck mounted at an oblique angle. The average error for this approximation was as low as 2–4%.

  • 9.
    Jonsson, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Hand position on steering wheel during driving2011Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 12, nr 2, s. 187-190Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The objective was to study hand position on the steering wheel during driving and differences in hand position within and between the genders. Methods: This cross-sectional pilot study was conducted in Ornskoldsvik, Sweden. Photos were taken of drivers on a public road with a speed limit of 70 km/h, and hand position and gender were registered. Results: Hand positions on the steering wheel with one or both hands in a 10 minutes to 2 o'clock position is common, males 55 percent and females 64 percent, during low-risk driving conditions. Symmetric (left-right) hand positions, at 9 and 3, 10 and 2, and finally 11 and 1 o'clock are rare, 6 percent among males and 12 percent among females. Conclusions: The results call for further studies of hand position on the steering wheel during naturalistic driving in traffic areas where rear-end impacts are frequent, particularly because upper hand position might affect spinal posture and thereby increased backset distance between the back of the head and the head restraint (backset), which influences neck injury risk in rear-end impacts.

  • 10.
    Lindkvist, Mats
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kjaer, Christoffer
    Sunnevang, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Side Collision Induced Pelvis Fracturers in Modern Cars2014Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, s. S273-S274Artikel i tidskrift (Övrigt vetenskapligt)
  • 11. Lopez-Valdes, F. J.
    et al.
    Juste, O.
    Pipkorn, B.
    Garcia-Munoz, I.
    Sunnevang, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlgren, M.
    Alba, J. J.
    A Comparison of the Performance of Two Advanced Restraint Systems in Frontal Impacts2014Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, s. S119-S125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The goal of the study is to compare the kinematics and dynamics of the THOR dummy in a frontal impact under the action of 2 state-of-the-art restraint systems.

    Methods: Ten frontal sled tests were performed with THOR at 2 different impact speeds (35 and 9km/h). Two advanced restraint systems were used: a pretensioned force-limiting belt (PT+FL) and a pretensioned belt incorporating an inflatable portion (PT+BB). Dummy measurements included upper and lower neck reactions, multipoint thoracic deflection, and rib deformation. Data were acquired at 10,000Hz. Three-dimensional motion of relevant dummy landmarks was tracked at 1,000Hz. Results are reported in a local coordinate system moving with the test buck.

    Results: Average forward displacement of the head was greater when the PT+FL belt was used (35km/h: 376.3 +/- 16.1mm [PT+BB] vs. 393.6 +/- 26.1mm [PT+FL]; 9km/h: 82.1 +/- 26.0mm [PT+BB] vs. 98.8 +/- 0.2mm [PT+FL]). The forward displacement of T1 was greater for the PT+FL belt at 35km/h but smaller at 9km/h. The forward motion of the pelvis was greater when the PT+BB was used, exhibiting a difference of 82mm in the 9km/h tests and 95.5mm in the 35km/h test. At 35km/h, upper shoulder belt forces were similar (PT+FL: 4,756.8 +/- 116.6N; PT+BB: 4,957.7 +/- 116.4N). At 9km/h, the PT+BB belt force was significantly greater than the PT+FL one. Lower neck flexion moments were higher for the PT+BB at 35km/h but lower at 9km/h (PT+FL: 34.2 +/- 3.5 Nm; PT+BB: 26.8 +/- 2.1 Nm). Maximum chest deflection occurred at the chest upper left region for both belts and regardless of the speed.

    Conclusion: The comparison of the performance of different restraints requires assessing occupant kinematics and dynamics from a global point of view. Even if the force acting on the chest is similar, kinematics can be substantially different. The 2 advanced belts compared here showed that while the PT+BB significantly reduced peak and resultant chest deflection, the resulting kinematics indicated an increased forward motion of the pelvis and a reduced rotation of the occupant's torso. Further research is needed to understand how these effects can influence the protection of real occupants in more realistic vehicle environments.

