How motorcycle helmets affect trauma mortality: Clinical and policy implications

Background: Motorcycles are the most popular vehicles in Taiwan, where more than 14.8 million motorcycles (1 motorcycle per 1.6 people) are in service. Despite the mandatory helmet law passed in 1997, less than 80% of motorcyclists in Taiwan wear helmets.

Objective: The objective of this study was to analyze the effect of using motorcycle helmets on fatality rates.

Methods: A clinical data set including 2,868 trauma patients was analyzed; the cross-sectional registration database was administered by a university medical center in Central Taiwan. A path analysis framework and multiple logistic regressions were used to estimate the marginal effect of helmet use on mortality.

Results: Using a helmet did not directly reduce the mortality rate but rather indirectly reduced the mortality rate through intervening variables such as the severity of head injuries, number of craniotomies, and complications during therapeutic processes. Wearing a helmet can reduce the fatality rate by 1.3%, the rate of severe head injury by 34.5%, the craniotomy rate by 7.8%, and the rate of complications during therapeutic processes by 1.5%. These rates comprise 33.3% of the mortality rate for people who do not wear helmets, 67.3% of the severe head injury rate, 60.0% of the craniotomy rate, and 12.2% of the rate of complications during therapeutic processes.

Discussion: Wearing a helmet and trauma system designation are crucial factors that reduce the fatality rate.     

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.     

Motorcycle crashes potentially preventable by three crash avoidance technologies on passenger vehicles

Objective: The objective of this study was to identify and quantify the motorcycle crash population that would be potential beneficiaries of 3 crash avoidance technologies recently available on passenger vehicles.

Methods: Two-vehicle crashes between a motorcycle and a passenger vehicle that occurred in the United States during 2011–2015 were classified by type, with consideration of the functionality of 3 classes of passenger vehicle crash avoidance technologies: frontal crash prevention, lane maintenance, and blind spot detection. Results were expressed as the percentage of crashes potentially preventable by each type of technology, based on all known types of 2-vehicle crashes and based on all crashes involving motorcycles.

Results: Frontal crash prevention had the largest potential to prevent 2-vehicle motorcycle crashes with passenger vehicles. The 3 technologies in sum had the potential to prevent 10% of fatal 2-vehicle crashes and 23% of police-reported crashes. However, because 2-vehicle crashes with a passenger vehicle represent fewer than half of all motorcycle crashes, these technologies represent a potential to avoid 4% of all fatal motorcycle crashes and 10% of all police-reported motorcycle crashes.

Discussion: Refining the ability of passenger vehicle crash avoidance systems to detect motorcycles represents an opportunity to improve motorcycle safety. Expanding the capabilities of these technologies represents an even greater opportunity. However, even fully realizing these opportunities can affect only a minority of motorcycle crashes and does not change the need for other motorcycle safety countermeasures such as helmets, universal helmet laws, and antilock braking systems.     

Motorcycle helmet use in Calicut,India: User behaviors,attitudes, and perceptions

Objectives: The objectives of this study include assessing the motorcycle helmet use pattern in Calicut, India, and analyzing the factors influencing helmet use including motorcyclists' perceptions.

Methods: Field observational studies at 15 locations were conducted to determine the helmet use rate among motorcyclists and pillion passengers. A structured questionnaire interview survey was conducted with 709 motorcyclists to evaluate the users' perceptions and opinions regarding the use of motorcycle helmets.

Results: There was a considerable difference in the level of motorcycle helmet use observed between the locations within and outside the city limits, where different levels of helmet law enforcement were exercised. The helmet use was observed at a maximum of 89% within the city and a minimum of 23% in some locations outside the city. The decreasing percentage of helmet use while moving toward the locations outside the city was confirmed statistically through t tests (t = 1.771, df = 13, P < .05). It was found that only 42% of users revealed that helmets are comfortable and 42% expressed that helmets affect hearing ability. It is important to note that 57% of users are of the opinion that there is no need to use a helmet if you drive slowly and carefully. The price of the helmet was not a deterrent for helmet use. In addition, it was observed that only 45% of helmets used by the motorist were standard helmets with an Indian Standards Institute (ISI) mark.

