Bicycle helmet use among persons 5 years and older in the United States, 2012

IntroductionIn 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States.MethodCDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18 + years) were asked about bicycle riding and helmet use in the last 30 days for themselves and their children (5 to 17 years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use.ResultsAmong adults, 21% rode bicycles within the past 30 days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30 days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%).ConclusionsDespite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding.Practical applicationStates and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14.     

Characteristics of bicycle crashes among children and the effect of bicycle helmets

Abstract

Objective: Focusing on children (0–17?years), this study aimed to investigate injury and accident characteristics for bicyclists and to evaluate the use and protective effect of bicycle helmets.

Method: This nationwide Swedish study included children who had visited an emergency care center due to injuries from a bicycle crash. In order to investigate the causes of bicycle crashes, data from 2014 to 2016 were analyzed thoroughly (n?=?7967). The causes of the crashes were analyzed and categorized, focusing on 3 subgroups: children 0–6, 7–12, and 13–17?years of age. To assess helmet effectiveness, the induced exposure approach was applied using data from 2006 to 2016 (n?=?24,623). In order to control for crash severity, only bicyclists who had sustained at least one Abbreviated Injury Scale (AIS) 2+ injury (moderate injury or more severe) in body regions other than the head were included.

Results: In 82% of the cases the children were injured in a single-bicycle crash, and the proportion decreased with age (0–6: 91%, 7–12: 84%, 13–17: 77%). Of AIS 2+ injuries, 8% were head injuries and 85% were injuries to the extremities (73% upper extremities and 13% lower extremities). Helmet use was relatively high up to the age of 10 (90%), after which it dropped. Helmets were much less frequently used by teenagers (14%), especially girls. Consistently, the share of head injuries increased as the children got older. Bicycle helmets were found to reduce all head injuries by 61% (95% confidence interval [CI], 10: +/? 10%) and AIS 2+ head injuries by 68% (95% CI, 12: +/? 12%). The effectiveness in reducing face injuries was lower (45% CI +/? 10% for all injuries and 54% CI +/? 32% for AIS2+ injuries).

Conclusions: This study indicated that bicycle helmets effectively reduce injuries to the head and face. The results thus point to the need for actions aimed at increasing helmet use, especially among teenagers. Protective measures are necessary to further reduce injuries, especially to the upper extremities.     

Protective effect of different types of bicycle helmets

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21-0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41-1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58-1.41) among users of hard shell helmets, and 1.87 (CI = 1.03-3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.     

Protective Effect of Different Types of Bicycle Helmets

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21–0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41–1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58–1.41) among users of hard shell helmets, and 1.87 (CI = 1.03–3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.     

Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors

Introduction

Children ages 5-14 years have the highest rate of bicycle-related injuries in the country. Bicycle helmets can prevent head and brain injuries, which represent the most serious type of bicycle-related injury.

Objectives

This paper compares children's bicycle helmet use to that estimated from an earlier study, and explores regional differences in helmet use by existing helmet legislation.

Methods

This study was a cross-sectional, list-assisted random-digit-dial telephone survey. Interviews were completed by 9,684 respondents during 2001-2003. The subset with at least one child in the household age 5-14 years (2,409 respondents) answered questions about bicycle helmet use for a randomly selected child in their household.

Results

Almost half (48%) of the children always wore their helmet, 23% sometimes wore their helmet, and 29% never wore their helmet. Helmet wearing was significantly associated with race, ethnicity, and child age but was not associated with the sex of the child. Other significant predictors of use included household income, household education, census region, and bicycle helmet law status. Statewide laws were more effective than laws covering smaller areas. The proportion of children who always wore a helmet increased from 25% in 1994 to 48% in 2001-2002. Significant increases in helmet use from 20% to 26% were seen among both sexes, younger (5-9 years) and older (10-14 years) children, and in all four regions of the country.

Conclusions

While there has been substantial progress in the number of children who always wear their helmets, more than half do not. Further progress will require using a combination of methods that have been shown to successfully promote consistent helmet use. Impact on industry: minimal.     

