Pediatric bicycle-related head injuries: a population-based study in a county without a helmet law

Abstract

BackgroundHead injuries are the leading cause of death among cyclists, 85 % of which can be prevented by wearing a bicycle helmet. This study aims to estimate the incidence of pediatric bicycle-related injuries in Olmsted County and assess differences in injuries between those wearing helmets vs. not.MethodsOlmsted County, Minnesota residents 5 to 18 years of age with a diagnostic code consistent with an injury associated with the use of a bicycle between January 1, 2002, and December 31, 2011, were identified. Incidence rates were calculated and standardized to the age and sex distribution of the 2000 US white population. Type of injuries, the percentage requiring head CT or X-ray, and hospitalization were compared using a chi-square test. Pediatric intensive care unit (PICU) admission, permanent neurologic injury, seizure, need for mechanical ventilation, and mortality were compared using Fisher’s exact test.ResultsA total of 1189 bicycle injuries were identified. The overall age-adjusted incidence rate of all injuries was 278 (95 % CI, 249 to 306) per 100,000 person-years for females and 589 (95 % CI, 549 to 629) for males. The corresponding rates for head injuries were 104 (95 % CI, 87 to 121) for females and 255 (95 % CI, 229 to 281) for males. Of patients with head injuries, 17.4 % were documented to have been wearing a helmet, 44.8 % were documented as not wearing a helmet, and 37.8 % had no helmet use documentation. Patients with a head injury who were documented as not wearing a helmet were significantly more likely to undergo imaging of the head (32.1 percent vs. 11.5 %; p < 0.001) and to experience a brain injury (28.1 vs. 13.8 %; p = 0.008).ConclusionsChildren and adolescents continue to ride bicycles without wearing helmets, resulting in severe head and facial injuries and mortality.

Evidence bicycle helmets mitigate intra-cranial injury is not controversial

“…In particular, helmet use is associated with a 51 % reduction in the odds of intra-cranial hemorrhage (OR = 0.49, 95 % CI 0.29-0.83) while cervical spine fracture is not statistically significant with an odds ratio near 1 (OR = 1.05, p = 0.9) when using the alternative controls. Note that the odds ratios have been inverted to be consistent with other published studies [3,5,8], i.e., OR < 1 indicates a protective effect of helmets.…”

“…Since Joseph and colleagues have limited presentations to cyclists with an initial head CT, it is unlikely the substitution assumption is valid as it is known helmeted cyclists receive head imaging at a significantly lower rate than non-helmeted cyclists [3]. There is also evidence nonhelmeted cyclists have poorer outcomes in the data set analyzed by Joseph and colleagues as they were associated with higher rates of hospital (OR = 2.03, 95 % CI 1.49-2.78, p < 0.001) and ICU admissions (OR = 1.61, 95 % CI 1.03-2.53, p = 0.037).…”

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

“…In another population-based study of pediatric bicyclerelated head injuries, a small subgroup analysis noted those with severe outcomes, such as intensive care unit admission or death, were patients whose primary injury mechanism was being struck by a motor vehicle. Further, of the youth bicyclists presenting with a head injury, that group was less likely to have worn a helmet, and more likely to undergo CT scans and X-rays when compared to helmeted riders (Kaushik et al 2015). Motor vehicle involvement increased the risk of serious injury requiring hospitalizations among children treated in emergency departments (McAdams et al 2018).…”

Incidence and severity of head injury hospitalisations in Australian children over a 10‐year period

“…The most common mechanisms that cause head injuries in children are falls, road traffic crashes and sports activities, which are all preventable. Numerous safety measures have been introduced with the aim of reducing head injuries among children, including air bags, seat belt height adjusting booster seats and rear facing infant car seats, helmets, impact attenuating playground surfaces and trampoline safety enclosures . However, head injuries still remain a common cause of hospitalisation among children.…”