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Risk of thoracic injury from direct steering wheel impact in frontal crashes

Chen, Rong MS; Gabler, Hampton C. PhD

Journal of Trauma and Acute Care Surgery: June 2014 - Volume 76 - Issue 6 - p 1441–1446
doi: 10.1097/TA.0000000000000222
Original Articles

BACKGROUND The combination of airbag and seat belt is considered to be the most effective vehicle safety system. However, despite the widespread availability of airbags and a belt use rate of more than 85%, US drivers involved in crashes continue to be at risk of serious thoracic injury. The objective of this study was to determine the influence of steering wheel deformation on driver injury risk in frontal automobile crash.

METHODS The analysis is based on cases extracted from the National Automotive Sampling System Crashworthiness Data System database for case years 1993 to 2011. The approach was to compare the adjusted odds of frontal crash injury experienced by drivers in vehicles with and without steering wheel deformation.

RESULTS Among frontal crash cases with belted drivers, observable steering wheel deformation occurred in less than 4% of all cases but accounted for 30% of belted drivers with serious (Abbreviated Injury Scale [AIS] score, 3+) thoracic injuries. Similarly, steering wheel deformation occurred in approximately 13% of unbelted drivers but accounted for 60% of unbelted drivers with serious thoracic injuries. Belted drivers in frontal crashes with steering wheel deformation were found to have two times greater odds of serious thoracic injury. Unbelted drivers were found to have four times greater odds of serious thoracic injury in crashes with steering wheel deformation. In frontal crashes, steering wheel deformation was more likely to occur in unbelted drivers than belted drivers, as well as higher severity crashes and with heavier drivers.

CONCLUSION The results of the present study show that airbag deployment and seat belt restraint do not completely eliminate the possibility of steering wheel contact. Even with the most advanced restraint systems, there remains an opportunity for further reduction in thoracic injury by continued enhancement to the seat belt and airbag systems. Furthermore, the results showed that steering wheel deformation is an indicator of potential serious thoracic injury and can be useful to prehospital personnel in improving the diagnosis of serious injuries.

LEVEL OF EVIDENCE Prognostic study, level III.

Supplemental digital content is available in the text.

From the Virginia Tech—Wake Forest Center for Injury Biomechanics (R.C.), and Virginia Tech—Wake Forest Center for Injury Biomechanics (H.C.G.), Blacksburg, Virginia.

Submitted: November 11, 2013, Revised: January 17, 2014, Accepted: January 17, 2014.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Rong Chen, MS, Virginia Tech—Wake Forest Center for Injury Biomechanics, 440 Kelly Hall, Stanger St, MC 0194, Blacksburg, VA 24061; email:

© 2014 Lippincott Williams & Wilkins, Inc.