Current playground surface test standards underestimate brain injury risk for children.
Playgrounds surface test standards have been introduced to reduce the number of fatal and severe injuries. However, these test standards have several simplifications to make it practical, robust and cost-effective, such as the head is represented with a hemisphere, only the linear kinematics is evaluated and the body is excluded. Little is known about how these simplifications may influence the test results. The objective of this study was to evaluate the effect of these simplifications on global head kinematics and head injury prediction for different age groups. The finite element human body model PIPER was used and scaled to seven different age groups from 1.5 up to 18 years old, and each model was impacted at three different playground surface stiffness and three head impact locations. All simulations were performed in pairs, including and excluding the body. Linear kinematics and skull bone stress showed small influence if excluding the body while head angular kinematics and brain tissue strain were underestimated by the same simplification. The predicted performance of the three different playground surface materials, in terms of head angular kinematics and brain tissue strain, was also altered when including the body. A body and biofidelic neck need to be included, together with suitable head angular kinematics based injury thresholds, in future physical or virtual playground surface test standards to better prevent brain injuries.