Conclusion: The widely varying helmet use pattern observed in the study area may be attributed due to the users' behaviors; that is, using a helmet only when the helmet law is strictly enforced rather than using a helmet as a protective device. Further, some of the problems and beliefs associated with helmet use prevent motorcyclists from using a helmet. Hence, the road safety of motorcyclists can be improved only through addressing the identified measures comprehensively.     

Motorcycle safety among motorcycle taxi drivers and nonoccupational motorcyclists in developing countries: A case study of Maoming,South China

Objective: An increasing number of motorcycle taxis have been involved in traffic crashes in many developing countries. This study examines the characteristics of both motorcycle taxi drivers and nonoccupational motorcyclists, investigates the risks they pose to road safety, and provides recommendations to minimize their risks.

Methods: Based on the data collected from a questionnaire survey of 867 motorcycle taxi drivers and 2,029 nonoccupational motorcyclists in Maoming, South China, comparisons were made to analyze differences of personal attributes, attitudes toward road safety, and self-reported behavior of the 2 groups.

Results: Results of the chi-square tests show that not only motorcycle taxi drivers but also nonoccupational motorcyclists in Maoming held poor attitudes toward road safety and both groups reported unsafe driving behavior. There is much room for improving local road safety education among all motorcyclists in Maoming. Yet, motorcycle taxi drivers were more likely to pose road safety risks than nonoccupational motorcyclists under some circumstances, such as speeding late at night or early in the morning, not requiring passengers to wear helmets, and running a red light. The results of the binary logistic regression model show that possessing a vehicle license for a motorcycle or not was the common significant predictor for unsafe driving behavior of motorcycle taxi drivers and nonoccupational motorcyclists. Therefore, enforcement against all motorcyclists not showing vehicle licenses for their motorcycles should be stepped up.

Conclusion: Motorcycle safety is largely poor in Maoming. Therefore, efforts to improve motorcycle safety should be strengthened by targeting not only motorcycle taxi drivers but also nonoccupational motorcyclists.     

Helmet retention system types as a risk factor to properly attach the chin strap

Objectives: This study aimed to determine the factors associated with the incorrect use of a helmet retention system (loose or open) and how often this happens.

Methods: This was an observational transversal study conducted in Curitiba, Brazil. Trained observers positioned at traffic lights collected information about the helmet fixation mode, the helmet model (full-face, open-face, modular, half), and the helmet retention system model (micrometric, double-D, fast-release). Additional data including position on the motorcycle, gender, and function of the motorcycle (as a work vehicle) were collected. The observers, collection site, and periods were randomly selected by lots.

Results: From a total of 3,050 motorcyclists, 1,807 (59.2%) had their helmets fastened correctly, 907 (29.7%) had the retention system fastened loosely, and in 336 (11.0%), the retention system was completely open. Increased odds of incorrect use were observed for the fast-release and double-D buckles compared to the micrometrics buckles, with a fixed odds ratio (OR) of 4.62 (95% confidence interval [CI], 3.89–5.51) and 3.54 (95% CI, 2.46–5.09), respectively (P <.0001). Full-face helmets had a higher chance of incorrect use (P <.0001), and passengers had a higher incidence of incorrect use of the helmet than drivers (P <.0001).

Conclusion: An important risk factor related to the incorrect use of the helmet was the type of retention system. The helmet model and being a passenger had a secondary influence on incorrect use of helmets.     

Emergency department visits by pediatric patients sustained as a passenger on a motorcycle

Objective: Currently only 5 out of the 50 states in the United States have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to U.S. emergency departments (EDs) for injuries sustained as a passenger on a motorcycle.

Methods: In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using International Classification of Diseases, Ninth Revision (ICD-9) External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges.

Results: Between 2006 and 2011 there were an estimated 9,689 visits to U.S. EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were $2,116.50 and amounted to roughly $17,500,000 during the 6 years. The average cost for admission was $51,446 per patient and totaled over $54 million. The most common primary injuries included superficial contusions; sprains and strains; upper limb fractures; open wounds of head, neck, and trunk; and intracranial injuries.

