Rear-Impact Crash Injury Patterns and Predictors: Insights from Contemporary CISS and CIREN Field Data

The objective of this study was to investigate occupant injury patterns and predictors in rear-impact crashes using recent US field data. Cases were queried from the Crash Investigation Sampling System (CISS, 2017–2023) and the Crash Injury Research and Engineering Network (CIREN, 2017–2024), yielding 1923 front-row outboard occupants from 1533 crashes. Crash documentation and vehicle photographs were manually reviewed to classify seatback deformation magnitude and secondary impact severity. Multivariable logistic regression models estimated associations between occupant, vehicle, and crash characteristics and Abbreviated Injury Scale (AIS) ≥ 2 and AIS ≥ 3 injury outcomes across body regions. Sensitivity analyses included CISS-only, weighted, single-event, and interaction models. Thoracic injuries were further subdivided into skeletal and cardiopulmonary categories. Findings reflect associations within the pooled CISS + CIREN analytic sample rather than nationally representative injury rates. Seatback deformation and multievent crash classification are proxy measures and may introduce misclassification and residual confounding. A total of 188 occupants sustained AIS ≥ 2 injuries and 81 sustained AIS ≥ 3 injuries. Head injury was the most frequent AIS ≥ 2 outcome, while thoracic injury was the most frequent serious injury outcome, accounting for 60% of AIS ≥ 3 cases. Across AIS ≥ 2 and AIS ≥ 3 models, crash severity (delta-v) was the most consistent predictor of injury. Age was strongly associated with injury across most AIS ≥ 2 outcomes and several AIS ≥ 3 models, particularly for overall maximum Abbreviated Injury Scale (MAIS) and thoracic injury. Seatback deformation was associated with injury across multiple models after controlling for crash severity and occupant characteristics, with severe deformation showing stronger associations with AIS ≥ 3 outcomes. Unbelted status was associated with abdominal, pelvic, and lumbar spine injury. Female sex was associated with thoracic injury, primarily attributable to cardiopulmonary rather than skeletal injury. These findings highlight statistical associations between seatback deformation severity, restraint status, occupant characteristics, and injury outcomes in rear-impact crashes.