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Upper Extremity Injuries in Motor Vehicle Crashes Involving Partial Ejection; an Analysis of 20 years of NASS-CDS Data
Angelo B. Lipira, MD1; Laura A. Blanar, MHS2; Jessica Hsu, MD, PhD3; Robert P. Kaufman, BS2; Eileen M. Bulger, MD4; Jeffrey B. Friedrich, MD1
1Plastic Surgery, University of Washington, Seattle, WA; 2Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; 3Plastic Surgery, University of Michigan, Ann Arbor, MI; 4Trauma Surgery, University of Washington, Seattle, WA

Introduction: Partial ejection remains a significant problem in motor vehicle collisions (MVCs). Upper extremity ejection can lead to severe injuries, but literature is limited to small case series. This study examines the occurrence, crash characteristics, and efficacy of restraint systems in partial ejections and upper extremity injuries in MVCs, and describes the relationship between upper extremity injuries and partial ejection. We hypothesize that partial ejection increases risk of upper extremity injury, especially severe soft tissue injuries, and is significantly associated with rollover.

Materials and Methods: Weighted data from the National Automotive Sampling System Crashworthiness Data System (NASS CDS) from 1993-2012 were used. The study population included belted outboard occupants in four-wheeled passenger vehicles, aged 14 and older. Upper extremity injuries were identified and characterized using Abbreviated Injury Score definitions. Descriptive and comparative statistics were employed in analysis, and logistic regression modeling was used to assess the relationship between partial ejection and side-curtain airbags.

Results (all figures are weighted estimates): Upper extremity injuries were the third most common injury in MVCs, with 920,000 from 1993-2012. There were 100,000 belted partial ejections. Partial ejection increased risk of upper extremity injury five-fold. The majority of severe soft tissue injuries were associated with partial ejection (61%) and rollover (67%, p < 0.0001). 63% of partial ejections occurred in rollover MVCs. Light truck vehicles had the highest rates of partial ejection (3.6%), but SUVs had the highest rate of upper extremity injury in partial ejection (59%). Logistic regression revealed an odds ratio (OR) of 3.9 (95% CI = 2.1 - 7.4) for partial ejection in vehicles without side-curtain airbags (SABs) compared to those with side-curtain airbags. The odds increased significantly with increasing deltaV (OR = 12.1; CI = 1.2 - 119.9 for deltaV > 30kph). Regression did not reveal a significant difference in upper extremity injuries with SABs (OR = 1.34; CI = 0.81 2.23). No severe soft tissue injuries occurred when SABs deployed. Window status (up or down) was not associated with partial ejection or upper extremity injury.

Conclusions: Upper extremity injuries represent a considerable portion of the trauma burden of MVCs. Partial ejection is associated with a five-fold increase in upper extremity injuries, and most severe soft tissue injuries occur in partial ejection during rollovers. Side-curtain airbags significantly reduce the risk of partial ejection, especially with increasing deltaV.

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