Conclusion: Although there were only about 9,700 visits to U.S. EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission amounted to over $71 million.     

Independent factors associated with bicycle helmet use in a Korean population: A cross-sectional study

Objective: Although identification of factors that influence helmet use during bicycle riding is necessary for the selection of groups that require safe cycling education, limited baseline data are available. The aim of the present study was to analyze the rate of helmet use and the demographic factors that were independently associated with helmet use among Korean bicycle riders.

Methods: In this cross-sectional study, we used public data from the Sixth Korean National Health and Nutrition Examination Survey conducted in 2013 and 2014. Helmet users were defined as subjects who always, usually, or frequently wore helmets when cycling. Independent factors associated with helmet use were determined using odds ratios (ORss) adjusted for 5 demographic factors via multivariate logistic regression analysis.

Results: In the total population, 4,103 individuals were bicycle riders; among these, 782 individuals (19.1%) wore helmets. A total of 21.1% of male riders used helmets, compared to 15.5% of female riders (P <.001). The adjusted logistic regression model revealed that female sex (OR = 0.665; 95% confidence interval [CI], 0.554–0.797), teenage status (OR = 0.475, 95% CI, 0.333–0.678), and low household income (OR = 0.657, 95% CI 0.513–0.841) were significantly associated with nonuse of helmets.

Conclusions: Female sex, teenage status, and low household income were independent factors associated with the nonuse of helmets. We identified factors associated with helmet use during bicycle riding through analysis of baseline data on helmet usage.     

Impact of helmet use on traumatic brain injury from road traffic accidents in Cambodia

Objective: Rapid urbanization and motorization without corresponding increases in helmet usage have made traumatic brain injury due to road traffic accidents a major public health crisis in Cambodia. This analysis was conducted to quantify the impact of helmets on severity of injury, neurosurgical indication, and functional outcomes at discharge for motorcycle operators who required hospitalization for a traumatic brain injury following a road traffic accident in Cambodia.

Methods: The medical records of 491 motorcycle operators who presented to a major tertiary care center in Cambodia with traumatic brain injury were retrospectively analyzed using multivariate logistic regression.

Results: The most common injuries at presentation were contusions (47.0%), epidural hematomas (30.1%), subdural hematomas (27.9%), subarachnoid hemorrhages (12.4%), skull fractures (21.4%), and facial fractures (18.5%). Moderate-to-severe loss of consciousness was present in 36.3% of patients. Not wearing a helmet was associated with an odds ratio of 2.20 (95% confidence interval [CI], 1.15–4.22) for presenting with moderate to severe loss of consciousness compared to helmeted patients. Craniotomy or craniectomy was indicated for evacuation of hematoma in 20.0% of cases, and nonhelmeted patients had 3.21-fold higher odds of requiring neurosurgical intervention (95% CI, 1.25–8.27). Furthermore, lack of helmet usage was associated with 2.72-fold higher odds of discharge with functional deficits (95% CI, 1.14–6.49). In total, 30.1% of patients were discharged with severe functional deficits.

Conclusions: Helmets demonstrate a protective effect and may be an effective public health intervention to significantly reduce the burden of traumatic brain injury in Cambodia and other developing countries with increasing rates of motorization across the world.     

Calling,texting, and searching for information while riding a motorcycle: A study of university students in Vietnam

Objective: The objective of this study was to investigate the prevalence of calling, texting, and searching for information while riding a motorcycle among university students and the influences of sociodemographic characteristics, social norms, and risk perceptions on these behaviors.

Methods: Students at 2 university campuses in Hanoi and Ho Chi Minh City, the 2 largest cities in Vietnam, were invited to participate in an anonymous online survey. Data collection was conducted during March and May 2016.

