Gayzik F Scott, Martin R Shayn, Gabler H Clay, Hoth J Jason, Duma Stefan M, Meredith J Wayne, Stitzel Joel D
Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
J Trauma. 2009 Mar;66(3):840-9. doi: 10.1097/TA.0b013e318186251e.
Pulmonary contusion (PC) is commonly sustained in motor vehicle crash. This study utilizes the Crash Injury Research and Engineering Network (CIREN) database and vehicle crash tests to characterize the occupants and loading characteristics associated with PC. A technique to match CIREN cases to vehicle crash tests is applied to quantify the thoracic loading associated with this injury.
The CIREN database and crash test data from the National Highway Traffic Safety Administration were used in this study. An analysis of CIREN data were conducted between three study cohorts: patients that sustained PC and any other chest injury (PC+ and chest+), patients with chest injury and an absence of PC (PC- and chest+), and a control group without chest injury and an absence of PC (PC- and chest-). Forty-one lateral impact crash tests were analyzed and thoracic loading data from onboard crash tests dummies were collected.
The incidence of PC in CIREN data were 21.7%. Crashes resulting in PC demonstrated significantly greater mortality (23.9%) and Injury Severity Score (33.1 +/- 15.7) than the control group. The portion of lateral impacts increased from 27% to 48% between the control group and PC+ and chest+ cohort, prompting the use of lateral impact crash tests for the case-matching portion of the study. Crash tests were analyzed in two configurations; vehicle-to-vehicle tests and vehicle-to-pole tests. The average maximum chest compression and deflection velocity from the dummy occupants were found to be 25.3% +/- 2.6% and 4.6 m/s +/- 0.42 m/s for the vehicle-to-pole tests and 23.0% +/- 4.8% and 3.9 m/s +/- 1.1 m/s for the vehicle-to-vehicle tests. Chest deflection versus time followed a roughly symmetric and sinusoidal profile. Sixteen CIREN cases were identified that matched the vehicle crash tests. Of the 16 matched cases, 12 (75%) sustained chest injuries, with half of these patients presenting with PC.
Quantified loading at the chest wall indicative of PC and chest injury in motor vehicle crash is valuable boundary condition data for bench-top studies or computer simulations focused on this injury. In addition, because PC often exhibits a delayed onset, knowing the population and crash modes highly associated with this injury may promote earlier detection and improved management of this injury.
肺挫伤（PC）在机动车碰撞事故中较为常见。本研究利用碰撞损伤研究与工程网络（CIREN）数据库及车辆碰撞试验，来描述与PC相关的驾乘人员和载荷特征。应用一种将CIREN案例与车辆碰撞试验相匹配的技术，以量化与该损伤相关的胸部载荷。
本研究使用了CIREN数据库和美国国家公路交通安全管理局的碰撞试验数据。在三个研究队列之间对CIREN数据进行了分析：发生PC且伴有其他胸部损伤的患者（PC+且胸部+）、有胸部损伤但无PC的患者（PC-且胸部+）以及无胸部损伤且无PC的对照组（PC-且胸部-）。分析了41次侧面碰撞试验，并收集了车载碰撞试验假人的胸部载荷数据。
CIREN数据中PC的发生率为21.7%。导致PC的碰撞事故死亡率（23.9%）和损伤严重度评分（33.1±15.7）显著高于对照组。对照组与PC+且胸部+队列之间，侧面碰撞的比例从27%增至48%，促使在研究的案例匹配部分采用侧面碰撞试验。碰撞试验按两种配置进行分析；车辆对车辆试验和车辆对电线杆试验。对于车辆对电线杆试验，假人驾乘人员的平均最大胸部压缩量和偏转速度分别为25.3%±2.6%和4.6 m/s±0.42 m/s；对于车辆对车辆试验，分别为23.0%±4.8%和3.9 m/s±1.1 m/s。胸部偏转量与时间的关系大致呈对称的正弦曲线。确定了16例与车辆碰撞试验匹配的CIREN案例。在这16例匹配案例中，12例（75%）有胸部损伤，其中一半患者有PC。
机动车碰撞中表明PC和胸部损伤的胸壁量化载荷，对于专注于该损伤的台式研究或计算机模拟而言，是有价值的边界条件数据。此外，由于PC常表现为延迟发作，了解与该损伤高度相关的人群和碰撞模式可能会促进对该损伤的早期检测和更好的管理。
