Abstract
BackgroundThe effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.Method755 injured motorcyclists were recruited over a 12-month period in 2010–2011 in southern Klang Valley, Malaysia in this case control study. Of the 755 injured motorcyclists, 391participants (51.8%) sustained facial injuries (cases) while 364 (48.2%) participants were without facial injury (control). The outcomes of interest were facial injury and location of facial injury (i.e. upper, middle and lower face injuries). A binary logistic regression was conducted to examine the association between helmet characteristics and the outcomes, taking into account potential confounders such as age, riding position, alcohol and illicit substance use, type of colliding vehicle and type of collision. Helmet fixation was defined as the position of the helmet during the crash whether it was still secured on the head or had been dislodged.ResultsHelmet fixation was shown to have a greater effect on facial injury outcome than helmet type. Increased odds of adverse outcome was observed for the non-fixed helmet compared to the fixed helmet with adjusted odds ratio (AOR) = 2.10 (95% CI 1.41- 3.13) for facial injury; AOR = 6.64 (95% CI 3.71-11.91) for upper face injury; AOR = 5.36 (95% CI 3.05-9.44) for middle face injury; and AOR = 2.00 (95% CI 1.22-3.26) for lower face injury. Motorcyclists with visor damage were shown with AOR = 5.48 (95% CI 1.46-20.57) to have facial injuries compared to those with an undamaged visor.ConclusionsA helmet of any type that is properly worn and remains fixed on the head throughout a crash will provide some form of protection against facial injury. Visor damage is a significant contributing factor for facial injury. These findings are discussed with reference to implications for policy and initiatives addressing helmet use and wearing behaviors.
Highlights
The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established
Helmet fixation was shown to have a greater effect on facial injury outcome than helmet type
Increased odds of adverse outcome was observed for the non-fixed helmet compared to the fixed helmet with adjusted odds ratio (AOR) = 2.10 for facial injury; AOR = 6.64 for upper face injury; AOR = 5.36 for middle face injury; and AOR = 2.00 for lower face injury
Summary
The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists. Malaysia experiences a high number of motorcycle-related crashes and fatalities, with 120,156 reported crashes and 4,036 deaths in 2010 The prevalence and severity of head injury and its association with motorcycle helmet use has been well established [3], the issues surrounding facial injuries and association with helmet use have received less attention [3,4]. Post traumatic stress disorder following facial injury was shown to be present between 26% and 41% of adults sustaining facial injury [5,6,7], and long-term consequences are not always directly related to the severity of the injury [8,9,10,11]
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