Siegel J H, Mason-Gonzalez S, Dischinger P, Cushing B, Read K, Robinson R, Smialek J, Heatfield B, Hill W, Bents F
Maryland Institute for Emergency Medical Services Systems, University of Maryland.
J Trauma. 1993 May;34(5):736-58; discussion 758-9. doi: 10.1097/00005373-199305000-00017.
A 3-year prospective study examined 76 frontal (F) and 45 lateral (L) motor vehicle crash (MVC) patients with regard to seatbelt restraint use and occupant compartment contact and intrusion injuries. These 121 MVC victims with multiple injuries (39 belted [B] and 82 non-belted [NB]), admitted to a level I trauma center, were studied by accident reconstruction and medical data analysis. They had a MVC mean impact velocity (delta V) of 30 +/- 11 mph and an injury Severity Score of 29 +/- 12. Proper restraint use reduced brain injury in F MVCs (30% FB vs. 47% FNB) but had no effect in L MVCs (63% LB vs. 30% FB [p < 0.06]). Belt use did not protect against lung, liver, spleen, pelvis, or lower extremity (LE) injury. These appeared to be more a function of crash direction, with LE injuries higher in F crashes (p < 0.04) and pelvis injuries (p < 0.001) higher in L crashes. In FB crashes, however, properly used safety restraints were the primary cause of bowel or colon injuries (p < 0.006). Belts did not prevent thoracic or abdominal solid organ injuries in L crashes. Contact-intrusions (CI) of the car occupant compartment in F crashes were the main cause of brain (A-pillar), lung and liver (steering wheel and instrument panel), and LE (toepan) injuries; but in L crashes, side-door CI caused lung, aorta, liver, and pelvic injuries. In contrast, contact-only (CO) injuries of the steering assembly were mainly responsible for injuries to the lung, heart, and liver in F crashes, and side-door CO for lung, liver, and spleen injuries in L crashes. Deaths and complications after injury were higher among F MVC occupants, or when delta V was > or = 30 mph. Hospital and professional costs reflect the complex care needed for victims of multiple injuries: FB, $99,000; FNB, $95,000; LB, $75,000; LNB, $79,000; total, $10.7 million. Present vehicle safety standards are not adequate, and structural design changes are needed to improve restraints and protect occupants from intrusion-related injuries.
一项为期3年的前瞻性研究，对76名正面（F）和45名侧面（L）机动车碰撞（MVC）患者的安全带使用情况、乘员舱接触及侵入性损伤进行了调查。这121名多处受伤的MVC受害者（39名系安全带[B]，82名未系安全带[NB]）被送往一级创伤中心，通过事故重建和医疗数据分析进行研究。他们的MVC平均碰撞速度（ΔV）为30±11英里/小时，损伤严重度评分为29±12。正确使用安全带可降低正面MVC中的脑损伤（30%系安全带的正面碰撞[FB]患者 vs. 47%未系安全带的正面碰撞[FNB]患者），但对侧面MVC没有影响（63%系安全带的侧面碰撞[LB]患者 vs. 30%系安全带的正面碰撞[FB]患者[p < 0.06]）。系安全带并不能预防肺、肝、脾、骨盆或下肢（LE）损伤。这些损伤似乎更多地取决于碰撞方向，正面碰撞中下肢损伤发生率更高（p < 0.04），侧面碰撞中骨盆损伤发生率更高（p < 0.001）。然而，在系安全带的正面碰撞（FB）中，正确使用的安全约束装置是肠道或结肠损伤的主要原因（p < 0.006）。在侧面碰撞（L）中，安全带并不能预防胸部或腹部实性器官损伤。正面碰撞中汽车乘员舱的接触-侵入（CI）是脑（A柱）、肺和肝（方向盘和仪表盘）以及下肢（脚踏板）损伤的主要原因；但在侧面碰撞中，侧门CI导致肺、主动脉、肝和骨盆损伤。相比之下，转向组件的仅接触（CO）损伤在正面碰撞中主要导致肺、心脏和肝损伤，在侧面碰撞中侧门CO导致肺、肝和脾损伤。正面MVC乘员中受伤后的死亡和并发症发生率更高，或者当ΔV≥30英里/小时时也是如此。医院和专业费用反映了多处受伤受害者所需的复杂护理：FB为99,000美元；FNB为95,000美元；LB为75,000美元；LNB为79,000美元；总计1070万美元。当前的车辆安全标准并不充分，需要进行结构设计更改以改进约束装置并保护乘员免受侵入相关损伤。
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