  • 12. López-Valdés, F. J.
    et al.
    Juste-Lorente, O.
    Maza-Frechin, M.
    Pipkorn, B.
    Sunnevång, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Autoliv Research, Vårgårda, Sweden.
    Lorente, A.
    Aso-Vizan, A.
    Davidsson, J.
    Analysis of occupant kinematics and dynamics in nearside oblique impacts2016Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 17, s. 86-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The objective of this article is to analyze the kinematics and dynamics of restrained postmortem human surrogates (PMHS) exposed to a nearside oblique impact and the injuries that were found after the tests.Methods: Three male PMHS of similar age (64 4years) and anthropometry (weight: 61 9.6kg; stature: 172 +/- 2.7cm) were exposed to a 30 degrees nearside oblique impact at 34km/h. The test fixture approximated the seating position of a front seat occupant. A rigid seat was designed to match the pelvic displacement in a vehicle seat. Surrogates were restrained by a 3-point seat belt consisting of a 2kN pretensioner (PT), 4.5kN force-limiting shoulder belt, and a 3.5kN PT lap belt. The shoulder belt PT was not fired in one of the tests. Trajectories of the head, shoulder, and hip joint (bilaterally) were recorded at 1,000Hz by a 3D motion capture system. The 3D acceleration and angular rate of the head, T1, and pelvis, and the 3D acceleration of selected spinal locations was measured at 10,000Hz. Seat belt load cells measured the belt tension at 4 locations. PMHS donation and handling were performed with the approval of the relevant regional ethics review board.Results: Activation of the shoulder PT reduced substantially the peak forward excursion of the head but did not influence the lateral displacement of the head center of gravity (CG). In all 3 subjects, the lateral excursion of the head CG (291.1, 290, 292.1mm) was greater than the forward displacement (271.4, 216.7, 171.5mm). The hip joint excursion of the PMHS that was not exposed to the shoulder PT seat belt was twice the magnitude observed for the other 2 subjects. The 3 PMHS sustained clavicle fractures on the shoulder loaded by the seat belt and 2 of them were diagnosed atlantoaxial subluxation in the radiologist examination. Avulsion fractures of the right lamina of T1, T2, T3, and T4 were found when the PT was not used. The 3 PMHS received multiple fractures spread over both aspects of the rib cage and involving the posterior aspect of it.Conclusion: In this study of nearside oblique impact loading, the PMHS exhibited kinematics characterized by reduced torso pitching and increased lateral head excursion as compared to previous frontal impact results. These kinematics resulted in potential cervical and thoracic spinal injuries and in complete, displaced fractures of the lateral and posterior aspects of the rib cage. Though this is a limited number of subjects, it shows the necessity of further understanding of the kinematics of occupants exposed to this loading mode.

  • 13. Pipkorn, Bengt
    et al.
    López-Valdés, Francisco J.
    Juste-Lorente, Oscar
    Insausti, Ricardo
    Lundgren, Christer
    Sunnevång, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Autoliv Research, Vårgårda, Sweden.
    Assessment of an innovative seat belt with independent control of the shoulder and lap portions using THOR tests, the THUMS model, and PMHS tests2016Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 17, s. 124-130Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The objective of this study was to determine the potential chest injury benefits and influence on occupant kinematics of a belt system with independent control of the shoulder and lap portions. Methods: This article investigates the kinematics and dynamics of human surrogates in 35km/h impacts with 2 different restraints: a pretensioning (PT), force-limiting (FL) seat belt, a reference belt system, and a concept design with a split buckle consisting (SB) of 2 separate shoulder and lap belt bands. The study combines mathematical simulations with the THOR dummy and THUMS human body model, and mechanical tests with the THOR dummy and 2 postmortem human surrogate (PMHS) tests of similar age (39 and 42years) and anthropometry (62kg, 181cm vs. 60kg, 171.5cm). The test setup consisted of a rigid metallic frame representing a standard seating position of a right front passenger. The THOR dummy model predictions were compared to the mechanical THOR dummy test results. The THUMS-predicted number of fractured ribs were compared to the number of fractured ribs in the PMHS. Results: THOR sled tests showed that the SB seat belt system decreased chest deflection significantly without increasing the forward displacement of the head. The THOR model and the THOR physical dummy predicted a 13- and 7-mm reduction in peak chest deflection, respectively. Peak diagonal belt force in the mechanical test with the reference belt was 5,582N and the predicted force was 4,770N. The THOR model also predicted lower belt forces with the SB system than observed in the tests (5,606vs. 6,085N). THUMS predicted somewhat increased head displacement for the SB system compared to the reference system. Peak diagonal force with the reference belt was 4,000N and for the SB system it was 5,200N. The PMHS test with the SB belt resulted in improved kinematics and a smaller number of rib fractures (2vs. 5 fractures) compared to the reference belt. Conclusion: Concepts for a belt system that can reduce the load on the chest of the occupant in a crash and thereby reduce the number of injured occupants, in particular the elderly, was proposed.