Features of fatal injuries in older cyclists in vehicle–bicycle accidents in Japan

Objective: The purpose of this study was to identify and better understand the features of fatal injuries in cyclists aged 75 years and over involved in collisions with either hood- or van-type vehicles.

Methods: This study investigated the fatal injuries of cyclists aged 75 years old and over by analyzing accident data. We focused on the body regions to which the fatal injury occurred using vehicle–bicycle accident data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) in Japan. Using data from 2009 to 2013, we examined the frequency of fatally injured body region by gender, age, and actual vehicle travel speed. We investigated any significant differences in distributions of fatal injuries by body region for cyclists aged 75 years and over using chi-square tests to compare with cyclists in other age groups. We also investigated the cause of fatal head injuries, such as impact with a road surface or vehicle.

Results: The results indicated that head injuries were the most common cause of fatalities among the study group. At low vehicle travel speeds for both hood- and van-type vehicles, fatalities were most likely to be the result of head impacts against the road surface.

The percentage of fatalities following hip injuries was significantly higher for cyclists aged 75 years and over than for those aged 65–74 or 13–59 in impacts with hood-type vehicles. It was also higher for women than men in the over-75 age group in impacts with these vehicles.

Conclusions: For cyclists aged 75 years and over, wearing a helmet may be helpful to prevent head injuries in vehicle-to-cyclist accidents. It may also be helpful to introduce some safety measures to prevent hip injuries, given the higher level of fatalities following hip injury among all cyclists aged 75 and over, particularly women.     

The effects of a mandatory motorcycle helmet law on helmet use and injury patterns among motorcyclist fatalities

BACKGROUND: The National Highway Traffic Safety Administration (NHTSA) has found that motorcycle helmets are 37% effective in preventing death and 65% effective in preventing brain injuries in a crash. Unfortunately, in 1995 Congress lifted federal sanctions against states without helmet laws and since then there have been a number of primary motorcycle helmet laws repealed or weakened. More lives could be saved and serious injuries avoided if there was increased helmet use throughout the United States. METHODS: This study analyzed helmet use and injury patterns among motorcycle riders in the United States involved in fatal crashes from 1995 through 2003 and compared the results between states with and without a primary helmet law. Age, sex, injury severity and helmet use are some of the variables obtained from the Fatality Analysis Reporting System (FARS). RESULTS: In the 20 states and the District of Columbia, which currently have a primary helmet law, 84.0% of fatally injured riders were wearing a helmet. In the 27 states with a secondary helmet law, 36.2% of fatalities used a helmet, and in the remaining three states with no law at all, helmet use dropped to 17.6%. In the two states (Arkansas and Texas) that changed from a primary helmet law to a secondary helmet law in 1997, helmet use decreased from 78.2% in 1996 to 31.7% in 2000. CONCLUSION: If all states were to enact a primary motorcycle helmet law, helmet use would dramatically increase while decreasing the number of motorcyclist head injuries and fatalities. IMPACT ON INDUSTRY: The results of this study will hopefully persuade law makers to enact primary helmet laws in all states throughout the nation. Helmet manufacturers can use this data to design more comfortable helmets while also improving upon the protective qualities of these safety devices.     

Changes in motorcycle-related injuries and deaths after mandatory motorcycle helmet law in a district of Vietnam

Objective: Our study measured the change in head injuries and deaths among motorcycle users in Cu Chi district, a suburban district of Ho Chi Minh City.

Methods: Hospital records for road traffic injuries (RTIs) were collected from the Cu Chi Trauma Centre and motorcycle-related death records were obtained from mortality registries in commune health offices. Head injury severity was categorized using the Abbreviated Injury Score (AIS). Rate ratios (RRs) were used to compare rates pre- and post-law (2005/2006–2009/2010). Cu Chi's population, stratified by year, age, and sex, was used as the denominator.

