• No results found

OCULAR INJURIES IN AUTOMOBILE CRASHES

N/A
N/A
Protected

Academic year: 2021

Share "OCULAR INJURIES IN AUTOMOBILE CRASHES"

Copied!
13
0
0

Loading.... (view fulltext now)

Full text

(1)

OCULAR INJURIES IN AUTOMOBILE CRASHES

Report Number UM-HSRI

-

80-22

Donald F. Huelke and

James 0 ' Day

Highway S a f e t y Research I n s t i t u t e The U n i v e r s i t y of Michigan

Ann Arbor, Michigan 48109

April 1980

Prepared under Contract DOT-HS-8-01944

National Highway T r a f f i c S a f e t y Admi n i s t r a t i o n Department of Transport a t i on

(2)

Tuhaical Report Doctrrmtatioll Page

1. R-t No. 2. G o v o ~ m t Accession No. 3. Reciplmt's Cot0109 No.

4. Tltl* ad Ilubtitlo

Ocular I n j u r i e s i n Automobile Crashes

7. h h d a)

Dona1 d I=. Hue1 key James 0 ' Day

9. P u h r m ~ n g Otgm~zotiom None ard Address

Highway Safety Research I n s t i t u t e The U n i v e r s i t y o f Michigan

Ann Arbor, Michigan 48109

I 12. h s w l n g Agmcy M a e cnd AYr*..

National Highway T r a f f i c Safety A d m i n i s t r a t i o n Department o f Transportation

Washington, D.C. 20590

IS. S ~ p p l - t a t Motor

5. Roport Dote

. May 1980

6. Porforning Orgm~zotio. Cod.

4. Porfom~ng O r g o n ~ x d o n Roport No.

UM-HSRI-80-22

10. W o d U n ~ t No.

11. Controct or Gmnt No.

-

- -

44

13. Type of Report ond Pertod Coverod

Speci a1

14. S p o n r w ~ n ~ Agency Code

16. Abotvost

Analysis o f t h e National Crash S e v e r i t y Study data on "eye" i n j u r i e s i n d i c a t e s t h a t o f 62,026 passenger c a r occupants i n crashes severe enough t o r e q u i r e t h e cars t o be towed, t h e r e were 45 c a r occupants w i t h a r e p o r t e d "eye" i n j u r y . Only 14 had an eyeball involvement; e i g h t occupants were completely o r par- t i a l l y blinded. More than h a l f o f the i n j u r e d were males; most a1 1 were f r o n t seat occupants. None of t h e occupants were wearing seat b e l t s a t t h e time o f the crash. No s p e c i f i c impact o b j e c t was noted t o be t h e primary cause o f t h e eye i n j u r i e s .

17. Koy Wmvds

Accident, Eye i n j u r y , I n j u r y frequency, I n j u r y cause, Seat be1 t s

18. D i s t r ~ b t i a Stot.m.nt

19. SIQ(riv CIeseif. (of this 1-0

I

13 I

(3)

INTRODUCTION

Itijuries t o the eye and periorbital structures in automobile

crashes have never been documented as t o injury type and mechanism of

injury, i.e., the specific object impacted within the car. Clinical

records themsel ves general ly do n o t contain i nformati on on the i njury

mechanism, a n d a review of hospital records cannot be used t o detemi ne

nationill estimates of the more serious ocular i n j u r i e s , i.e.,

bl i ndness.

Only recently has a nationwide s t a t i s t i c a l sampling program

col1ect:ing data on automobi 1e crashes been established t o sample occuparit injuries and the causes of stich injuries. This, the National

Crash Severity Study (NCSS) i s a major accident data collection program

of the National Center f o r S t a t i s t i c s and Analysis (NCSA) of the

National Highway Traffic Safety Admi nistration (NHTSA). Field

investigators collect detailed i nformation on passenger cars, and the

occupants, in crashes which were severe enough t o disable the car.

Excluded are crashes involving only trucks, motorcycles, buses, or

pedestrians, and passenger cars not towed from the scene.

