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Introduction: Underbody blast loading can result in injuries to the pelvis and the lumbosacral spine. The purpose of this study was to determine human tolerance in this region based on survival analysis., Methods: Twenty-six unembalmed postmortem human surrogate lumbopelvic complexes were procured and pretest medical images were obtained. They were fixed in polymethylmethacrylate at the cranial end and a six-axis load cell was attached. The specimens were aligned in a seated soldier posture. Impacts were applied to the pelvis using a custom vertical accelerator. The experimental design consisted of non-injury and injury tests. Pretest and post-test X-rays and palpation were done following non-injury test, and after injury test medical imaging and gross dissections were done. Injuries were scored using the Abbreviated Injury Scale (AIS). Axial and resultant forces were used to develop human injury probability curves (HIPCs) at AIS 3+ and AIS 4 severities using survival analysis. Then ±95% CI was computed using the delta method, normalised CI size was obtained, and the quality of the injury risk curves was assigned adjectival ratings., Results: At the 50% probability level, the resultant and axial forces at the AIS 3+ level were 6.6 kN and 5.9 kN, and at the AIS 4 level these were 8.4 kN and 7.5 kN, respectively. Individual injury risk curves along with ±95% CIs are presented in the paper. Increased injury severity increased the HIPC metrics. Curve qualities were in the good and fair ranges for axial and shear forces at all probability levels and for both injury severities., Conclusions: This is the first study to develop axial and resultant force-based HIPCs defining human tolerance to injuries to the pelvis from vertical impacts using parametric survival analysis. Data can be used to advance military safety under vertical loading to the seated pelvis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Development of the Warrior Injury Assessment Manikin (WIAMan) capability has included the creation of injury assessment reference curves (IARCs) specific to under-body blast (UBB) loading mechanisms and injuries. The WIAMan IARCs were created from high-rate vertical loading tests of component post-mortem human surrogates (PMHS) and analogous components of the WIAMan anthropomorphic test device (ATD). Validation of the WIAMan IARCs is required prior to the WIAMan ATD being utilized for injury assessment in live-fire vehicle test events. A portion of the validation process involves evaluating the ability of the IARCs to predict injury at the system level (whole body). This study evaluates a methodology to assess the performance of the WIAMan IARCs using match-paired tests of whole body PMHS and the WIAMan ATD. The methodology includes a qualitative analysis designed to identify false-positive and false-negative ATD predictions, as well as a quantitative analysis that utilizes area under the receiver-operating characteristic curve (AROC) and Brier score indices to grade IARC performance. Three WIAMan IARCs were used to exemplify the proposed methodology and results are provided. Attributes of the false-prediction, AROC, and Brier score portions of the methodology are presented, with results indicating the new methodology is thorough and robust in evaluation of IARCs., (© 2021. Biomedical Engineering Society.)

For the current study, an existing theater injury data set was compared to component and whole body experiments meant to replicate the theater high rate vertical loading environment. The theater injury data set was derived from real world events that were within the design range of the Warrior Injury Assessment Manikin. A qualitative and quantitative assessment of the whole body fracture patterns was developed to determine whether the laboratory loading was correctly representing the resulting injuries seen in theater Underbody Blast (UBB) events. Results indicated that most of the experimental test fracture patterns were similar to the theater injuries for Abbreviated Injury Scale body regions of interest (lower extremities, pelvis, and spine); however, some of the body regions had higher similarity scores compared to others. Whole body fracture distribution was less similar than the component tests because of differences in injury distributions. The lower extremity whole body similarity was lower than spine and pelvis similarity. This analysis was able to identify some experimental tests that might not represent theater loading. In conclusion, this analysis confirmed that some laboratory testing produced skeletal injury patterns that are seen in comparable theater UBB events., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Fracture to the lumbo-pelvis region is prevalent in warfighters seated in military vehicles exposed to under-body blast (UBB). Previous high-rate vertical loading experimentation using whole body post-mortem human surrogates (PMHS) indicated that pelvis fracture tends to occur earlier in events and under higher magnitude seat input conditions compared to lumbar spine fracture. The current study hypothesizes that fracture of the pelvis under high-rate vertical loading reduces load transfer to the lumbar spine, thus reducing the potential for spine fracture. PMHS lumbo-pelvis components (L4-pelvis) were tested under high-rate vertical loading and force and acceleration metrics were measured both inferior-to and superior-to the specimen. The ratio of inferior-tosuperior responses was significantly reduced by unstable pelvis fracture for all metrics and a trend of reduced ratio was observed with increased pelvis AIS severity. This study has established that pelvis fracture reduces compression forces at the lumbar spine during high-rate vertical loading, thus reducing the potential for fracture to the lumbar spine. Therefore, pelvis injury potential should be considered when implementing lumbar injury criteria specific to UBB.

