Harborview Injury Prevention amp Research Center Seattle WA University of Maryland Baltimore MD Wake Forest University Winston Salem NC Virginia Tech Blacksburg VA University of Alabama at Birmingham Birmingham AL ID: 1033847
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1. Medical College of Wisconsin, Milwaukee, WIHarborview Injury Prevention & Research Center, Seattle, WAUniversity of Maryland, Baltimore, MDWake Forest University, Winston Salem, NC / Virginia Tech, Blacksburg, VA University of Alabama at Birmingham, Birmingham, ALUniversity of Virginia Charlottesville, VA / Inova Fairfax Hospital, Falls Church, VACIREN
2. CRASH INJURY RESEARCH and ENGINEERING NETWORK’sMISSIONThe mission of the CIREN is to improve the prevention, treatment, and rehabilitation of motor vehicle crash injuries to reduce deaths, disabilities, and human and economic costs. The CIREN process combines prospective data collection with professional multidisciplinary analysis of medical and engineering evidence to determine injury causation in every crash investigation conducted.
3. CIREN Overview/History“Injury In America” from – 1985Recommends multidisciplinary injury researchPre-CIREN Hospital Studies – early 1990’s Four centersGM Funding – 1995 (settlement action)Birth of CIREN – 1997Database Structure Completed - 1999Industry funding Ford, Daimler/Chrysler, Honda and ToyotaRecompetition completed – 2005 and 2010Bio-Tab coding initiated2010 – Six CIREN centers in the program
4. CIREN’s Population MicroscopeCIREN is a detailed study into the 12% of crash injuries making up 77% of the nation’s economic crash burden.Crash Injury
5. Current Network DesignCIREN utilizes two types of centersMedical CenterEngineering Center
6. CIREN Medical CenterBased at a Level 1 trauma centerMust have high volume of motor vehicle crash occupantsLed by a trauma or emergency medicine physician Primary task large volume case enrollmentInvestigation of enrolled crashesInjury causation analysisAnnual research project
7. CIREN Engineering CenterBased at an academic crash lab facilityWill be partnered with a trauma center for crash occupant accessLed by an experienced mechanical engineerPrimary task is engineering analysis of cases from other CIREN centersSecondary task case enrollment Investigation of enrolled crashesInjury causation analysis Annual research project
8. Basic Inclusion CriteriaAdmission to a participating CIREN CenterInjury requiredAt lease one AIS3+ injuryAIS2 injury in two different AIS body regionsSignificant articular injury to a lower extremity (AIS2)Vehicle model year no older than six yearsSister and clone platforms may extend vehicle ageRestraintFrontal crash – Air bag and/or belt required (80%)Side impact – Unbelted is acceptableRollover – 100% eject occupants are excluded
9. Prospective Data Capture100% access to medical data (real-time)Radiology (images)Labs Medical documentationOperative notesRadiology reportsClinical notesUnclear dataClarified by source
10. Current Data – 6/2011Over 4,200 cases enrolledGenderFemale = 51%Age 0-12 yr = 10%12-55 yr = 66%55+ = 24%Avg = 38.5 yrAvg ISS = 21.2 Fatality rate = 11%
11. General DataCrash Mode and Injury Severity62%Frontal14%RightSide1% Rear20%Left SideN=4,200+ Crashes4%Rollover
12. CIREN Case Review ProcessEnrolling center completes investigation and initial data collectionAssigns initial causation Engineering center reviews caseCI reviews investigationCoder reviews AIS/ICD-9Engineer reviews crash dynamics and injury causationInitial review by EC returned to enrolling centerCase updated and prepared for reviewCase review involves enrolling center, reviewing center, NHTSA and others
13. Video StreamingHow does it work?Case presentedInjuries discussedCausation codedMedical and engineering inputBio-Tab coding utilizedEnrolling CenterStreaming ServerIndustry/OEMNHTSAEngineering Center
14. What is the BioTab?A method to objectively and completely analyze and document the causes of injuries using data obtained from detailed medical records and imaging, in-depth crash investigations, and findings from the medical and biomechanical literature.
15. ICS-Body region injured-Source of energy-ICS Description-ICS ConfidenceICS EvidenceContributing factor(s)Bio-Tab CodingInjury Causation Scenario (ICS)
16. Bio-Tab CodingInvolved Physical Component (IPC) / ICSICS-Body region injured-Source of energy-ICS Description-ICS ConfidenceICS EvidenceContributing factor(s)Involved Physical Component (IPC)“NASS Sources”
17. Bio-Tab CodingInvolved Physical Component (IPC) / ICSncICS-Body region injured-Source of energy-ICS Description-ICS ConfidenceICS EvidenceContributing factor(s)Involved Physical Component (IPC)“NASS Sources”-Body region contacted-Path of loading-IPC ConfidenceCritical intrusion?IPC Evidence
18. Bio-Tab CodingInvolved Physical Component (IPC) / ICSICS-Body region injured-Source of energy-ICS Description-ICS ConfidenceICS EvidenceContributing factor(s)Involved Physical Component (IPC)“Alternate”Involved Physical Component (IPC)“Primary”Involved Physical Component (IPC)“Critical Primary”Involved Physical Component (IPC)“Critical Primary”AND optionORRegional mechanism(s)Organ mechanism
19. CIRENFocused Multidisciplinary ResearchAdvanced Crash DataState of the Art – Medical DataImproved Engineering+=
20. CIREN ResearchLong-term disability and lower extremity injuryFragility of elderly occupantsSmall overlap crashes and injury causationBrain injury mechanismsKnee-Thigh-Hip (KTH) injury criteriaRollover crashes and injury causationFinite element modeling
21. CIRENMedical and Engineering Science Joined From the crash to the treatment to the lab, the entire program is engaged.
22. CIRENThank You