Article, Ophthalmology

The effects of depowered airbags on eye injuries in frontal automobile crashes

The effects of Depowered airbags on eye injuries in Frontal automobile crashes

Stefan M. Duma PhD*, Amber L. Rath BS, Mary Virginia Jernigan MS, Joel D. Stitzel PhD, Ian P. Herring DVM

Virginia Tech-Wake Forest, Mechanical Engineering, Center for Injury Biomechanics, Blacksburg, VA 24061, USA

Received 11 December 2003; accepted 12 December 2003

Abstract The purpose of this study was to investigate eye injuries resulting from frontal automobile crashes and to determine the effects of depowered airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a 3-part investigation of 22236 individual crashes. Of the 2103308 occupants exposed to a full powered deployment, 3.7% sustained an eye injury compared to 1.7% of the 310039 occupants exposed to a depowered Airbag deployment. Occupants were at a significantly higher risk to sustain an airbag-induced eye injury when exposed to a full powered airbag compared with occupants exposed to a depowered airbag deployment ( P = .04). Approximately, 90% of the eye injuries in full powered airbag deployments were caused by the airbag, compared to only 35% of the depowered airbag eye injuries.

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Introduction

Although airbags have reduced the incidence of Fatal and severe injuries in automobile collisions, they have increased the risk of less severe injuries [1]. These associated minor injuries include upper extremity fractures, skin abrasions, and eye injuries. In particular, the medical literature is replete with case studies on airbag-induced eye injuries [2-71]. In addition to airbag-induced eye injuries, Muller-Jensen and Hollweck [72] presented a discussion on German trends of eye injuries resulting from broken windshields. Over a period of 5 years, 26% of patients with eye injury induced by windshield suffered bilateral eye injuries from broken

* Corresponding author. Tel.: +1 540 231 3945; fax: +1 540 231 9100.

E-mail address: [email protected] (S.M. Duma).

windshield glass, and 40% of cases resulted in blindness in at least one eye.

Most of these case studies focus on only a few occupants; however, several papers include numerous cases of airbag-induced eye injuries, offering more extensive information on occupant and collision character- istics [15,17,22,58,64] Duma et al [15] presented an analysis of 25 airbag-induced eye injury cases taken from the National Automotive Sampling System ( NASS) database that were analyzed extensively for associated eye injuries, and occupant and crash characteristics [73]. Most of the occupants sustained injury from contact with the fully deployed airbag, but the most Serious injuries were a result of the occupant being struck by the airbag during deployment. In 2002, another study using NASS was conducted by Duma et al [17]. The study found that of all occupants who were exposed to an airbag deployment,

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3% sustained an eye injury, whereas only 2% of occupants who were not exposed to an airbag deployment sustained an eye injury. Stein et al [58] outlined a detailed summary of the 97 published case studies on ocular injuries from airbag deployment between 1991 and 1998. This study attempted to identify potential risk factors in motor vehicle crashes; however, because the statistics were based solely on reported published cases in the literature, the statistical results do not necessarily reflect national incidence, injury type, or severity. For each of these papers, there was a wide range of ocular injuries reported from a minor eyelid or corneal abrasion to a more severe ruptured globe or dis- located lens.

In addition to the case study data, computational models of the eye have been created [74 -76]. Most recently, in 2002, a nonlinear finite element model of the eye that included experimental validation for the prediction of globe rupture was completed by Stitzel et al [74]. The model is able to accurately predict globe rupture and has the ability to simulate the interaction between the eye and a deployed airbag.

To reduce the incidence of airbag-induced fatal and severe injuries to small women and children, the National Highway Traffic Safety Administration [77] submitted a change in safety standards. The new safety regulations, effective in 1998 model vehicles, allowed automobile manufactures to reduce the power of the deploying airbag and still meet the safety standards by passing a standardized sled test rather than a full vehicle crash test. The new depowered airbags could be less aggressive than the pre- 1998 full powered airbags. Several recent studies have shown that depowered airbags did reduce the risk of serious injuries as well as changing the overall injury patterns [51,78-80]. It was found that significantly fewer and less injuries occurred to drivers of the later model vehicles, and that the depowered airbags could be responsible for these improvements. Although previous studies have provided insight into the interaction between an airbag and the eye, the national incidence and relative risk of airbag-induced eye injuries are unknown for depowered airbags. Therefore, the purpose of this article is to elucidate the effect of depowered frontal airbags on eye injury patterns.

Methods

To eliminate the inaccuracies associated with small case study projections, this study uses the NASS [73]. The primary advantage of using the NASS is that the database includes an analysis of approximately 5000 cases per year and it allows for national incidence estimates. The injuries are coded by Trained nurses using the Abbreviated Injury Scale [82]. The AIS classifies injuries by body region on a 6-point scale ranging from low severity (AIS1) to fatal (AIS6). The AIS values are assigned for each injury sustained and do not include combined effects from

multiple injuries to the same patient. In the present study, this coding allows for a consistent and accurate distinction and identification of eye injuries. Each crash scene is investigated by a group of trained accident investigators who examine and document vehicle damage, occupant injuries, and crash dynamics. This investigation team also examines the vehicle interior components that would indicate mechanisms for each recorded injury. All occupants in the study gave informed consent.

