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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, VACIREN1CRASH INJURY RESEARCH and ENGINEERING NETWORKsMISSIONThe 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.

CIREN Overview/HistoryInjury In America from 1985Recommends multidisciplinary injury researchPre-CIREN Hospital Studies early 1990s 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

3 Well let me give you a brief history of CIREN As I mentioned earlier the roots of the program go back to the mid 80s as exemplified by the work of Dr. Champion and Omaya Then I 1985 the National Academy of Sciences issued Injury In America which gave impetus to the concept of coordinated research by Physicians, Physiologists, and Engineers on the subject of injury . To pursue this recommendation NHTSA funded research programs with a number of separate trauma hospitals in the early 90s. These were trauma centers in Baltimore, New Jersey, Miami, and Childrens Hospital in Washington DC In 1996 Dr. Martinez conceived of the idea of linking all of these centers together in a network, together with 3 other centers that were being funded by GM. The 3 additional centers were at Michigan, Seattle, and San Diego. Thus the CIREN as we know it today was born in 1996 It took a couple of years to put into place the hardware and software infratructure to make CIREN really functional accomplished 1998 Since then CIREN has grown from 7 to 10 centers. The original 7 are federally funded We now have the Daimler-Chrysler center in Alabama, the Ford-INNOVA center in Virgina, and the Medical College of Wisconsin center in Milwaukee which is self funded.

CIRENs Population MicroscopeCIREN is a detailed study into the 12% of crash injuries making up 77% of the nations economic crash burden.Crash Injury

Current Network DesignCIREN utilizes two types of centersMedical CenterEngineering Center

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

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

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

Prospective Data Capture100% access to medical data (real-time)Radiology (images)Labs Medical documentationOperative notesRadiology reportsClinical notesUnclear dataClarified by source

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%

General DataCrash Mode and Injury Severity

62%Frontal14%RightSide1% Rear20%Left SideN=4,200+ Crashes4%RolloverCIREN 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

Video StreamingHow does it work?Case presentedInjuries discussedCausation codedMedical and engineering inputBio-Tab coding utilized

Enrolling CenterStreaming Server

Industry/OEMNHTSAEngineering CenterWhat 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.ICS-Body region injured-Source of energy-ICS Description-ICS ConfidenceICS EvidenceContributing factor(s)Bio-Tab CodingInjury Causation Scenario (ICS)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 SourcesBio-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 Confidence

Critical intrusion?IPC EvidenceBio-Tab CodingInvolved Physical Component (IPC) / ICSICS-Body region injured-Source of energy-ICS Description-ICS ConfidenceICS EvidenceContributing factor(s)Involved Physical Component (IPC)AlternateInvolved Physical Component (IPC)PrimaryInvolved Physical Component (IPC)Critical PrimaryInvolved Physical Component (IPC)Critical PrimaryAND optionORRegional mechanism(s)Organ mechanismCIRENFocused Multidisciplinary Research

Advanced Crash DataState of the Art Medical DataImproved Engineering+=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

CIRENMedical and Engineering Science Joined

From the crash to the treatment to the lab, the entire program is engaged.

CIRENThank You