---

The data contain information on the vehicle damage i n a codified

form, on the instantaneous change of velocity during the impact phase of

the craish, and descriptions of the occupant injuries and injury contact

areas. Information on other vehicles involved in these accidents

(trucks,, or non-towed passenger cars which were i n crashes w i t h towed

passenger cars) i s included in the data, b u t i s used only t o describe

the crash conditions surrounding the vehicle of interest. Data

collection began in January, 1977, and the data available for t h i s study

cover the period from January 1977 through March, 1977. Crashes are selected by s t r i c t adherence t o a s t r a t i f i e d sampl ing plan. Accidents

el igi ble for i nvestigation are a1 1 poli ce-reported accidents within

defined geographical areas in which at least one occupied passenger

automobile was towed from the scene due t o collision damage. Towed

passenger cars and t h e i r occupants constitute the population under study.

(4)

INJURY CODING

The Abbreviated Injury Scale (AIS) i s used i n the NCSS f i l e t o

appropriately categorize the severity of injury ( 2 ) . Most a1 1

periorbital or ocular injuries are a t either of the minor (AIS-1) or

modera-l:e (AIS-2) level. The only severe (AIS-3) "eye" injury would be

optic nerve avulsion. 1

Orieof the body areas which can be identified in the injury classification scheme used in t h i s study i s the eye(1). All cases

involving eye injuries coded as greater t h a n "minor" on the injury

reporti ng scale ( 2 ) were retrieved by computer search. There were 45

persons who had reported "eye" injuries of moderate or greater severity. The origi nal detailed i nvestigation reports were obtained for each of

these and reviewed. O f the 45 occupants, two were killed, each having

massive head/orbital injuries. These two individuals will be omitted from the analysis.

DATA ANALYSIS

Twenty-five of the 43 survi ving eye-i njured occupants were drivers

(13 males, 12 females), 1 2 were front-right passengers, and 6 were the

rear seat occupants. Approximately three o_u_t of four injured occupants

were 25 years of age or younger. As might be expected, most of the injuries were lacerations of the periorbital structures. None of these

injured occupants were wearing seat belts. A summary of the eye

injuries and the impact object t o which the injury was attributed are

presented in Table 1.

There were 14 passenger car occupants who sustained injuries t o the

eyeball or i t s musculature (Table 2 ) . Five of these were completely

blinded in one eye and three were partially blinded. One other person had eyeball muscle paralysis.

The impact areas related t o the injuries i s shown in Table 3. Note

that f o r the 29 occupants without ocular involvement a t least 16 were

injured by contact with the windshield. No other single car structure

he

Abbreviated Injury Scale: 0-No injury , 1-Mi nor, 2-Moderate, 3-

(5)
(6)
(7)
(8)
(9)

was so highly involved. However, when the globe i t s e l f was injured (14 occuparits), no single injury-producing object stood o u t as the most common,, although there were two injuries attributed t o the side glass and three t o the pre-1966 windshield.

TABLE 3

CONTACT AREAS RELATED TO ORBITAL/PERIORBITAL INJURIES

Steering wheel

...

A-pi1 l a r (side

wi nds hi el d support )

Contact Area

Front seat back

I

Number

...

No Eyeball Eyeball Injury

1

Injury* Side glass ---+---*-+---

Rear view mi rror 1

-

U~pper i nstrument panel or

steeri ng wheel

Hood or windshield Side surface of car Uriknown

TOTAL

1

2 9

1

14

---..---

*Numbers in parentheses are individuals with part ia1 or complete bli ndness in one eye.

(10)

RELATIVE FREQUENCY OF OCCURRENCE

The total NCSS data (for the fifteen month period) represent

approximately 62,000 occupants of towed passenger cars. The eight cases

of the more serious eye injuries, i.e., blindness in one eye ( 5 ) ,

partial blindness in one eye ( 2 ) , and eye muscle paralysis ( I ) , a l l

occurred in crashes sampled a t the 100% rate, and thus a f i r s t estimate

of the relative frequency of permanent eye impairment might be based on

t h i s ratio: 8162,000. Approximately one-third of the persons i n the

NCSS d a t a have injuries 1 isted as "unknown"--i .e., detailed medical

reports for these persons were not available. I t i s not possible t o

detemi ne whether the incidence of eye problems in t h i s group was the same or di fferent from those actual ly determi ned.