The NASS cases are collected from 24 separate field research teams across the United States. Because it is not practical to investigate every single crash in the United States, each case that is investigated for the NASS database is assigned a weighted value, which scales the incidence of that particular crash to a number that represents the actual occurrence of similar uninvestigated crashes that occur in the United States each year. In other words, the 5000 cases that are investigated each year can be weighted to predict what happens to the total number of occupants in crashes each year in the United States. This procedure has been used for national injury studies to analyze injury severity and crash characteristics for such things as lower extremity injury patterns, upper extremity injury patterns, and restraint effectiveness in motor vehicle crashes [1,15,17,82 – 87]. The occupant and injury numbers used in this report represent the weighted numbers calculated from the raw cases. Statistical analysis was performed using the SUDAAN statistical software, version 7.0, for weighted survey data (Research Triangle Institute, Research Triangle Park, NC).

For this study, cases in NASS with an airbag deployment were selected from an 8-year span, years 1993 through 2000, which included drivers and front-seat occupants only, and excluded ejected occupants and rollovers. In addition, only frontal impacts were considered, which are defined as having a primary direction of force at 11, 12, or 1 o’clock position. Eye injuries were defined as damage to the periorbital skin, globe, or orbital bones as identified in the NASS database using the current AIS injury codes. The study is divided into 2 parts.

Part 1: depowered and full powered airbag deployments

For all occupants who were exposed to a full powered airbag deployment (vehicle model years before and during 1997), the number of occupants that sustained an eye injury was compared with the total number of occupants who did not sustain an eye injury. Next, an analogous search was performed for occupants in crashes with a depowered airbag deployment (vehicle model, years 1998-2001). For all occupants who were exposed to a depowered airbag, the number of occupants that sustained an eye injury was compared with the total number of occupants who did not sustain an eye injury. Injured occupants, number of injuries, and injury sources were analyzed.

Part 2: occupant and crash characteristics

Occupant and crash characteristics were examined to identify trends that correlate with incidence of eye injury for occupants exposed to airbag deployment. The first analysis involved a comparison among the types of occupants exposed to each type of airbag deployment. This identified differences in the population exposed to full powered airbags compared with those exposed to depowered airbags. Group 1 was the group of occupants exposed to a full powered airbag deployment, whereas group 2 was the group of occupants exposed to a depowered airbag deployment. Next, a similar investigation was performed for occupants with airbag-induced eye injuries depending on whether the airbag was full powered or depowered. Group 1-A was the group with an airbag-induced injury from a full powered airbag, whereas group 2-A was the group of occupants with an airbag-induced injury from a depowered airbag. Average values and standard deviations were calculated for occupant height, weight, age, sex, seat position, seatbelt use, and crash change in velocity (DV ).

Results

Part 1: depowered and full powered airbag deployments

A total of 2 413347 occupants from 6091 cases were exposed to an airbag deployment between the years 1993 and 2000. Because the proportion of airbag-equipped vehicles in the fleet is increasing, more occupants are exposed to airbag deployments each year. Accordingly, the number of occupants who sustained an eye injury in a crash with airbag deployment has also increased (Fig. 1). Every year, there have been more occupants who sustained an eye injury when exposed to a full powered airbag deployment than when exposed to a depowered airbag deployment.

Fig. 2 Incidence of eye injury for occupants in frontal crashes that were exposed to a full powered or depowered airbag deployment.

Of the 2103308 occupants exposed to a full powered deployment, 3.7% sustained an eye injury (Fig. 2). However, only 1.7% of the 310039 occupants exposed to a depowered airbag deployment sustained an eye injury. This difference was not statistically significant ( P = .17). However, 70 227 of the occupants who were exposed to a full powered airbag deployment sustained an eye specific- ally from the airbag (3.34%), whereas just 2084 of the occupants exposed to a depowered airbag sustained an eye injury from the airbag (0.67%). Occupants were at a significantly higher risk to sustain an airbag-induced eye injury when exposed to a full powered airbag compared with occupants exposed to a depowered airbag deploy- ment ( P = .04). There were 125258 total eye injuries to occupants exposed to airbag deployment, 92.7% of which

Fig. 1 Occupants with eye injuries in frontal crashes that were exposed to a full powered or depowered airbag deployment by crash year.

Fig. 3 Number of eye injuries that occurred to occupants in frontal crashes.

were to occupants exposed to a full powered airbag deployment, whereas the remaining 7.3% occurred to occupants who were exposed to a depowered airbag deployment (Fig. 3).

Part 2: occupant and crash characteristics

The next analysis was made by examining occupant and crash characteristics for the 2413 347 occupants who were exposed to an airbag deployment. It was found that the 2 groups had similar exposure trends because there was no significant difference in the occupant and crash variables for those occupants exposed to a full powered or depowered airbag deployment (Table 1).