Results: Of records identifying the transportation mode at the time of injury, motorcyclists accounted for most injuries (3,035, 87%) and deaths (238, 90%). Head injuries accounted for 70% of motorcycle-related hospitalizations. Helmet use was not recorded in any death records and not in 97% of medical records. Males accounted for most injuries (73%) and deaths (88%). The median age was 28 years and 32 years for injuries and deaths, respectively. Compared to the pre-law period, rates of motorcycle injuries (RR = 0.53; 95% confidence interval [CI], 0.49–0.58), head injuries (RR = 0.35; 95% CI, 0.31–0.39), severe head injuries (RR = 0.47; 95% CI, 0.34–0.63), and deaths (RR = 0.69; 95% CI, 0.53–0.89) significantly decreased in the post-law period.

Conclusions: Rates of head injuries and deaths among motorcycle riders decreased significantly after implementation of the mandatory helmet law in Vietnam. To further examine the impact of the motorcycle helmet law, including compliance and helmet quality, further emphasis should be placed on gathering helmet use data from injured motorcyclists.     

Protection performance of bicycle helmets

IntroductionThe evaluation of head protection systems needs proper knowledge of the head impact conditions in terms of impact speed and angle, as well as a realistic estimation of brain tolerance limits. In current bicycle helmet test procedures, both of these aspects should be improved. Method: The present paper suggests a bicycle helmet evaluation methodology based on realistic impact conditions and consideration of tissue level brain injury risk, in addition to well known headform kinematic parameters. The method is then applied to a set of 32 existing helmets, leading to a total of 576 experimental impact tests followed by 576 numerical simulations of the brain response. Results: It is shown that the most critical impacts are the linear-lateral ones as well as the oblique impact leading to rotation around the vertical axis (ZRot), leading both to around 50% risks of moderate neurological injuries. Based on this test method, the study enables us to compare the protection capability of a given helmet and eventually to compare helmets via a dedicated rating system.     

Characteristics and clinical outcomes of head-injured cyclists with and without helmets in urban and rural areas of Taiwan: A 15-year study

Objective: Bicycle riding is increasingly popular in Taiwan, but the number of cyclists injured and cyclists' death rates are both increasing. The aim of this study was to investigate the different characteristics and clinical outcomes of traffic accident–related head injuries among cyclists in urban and rural areas.

Methods: Records of 812 patients (533 urban and 279 rural) admitted to 27 hospitals in Taipei City and Hualien County as the result of a traumatic head injury while bicycling between 1998 and 2013 were retrieved for study. Demographics, details about the accident, protective helmet use, and clinical outcomes were then subjected to analysis.

Results: Urban victims were more likely to be injured during morning and early evening rush hours and rural victims during the day; most urban victims were between 19 and 34 years of age and injured in the slow lane; rural victims tended to be younger or older and were injured in the fast lane (all P ≤.001). Riders who wore a helmet were less likely to suffer loss of consciousness (odds ratio [OR] = 0.31), amnesia (OR = 0.069), neurological disorders (OR = 0.205), or facial fractures (OR = 0.369). Older age, more severe head injuries, and bicycle–motor vehicle collisions influenced the severity of symptoms on admission and the residual effects at discharge.

Conclusions: Differences in the characteristics of injuries in urban and rural areas and the utilization of protective helmets may help government authorities adopt appropriate policies to promote safer and more enjoyable cycling.     

Bicycle helmet effectiveness is not overstated

Objective: The objective of this study was to discuss the challenges in estimating bicycle helmet effectiveness from case–control studies of injured cyclists and to estimate helmet effectiveness from cases and available exposure data.

Methods: Data were extracted from studies of cyclists in Seattle; Victoria and New South Wales, Australia; and The Netherlands. Estimates of helmet use were used as exposure to compute relative risks for Seattle and Victorian data. Cycling distance data are routinely collected in The Netherlands; however, these data cannot be disaggregated by helmet use, which makes it unsuitable for estimating helmet effectiveness. Alternative controls were identified from larger cohorts for the Seattle and New South Wales cases.

