Source: Macpherson AK, To TM, Macarthur C, et al. Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study. Pediatrics. 2002;110:e60.The authors from Toronto, Canada, studied Canadian children with injuries related to bicycle crashes that led to hospitalization in fiscal years 1994–1998. They compared 4 provinces that have legislation requiring helmet use to provinces without legislation. Bicycle-related injuries were divided into those of the head versus injuries to “other” parts of the body using External Injury Codes (E codes) and International Classification of Disease Codes, Ninth Revision (ICD-9 codes) and calculated for the 2 groups.During the 4 years of study, 9,769 children were admitted to Canadian hospitals after bicycle crashes. Thirty-five percent of children sustained injuries to the head while 65% had injuries to other parts of the body. The head injury rate was similar in the 2 groups (no legislation provinces versus helmet legislation provinces) prior to enactment of helmet legislation. However, after enactment (data from provinces were combined for this study, irrespective of timing of legislation), there was a 45% decrease in head injuries in the provinces with legislation compared to a 27% decline in provinces without legislation (P=.001). Non-head injuries also declined over the 4 years of study, but did not differ significantly between provinces with and without helmet legislation. Fifty-eight children died from bike-related injuries. Death rates were consistently lower in provinces with helmet legislation compared to those without helmet laws.There are about 67 million bicycle riders in the United States,1 and about 900 are killed each year in crashes. About 800 of these deaths involve a crash with a car.2 Nonfatal injuries cause approximately 567,000 people to seek care in an emergency department and about two-thirds of these injuries occur in children and adolescents.2Head injuries are the most likely cause of severe injury in bicycle crashes and are present in about one-third of emergency department visits, two-thirds of hospital admissions and three-quarters of bicycle-related deaths.3 Use of helmets has been shown to reduce the risk of brain injury by 63–88% and injuries to the mid-face are reduced by about 65%.4 The above report, which demonstrates a decreased risk of head injuries in Canadian provinces requiring helmet use, supports these previous studies.The authors do not report information on what proportion of the children in each province actually wore helmets. Unfortunately, helmet use remains low in the US. About 25% of children 5–14 years of age wear a helmet when riding a bike and teenagers rarely use helmets.5 Reasons for non-use include fashion issues, discomfort, and lack of safety knowledge. Universal helmet use by children 4–15 years of age could prevent between 135 and 155 deaths and between 39,000 and 45,000 head injuries annually in the US. Every dollar spent on a bicycle helmet saves $30.00 in direct medical and other costs to society.6Prevention strategies for bicycle crash injuries include educational programs, helmet distribution, safe parks and roads, and legislation. However, legislation appears to be more cost-effective than educational programs.7 Pediatricians should continue to emphasize to parents that trauma is the number one killer of children over age 1 year and that simple safety practices such as helmet use while bike riding save lives and decrease morbidity. Furthermore, pediatricians and parents need to model behavior and use helmets when bike riding.
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