  • 14. Stigson, Helena
    et al.
    Gustafsson, Markus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Sunnevang, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kullgren, Anders
    Differences in Long-Term Medical Consequences Depending on Impact Direction Involving Passenger Cars2015Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 16, s. S133-S139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction. Methods: In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS. Results: It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions. Conclusions: Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.

  • 15. Stigson, Helena
    et al.
    Hagberg, Jan
    Kullgren, Anders
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    A One Year Pay-as-You-Speed Trial With Economic Incentives for Not Speeding2014Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, nr 6, s. 612-618Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The objective was to identify whether it was possible to change driver behavior by economic incentives and thereby reduce crash risk. Furthermore, the objective was to evaluate the participants' attitudes toward the pay-as-you-speed (PAYS) concept. Methods: A one-year PAYS trial with economic incentives for keeping speed limits using intelligent speed assistance (ISA) was conducted in Sweden during 2011-2012. The full incentive was a 30 percent discount off the insurance premium. The participants were private insurance customers and were randomized into a test group (initial n = 152, final n = 128) and a control group (initial n = 98, final n = 68). When driving, the drivers in the test group were informed and warned visually when the speed limit was exceeded. They could also follow their driving results on a personal website. The control group was not given any feedback at all. To reflect the impact of the PAYS concept the proportion of distance driven above the speed limit was compared between the 2 groups. Results: The introduction of a PAYS concept shows that the test group significantly reduced the proportion of distance driven above the speed limit. The proportion of driving at a speed exceeding 5 km/h over the speed limit was 6 percent for the test group and 14 percent for the control group. It also showed that the effect was higher the higher the violation of speed. The result remained constant over time. Conclusions: It was shown that a PAYS concept is an effective way to reduce speed violations. Hence, it has the possibility to reduce crash severity and thereby to save lives. This could be an important step toward a safer road transport system. The majority of the participants were in favor of the concept, which indicates the potential of a new insurance product in the future.

  • 16.
    Stjernbrandt, Albin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Öström, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Eriksson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Land Motor Vehicle-Related Drownings in Sweden2008Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 9, nr 6, s. 539-543Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Knowledge regarding drownings related to land motor vehicle events is limited although reports of these events occur globally. This study elucidates crash and injury mechanisms in motor vehicle-related drownings in a Swedish population during 1992 through 2006 in order to suggest preventive countermeasures. Methods: The cases were identified in the National Board of Forensic Medicine database and crosschecked against the official statistics. All available autopsy reports, hospital records, and police records were analyzed. In addition, corresponding in-depth analyses performed by the Swedish Road Administration were reviewed and analyzed. Results: In total, 83 drownings occurred in 64 vehicles. The great majority of victims had no serious injuries (92% MAIS ≤ 2) and would probably have survived if they had not drowned. Most events took place in waters directly adjacent to a roadway (36%) or bridge (34%). The vehicles were most often (72%) found upside down, and most drownings occurred in shallow water (65% depth <2 m). One third (32%) of the drivers tested positive for alcohol (mean BAC of 2.0 g/L; range 0.16-2.6). The majority (69%) of the fatalities could possibly have been prevented if effective guardrails had been in place. Conclusions: Drownings in motor vehicles are not negligible events and in many cases they are preventable. Sufficient design and placement of guardrails can minimize these events, but further experimental investigation should be conducted to better understand these events and how to optimize vehicle design, rescue operations, and self-rescue.

