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Supplemental material, sj-docx-1-pip-10.1177_17543371211020614 for Head shape analysis of National Football League Players by Gwansik Park, Lee F Gabler, Ann M Bailey, Nathan Z Dau, Chris Sherwood, Jeff R Crandall and Kristy B Arbogast in Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology

Supplemental material, sj-docx-1-pip-10.1177_17543371211063124 for Laboratory assessment of a head impact sensor for youth soccer ball heading impacts using an anthropomorphic test device by Declan A Patton, Colin M Huber, Ethan C Douglas, Thomas Seacrist and Kristy B Arbogast in Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology

Supplemental material, DS_10.1177_0363546520906406 for Video Confirmation of Head Impact Sensor Data From High School Soccer Players by Declan A. Patton, Colin M. Huber, Catherine C. McDonald, Susan S. Margulies, Christina L. Master and Kristy B. Arbogast in The American Journal of Sports Medicine

Supplemental material, Injury_Prevention_Counseling_Appendices for Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings by Christopher E. Gaw, Ellora Berthet, Allison E. Curry, Mark R. Zonfrillo, Kristy B. Arbogast and Daniel J. Corwin in Clinical Pediatrics

Objective: The research objective was to quantify the influence of child restraint lower attachment method on head kinematics, head impact potential, and head, neck, and thorax injury metrics for a child occupant secured in a forward-facing child restraint system (FFCRS) in oblique side impacts. Methods: Fifteen sled tests were conducted with a Q3s seated in an FFCRS secured to the center position on a production small SUV bench seat. Three lower attachment methods were evaluated: rigid ISOFIX, a flexible single loop lower anchors and tethers for children (LATCH) webbing routed through the vehicle belt path of the FFCRS, and dual flexible LATCH webbing attachments on either side of the FFCRS. All were tested with and without a tether with one repeat test in each test condition. The same model FFCRS was used for all tests; only the attachment method varied. The vehicle bench seat was fixed on the sled carriage at 80° (from full frontal). The input pulse was the proposed FMVSS 213 side impact pulse scaled to a 35 km/h delta-v. Two-way analysis of variance (ANOVA) was used to evaluate the effect of lower attachment and tether use on 3 outcome metrics: lateral head excursion, neck tension, and neck lateral bending. Data included anthropomorphic test dummy (ATD) head excursions, head linear accelerations and angular velocities, neck loads and moments, thoracic accelerations, lateral chest deflections, lower anchor loads, and tether webbing loads. ATD head kinematics were collected from 3-dimensional motion capture cameras. Results: Results demonstrated a reduction in injury measures with the rigid ISOFIX and dual webbing attachment compared to the single webbing attachment with decreased lateral head excursions (331, 356, and 441 mm for the rigid ISOFIX, dual webbing, and single webbing systems, respectively, P P P =.002). The tether had a greater influence on lateral head excursion for the FFCRS with flexible webbing attachments than those with the rigid attachment, with the tether forces being highest with the single webbing attachment. Lateral head excursions were significantly lower and lateral neck bending moments were significantly higher with tether use (P Conclusion: The CRS lower attachment system influenced occupant kinetics. The results indicate that CRS attached to the vehicle via rigid and dual webbing systems exhibit improved kinematics by reducing the rotation and tipping seen with the single webbing attachment. This leads to reduced lateral head excursions and neck tension values. The advantages of the tether in reducing lateral head excursion in side impacts are most pronounced with the flexible webbing attachments. With tether use low in the United States, a dual webbing type FFCRS attachment system may be a better attachment method than single webbing and provide a simpler engineering solution than rigid ISOFIX attachment.

Supplemental material, DS_10.1177_0363546518804498 for Video Analysis of Reported Concussion Events in the National Football League During the 2015-2016 and 2016-2017 Seasons by David J. Lessley, Richard W. Kent, James R. Funk, Christopher P. Sherwood, Joseph M. Cormier, Jeff R. Crandall, Kristy B. Arbogast and Barry S. Myers in The American Journal of Sports Medicine

The purpose of this study was to compare the dynamic response of rear-facing child restraint systems (RFCRS) installed on the CMVSS 213 sled bench and a selection of vehicle seats. Thirty-six sled tests were conducted: three models of rear facing CRS with an anthropomorphic test device (ATD) representing a 12 month old child (CRABI) were affixed via lower anchors (LATCH), 3 point belt without CRS base, and 3 point belt with CRS base to one of three vehicle seats or the CMVSS 213 bench seat. All CRS were subjected to an identical sled acceleration pulse. Two types of matched pair analysis: "bench-to-vehicle" and "method of attachment" were conducted. Statistically significant differences were observed in the kinematic responses of the ATD and the CRS.This is the first study to quantify differences between the regulatory bench and vehicle seats on a system level and evaluate the influence of attachment method. Our results show that the difference in RFCRS forward excursion between 3-point belt with base and LATCH installations was between 1 and 7 percent on the bench and 22 to 76 percent on the vehicle seats. When evaluating the dynamic performance of RFCRS, the use of real vehicle seats from vehicles that commonly carry children may provide valuable insight. The findings would require further confirmation using a broader selection of RFCRS and vehicle seats, before generalizable conclusions can be drawn.

