Risk of Injury and Fatality in Single Vehicle Rollover Crashes: Danger for the Front Seat Occupant in the "Outside Arc"

Department of Emergency Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
Academic Emergency Medicine (Impact Factor: 2.01). 11/2007; 14(10):899-902. DOI: 10.1197/j.aem.2007.06.029
Source: PubMed


Rollover crashes are responsible for a large portion of motor vehicle occupant injuries and fatalities.
To examine if there is an increased risk of injury or death for either front seat occupant depending on the direction the vehicle rolled over.
Between 1992 and 2002, crash data were collected and analyzed from the National Accident Sampling System Crashworthiness Data System (NASS/CDS) database of police reported tow-away crashes in the United States. These data were limited to information concerning single vehicle crashes with right or left initial rollover, in which both driver and front seat passenger were present and secured with lap-shoulder belts. The "outside arc" occupant was defined as the occupant who underwent the greatest degree of initial rotational torque during the rollover. Crashes involving sport utility vehicles (SUVs) were further evaluated for risks of injury or death based on the direction of the initial rollover. The location of roof crush and the types of injuries were also analyzed for these rollovers. This weighted database allows for the calculation of mortality and injury prevalence in the population.
There was a significantly higher fatality rate for outside arc occupants than inside arc occupants in rollover crashes. The weighted percentage fatality for the occupant on the outside arc for all classes of light passenger vehicles was 0.38%, while the percentage fatality for the occupant on the inside arc was 0.23% (odds ratio [OR], 1.64; p = 0.04). As a subgroup, the SUV class showed a weighted outside arc fatality percentage of 0.23%, while the inside arc fatality percentage was 0.02% (OR, 10.69; p = 0.06). Additionally, in SUVs, the weighted percentage having an Injury Severity Score of 9-75 was 0.99% for the outside arc passengers but only 0.19% for the inside arc passengers (OR, 5.42; p = 0.04). Roof crush was located more commonly on the outside arc of the rollovers than on the inside arc (42% vs. 26.3%; p < 0.01). There was a trend toward increased head and neck injuries in the fatal rollover crashes when compared with fatalities in the entire NASS/CDS database (91% vs. 58%; p = 0.06).
The risk of death for outside arc occupants was higher than for inside arc occupants in rollovers. In addition, outside arc occupants in SUV rollover crashes were more likely to incur moderate or severe traumatic injuries. Roof crush occurs more commonly on the outside arc, and head and neck injuries were more prevalent in rollover crashes.

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Available from: Dietrich Jehle, Dec 05, 2014
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    • "Side airbags were excluded because of the relatively low frequency of vehicles equipped with side airbags represented in the NASS- CDS and in the vehicle fleet for the years of our study. It has been demonstrated that occupants in the outside of the roll arc (following side) are at increased risk for injury, compared to occupants in the inside of the roll arc (leading side) (Jehle et al., 2007). This risk was accounted for in the variable " roll arc side. "
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    ABSTRACT: Background: It is well established that rollover crashes are associated with a higher risk of serious injury and death than other types of crashes. Some of the most serious injuries that can result from a rollover crash are those to the head, neck and spine. The mechanism of injury to these body parts in a rollover is a matter of dispute in the literature. Some authors have concluded that the magnitude of vehicle roof deformation or vertical roof crush resulting from a rollover crash is not causally associated with head and neck injury severity, while others offer support for a causal association between roof crush and the degree of injury. A better understanding of the cause of serious injuries resulting from rollover crashes is important for improving injury prevention. Methods: This study utilized data from the National Automotive Sampling System--Crashworthiness Data System (NASS-CDS) for the years 1997 through 2007. Both cross-sectional and matched case-control designs along with a new composite injury metric termed the Head, Neck and Spine New Injury Severity Score (HNS-NISS) were used to analyze these data. Results: The cross-sectional analysis demonstrated a 64% (95% CI: 26-114%) increase in the odds of a life-threatening injury as estimated by the HNS-NISS with every 10 cm of increased roof crush. The results of the matched case-control analysis demonstrated a 44% (95% CI: 8-91%) increase in the odds of sustaining any injury to the head, neck or spine with every 10 cm increase in roof crush. Conclusion: These results lend statistical support to a causal association between roof crush and head, neck and spine injury severity. Though they do not constitute definitive proof, they do contradict previously published theories suggesting that roof deformation is unrelated to such injuries.
    Full-text · Article · Apr 2013 · Accident; analysis and prevention
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    • "A rollover crash involves a vehicle that experiences at least a turn about its long axis of at least 1808. Rollover crashes are associated with a higher rate of serious injury and fatality than other crash types such as frontal, side, and rear impact collisions [2] [3] [4]. Rollovers comprised only 4% of traffic crashes in 2005 in the US, however they accounted for 34% of all motor vehicle occupant fatalities in the same year [5]. "
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    ABSTRACT: Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the National Automotive Sampling System-Crashworthiness Data System for the years 1997 through 2007 in which we examined the relationship between a serious head and neck injury in an occupant and a specified degree of roof deformation at the occupant's seating position. We found 960 occupants who qualified for the analysis, with 142 deaths among the subjects. Using a ranked composite head and neck injury score (the HNISS) we found a strong relationship between HNISS and the degree of roof crush. As a result of the analysis, we arrived at a predictive model, in which each additional unit increase in HNISS equated to an increased odds of roof crush as follows: for ≥8 cm of roof crush compared with <8 cm by 4%, for ≥15 cm of roof crush compared to <8 cm by 6% and for ≥30 cm of roof crush compared to <8 cm by 11%. We describe two hypothetical scenarios in which the model could be applied to the real world investigation of occupant position in a rollover crash-related fatality.
    Full-text · Article · Jun 2012 · Forensic science international
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    ABSTRACT: The objective of this article was to review the importance of vehicle rollover as a field triage criterion. In 1987, field triage criteria were developed by the American College of Surgeons Committee on Trauma that have been propagated repeatedly over the subsequent 20+ years. The field triage decision scheme is based on abnormal physiology, obvious abnormal anatomy, mechanism of injury likely to result in severe injury, and other factors (age, etc.) and was supported by available science at that time. In 2005, the triage scheme was revised by a committee, and vehicle rollover as a crash scene triage criterion was dropped in 2006. The medical literature and data from the Department of Transportation/National Highway Traffic Safety Administration (NHTSA) Fatal Accident Reporting System and the National Automotive Sampling System were analyzed to determine the contribution of rollover to morbidity and mortality. Vehicle rollovers represent a small but significant percentage of crashes; of the almost 12 million vehicle crashes reported by NHTSA in 2004, only 2.4% were rollovers, but these accounted for one-third of all crash-related occupant deaths and about 25,000 serious injuries every year. Rollovers are associated with the second highest number of vehicle occupant deaths by crash mode, three times the risk of injury when compared with other impact directions (p < 0.0001), specific types of injury such as head and spinal cord injuries, and a risk of death >15 times the risk in nonrollover crashes. The data and literature unequivocally show a strong and disproportionate association between vehicle rollover and injury severity and death. Because it is difficult to devise simple, accurate decision rules for point of wounding and vehicle crash scene triage, simple, powerful relationships should be used when possible. Thus, the exclusion of rollover as a triage criterion seems to be ill advised.
    No preview · Article · Sep 2009 · The Journal of trauma
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