Objective: The objective of the mapping project was to develop an expert derived map between the International Statistical Classification of Diseases and Related Health Problems (ICD) clinical modifications (CM) and the Abbreviated Injury Scale (AIS) to be able to relate AIS severity to ICD coded data road traffic collision data in EU datasets. The maps were developed to enable the identification of serious AIS3+ injury and provide details of the mapping process for assumptions to be made about injury severity from mass datasets. This article describes in detail the mapping process of the International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) and the International Classification of Diseases Tenth Revision, Clinical Modification (ICD-10-CM) codes to the Abbreviated Injury Scale 2005, Update 2008 (AIS08) codes to identify injury with an AIS severity of 3 or more (AIS3+ severity) to determine 'serious' (MAIS3+) road traffic injuries. Methods: Over 19,000 ICD codes were mapped from the following injury categories; injury ICD-9-CM (Chapter 17) codes between '800 and 999.9' and injury ICD-10-CM (Chapter 19) 'S' and 'T' prefixed codes were reviewed and mapped to an AIS08 category and then relate the severity to three groups; AIS3+, AIS < =2 and AIS 9 (no-map). The mapping was undertaken by ICD coding experts and certified AIS specialists from Europe, North America, Australia and Canada in face-to-face working groups and subsequent webinars between May 2014 and October 2015. During the process, the business rules were documented to define guidelines for the mapping process and enable inter-rater discrepancies to be resolved. Results: In total 2,504 ICD-9-CM codes were mapped to the AIS, of which 780 (31%) were assigned an AIS3+ severity. For the16,508 ICD-10-CM mapped codes a total of 2,323 (14%) were assigned an AIS3+ severity. Some 17% (n = 426) and 27% (n = 4,485) of ICD-9-CM and ICD-10-CM codes respectively were assigned to AIS9 (no-map) following the mapping process. It was evident there were 'problem' codes that could not be easily mapped to an AIS code to reflect severity. Problem maps affect the specificity of the map and severity when used to translate historical data in large datasets. Conclusions: The Association for the Advancement in Automotive Medicine, AAAM-endorsed expert-derived map offers a unique tool to road safety researchers to establish the number of MAIS3+ serious injuries occurring on the roads. The detailed process offered in this paper will enable researchers to understand the decision making and identify limitations when using the AIS08/ICD map on country-specific data. The results could inform protocols for dealing with problem codes to enable country comparisons of MAIS3+ serious injury rates.

Background: To fully understand the injury mechanisms during an underbody blast (UBB) event with military vehicles and develop new testing standards specific to military vehicles, one must understand the injuries sustained by the occupants., Methods: Injury data from Service Members (SM) involved in UBB theater events that occurred from 2010 to 2014 were analyzed. Analysis included the investigation of prominent skeletal and visceral torso injuries. Results were categorized by killed-in-action (n = 132 SM) and wounded-in-action (n = 1,887 SM)., Results: Over 90% (553/606 SM) of casualties in UBB events with Abbreviated Injury Scale (AIS) 2+ injury sustained at least one skeletal fracture, when excluding concussion. The most frequent skeletal injuries from UBB were foot fractures (13% of injuries) for wounded-in-action and tibia/fibula fractures (10% of injuries) for killed-in-action. Only 1% (11/1037 SM) of all casualties with AIS 2+ injuries had visceral torso injuries without also sustaining skeletal fractures. In these few casualties, the coded injuries were likely due to trauma from a loading path other than direct UBB loading., Conclusion: Skeletal fractures are the most frequent AIS 2+ injury resulting from UBB events. Visceral torso injuries are infrequent in individuals that survive and they generally occur in conjunction with skeletal injuries., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