Results: Estimates of helmet effectiveness were similar from odds ratios (ORs) using hospital controls or from relative risks (RRs) using helmet use estimates (Seattle: OR = 0.339, RR = 0.444; Victoria: OR = 0.500, RR = 0.353). Additionally, the odds ratios using hospital controls were similar when controls were taken from a larger cohort for head injury of any severity (Seattle: OR = 0.250, alt OR = 0.257; NSW: OR = 0.446, alt OR = 0.411) and for serious head injury (Seattle: OR = 0.135, alt OR = 0.139; NSW: OR = 0.335, alt OR = 0.308). Although relevant exposure data were unavailable for The Netherlands, the odds ratio for helmet effectiveness of those using racing, mountain, or hybrid bikes was similar to other estimates (OR = 0.371).

Conclusions: Despite potential weaknesses with case–control study designs, the best available evidence suggests that helmet use is an effective measure of reducing cycling head injury.     

Factors related to youth self-efficacy for injury prevention bicycle skills

Introduction: Bicycle riding is a common activity for children, but they are prone to bicycle-related injuries. It is well-established that injury prevention measures such as wearing a helmet and correctly riding a bicycle can reduce the severity of an injury and the likelihood of having an accident. However, how to increase bicycle injury prevention behaviors among children, who collectively fail to engage in injury prevention behaviors, is less well understood. Self-efficacy is consistently predictive of injury prevention behavior, making it an important approach to understanding injury prevention skills among this key population. The objective of this study was to explore and identify factors internal to the child as well as factors about his or her environment that predict a child’s self-efficacy for injury prevention skills. Method: Two generalized linear mixed effects models were created from survey data collected from elementary school students (n = 2,255) as part of a school-based bicycle education program. Models focused on self-efficacy for riding a bicycle and self-efficacy for wearing a helmet correctly. Results: In both models, road safety knowledge, opportunity for skill building through owning appropriate equipment (a bicycle or helmet), and situation through perception of neighborhood safety were predictive. The analyses reveal these variables as key factors for greater confidence, with feeling safe riding in the neighborhood, in particular, emerging as highly predictive of self-efficacy for injury prevention skills. Conclusions: These findings highlight the interplay of individual and environmental factors within confidence for injury prevention behavior. Given self-efficacy’s strong relationship to prevention behavior, these findings indicate actionable strategies. Practical Applications: The key factors highlighted in this study can be used by policymakers to target specific areas (e.g., neighborhood safety) to promote self-efficacy and thus improve injury prevention. These factors can also inform strategies for establishing safety skills in bicycle-safety education programs.     

Severity and patterns of injury in helmeted vs. non-helmeted motorcyclists in a rural state

Introduction: Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders. Methods: Retrospective review (2014–2018) of a single level 1 trauma center’s registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student’s t-test or Pearson’s χ² p-value ≤0.05 as significant. State Department of Transportation data registry for state level mortality and collision incidence over the same time period was also obtained. Results: Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS. Conclusions: Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.     

Can social psychological models be used to promote bicycle helmet use among teenagers? A comparison of the Health Belief Model, Theory of Planned Behavior and the Locus of Control

PROBLEM: The bicycle helmet use rate is still low among teenagers despite the cumulating evidence that bicycle helmets can prevent cyclists from serious injuries and death. The objective of this study was to investigate the usefulness of the Health Belief Model (HBM; Health Education Monographs, 2 (1974) (1), Theory of Planned Behavior (TPB; Ajzen, I. (1988). Attitudes, personality and behavior. Open University Press, Milton Keynes) and Locus of Control model (LC; Psychological Monographs, (1966) (80) in understanding the intention to use bicycle helmet use among bicycle helmet owners. METHOD: Data were collected at two schools in Helsinki, Finland. Students (N=965) completed a questionnaire including three social psychological models applied to helmet use. Models were compared by structural equation modeling techniques. SUMMARY: Results showed that the TPB and LC model fitted the data well, whereas fit of the HBM model was lower than the fit of TPB and LC models. All components of TPB and external LC orientation were significantly related to the intention to use a helmet. TPB together with LC model provide a promising theoretical framework for helmet use promotion campaigns. Practical suggestions for future bicycle helmet campaigns were provided.     

