Bike helmets prevent pediatric head injury in serious bicycle crashes with motor vehicles

Stephen J Strotmeyer,Christopher Behr,Anthony Fabio,Barbara A Gaines

doi:10.1186/s40621-020-00249-y

Stephen J Strotmeyer, Christopher Behr + Show 2 more

Open Access

https://doi.org/10.1186/s40621-020-00249-y

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Abstract

BackgroundApproximately 75% of all bicycle-related mortality is secondary to head injuries, 85% of which could have been prevented by wearing a bicycle helmet. Younger children appear to be at greater risk than adults, yet helmet use is low despite this risk and legislation and ordinances requiring helmet use among younger riders. We sought to determine whether bicycle helmets are associated with the incidence and severity of head injury among pediatric bicyclists involved in a bicycle crash involving a motor vehicle.MethodsWe performed a retrospective review of patients age ≤ 18 years hospitalized at a level I pediatric trauma center between January 1, 2008, and December 31, 2018. Data were abstracted from the institutional trauma registry and electronic medical record. International Classification of Diseases 9th and 10th editions and external causes of injury codes were used to identify MV related bicycle crashes and determine the abbreviated injury severity (AIS) for head injury severity. Injury narratives were reviewed to determine helmet use. We calculated the incidence of head injury from bicycle vs. MV crashes utilizing descriptive statistics. We analyzed the risk and severity of injury utilizing univariate and multivariate logistic regression.ResultsOverall, 226 bicyclists were treated for injuries from being struck by a MV. The median age was 11 (interquartile range (IQR): 8 to 13) years. Helmeted bicyclists (n = 26, 27%) were younger (9.4 years versus 10.8 years, p = 0.04), and were less likely (OR 0.21, 95% CI 0.09 to 0.49) to be diagnosed with a head injury compared to unhelmeted bicyclists (n = 199). Of those with a head injury, helmeted bicyclists were less likely (OR 0.57, 95% CI 0.11–2.82) to sustain severe or higher injury using AIS. When adjusting for demographics (age, sex, race) and injury severity, helmet use predicted a reduction in head injury (OR 6.02, 95% CI 2.4–15.2).ConclusionsBicycle helmet use was associated with reduced odds of head injury and severity of injury.. These results support the use of strategies to increase the uptake of bicycle helmets wearing as part of a comprehensive youth bicycling injury prevention program.

Highlights

75% of all bicycle-related mortality is secondary to head injuries, 85% of which could have been prevented by wearing a bicycle helmet
The International Classification of Diseases (ICD)-9-CM E-code E813.6 (MVA Traffic, Collision w/ Other Vehicle - Pedal Cyclist), the ICD-10-CM codes V13.4-.9XXA (Pedal cycle driver injured in collision with a car, pick-up truck or van in a traffic accident, initial encounter) and V14.4-.9XXA (Pedal cycle driver injured in collision with heavy transport vehicle or bus in a traffic accident, initial encounter), and medical record injury narratives were used to identify bicycle crashes in traffic with an motor vehicles (MV), as well as documented helmet use
Looking at the 11 years of trauma registry data, we identified 226 children who were treated for injuries sustained from being struck by a motor vehicle in traffic while riding a bike

Summary

Introduction

75% of all bicycle-related mortality is secondary to head injuries, 85% of which could have been prevented by wearing a bicycle helmet. Younger children appear to be at greater risk than adults, yet helmet use is low despite this risk and legislation and ordinances requiring helmet use among younger riders. When looking at injuries associated with consumer products, bicycle-related injuries rank second as a cause of injury, behind only motor vehicles (MV) (United States Consumer Product Safety Commission n.d.). Further research claimed roughly 75% of all bicycle-related mortality is secondary to head injuries, and that 85% of those injuries could have been prevented by by wearing a bicycle helmet (Brainline: All about brain injury and PTSD n.d.). Younger children appear to be at greater risk of head injuries than adults, yet despite legislation and ordinances requiring helmet use among younger riders, helmet use has reportedly remained low (Schroeder and Wilbur 2013). Previous reports found bicycle helmets more effective in single bicycle crashes than in collisions with motor vehicles (Høye 2018) A Cochrane review of controlled studies evaluating the effect of bicycle helmets on injuries found helmets provide up to a 63–88% reduction in the risk of head, brain, and severe brain injury for cyclists of all ages (Thompson et al 1999)

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