A recent study of all mounted vehicle underbody blast attacks found that 21% of Abbreviated Injury Scale Severity 2+ injuries in the Joint Trauma Analysis and Prevention of Injury in Combat network were injuries to the leg and ankle. To develop effective countermeasure systems for these attacks, the epidemiology and mechanisms of injury from this loading environment need to be quantified. The goal of this study was to develop a military correlate of an existing civilian case review framework, the Crash Injury Research and Engineering Network (CIREN), to consider the differences in military event types and the amount of available vehicle/attack information. Additional data fields were added to the CIREN process to cover military-specific data and "certainty" definitions in the proposed injury hypothesis were modified. To date, six group reviews have been conducted analyzing 253 injuries to the foot/ankle, tibia, femur, pelvis, and lumbar spine from 52 occupants. The familiar format and unclassified nature of the presentations allowed for the involvement of biomechanics experts from multiple disciplines., (Published by Oxford University Press on behalf of Association of Military Surgeons of the United States 2019.)

Objective: Although the Abbreviated Injury Scale (AIS) was initially developed in the mid-1960s for tracking injury in automotive and aircraft crashes, it has grown to become an internationally recognized scoring system for a variety of traumatic injuries. This shift in focus and advances in organized medical care, combined with feedback from field use and outcome analysis, have resulted in several AIS updates and revisions. This article demonstrates how AIS codes and severities have changed over the last 25 years and investigates the effects of those changes., Methods: Data from each version and update of the AIS dictionary (AIS 1990, AIS 1998, AIS 2005, AIS 2008, and AIS 2015) were analyzed for changes and shifts in injury descriptions, severities, and code counts., Results: The number of AIS codes has increased to improve coding specificity and reliability for a growing number of injury types. There has also been a shift in severities, mainly within the moderate (AIS 2) to severe (AIS 4) range. AIS 1990 was the first version to utilize the 6-digit predot identifier, to add modifiers for pediatric injury, and to substantially expand brain injury codes. AIS 1998 added coding rules and guidelines throughout the dictionary and integrated the Organ Injury Scale scores. The AIS 2005 dictionary added over 400 codes and made significant changes throughout. Fewer changes were made in the AIS 2008 update. AIS 2015 includes descriptions for tissue injuries with loss of soft tissue that do not qualify as amputations, a need identified in military injury analysis., Conclusions: Each updated version of AIS reflects improving medical care and new advances in understanding, measuring, and documenting injury. AIS changes over time reflect its international and cross-domain utilization for describing injury severity and set the standard for how the world now studies traumatic injury.

Objective: This article describes how maps were developed from the clinical modifications of the 9th and 10th revisions of the International Classification of Diseases (ICD) to the Abbreviated Injury Scale 2005 Update 2008 (AIS08). The development of the mapping methodology is described, with discussion of the major assumptions used in the process to map ICD codes to AIS severities. There were many intricacies to developing the maps, because the 2 coding systems, ICD and AIS, were developed for different purposes and contain unique classification structures to meet these purposes., Methods: Experts in ICD and AIS analyzed the rules and coding guidelines of both injury coding schemes to develop rules for mapping ICD injury codes to the AIS08. This involved subject-matter expertise, detailed knowledge of anatomy, and an in-depth understanding of injury terms and definitions as applied in both taxonomies. The official ICD-9-CM and ICD-10-CM versions (injury sections) were mapped to the AIS08 codes and severities, following the rules outlined in each coding manual. The panel of experts was composed of coders certified in ICD and/or AIS from around the world. In the process of developing the map from ICD to AIS, the experts created rules to address issues with the differences in coding guidelines between the 2 schemas and assure a consistent approach to all codes., Results: Over 19,000 ICD codes were analyzed and maps were generated for each code to AIS08 chapters, AIS08 severities, and Injury Severity Score (ISS) body regions. After completion of the maps, 14,101 (74%) of the eligible 19,012 injury-related ICD-9-CM and ICD-10-CM codes were assigned valid AIS08 severity scores between 1 and 6. The remaining 4,911 codes were assigned an AIS08 of 9 (unknown) or were determined to be nonmappable because the ICD description lacked sufficient qualifying information for determining severity according to AIS rules. There were also 15,214 (80%) ICD codes mapped to AIS08 chapter and ISS body region, which allow for ISS calculations for patient data sets., Conclusion: This mapping between ICD and AIS provides a comprehensive, expert-designed solution for analysts to bridge the data gap between the injury descriptions provided in hospital codes (ICD-9-CM, ICD-10-CM) and injury severity codes (AIS08). By applying consistent rules from both the ICD and AIS taxonomies, the expert panel created these definitive maps, which are the only ones endorsed by the Association for the Advancement of Automotive Medicine (AAAM). Initial validation upheld the quality of these maps for the estimation of AIS severity, but future work should include verification of these maps for MAIS and ISS estimations with large data sets. These ICD-AIS maps will support data analysis from databases with injury information classified in these 2 different systems and open new doors for the investigation of injury from traumatic events using large injury data sets.