Results: There were 741 respondents, of whom nearly 90% of students (665) were motorcycle riders. Overall prevalence of mobile phone use while riding is 80.9% (95% confidence interval [CI], 77.9–83.9%) with calling having a higher level of prevalence than texting or searching for information while riding: 74% (95% CI, 70.7–77.3%) vs. 51.7% (95% CI, 47.9–55.5%) and 49.9% (95% CI, 46.1–53.7%), respectively. Random parameter ordered probit modeling results indicate that mobile phone use while riding is associated with gender, motorcycle license duration, perceived crash risk, perceived risk of mobile phone snatching, and perceptions of friends' mobile phone use while riding.

Conclusions: Mobile phone use while riding a motorcycle is highly prevalent among university students. Educational programs should focus on the crash and economic risk of all types of mobile phone use while riding, including calling, texting, and searching for information. In addition, they should consider targeting the influence of social norms and peers on mobile phone use while riding.     

Motorcycle fuel tanks and pelvic fractures: A motorcycle fuel tank syndrome

Objective: Pelvic injuries are a serious and commonly occurring injury to motorcycle riders involved in crashes, yet there has been limited research investigating the mechanisms involved in these injuries. This study aimed to investigate the mechanisms involved in pelvic injuries to crashed motorcyclists.

Method: This study involved in-depth crash investigation and 2 convenience-based data sets were used. These data sets investigated motorcycle crashes in the Sydney, Newcastle, and Adelaide regions. Participants included motorcycle riders who had crashed either on a public road or private property within the study areas. The mechanism of injury and the type of injuries were investigated.

Results: The most frequent cause of pelvic injuries in crashed motorcyclists was due to contact with the motorcycle fuel tank during the crash (85%). For riders who had come into contact with the fuel tank, the injury types were able to be grouped into 3 categories based on the complexity of the injury. The complexity of the injury appeared to increase with impact speed but this was a nonsignificant trend. The pelvic injuries that did not occur from contact with the fuel tank in this sample differed in asymmetry of loading and did not commonly involve injury to the bladder. They were commonly one-sided injuries but this differed based on the point of loading; however, a larger sample of these injuries needs to be investigated.

Conclusion: Overall improvements in road safety have not been replicated in the amelioration of pelvic injuries in motorcyclists and improvements in the design of crashworthy motorcycle fuel tanks appear to be required.     

Exploratory field trial of motorcycle autonomous emergency braking (MAEB): Considerations on the acceptability of unexpected automatic decelerations

Objective: Autonomous emergency braking (AEB) acts to slow down a vehicle when an unavoidable impending collision is detected. In addition to documented benefits when applied to passenger cars, AEB has also shown potential when applied to motorcycles (MAEB). However, the feasibility of MAEB as practically applied to motorcycles in the real world is not well understood.

Methods: In this study we performed a field trial involving 16 riders on a test motorcycle subjected to automatic decelerations, thus simulating MAEB activation. The tests were conducted along a rectilinear path at nominal speed of 40 km/h and with mean deceleration of 0.15 g (15% of full braking) deployed at random times. Riders were also exposed to one final undeclared brake activation with the aim of providing genuinely unexpected automatic braking events.

Results: Participants were consistently able to manage automatic decelerations of the vehicle with minor to moderate effort. Results of undeclared activations were consistent with those of standard runs.

Conclusions: This study demonstrated the feasibility of a moderate automatic deceleration in a scenario of motorcycle travelling in a straight path, supporting the notion that the application of AEB on motorcycles is practicable. Furthermore, the proposed field trial can be used as a reference for future regulation or consumer tests in order to address safety and acceptability of unexpected automatic decelerations on a motorcycle.     

Risk factors for motorcycle loss-of-control crashes

Objective: The present article identifies and assesses the effect of critical factors on the risk of motorcycle loss-of-control (LOC) crashes.

Method: Data come from a French project on road crashes, which include all fatal road crashes and a random sample of 1/20th of nonfatal crashes in France in 2011, based on police reports. A case–control study was carried out on a sample of 903 crashes for 444 LOC motorcycle riders (case) and 470 non-LOC and nonresponsible motorcycle riders (control). The sample was weighted due to the randomization of nonfatal crashes. Missing values were imputed using multiple imputation.