  • 17.
    Sunnevang, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Lecuyer, Erwan
    Hynd, David
    Carroll, Jolyon
    Kruse, Dion
    Bostrom, Ola
    Evaluation of Near-Side Oblique Frontal Impacts Using THOR With SD3 Shoulder2014Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, nr Supplement 1, s. S96-S102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Within the EC Seventh Framework project THORAX, the Mod-Kit THOR was upgraded with a new thorax and shoulder. The aim of this study was to investigate whether the THOR ATD met a set of prerequisites to a greater extent than Hybrid III and by that measure whether the dummy could serve as a potential tool for future evaluation of serious head and chest injuries in near-side oblique frontal impacts.

    Method: A small-overlap/oblique sled system was used to reflect occupant forces observed in oblique frontal crashes. The head and thoracic response from THOR was evaluated for 3 combinations: belt only with no deformation of the driver's side door (configuration A), belt only in combination with a predeformed door (configuration B), and prepretensioning belt and driver airbag (PPT+DAB) in combination with a predeformed door (configuration C). To evaluate head injury risk, the head injury criterion (HIC) and brain injury criteria (BrIC) were used. For evaluation of the thoracic injury risk, 3 injury criteria proposed by the THORAX project were evaluated: Dmax, DcTHOR, and strain (dummy rib fractures).

    Results: Unlike Hybrid III, the THOR with SD3 shoulder interacted with the side structure in a near-side oblique frontal impact. HIC values for the 3 test configurations corresponded to a 90% (A) and 100% (B and C) risk of Abbreviated Injury Scale (AIS) 2+ head injury, and BrIC values resulted in a 100% risk of AIS 2+ head injury in configurations A and B. In C the risk was reduced to 75%. The AIS 2+ thoracic injury risks based on Dmax were similar (14-18%) for all tests. Based on DcTHOR, AIS 2+ injury risk increased from 29 to 53% as the predeformed door side was introduced (A to B), and the risk increased, to 64%, as a PPT+DAB was added (C). Considering the AIS 2+ injury risk based on strain, tests in A resulted in an average of 3 dummy rib fractures (17%). Introducing the predeformed door (B) increased the average of dummy fractures to 5 (39%), but in C the average number of dummy rib fractures decreased to 4 (28%).

    Conclusions: THOR with an SD3 shoulder should be the preferred ATD rather than the Hybrid III for evaluating head and thorax injuries in oblique frontal impacts. Thoracic interaction with the predeformed door was not well captured by the 3D IR-Traccs; hence, use of deflection as an injury predictor in oblique loading is insufficient for evaluating injury risk in this load case. However, injury risk evaluation may be performed using the strain measurements, which characterize loading from seat belt and airbag as well as the lateral contribution of the structural impact in the loading condition used in this study.

  • 18.
    Sunnevang, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Autoliv Res, Vargarda, Sweden.
    Rosén, Erik
    Bostrom, Ola
    Real-life fatal outcome in car-to-car near-side impacts--implications for improved protection considering age and crash severity.2009Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 10, nr 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Recent studies have shown that current side airbags, protecting head and chest, are saving lives in near-side impacts (Kahane 2007; McCartt and Kyrychenko 2007). The aim of this study was to analyze NASS/CDS real-life data on fatal trauma in near-side car-to-car crashes, stratified by age into non-senior and senior occupants. Furthermore, a hypothetical model explaining side airbag effectiveness as a function of lateral delta-v was presented. The model together with the field data was then used to demonstrate further enhancement of side airbag restraint performance.