Motor vehicle crashes result in millions of injuries and thousands of deaths each year in the United States. While most crash research datasets use Abbreviated Injury Scale (AIS) codes to identify injuries, most hospital datasets use the International Classification of Diseases, version 9 (ICD-9) codes. The objective of this research was to establish a one-to-one mapping between AIS and ICD-9 codes for use with motor vehicle crash injury research. This paper presents results from investigating different mapping approaches using the most common AIS 2+ injuries from the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS). The mapping approaches were generated from the National Trauma Data Bank (NTDB) (428,637 code pairs), ICDMAP (2500 code pairs), and the Crash Injury Research and Engineering Network (CIREN) (4125 code pairs). Each approach may pair given AIS code with more than one ICD-9 code (mean number of pairs per AIS code: NTDB=211, ICDMAP=7, CIREN=5), and some of the potential pairs are unrelated. The mappings were evaluated using two comparative metrics coupled with qualitative inspection by an expert physician. Based on the number of false mappings and correct pairs, the best mapping was derived from CIREN. AIS and ICD-9 codes in CIREN are both manually coded, leading to more proper mappings between the two. Using the mapping presented herein, data from crash and hospital datasets can be used together to better understand and prevent motor vehicle crash injuries in the future., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: The lower extremity is the most frequently injured body region and knee-thigh-hip (KTH) injuries account for half of these injuries. Knee bolster air bags (KBABs) have been incorporated in some vehicles to serve as an additional restraint for the occupant's knees and reduce KTH injuries. To investigate the safety benefits of KBABs, similar frontal crashes with opposing KBAB deployment were selected from the Crash Injury Research and Engineering Network (CIREN) database., Methods: An 8-point similarity scoring algorithm was used to quantify crash and occupant similarity and select case comparisons. A total of 183 cases without a KBAB were scored for similarity to 9 KBAB cases. These similarity scores were used to select 31 final case comparisons. The effect of KBAB deployment on occupant injury patterns was investigated with a particular focus on KTH injuries., Results: Over half of the occupants exposed to a KBAB sustained no KTH injuries and a reduction in femur fractures was observed in KBAB occupants (P = .036). However, increases in proximal tibia/fibula and foot/ankle fractures were observed in KBAB occupants (P = .022 and .002, respectively). Mildly significant decreases in pelvic fractures and Abbreviated Injury Scale (AIS) 2+ head injuries were observed in the KBAB occupants, supporting the notion that KBABs reduce forward occupant excursion (P = .094 and .055, respectively). Investigation of each case comparison yielded further insight into the reasons for injury pattern differences between cases with opposing KBAB deployment. In addition to KBAB deployment status, differences in occupant factors (age, height, and weight) and crash factors (delta V and belt use) between the cases for a particular comparison could explain variation in injury patterns., Conclusions: The current study presents a preliminary in-depth qualitative and quantitative assessment of KBAB safety benefits. However, further investigation is recommended to provide conclusive evidence of KBAB effectiveness.