Results: Road alignment and surface conditions, human factors, and motorcycle type played important roles in motorcycle LOC crashes. Riding in a curve was associated with a 3-fold greater risk of losing control of motorcycle than riding in a straight line. Poor road adhesion significantly increased the risk of losing control; the risk increased more than 20-fold when deteriorated road adhesion was encountered unexpectedly, due to loose gravel, ice, oil, bumps, road marking, metal plates, etc. For motorcyclists, riding with a positive blood alcohol concentration (over or equal to the legal limit of 0.5 g/L) was very dangerous, often resulting in losing control. The risk of LOC crash varied for different types of motorcycle: Riders of roadsters and sports bikes were more likely to have an LOC crash greater than that of riders of basic or touring motorcycles. In addition, LOC risk increased with speed; a model using the square of the traveling speed showed better fit than one using speed itself.

Conclusion: The LOC crash factors related to riders, vehicles, and road infrastructure identified here were expected but were rarely identified and taken simultaneously into account in previous studies. They could be targeted by countermeasures to improve motorcyclist safety.     

Does the improved stability offered by motorcycle antilock brakes (ABS) make sliding crashes less common? In-depth analysis of fatal crashes involving motorcycles fitted with ABS

Objective: This research investigated the following issue. Though several tests indicate that motorcycle ABS may increase motorcycle stability, thus reducing the risk of a sliding crash involving braking (i.e., the rider is separated from the motorcycle and slides along the road surface prior to collision), there is limited research showing to what extent sliding crashes are reduced by ABS in real-life conditions.

Methods: The Swedish Transport Administration (STA) and the Norwegian Public Roads Administration (NPRA) carry out in-depth studies for all road fatalities. A total of 38 in-depth studies with ABS motorcycles were included: 22 in Sweden and 16 in Norway (2005–2014). These were compared with 98 cases in Sweden and 32 in Norway involving motorcycles of the same types but without ABS. The data sets were analyzed separately and also merged together. The difference between the proportions of sliding crashes regardless braking was analyzed; selective recruitment was handled with a sensitivity analysis. Induced exposure was used to calculate the reduction of all crashes and those involving braking.

Results: Four ABS cases (11%) involved falling off the motorcycle prior to collision, and 35% of the non-ABS crashes were sliding (P =.004). The sensitivity analysis showed that the results were stable, with a relative difference of sliding crashes ranging between 65 and 78%.

None of the 4 sliding crashes with ABS occurred during braking; that is, all ABS riders who braked prior to collision crashed in an upright position. In the 4 sliding cases with ABS, the riders lost control of their motorcycles: 2 while accelerating on asphalt with very poor friction, 1 while negotiating a curve with an excessive lean angle, and 1 by abruptly releasing the throttle in the middle of a curve.

Although based on a limited number of cases, the distributions of sliding and upright collisions among crashes without braking were similar, thus suggesting that the crash posture would not be affected by ABS if no braking occurred. The calculations with induced exposure showed that upright crashes with braking were also reduced by ABS; all fatal crashes, regardless of braking, were reduced by 52%.

Conclusions: Though this research was based on a limited material, it confirmed that sliding fatal crashes are significantly decreased by ABS. Considering that ABS will soon be mandatory in the European Union on all new motorcycles with engine displacement over 125cc, these findings should be taken into account in the future design and testing of motorcycle-friendly road barriers and integrated protection systems.     

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.     

Social and hospital costs of patients admitted to a university hospital in Brazil due to motorcycle crashes

Objective: This study aimed to investigate the social and hospital costs of patients treated at a public hospital who were motorcycle crash victims.

Method: This prospective study was on 68 motorcycle riders (drivers or passengers), who were followed up from hospital admission to 6 months after the crash. A questionnaire covering quantitative and qualitative questions was administered.