The effect of speed limit reductions in urban areas on cyclists’ injuries in collisions with cars

Abstract

Objective: Impact speed is one of the most important factors explaining the severity of injuries to cyclists when they collide with passenger cars. To reduce injury severity (especially for vulnerable road users), since 2008, Swedish municipalities have the authority to lower the speed limit to 30 or 40?km/h in urban areas as appropriate. The aim of this study was to evaluate how this speed limit reduction has influenced the injury severity for cyclists in this type of collision.

Method: Data from 1,953 collisions between bicycles and passenger cars were collected using information from third-party-liability insurance claims from 2005 to 2017. The change of speed limit distribution, influenced by the reduction of speed limits in urban areas, where car-to-cyclist collisions occurred was studied. Following that, injury severity for cyclists was evaluated regarding collisions occurring in areas with different speed limits.

Results: The results show that, in collisions with cars, cyclists have a significantly lower risk of a moderate-to-fatal (MAIS 2+) injury when the speed limit is 30–40?km/h compared to 50–60?km/h. During the last decade, while the speed-limit has been lowered on many road-sections in urban areas from 50–60?km/h to 30–40?km/h the risk of a cyclist getting a MAIS 2+ injury decreased by 25%. In 2005 to 2011, 16% of the crashes happened on a road with a speed limit of 30–40?km/h; in 2016–2017, this percentage had increased to approximately 50%. Thus, in recent years more crashes occurred on roads with lower speed limits, and in these crashes, there was a lower risk of severe injuries to cyclists. Unfortunately, it was not possible to evaluate the risk of a crash for specific speed limits; since one limitation of this study was the lack of exposure data, nor do we know the impact speed or the actual speed of the vehicles.

Conclusions: This study is an important follow-up on the implementation of measures that can influence bicycle safety. The insurance data used, made it possible to quantify a positive effect on injury severity for cyclists in passenger car-to-cyclist collisions when the speed limit was reduced in urban areas. Insurance claims cover collisions of all crash severity, so they include data covering all types of injuries—not just the most severe/fatal ones. This aspect is especially important in the speed intervals evaluated here, since moderate (MAIS 2) injuries are very frequent in lower-speed crashes and even these injuries can result in long-term consequences.     

Using latent class clustering and binary logistic regression to model Australian cyclist injury severity in motor vehicle–bicycle crashes

Introduction: In recent years, Australia is seeing an increase in the total number of cyclists. However, the rise of serious injuries and fatalities to cyclists has been a major concern. Understanding the factors affecting the fatalities and injuries of bicyclists in crashes with motor vehicles is important to develop effective policy measures aimed at improving the safety of bicyclists. This study aims to identify the factors affecting motor vehicle-bicycle (MVB) crashes in Victoria, Australia and introducing effective countermeasures for the identified risk factors. Method: A data set of 14,759 MVB crash records from Victoria, Australia between 2006 and 2019 was analyzed using the binary logit model and latent class clustering. Results: It was observed that the factors that increase the risk of fatalities and serious injuries of bicyclists (FSI) in all clusters are: elderly bicyclist, not using a helmet, and darkness condition. Likewise, in areas with no traffic control, clear weather, and dry surface condition (cluster 1), high speed limits increase the risk of FSI, but the occurrence of MVB crashes in cross intersection and T-intersection has been significantly associated with a reduction in the risk of FSI. In areas with traffic control and unfavorable weather conditions (cluster 2), wet road surface increases the risk of FSI, but the areas with give way sign and pedestrian crossing signs reduce the risk of FSI. Practical Applications: Recommendations to reduce the risk of fatalities or serious injury to bicyclists are: improvement of road lighting and more exposure of bicyclists using reflective clothing and reflectors, separation of the bicycle and vehicle path in mid blocks especially in high-speed areas, using a more stable bicycle for the older people, monitoring helmet use, improving autonomous emergency braking, and using bicyclist detection technology for vehicles.     