To account f o r the one-third missing data, the eight cases may be

mu1 t i p l i ed by 1.5--yieldi ng an estimate of 1 2 cases of permanent eye

impaimlent (7.5 blind in one eye) among the 62,000.

The number of cases of complete blindness i n one eye i s so small

that extrapolation t o a national population i s hazardous. For the areas

sampled, the time period of the study was 1 5 months. An annual estimate

for these areas may be computed by multiplying the above numbers by

12/15 thus yielding six cases of blindness in one eye annually or 9.6

t o t a l eye-impaired car occupants. These numbers are so small --i

.

e,

,

permanent ocular damage in these crashes is so rare--that i t would not

be appropriate t o attempt a national projection. A second year of NCSS

data, and the upcoming National Accident Severity Study data will add

significantly t o the data base and should ultimately lead t o a

defensible national estimate. 2

DISCUSS

-

I ON

Begi n n i n g with the 1966 models, the windshield construction of

United States manufactured cars was of a "new typeu--a High Penetration

Resistant ( H P R ) windshield, This improved laminated windshield markedly

reduces head penetration through the glass, and decreases the extensive,

' ~ a t a f o r the l a s t 12 months of the NCSS became available l a t e i n

t h i s study of ocular injuries, and have not been included in the

s t a t i s t i c s presented. We note, however, t h a t there i s a somewhat lower

incidence of eyeball injury in the l a t e r data, a n d that the t o t a l

(11)

disfiguring facial lacerations previously seen from windshield impacts

(3-7). I n that more t h a n h a l f of theautomobile crashes are frontal

collis-ions, i t i s not surprising t h a t the windshield would be most often

involved with periorbital or ocular injuries for the non-seat belted front seat occupant.

I n England a n d Europe many of the cars have tempered windshields.

When impacted, t h i s glass breaks into small pieces b u t not infrequently

the occupant's face contacts the jagged glass retained i n the lower

windshield frame, the main cause of ocular perforations ( 8 ) . MacKay

(Engl arid) i ndi cated that of seriously i njured front seat occupants 3-5%

have an eye injury with perhaps 1800 car occupants receiving serious injuries in Britain each year. At least 70% of these injuries can be

attributed t o the tempered windscreens ( 9 ) . A review of MacKay's

excel lent summary of the eye injury l i t e r a t u r e indicates that most

authors agree that eyeball injury i s highly related t o the tempered

windshield that has been typical of cars i n Europe, England, Australia,

and Asian countries ( 8 ) . Most authors agree that lap-shoulder belts

will decrease the frequency of eyeball injuries ( 8 ) , and many have

suggested laminated glass f o r the windshield ( 8 ) . Langwieder (Germany)

found only one eye injury from the HPR laminated glass ( o u t of 228

occupants with head injury), and 1 7 eye injury cases from tempered glass

(of 545 head i n j u r i e s ) , a nine-fold increase in cars with tempered

windshields (10).

Holland estimated about 1,000 people per year (1970) sustain severe

eye/eyel id injuries from road accidents i n the Federal Republic of

Germany. I n about 25% of these cases, or about 250 people, the injuries

lead t o almost complete loss of vision f o r one eye, a n d f o r a smaller

group i t results in a loss of b o t h eyes (11). I t has been estimated

that blindness of one or b o t h eyes occurs t o 2,500 people each year in

Europe (12).

CONCLUSIONS

-

Tempered windshields commonly used in Europe have been shown t o be

highly related t o ocular injuries. A l t h o u g h windshields of the HPR type

in cars i n North America are not a t a l l significantly involved in ocular

(12)

glass. The HPR windshield probably i s the main reason for the

r e l a t i wely 1 ow occurrence of ocular i njuri es i n United States crashes

compared t o these injuries reported from countries with tempered wi ndshi elds.

No ocular injuries were observed among belted occupants i n t h i s

study. Increased use of lap-shoulder belts would decrease the

likelihood f o r occupant contact with the windshield, mirrors, A-Pillar,

steeri rig column and i nstrument panel --about half of the occupant

contacts f o r ocular injury--and thus further reduce the incidence of injuries leading t o decreased vision.

