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This paper reports on a study that examines the effect of shoulder belt load limiters and pretensioners as well as crash and occupant factors that influence upper torso harm in real-world frontal crashes. Cases from the University of Michigan International Center for Automotive Medicine (ICAM) database were analyzed. Additional information was used from other databases including the National Highway Traffic Safety Administration (NHTSA) New Car Assessment Program (NCAP), the Insurance Institute for Highway Safety (IIHS), the National Automotive Sampling System - Crashworthiness Data System (NASS-CDS), and patient data available from the University of Michigan Trauma Center. The ICAM database is comprised of information from real-world crashes in which occupants were seriously injured and required treatment at a Level 1 Trauma Center.