In military, automotive, and sporting safety, there is concern over eye protection and the effects of facial anthropometry differences on risk of eye injury. The objective of this study is to investigate differences in orbital geometry and analyze their effect on eye impact injury. Clinical measurements of the orbital aperture, brow protrusion angle, eye protrusion, and the eye location within the orbit were used to develop a matrix of simulations. A finite element (FE) model of the orbit was developed from a computed tomography (CT) scan of an average male and transformed to model 27 different anthropometries. Impacts were modeled using an eye model incorporating lagrangian-eulerian fluid flow for the eye, representing a full eye for evaluation of omnidirectional impact and interaction with the orbit. Computational simulations of a Little League (CD25) baseball impact at 30.1m/s were conducted to assess the effect of orbit anthropometry on eye injury metrics. Parameters measured include stress and strain in the corneoscleral shell, internal dynamic eye pressure, and contact forces between the orbit, eye, and baseball. The location of peak stresses and strains was also assessed. Main effects and interaction effects identified in the statistical analysis illustrate the complex relationship between the anthropometric variation and eye response. The results of the study showed that the eye is more protected from impact with smaller orbital apertures, more brow protrusion, and less eye protrusion, provided that the orbital aperture is large enough to deter contact of the eye with the orbit., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

In 2008, there were more than 5,000 motorcycle crash fatalities in the United States. Many states have motorcycle helmet laws that are meant to protect riders during a crash. After recruiting motorcycle occupants injured in crashes, a protocol was established to scan three different types of motorcycle helmets commonly worn (cap, ¾ shield, and full face shield) using a computed tomography (CT) scanner. The protocol developed was for a GE 64 slice PET/CT Discovery VCT scanner with axial images from anterior to posterior helmet acquired in helical mode. It had 512x512 resolution and the full face and ¾ face shield helmets were scanned with greater voxels in the axial plane compared to the skull cap helmets. New helmets were scanned as exemplary images for comparison with helmets involved in motorcycle crashes. After CT scans were gathered, three-dimensional reconstructions were made to visualize scratches and impacts to the exterior of the helmets. Initial work was also conducted in analyzing interior components, and a trend was seen in decreased thickness between the interior foam and shell with sides of the exterior helmet thought to have contacted roadside barriers or the ground during motorcycle crashes. These helmet analysis methods have been established, and will be used to investigate multiple motorcycle crashes in conjunction with occupant injuries and direct head impacts to improve helmet design and the understanding of head injuries. This work also establishes the basis for development of finite element models of three of the most common helmet types.

The objective of this study was to investigate side airbag (SAB) deployment in near side crashes and compare injuries and contact points between occupants with and without SAB deployment. Using NASS 2000-2008 and selecting for near side cases, with PDOF ± 20 degrees from 90 or 270, for non-pregnant adult belted occupants, there were 20,253 (weighted) SAB deployments. NASS showed that SABs have been increasing within the fleet, comprising 2% of airbags in 2000 and increasing to 33% of airbags in 2008. To investigate deployed SABs, we developed a three-step methology to pair CIREN cases to study the effects of deployment on occupant outcome. The first step involved extracting near side impacts from CIREN with adult, non-pregnant occupants seated in row 1 (drivers or right front passengers). In the second step, each case was quantitatively compared to FMVSS 214 barrier test standards using a 6 point similarity scoring system. Cases scoring at least 3 points were then qualitatively analyzed and 33 pairs of cases of the same vehicle make/model but opposite SAB status were chosen. Occupants with deployed SAB had reduced occurrences and severity of head and face, neck and cervical spine, and thoracic injuries and fewer injurious contacts to side components including the door, a-pillar, and window sill. SAB deployment was statistically significant for reducing occupant MAIS and ISS and thorax airbags were statistically significant for reducing thoracic and neck/cervical spine injury severity. The average ISS with SAB deployment was 21, while the average ISS of those without was 33. This study establishes methods for performing comparisons between CIREN cases based on regulatory conditions and shows injury reduction in key body regions with SAB deployment.