Small overlap crashes, where the primary crash engagement is outboard from the longitudinal energy absorbing structures of the vehicle, have received recent interest as a crash dynamic that results in high likelihood of injury. Previous analyses of good performing vehicles showed that 24% of crashes with AIS 3+ injuries to front seat occupants were small overlap crashes. However, similar evaluations have not been conducted for those rear seated. Vehicle dynamics suggest that rear seat occupants may be at greater risk due to lack of lateral seating support and a steering wheel to hold, making them more sensitive to lateral movement seen in these crashes. Thus, the objective was to calculate injury risk for rear-seated occupants in small overlap collisions. AIS 2+ and AIS 3+ injury risk was calculated from NASS-CDS data from 2000–2011. Inclusion criteria were vehicles of model year 2000 or later, with CDC codes of “FL” or “FR”, and an occupant in the second or third row. AIS2+ injury risk was 5.1%, and AIS3+ injury risk was 2.4%. Of note, half of the occupants were

In child-involved crashes, there was a greater risk of rollover in pickups and SUVs than in passenger cars and minivans. Risk of injury to the corresponding child occupants in rollovers was significantly higher than for those in non-rollover crashes. There has been little change in overall rollover rates for passenger cars, pickup trucks, and minivans in the most recent model years (since 2002); however, there has been evidence of a declining rollover rate in SUVs during this same period. Even with this decline in SUV rollover risk, similarly aged passenger cars and minivans still exhibited a rollover risk approximately half that of their SUV counterparts.

Previous work identified a similar risk of injury for children seated on the struck side and center rear in side impact crashes in passenger cars. In order to further explain this finding, we investigated the effect of sharing the rear row with other occupants on injury risk and delineated differences in injury patterns among the seat positions. These analyses, conducted from a large child specific crash surveillance system, included: children 4-15 years old, rear seated, seat belt restrained, in a passenger car, and in a side impact crash. Injury risk was compared among each rear seat position stratified by the presence of other occupants on the rear row. Occupants are at an increased risk of injury if they sit alone on their row as compared to sitting with other occupants. Patterns of injuries distinct to each seat position were delineated.

Previous work quantified a 59% reduction in injury risk for children in belt positioning booster seats (BPB) compared to those restrained in seat belts using a sample of crashes of all directions of impact. Experimental sled tests have highlighted the potential for extreme occupant excursion out of the BPB in side impact crash conditions. Using data from a large child specific crash surveillance system, the present study built upon these previous studies and quantified the relative effectiveness of BPB as compared to seat belts in reducing the risk of injury among 4-8 year olds in side impact crashes. Children in BPB were at a 58% reduction in risk of injury than those in seat belts in side impact crashes. This result varied by booster seat type: those in high back BPB were at a 70% reduction in injury risk while those in backless BPB did not experience a statistically significant reduction in injury risk compared to those in seat belts. This differential performance of the two types of BPB provides direction for future research into the design and performance of these restraints.

Lap and shoulder belts have been required in rear outboard positions since 1989. A recent congressional mandate encouraged the requirement of a lap and shoulder belt in the center rear seat position. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to quantify changes in seating patterns for children in vehicles that already have this feature compared to those which do not and measured the safety benefit associated with the provision of a shoulder belt in the center rear seat position. The data demonstrate that the presence of a shoulder belt in the center rear seating position influences seating practices only when there is a single child occupant in the vehicle. Belted children in the center rear of vehicles equipped with a lap shoulder belt are at an 81% reduction in risk of injury than those belted in the center rear equipped with a lap only belt. The data suggest that by requiring lap shoulder belts in the center rear, benefits would be realized to belted children, specifically the 4-8 year old group.

Following the fall of the Berlin Wall in late 1989, the combination of sudden wealth, sudden access to cars, and a flood of new young drivers had disastrous effects on East Germans. While motor vehicle occupant death rates decreased in West Germany, motor vehicle occupant death rates in East Germany surged upward. Between 1989 and 1991, the death rate increased for all age groups but was greatest for 18–20 year olds (from 5 to 54 deaths/100,000) and 21–24 year olds (from 5 to 44). Fatality rates for other classes of road users did not show increases such as those for car occupants.