Recommending Bicycle Helmets Is Not Enough: Fit Is Important

Abstract

Injury and Poison Prevention| February 01 2000 Recommending Bicycle Helmets Is Not Enough: Fit Is Important AAP Grand Rounds (2000) 3 (2): 17. https://doi.org/10.1542/gr.3-2-17 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Recommending Bicycle Helmets Is Not Enough: Fit Is Important. AAP Grand Rounds February 2000; 3 (2): 17. https://doi.org/10.1542/gr.3-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: protective helmet, craniocerebral trauma Source: Rivara F, Astley S, Clarren S, et al. Fit of bicycle safety helmets and risk of head injuries in children. Injury Prevention. 1999;5:194–197. To understand why some helmeted individuals sustain head injury with cycling, these authors examined the relationship between helmet fit and risk of injury. A questionnaire was sent to 1,718 helmeted riders who had crashed and sought care for a related injury in 1 of 7 emergency rooms in the Puget Sound area of Washington State 7–14 days after their emergency room visit inquiring about the circumstances and helmet use. A sample of 28 children 2–14 years of age who sustained a head injury while wearing a bicycle helmet, and 98 helmeted individuals of the same age treated in the same hospital emergency departments for injuries other than to the head but who had hit their head, helmet, or face, underwent anthropometric measurements of helmet fit. Measurements were made of the child’s head, the helmet, and on a cast made of the child’s head using techniques developed to manufacture helmets used to treat positional cranial deformities.1 Individuals whose helmets were reported to fit poorly had a 2-fold increased risk of head injury compared with those whose helmets fit well (odds ratio 1.96; 95% CI, 1.10–3.75). Children with head injuries had helmets that were significantly wider than their heads compared with children without head injuries (p=.05). Significantly, more of the head-injured children (47.4%) had helmets 2 cm or more larger than the width of their head compared to controls (19.5%; odds ratio 3.72; 95% CI, 1.11–12.17). Helmet fit was poorer among males and younger children. The authors concluded that poor fit of helmets may be associated with an increased risk of head injury in children, especially in males. Just recommending use of helmets with cycling is not enough: like child car seats, helmets need to fit and be properly “installed.” Capitalizing on a large case control study of the effectiveness of helmets in preventing bicycle head injuries, the authors sought to determine if poor helmet fit could explain why some helmeted children sustain head injuries. Guided by a team skilled in cranial facial dysmorphology, they employed a creative method to measure head size and shape and to measure helmet fit.1 Not surprisingly, both the degree of self-reported helmet fit and measured helmet fit were inversely related to the presence and severity of head injury. They found that width was the critical dimension for misfit which was observed predominantly in males and was significantly greater in younger than in older children. Given the limitation that the investigators used a sub-sample of convenience that was small in size, we should anticipate replication in larger, systematic samples and a refinement of measurement methodology that is applicable for general use. However, it is safe to say that helmet manufacturers will need to address bicycle helmet fit much more carefully than they do now and that pediatric anticipatory guidance will need to add advice about the... You do not currently have access to this content.