Medical College of Wisconsin, Milwaukee, WI

1. Harborview Injury Prevention & Research Center, Seattle, WA Medical College of Wisconsin, Milwaukee, WI University of Virginia Charlottesville, VA / InovaFairfax Hospital, Falls Church, VA CIREN University of Maryland, Baltimore, MD University of Alabama at Birmingham, Birmingham, AL Wake Forest University, Winston Salem, NC / Virginia Tech, Blacksburg, VA

2. CRASH INJURY RESEARCH and ENGINEERING NETWORK’sMISSION The 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 – 1985 • Recommends multidisciplinary injury research • Pre-CIREN Hospital Studies – early 1990’s • Four centers • GM Funding – 1995 (settlement action) • Birth of CIREN – 1997 • Database Structure Completed - 1999 • Industry funding • Ford, Daimler/Chrysler, Honda and Toyota • Recompetition completed – 2005 and 2010 • Bio-Tab coding initiated • 2010 – Six CIREN centers in the program

4. CIREN’s Population Microscope Crash Injury CIREN is a detailed study into the 12% of crash injuries making up 77% of the nation’s economic crash burden.

5. Current Network Design • CIREN utilizes two types of centers • Medical Center • Engineering Center

6. CIREN Medical Center • Based at a Level 1 trauma center • Must have high volume of motor vehicle crash occupants • Led by a trauma or emergency medicine physician • Primary task large volume case enrollment • Investigation of enrolled crashes • Injury causation analysis • Annual research project

7. CIREN Engineering Center • Based at an academic crash lab facility • Will be partnered with a trauma center for crash occupant access • Led by an experienced mechanical engineer • Primary task is engineering analysis of cases from other CIREN centers • Secondary task case enrollment • Investigation of enrolled crashes • Injury causation analysis • Annual research project

8. Basic Inclusion Criteria • Admission to a participating CIREN Center • Injury required • At lease one AIS3+ injury • AIS2 injury in two different AIS body regions • Significant articular injury to a lower extremity (AIS2) • Vehicle model year no older than six years • Sister and clone platforms may extend vehicle age • Restraint • Frontal crash – Air bag and/or belt required (80%) • Side impact – Unbelted is acceptable • Rollover – 100% eject occupants are excluded

9. Prospective Data Capture • 100% access to medical data (real-time) • Radiology (images) • Labs • Medical documentation • Operative notes • Radiology reports • Clinical notes • Unclear data • Clarified by source

10. Current Data – 6/2011 • Over 4,200 cases enrolled • Gender • Female = 51% • Age • 0-12 yr = 10% • 12-55 yr = 66% • 55+ = 24% • Avg = 38.5 yr • Avg ISS = 21.2 • Fatality rate = 11%

11. General DataCrash Mode and Injury Severity 62% Frontal 14% Right Side 20% Left Side 4% Rollover N=4,200+ Crashes 1% Rear

12. CIREN Case Review Process • Enrolling center completes investigation and initial data collection • Assigns initial causation • Engineering center reviews case • CI reviews investigation • Coder reviews AIS/ICD-9 • Engineer reviews crash dynamics and injury causation • Initial review by EC returned to enrolling center • Case updated and prepared for review • Case review involves enrolling center, reviewing center, NHTSA and others

13. Video Streaming How does it work? • Case presented • Injuries discussed • Causation coded • Medical and engineering input • Bio-Tab coding utilized Streaming Server Industry/OEM NHTSA EnrollingCenter Engineering 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. Bio-Tab CodingInjury Causation Scenario (ICS) ICS -Body region injured -Source of energy -ICS Description -ICS Confidence Contributing factor(s) ICS Evidence

16. Bio-Tab CodingInvolved Physical Component (IPC) / ICS ICS -Body region injured -Source of energy -ICS Description -ICS Confidence Involved Physical Component (IPC) “NASS Sources” Contributing factor(s) ICS Evidence

17. Bio-Tab CodingInvolved Physical Component (IPC) / ICS ICS nc Involved Physical Component (IPC) “NASS Sources” -Body region contacted -Path of loading -IPC Confidence Critical intrusion? -Body region injured -Source of energy -ICS Description -ICS Confidence Contributing factor(s) ICS Evidence IPC Evidence

18. Bio-Tab CodingInvolved Physical Component (IPC) / ICS ICS Involved Physical Component (IPC) “Primary” AND option -Body region injured -Source of energy -ICS Description -ICS Confidence Involved Physical Component (IPC) “Alternate” OR Involved Physical Component (IPC) “Critical Primary” Contributing factor(s) ICS Evidence Involved Physical Component (IPC) “Critical Primary” Regional mechanism(s) Organ mechanism

19. CIRENFocused Multidisciplinary Research = Advanced Crash Data + State of the Art – Medical Data Improved Engineering

20. CIREN Research • Long-term disability and lower extremity injury • Fragility of elderly occupants • Small overlap crashes and injury causation • Brain injury mechanisms • Knee-Thigh-Hip (KTH) injury criteria • Rollover crashes and injury causation • Finite element modeling

21. CIRENMedical and Engineering Science Joined From the crash to the treatment to the lab, the entire program is engaged.

22. CIREN Thank You