Pediatric occupants are vulnerable in motor vehicle crashes (MVCs), and alternative restraints have been developed for their protection. This study sought to characterize injuries in MVCs for pediatric occupants and to identify scenarios that may benefit from enhanced vehicle safety. Using the NASS-CDS database (2000-2008), pediatric occupants (< 19 yr old) were characterized by their age and injuries to look at national averages in MVCs. There were over 14 million pediatric injuries and non-injured occupants in weighted NASS-CDS (out of over 70 million total). Of these pediatric cases, 60% sustained injuries, which was comparable to the percentage of all occupants injured (65%). Six percent of NASS-CDS pediatric occupants had AIS 2+ injuries, which is the injury inclusion criteria for CIREN pediatric cases. CIREN was used to investigate pediatric occupants and injuries resulting from incorrect positioning and restraints according to NHTSA suggestions. Results indicated that many injured pediatric occupants were not properly restrained, with over 100 in the front row of the vehicle under 13 years of age. There were also over 200 CIREN pediatric occupants under 4’ 9” that were not seated in a child safety seat (CSS). The most frequently injured body region was the face, followed by the head and lower extremity. Eighty-six percent of head injuries and 82% of spinal injuries were AIS 2+. This study supports prior findings that demonstrate a need for enhanced public awareness for proper CSS use to reduce pediatric injuries in the future.

Purpose: To measure eye and orbit anthropometric variation within the normal population by using CT images and to determine the effects of age and sex on eye and orbit anthropometry. Quantification of eye and orbit anthropometric variation within the normal population and between persons of different age and sex is important in the prediction and prevention of eye injury., Methods: A systematic method was developed to align head CT images three dimensionally and to measure ocular and orbital parameters in 39 subjects. Twenty-four measurements were collected along the orbital rim, to quantify the orbital aperture. Protrusions of the brow and the eye were measured, along with relative distances, to describe location of the eye within the orbit., Results: The orbit widened with age, and significant relations were identified between orbital aperture and eye location measurements, both of which varied significantly between the sexes., Conclusions: The comprehensive set of measurements collected in this study provides three-dimensional information on orbit geometry, as well as placement of the eye within the orbit. These measurements and the methodology used will contribute to the development of finite element models of the orbit and eye for computational modeling purposes and may be useful in the design of eye protection equipment.

Injury statistics show that lower extremity injuries follow second to head trauma in motor vehicle crashes. Fractures to the ankle/foot make up approximately 35% of all lower extremity injuries in motor vehicle crashes. Previous studies have shown that toe pan intrusion is one of the main causes of foot and ankle fractures in motor vehicle crashes (MVC). This study investigates injury mechanisms of malleolar fractures involving occupants enrolled in the Wake Forest University Crash Injury Research and Engineering Network (WFU CIREN) center. By narrowing cases to frontal impacts (+/- 20 degrees principal direction of force) with the case occupant as the driver with lower leg fractures, 16 cases are identified and investigated for trends in lower leg injury. Of these fractures, 81% of the occupants have a body mass index (BMI) greater than 25 kg/m2, with an average BMI of 32 kg/m2, which is obese. For occupants with malleolar fractures the average delta V is 44.1 kph (27.4 mph) and the average intrusion is 9.6 cm. Using radiology images of each ankle fracture in conjunction with interior vehicle evidence, injury mechanisms for malleolar fracture types are identified using the Lauge-Hansen and Weber classifications. The most common malleolar fracture type was supination-exorotation with a Weber B fibular fracture (4 cases). There were also four drivers that sustained trimalleolar fractures. Drivers sustaining lower leg fractures other than malleolar fractures had an average BMI of 30 kg/m2, an average delta V of 39.6 kph (24.6 mph), and average toe pan intrusion of 12.0 cm. Results show that the malleolar fracture and other lower leg fracture datasets have similar average delta Vs and toe pan intrusions, but the average BMI is slightly higher in the malleolar fracture group. These preliminary data suggest that occupants with increased BMI may be more susceptible to ankle fractures in frontal crashes, particularly malleolar fractures. The trends presented in this research will be used for the development of future studies for the enhancement of vehicle safety.

