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FARS - A nationwide census of fatal injuries suffered in motor vehicle traffic crashes collected from crash reports NASS-CDS/GES - Detailed data on a representative, random sample of minor, serious, and fatal crashes. Field data with a focus on crashworthiness Special Crash Investigation – NASS project examing new, emerging, and rapidly changing technology, exploring for alleged or potential vehicle defects. NHTSA Crash Survey Programs
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A multi-center research program involving a collaboration of clinicians and engineers in academia, and government Unlike crash investigation where a case is a crash, a CIREN case is an vehicle occupant who has sustained multiple or serious injury Convenience sample of patients who consent to: – Allowing researches access to their complete medical record, including radiology – Documentation of their vehicle consistent with NASS protocols – Follow-up surveys of functional health and well-being for one year CIREN
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Medical College of Wisconsin, Milwaukee, WI Harborview Injury Prevention & Research Center, Seattle, WA University of Maryland, Baltimore, MD Wake Forest University, Winston Salem, NC / Virginia Tech, Blacksburg, VA University of Alabama at Birmingham, Birmingham, AL University of Virginia Charlottesville, VA / Inova Hospital, Falls Church, VA
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CIREN System Structure ENGINEERING CENTERS Medical College of Wisconsin University of Virginia/Inova Fairfax Hospital Wake Forest University/Virginia Tech MEDICAL CENTERS University of Alabama University of Maryland University of Washington
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CIREN System Operations All CENTERS Enroll patients, document forensic evidence from vehicles/scene and injury evidence in the medical record MEDICAL CENTERS - Enroll 65 cases a year Via the Internet present evidence for mechanism of injury to NHTSA and a reviewing Engineering center ENGINEERING CENTERS - Enroll 40 Cases a year Evaluate evidence for a mechanism of injury and finalize the coding of the ‘Bio-tab’, tying together the crash, medical and bio-mechanical data
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CIREN Bio-tab Method Systematic examination of case history of a crash Identifies necessary and/or sufficient factors explaining occurrence of an injury The understanding for how it came to be sustained is coded as a Injury Causation Scenario (ICS) An ICS has main four sections: – Involved Physical Component – Injury Causation Scenario/Contributing Factors – Regional Mechanism – Organ level mechanism
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Core Bio-tab Concepts Source of Energy (SOE) – Crash, pyrotechnic device or other Involved Physical Component (IPC) - Structure contacted Body Region Contacted (BRC) - Body region contacting the IPC Body Region Injured (BRI) – Site on body where the injury occurred Path - Route energy applied to BRC takes resulting in BRI in another body region Contributing factors – Conditions or events judged to facilitate the occurrence of an injury Regional Mechanism – Type of force required to produce the injury sustained in the BRI
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Bio-tab Analysis Once the SOE is established Bio-tab analysis focuses on: 1.Determining the IPC/BRI contact relationship, a.k.a. injury ‘source’ 2.Evaluating the vehicle/clinical injury evidence of contact 3.Determining the Path injurious energy took to the BRI 4.Identifying the type of mechanical force needed to produce the injury sustained 5.Evaluating the radiology/medical record evidence for the mechanism of injury 6.Evaluating the vehicle/clinical injury evidence for the kinematics need for the IPC/BRI contact relationship 7.Evaluating Contributing Factors for the injury sustained
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Crash/Vehicle Forensic Evidence Documentation in accord with NASS protocols – Scene and Vehicle exterior/interior documentation Crush profiles Images Contacts Static intrusion WinSMASH speed change estimates – Evaluation documentation of passive/ active restraints Belts Collapsible steering columns Air bags Pretensioners Down-loading of data from active restraint control module – Takata air bag data obtainable only from supported Ford vehicles
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Evidence from Medical Record Severity assigned with same AAAM AIS manual as NASS – Presence of and AIS coding of injuries reviewed by MD – Complete record reviewed EMS, ER record, Consults, Radiology reports and imaging OP reports Image types: Clinical, X-ray, CT; Bone, tissue and Angio, MRI Image formats: JPEG and DICOM
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Examples of CIREN Case Data 2000 Mazda MVP 2001 Nissan Pathfinder
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Examples of CIREN Case Data 2000 Mazda MVP 2001 Nissan Pathfinder
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Examples of CIREN Case Data 2000 Mazda MVP 2001 Nissan Pathfinder 544226.4 Spleen laceration, major These examples helped lead to a hypothesis which led to …. JPEGs linked to cases pre-2005 Images can be extracted from DICOMs 2005-on DICOM files can be reformatted in commercial viewers like OsiriX
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Experimental Application at MCW
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