Data from the f i r s t fifteen months of the NCSS program provide a n

estimate of 7.5 cases of blindness in one eye among 62,000 occupants of

(13)

REFERENCES

(1) Marsh, J . C. "An Occupant Injury Classification Procedure Incorporating t h e Abbreviated Injury Scale," NATO Committee

on the Challenges of Modern Society, Road Safety P i l o t Study, Brussels, June 1973.

( 2 ) "The Abbreviated Injury Scale: History, Growth, and Future," Trans., Nat. Safety Congress, School and Coll ege Conference, Chicago, Oct. 15, 1979.

( 3 ) Hue1 ke, . . D. F . , Grabb, W . C., and Dingman, R. O . , "Facial I n j u r i e s in Automobile Accidents." Proceedings, American Association f o r Automotive Medicine, Louisville, Oct. 1964.

(4) Huelke, D. F . , Grabb, W. C . , and Gikas, P . W., " I n j u r i e s and Deaths

From Windshield and Instrument Panel Impacts, " Proceedings,

Eighth Stapp Car Crash Conference, Detroit, Oct. 1964. Wayne S t a t e University Press, Detroit, Michigan, pp. 167-184, 1966.

( 5 ) Huelke, D . F . , Grabb, W. C . , and Dingman, R . O . , "Facial I n j u r i e s Due t o Windshield Impacts in Automobile Accidents. " J . Plast. and Reconst. Surg., 37:324-333, 1966.

( 6 ) Huelke, D. F., Grabb, W. C . , and Dingman, R . O., "Automobile Occupant I n j u r i e s From Striking The Windshield. " Highway Safety Research I n s t i t u t e , The University of Michigan, A n n

Arbor. HSRI Report No. Bio-5, 1967.

( 7 ) Huelke, D. F., Grabb, W. C . , Dingman, R . O., and Oneal, R . M., "The New Automobile Windshield and I t s Effectiveness in Reducing Faci a1 Lacerations. " J . PI ast. and Reconst. Surg.

,

41(6) :554-559, 1968.

(8) MacKay, G . M . , " I n j u r i e s from Windscreens. A Review of Some Recent Literature." A report t o the Corrimission of the E.E.C.; Feb., 1978.

( 9 ) MacKay, G. M . , "Incidence of Trauma t o the Eyes of Car Occupants." the United Kingdom, Vol. XCV, Part

(10) 1 i ~ n o w i ~ d ~ r . K.. " I n t e r i o r Safetv of Automobiles. " Proceedings,

(11) Holland, G . , "Eye and Eyelid I n j u r i e s from Windshields and Means

t o Prevent Them. " 1970 International Automobi 1 e Safety Conference Compendium, pp. 1187-1194, SAE

,

1970.

(12) W.i ndshield Symposium on Eye Injuries: XI 11th FISITA Congress, International Automobi 1 e Safety Conference, Brussels, 1970.

References

Related documents

Al-Hazemi (2000) suggested that vocabulary is more vulnerable to attrition than grammar in advanced L2 learners who had acquired the language in a natural setting and similar

Word formation in Toba Batak language can generate acceptable words, unacceptable words, and potential words (Ambarita 2018b: 184).. Unacceptable words are the implication

diversified cropping systems that utilize organic N fertility sources can maintain relatively small inorganic N pools yet still achieve high maize N uptake (Sanchez et al. We

characterized by the hegemony of persons in fundamental and subsumed capitalist class positions who uphold their class interests and seek the exercise of State power in

The purpose of this paper is to provide a background to and guide for mainstreaming Disaster Risk Man- agement (DRM) into higher education and training institutions in Small

( d ) Scatter diagram of the amplitude of the conductance blockade versus translocation time for DNA translocation through a 10-nm diameter nanopore in a graphene monolayer.

For restoring salt contaminated substrates, KÖSTER offers products that can be used in combination with our waterproofing products: KÖSTER Polysil® TG 500 and KÖSTER Restoration

Players can create characters and participate in any adventure allowed as a part of the D&D Adventurers League.. As they adventure, players track their characters’