    METHOD: Weighted NASS/CDS data from 1994 to 2006 for front seat occupants in near-side car-to-car impacts was used to calculate the exposure, incidence, and risk of fatal trauma with respect to lateral delta-v. The dataset was also divided into non-senior (10-59 years) and senior (age > or = 60 years) occupants. The hypothetical model was created to adjust the NASS/CDS data to represent a car fleet fully equipped with current side airbag protection. The model was then used to evaluate the increase in effectiveness of improved side airbag protection achieved by increasing the lateral delta-v in the range where the airbag have most mitigating effect, increasing the airbag protection level within the delta-v range currently tested, and a combination of the two approaches.

    RESULTS: From the NASS/CDS data, the median delta-v for fatal injury was 37 km/h for the total sample. When stratified with respect to age, the median delta-v for fatal injury was 41 km/h for non-seniors and 28 km/h for senior occupants. The exposures for both age groups were similar. However, the fatal incidence showed a difference in delta-v range between non-senior and senior occupants. Applying the airbag model increased the median delta-v to 40 km/h for the total sample and 47 and 30 km/h for non-seniors and seniors, respectively.

    CONCLUSIONS: Current side airbag systems offer very good protection for non-senior occupants up to delta-v 40 km/h. Though still high, the protection for senior occupants is lower. To enhance side airbag protection, the side airbag performance should be maximized where the fatal incidence is high. Therefore, to further reduce non-senior fatalities, the test speed should be increased. To further reduce senior fatalities, the protection level within severities currently tested should be increased. A combination of the two approaches would result in about a 40 percent increase of the side airbag effectiveness.

  • 19.
    Sunnevang, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sui, Bo
    Lindkvist, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Census Study of Real-Life Near-Side Crashes with Modern Side Airbag-Equipped Vehicles in the United States2015Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 16, nr Supplement 1, s. S117-S124Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study aimed to investigate the crash characteristics, injury distribution, and injury mechanisms for Maximum Abbreviated Injury Score (MAIS) 2+ injured belted, near-side occupants in airbag-equipped modern vehicles. Furthermore, differences in injury distribution for senior occupants compared to non-senior occupants was investigated, as well as whether the near-side occupant injury risk to the head and thorax increases or decreases with a neighboring occupant. Method: National Automotive Sampling System's Crashworthiness Data System (NASS-CDS) data from 2000 to 2012 were searched for all side impacts (GAD L&R, all principal direction of force) for belted occupants in modern vehicles (model year > 1999). Rollovers were excluded, and only front seat occupants over the age of 10 were included. Twelve thousand three hundred fifty-four MAIS 2+ injured occupants seated adjacent to the intruding structure (near-side) and protected by at least one deployed side airbag were studied. To evaluate the injury risk influenced by the neighboring occupant, odds ratio with an induced exposure approach was used. Result: The most typical crash occurred either at an intersection or in a left turn where the striking vehicle impacted the target vehicle at a 60 to 70 degrees angle, resulting in a moderate change of velocity (delta-V) and intrusion at the B-pillar. The head, thorax, and pelvis were the most frequent body regions with rib fracture the most frequent specific injury. A majority of the head injuries included brain injuries without skull fracture, and non-senior rather than senior occupants had a higher frequency of head injuries on the whole. In approximately 50% of the cases there was a neighboring occupant influencing injury outcome. Conclusion: Compared to non-senior occupants, the senior occupants sustained a considerably higher rate of thoracic and pelvis injuries, which should be addressed by improved thorax side airbag protection. The influence on near-side occupant injury risk by the neighboring occupant should also be further evaluated. Furthermore, side airbag performance and injury assessments in intersection crashes, especially those involving senior occupants in lower severities, should be further investigated and side impact dummy biofidelity and injury criteria must be determined for these crash scenarios.