Results: Motorcycle crash victims were responsible for 12% of the institution's hospital admissions; 54.4% were young (18–28 years of age); 92.6% were the drivers; 91.2% were male; and 50% used their motorcycles as daily means of transportation. Six months afterward, 94.1% needed help from someone; 83.8% had changed their family dynamics; and 73.5% had not returned to their professional activities. Among the injuries, 94.7% had some type of fracture, of which 53.5% were exposed fractures; 35.3% presented temporary sequelae; and 32.4% presented permanent sequelae. They used the surgical center 2.53 times on average, with a mean hospital stay of 18 days. The per capita hospital cost of these victims’ treatment was US$17,481.50.

Conclusion: The social and hospital costs were high, relative to the characteristics of a public institution. Temporary or permanent disability caused changes to family dynamics, as shown by the high numbers of patients who were still away from their professional activities more than 6 months afterward.     

Epidemiology and patterns of facial fractures due to road traffic accidents in Taiwan: A 15-year retrospective study

Objective: The facial region is a commonly fractured site, but the etiology varies widely by country and geographic region. To date, there are no population-based studies of facial fractures in Taiwan.

Methods: We conducted a retrospective study of patients diagnosed with facial fracture and registered in the National Health Insurance Research Database of Taiwan between 1997 and 2011. The epidemiological characteristics of this cohort were analyzed, including the etiology, fracture site, associated injuries, and sex and age distributions.

Results: A total of 6,013 cases were identified that involved facial fractures. Most patients were male (69.8%), aged 18–29 years (35.8%), and had fractures caused by road traffic accidents (RTAs; 55.2%), particularly motorcycle accidents (31.5%). Falls increased in frequency with advancing age, reaching 23.9% among the elderly (age > 65 years). The most common sites of involvement were the malar and maxillary bones (54.0%), but nasal bone fractures were more common among those younger than 18 years.

Conclusion: Most facial injuries in Taiwan occur in young males and typically result from RTAs, particularly involving motorcycles. However, with increasing age, there is an increase in the proportion of facial injuries due to falls.     

Evaluation of the effectiveness of toe board energy-absorbing material for foot,ankle, and lower leg injury reduction

Objective: Since 2000, numerous improvements have been made to the National Association for Stock Car Auto Racing, Incorporated (NASCAR®) driver restraint system, resulting in improved crash protection for motorsports drivers. Advancements have included seats, head and neck restraints (HNRs), seat belt restraint systems, driver helmets, and others. These enhancements have increased protection for drivers from severe crash loading. Extending protection to the driver's extremities remains challenging. Though the drivers’ legs are well contained for lateral and vertical crashes, they remain largely unrestrained in frontal and frontal oblique crashes.

Method: Sled testing was conducted for the evaluation of an energy-absorbing (EA) toe board material to be used as a countermeasure for leg and foot injuries. Testing included baseline rigid toe boards, tests with EA material–covered toe boards, and pretest positioning of the 50th percentile male frontal Hybrid III anthropomorphic test device (ATD) lower extremities. ATD leg and foot instrumentation included foot acceleration and tibia forces and moments.

Results: The sled test data were evaluated using established injury criteria for tibial plateau fractures, leg shaft fractures, and calcaneus, talus, ankle, and midfoot fractures.

Conclusion: A polyurethane EA foam was found to be effective in limiting axial tibia force and foot accelerations when subjected to frontal impacts using the NASCAR motorsport restraint system.     

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.     

State helmet laws and helmet use among fatally injured moped riders in the United States, 2011–2015

Objective: Research has found that mandatory motorcycle helmet laws increase helmet use and reduce motorcycle-related fatalities. However, the association between state moped helmet laws and helmet use in the United States has not been examined. This study investigated this association among a census of fatally injured moped riders in the United States.

Methods: A logistic regression model was constructed to analyze data extracted from the Fatality Analysis Reporting System (FARS) to examine risk factors for helmet nonuse among 572 moped riders fatally injured between 2011 and 2015.

Results: Fatally injured moped riders in states with universal helmet laws had 69 times the odds of wearing a helmet (P < .001).

Conclusions: Findings suggest that universal moped helmet laws increase helmet use. However, additional research is needed to examine helmet laws and use among nonfatally injured moped riders.