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The William Lehman Injury Research Center has conducted multi-disciplinary investigations of one hundred seventy-eight crashes involving adult occupants protected by safety belts and air bags. In all cases, serious injuries were suspected. Nine cases involved serious heart injuries. These cases are not representative of crashes in general. However, when used in conjunction with National Accident Sampling System; Crashworthiness Data System (NASS/CDS) they provide insight into the most severe injuries suffered by restrained occupants in frontal crashes. Heart injuries are rare, but when they occur they are usually life threatening. NASS/CDS shows that heart injuries comprise about 0.2% of the injuries in frontal tow-away crashes. In the NHTSA file of Special Crash Investigations (SCI) of air bag cases, heart injuries are reported in 1% of the occupants over 15 years of age. Twenty-five percent of the fatally injured occupants had heart injuries, and 83% of those with heart injury died.

An evaluation of the four injury risk curves proposed in the NHTSA NCAP for estimating the risk of AIS≻=3 injuries to the head, neck, chest and AIS≻=2 injury to the Knee-Thigh-Hip (KTH) complex has been conducted. The predicted injury risk to the four body regions based on driver dummy responses in over 300 frontal NCAP tests were compared against those to drivers involved in real-world crashes of similar severity as represented in the NASS. The results of the study show that the predicted injury risks to the head and chest were slightly below those in NASS, and the predicted risk for the knee-thigh-hip complex was substantially below that observed in the NASS. The predicted risk for the neck by the Nij curve was greater than the observed risk in NASS by an order of magnitude due to the Nij risk curve predicting a non-zero risk when Nij = 0. An alternative and published Nte risk curve produced a risk estimate consistent with the NASS estimate of neck injury.