The growing elderly population in the United States presents medical, engineering, and legislative challenges in trauma management and prevention. Thoracic injury incidence, morbidity, and mortality increase with age. This study utilized receiver-operator characteristic analysis to identify the quantitative age thresholds associated with increased mortality in common isolated types of thoracic injuries from motor vehicle crashes (MVCs).The subject pool consisted of patients with a single AIS 3+ thorax injury and no injury greater than AIS 2 in any other body region. A logistic regression algorithm was performed for each injury to estimate an age threshold that maximally discriminates between survivors and fatalities. The c-index describing discrimination of the model and odds ratio describing the increased mortality risk associated with being older than the age threshold were computed.Twelve leading thoracic injuries were included in the study: unilateral and bilateral pulmonary contusion (AIS 3/4), hemo/pneumothorax, rib fractures with and without hemo/pneumothorax (AIS 3/4), bilateral flail chest, and thoracic penetrating injury with hemo/pneumothorax. Results are consistent with the traditional age threshold of 55, but were injury-specific. Pulmonary contusions had lower age thresholds compared to rib fractures. Higher severity pulmonary contusions and rib fractures had lower age thresholds compared to lower severity injuries.This study presents the first quantitatively estimated mortality age thresholds for common isolated thoracic injuries. This data provides information on the ideal 'threshold' beyond which age becomes an important factor to patient survival. Results of the current study and future work could lead to improvements in automotive safety design and regulation, automated crash notification, and hospital treatment for the elderly.

Eye trauma is an increasing problem, especially in the military, due to blunt force trauma. One way to mitigate eye injury is to wear protective eye equipment. An essential part of creating protective eye equipment is prototype testing in controlled eye trauma simulations. In addition, the protective equipment must fit properly and thus incorporate variance, specifically among gender, ethnicity, and age. It is beneficial to create standard orbits classified according to the aforementioned categories of gender, ethnicity, and age. Using head CT scans from grossly normal subjects, segmentation of the ocular orbit was performed. This segmented mask was then imported into a three dimensional printing software. Orbits from different sizes, ages, genders, and races were created and printed using a ZCorp printer. A mold negative was then created from the 3D printed orbits using InstaMold. After the mold was cured and removed from the printed orbit, reproductions of the eye orbit were created from this negative. These methods will be used in the future to make molds for many different ages, genders, and races in order to create accurate models of the eye orbit. These can then be used to develop impact tests by incorporating eye samples into these sockets of uniform shape. These methods for creating surrogate eye sockets will reduce the need for cadaver eye sockets and will increase the number of tests that can be performed. By creating accurate models, more accurate representations of eye trauma and its prevention can be investigated.

Motor vehicle accidents are the leading cause of death of people between one and thirty-four years of age in the U.S., and head trauma is a significant lethal injury in such cases. During a motor vehicle crash, the head often experiences blunt force trauma from impacts with seat backs, steering wheels, windows, and dashes. The resulting injuries can cause skull fractures, concussions, bleeding and swelling of the brain. Crash test dummies and finite element models are often used to study the nature and likelihood of injury during a crash, but these are currently based on scaled versions of a standard, 50th percentile male. This approach fails to accurately capture the size and shape variation in even the adult population, but may be especially inappropriate for modeling pediatric head injuries where, for instance, infants have fontanelles and reduced bone structure. In this presentation, an approach for modification of a finite element model of the human head based on 50th percentile male dimensions and representing the skull, brain, dura/CSF layer, and Falx Celebri, that will incorporate the anatomical and nonlinear morphological changes observed in pediatric skulls during ontogeny. Using 96 CT scans of normal pediatric skulls, landmark coordinate points are identified to map the changes in skull shape and size as aging occurs. The pediatric skull changes rapidly in size and shape during the first two years of age. Using this information, a pediatric finite element head model will be created, using parametric mesh generation software, to measure head injury in children in a motor vehicle crash.

To fully understand the effects of aging on the integrity of the normal skeleton, detailed geometric models are needed to complement material property data. The purpose of this research is to develop a predictive model for age-related changes in rib-cage geometry using the generalized Procrustes approach, an advanced method of shape analysis. This predictive model is coupled with the finite element method to isolate the effects age-related size and shape change have on the structural response of the rib cage. Using a relatively small sample set (n = 12), trends in the age-related size and shape change of the human thorax consistent with clinical observations are identified. Finite element models constructed from landmark datasets generated via the generalized Procrustes approach demonstrate a decrease with age in the energy absorbing capacity of the thorax during a blunt impact.