  • 20.
    Sunnevång, Cecilia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Autoliv Research, Vårgårda, Sweden.
    Pipkorn, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Boström, Ola
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Assessment of Bilateral Thoracic Loading on the Near-Side Occupant Due to Occupant-to-Occupant Interaction in Vehicle Crash Tests2015Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 16, nr Supplement 2, s. S217-S223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study aims, by means of the WorldSID 50th percentile male, to evaluate thoracic loading and injury risk to the near-side occupant due to occupant-to-occupant interaction in combination with loading from an intruding structure.Method: Nine vehicle crash tests were performed with a 50th percentile WorldSID male dummy in the near-side (adjacent to the intruding structure) seat and a THOR or ES2 dummy in the far-side (opposite the intruding structure) seat. The near-side seated WorldSID was equipped with 6 + 6 IR-Traccs (LH and RH) in the thorax/abdomen enabling measurement of bilateral deflection. To differentiate deflection caused by the intrusion, and the deflection caused by the neighboring occupant, time history curves were analyzed. The crash tests were performed with different modern vehicles, equipped with thorax side airbags and inflatable curtains, ranging from a compact car to a large sedan, and in different loading conditions such as car-to-car, barrier, and pole tests. Lateral delta V based on vehicle tunnel acceleration and maximum residual intrusion at occupant position were used as a measurement of crash severity to compare injury measurements.Result: In the 9 vehicle crash tests, thoracic loading, induced by the intruding structure as well as from the far-side occupant, varied due to the size and structural performance of the car as well as the severity of the crash. Peak deflection on the thoracic outboard side occurred during the first 50ms of the event. Between 70 to 150ms loading induced by the neighboring occupant occurred and resulted in an inboard-side peak deflection and viscous criterion. In the tests where the target vehicle lateral delta V was below 30km/h and intrusion less than 200mm, deflections were low on both the outboard (20-40mm) and inboard side (10-15mm). At higher crash severities, delta V 35km/h and above as well as intrusions larger than 350mm, the inboard deflections (caused by interaction to the far-side occupant) were of the same magnitude or even higher (30-70mm) than the outboard deflections (30-50mm).Conclusion: A WorldSID 50th percentile male equipped with bilateral IR-Traccs can detect loading to the thorax from a neighboring occupant making injury risk assessment feasible for this type of loading. At crash severities resulting in a delta V above 35km/h and intrusions larger than 350mm, both the inboard deflection and VC resulted in high risks of Abbreviated Injury Scale (AIS) 3+ injury, especially for a senior occupant.

  • 21. Viklund, Åsa
    et al.
    Björnstig, Johanna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Larsson, Magnus
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Car Crash Fatalities Associated With Fire in Sweden2013Ingår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 14, nr 8, s. 823-827Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To study the epidemiology and causes of death in fatal car crashes on Swedish roads in which the victim's vehicle caught fire. Methods: The data set is from the Swedish Transport Administrations in-depth studies of fatal crashes 1998-2008. Autopsies from all cases provided data on injuries, toxicological analyses, and cause of death. Results: In total, 181 people died in 133 burning cars, accounting for 5 percent of all deaths in passenger cars, sport utility vehicles, vans, and minibuses during 1998 to 2008. The cause of death for a third of the victims was fire related, as burns and/or smoke inhalation injuries, with no fatal trauma injuries. Twenty-five of these 55 deaths were persons 19 years or younger and included 15 of 18 rear seat deaths. Over half of the 181 deaths were in vehicles that had collided with another vehicle and, of these cases, half were killed in collisions with heavy vehicles. The percentage of drivers with illegal blood alcohol concentrations (27%) and suicides (5.5%) were not higher than in other fatal crashes on Swedish roads. The ignition point of the fire was indicated in only half of the cases and, of those, half started in the engine compartment and one fourth started around the fuel tank or lines. Conclusions: Car fires are a deadly postcrash problem. Reducing this risk would be primarily a responsibility for the automotive industry. A multifactor approach could be considered as follows: risk-reducing design, insulation, reduced flammability in motor compartment fluids and plastics, and automatic fire extinguishing equipment. Inspiration could be found in how, for example, the auto racing and aviation industries handle this problem.

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