It was found that drivers were significantly more likely to be exposed to a full powered airbag compared to passengers ( P = .01). In particular, 88.13% of drivers exposed to an airbag were exposed to a full powered airbag deployment, compared to 81.79% of passengers exposed to airbags. Of all the occupants exposed to full powered airbags, 49.13% were women, compared to 51.50% of occupants exposed to depowered airbag deployments. There was no significant difference in the sex of the occupants exposed to each type of airbag ( P = .67). Finally, there was no difference in the use of seatbelts for occupants exposed to depowered or full powered airbags ( P = .87).

It was found that within a 95% confidence interval, the occupants who sustained airbag-induced eye injuries from a depowered airbag were heavier than those occupants who sustained an airbag-induced eye injury from a full powered airbag (Table 2). In addition, occupants who sustained airbag-induced eye injuries from a depowered airbag were in crashes with higher DVs than those occupants with airbag- induced eye injuries from full powered airbags. There was no significant difference in occupant height or age.

There was no significant difference in incidence of airbag-induced eye injury for occupants exposed to depo- wered or full powered airbag deployment on the basis of the occupant seat position ( P = .73) or use of seatbelts ( P = .43). Finally, there was no difference in the use of seatbelts for occupants with airbag-induced eye injuries from depowered or full powered airbags. In particular, it was found that 87.81% of unbelted occupants with airbag-induced eye

Table 1 Comparison of occupant and crash characteristics for occupants exposed to a full powered or depowered airbag

Group 1: Group 2:

exposed to exposed to

full powered depowered

airbag deployment airbag deployment

Mean

SD

Mean

SD

Occupant’s height (in)

66.99

0.27

67.11

0.48

Occupant’s weight (lb)

159.83

2.27

162.77

4.47

Occupant’s age (y)

33.73

0.89

33.98

2.23

DV (mph)

13.55

0.32

15.08

0.47

Table 2 Comparison of occupant and crash characteristics for occupants with airbag-induced eye injuries from a full powered or depowered airbag

Group 1-A: airbag-induced eye injury from a full powered airbag

Mean SD

Group 2-A: airbag-induced eye injury from a depowered

airbag

Mean

SD

Occupant’s height (in)

61.28

4.04

65.83

0.91

Occupant’s weight (lb)

147.80

5.25

173.76

6.74

Occupant’s age (y)

32.56

7.18

41.58

6.36

DV (mph)

11.82

1.38

20.68

2.66

injuries were exposed to full powered airbags compared with 87.18% of belted occupants.

Discussion

This article examined the effects of depowered airbags on eye injuries. It appears that through the goal of depowering airbags to save lives, there has been a reduction in the risk of airbag-induced eye injuries. Although fewer occupants received eye injuries when exposed to a depowered airbag deployment, eye injuries still occurred. Of interest to this study is the understanding that an increasing proportion of the population will have had corrective vision procedures performed in the years to come. This, in addition to the rising proportion of airbag-equipped vehicles in the fleet, warrants further investigation. Whereas several studies show that there may be no increased risk of injury associated with eyes that have undergone photorefractive keratectomy, automated lamellar keratoplasty, or laser assisted in situ keratomileusis, they are in the minority [87-92]. Numerous studies indicate that these types of surgical procedures significantly weaken the cornea and make it far more susceptible to injury [93-101]. Moreover, a number of studies acknowledge that the mechanical integrity of the eye is reduced after vision correction procedures and that these negative effects persist years after the procedure [33,42,92,95,98,101-103]. Given that there was a large number of corneal abrasions for occupants exposed to either a full powered or depowered airbag deployment, patients who have undergone surgery affecting the cornea may be at a higher risk for more serious injuries. The benefit of depowered airbags in reducing eye injuries may be short lived as the practice of corrective eye surgery becomes more prevalent.

Conclusion

This is the first article that compares full powered and depowered airbags and their effect on eye injury. A total of 2413347 front-seat occupants from 6091 cases for the

8 years from 1993 to 2000 were investigated. Of the 2103308 occupants exposed to a full powered deployment, 3.7% sustained an eye injury and only 1.7% of the 310039 occupants exposed to a depowered airbag deployment sustained an eye injury. Moreover, occupants were at a significantly higher risk to sustain an airbag-induced eye injury when exposed to a full powered airbag compared with occupants exposed to a depowered airbag deployment ( P = .04). It was found that the occupants who sustained airbag-induced eye injuries from a depowered airbag were heavier than those occupants who sustained an airbag- induced eye injury from a full powered airbag. In addition, occupants who sustained airbag-induced eye injuries from a depowered airbag were in more severe crashes, with higher DVs, than those occupants with airbag-induced eye injuries from full powered airbags. It appears as if a side effect of depowering airbags has been to reduce the risk of eye injuries. Because all new vehicles are all being produced with a form of depowered airbags, a continuing trend showing a decrease in airbag-induced eye injuries could be seen over the coming years.

Acknowledgment

The authors thank JP Research for their assistance with the case selection and statistical analysis.

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