Reality and risk of contact-type head injuries related to bicycle-mounted child seats

Objective

The authors have treated numerous children who have been injured by falling from bicycle-mounted child seats. Despite the greatly increased use of such seats, the understanding of their risk and the importance of helmet use remains alarmingly poor. The objective of this study was to confirm the risk of bicycle-mounted child seats and to evaluate the efficacy of helmets, seat belts, and back seat height in terms of preventing or mitigating contact-type head impacts that occur in falls from bicycle-mounted child seats.

Materials and methods

Biometrical dummy tests were performed to examine contact-type head injuries in falls from stationary bicycles. A bicycle with an anthropometric test dummy placed in a bicycle-mounted child seat was tipped over. Each test was repeated three times and three-dimensional acceleration was measured using accelerometer. Head Injury Criteria (HIC) were calculated and the respective influences of a helmet, a seat belt, and increased height of the back of the seat on such impacts were evaluated.

Results

Only helmets unequivocally lowered maximal acceleration and/or HIC values with statistical significance. The seat belt lowered HIC values as long as it was used with the high-back seat. Only when the dummy wore a helmet sitting in a high-back seat did the HIC show less than the threshold of 570 for three-year-old children. The HIC showed the lowest score of 161.5 when the dummy wore both a helmet and a seat belt sitting in a high-back seat.

Conclusions

Riders in bicycle-mounted child seats definitely have higher risks of contact-type head injuries. In transporting a child on a bicycle-mounted child seat, parents must use both a child-bicycle helmet and a high-back child seat at least; a seat belt is highly recommended as long as it is used with the other safety devices.

Impact on Industry

The bicycle-mounted child seat should have a high enough back and an appropriate seat belt to protect the head of the child from a contact-type injury.     

Pediatric electric bicycle injuries and comparison to other pediatric traffic injuries

Objective: The objective of this study was to conduct a comprehensive analysis of demographics, injury characteristics and hospital resource utilization of significant pediatric electric bicycle (e-bike) injuries leading to hospitalization following an emergency department visit in comparison to pediatric injuries caused by other traffic related mechanisms.

Methods: A retrospective review of all pediatric traffic injury hospitalizations following an emergency department visit to a level I trauma center between October 2014 and September 2016 was conducted. Data regarding age, sex, number of computed tomography (CT) scans obtained, number of major procedures, length of hospital stay (LOS), Injury Severity Score (ISS), and number of injuries per patient were collected and compared between e-bike injuries and other traffic injuries.

Results: Three hundred thirty-seven admissions were analyzed: 46 (14%) were due to e-bike injuries (29% of patients >12 years). Age, proportion of brain injuries, and use of CT were significantly increased compared to mechanical bicycle injuries (13.1?±?3.4 vs. 10.6?±?3.6, 13% vs. 3%, 1 [0–3] vs. 1 [0–1], P < .01, P = .03, P = .05). Age, LOS, and use of CT were significantly increased compared to injuries caused to automobile passengers (13.1?±?3.4 vs. 7.4?±?5.3, 1 [1–3] vs. 1 [1–2], 1 [0–3] vs. 0 [0–1], P < .01, P = .03, P = .01), as well as ISS and number of injuries per patient (P = .04, P < .01). Injuries caused by e-bikes were similar to injuries caused to pedestrians, except for age (13.1?±?3.4 vs. 8.5?±?3.7, P < .01). Multivariable analysis revealed a significant association between mechanism of injury and ISS, with increased ISS among e-bike injuries compared to mecahnical bike injuries (OR 2.56, CI 1.1–5.88, P = 0.03) and automobile injuries (OR 4.16, CI 1.49–12.5, (P < .01).

Conclusion: E-bikes are a significant cause of severe injury in children compared to most other traffic injuries, particularly in older children.