Estimating helmet wearing rates via a scalable, low-cost algorithm: a novel integration of deep learning and google street view.

INTRODUCTION: Wearing a helmet reduces the risk of head injuries substantially in the event of a motorcycle crash. Countries around the world are committed to promoting helmet use, but the progress has been slow and uneven. There is an urgent need for large-scale data collection for situation assessment and intervention evaluation. METHODS: This study proposes a scalable, low-cost algorithm to estimate helmet-wearing rates. Applying the state-of-the-art deep learning technique for object detection to images acquired from Google Street View, the algorithm has the potential to provide accurate estimates at the global level. RESULTS: Trained on a sample of 3995 images, the algorithm achieved high accuracy. The out-of-sample prediction results for all three object classes (helmets, drivers, and passengers) reveal a precision of 0.927, a recall value of 0.922, and a mean average precision at 50 (mAP50) of 0.956. DISCUSSION: The remarkable model performance suggests the algorithm's capacity to generate accurate estimates of helmet-wearing rates from an image source with global coverage. The significant enhancement in the availability of helmet usage data resulting from this approach could bolster progress tracking and facilitate evidence-based policymaking for helmet wearing globally.

Abusive head trauma and crying infant-Public awareness of newborn and infant trauma.

AIM: Crying seems to be a common trigger for abusive head trauma (AHT), which is the leading cause of fatalities from physical abuse in infants. Our objective was to evaluate knowledge of AHT, crying infants and correct behavioural measures in a general population. METHODS: An online questionnaire (LimeSurvey) was created to assess the risk of shaking. The online survey contained a total of 41 questions, including a demonstration of a previously recorded video in which an infant doll is shaken. RESULTS: A total of 319 people, 245 of them (76.8%) with own children, participated in the study. Almost all respondents (98.4%) were aware of serious injuries due to shaking, even to the point of death (98.1%). Most participants (97.5%) had heard the term 'shaking trauma' prior but did not receive any professional information, neither before nor after birth (85.2% or 86%), or during follow-up examinations (88.5%). The majority of the participants (95%) considered that useful coping strategies in infant crying were inappropriate. CONCLUSION: The consequences of shaking an infant were common knowledge in a normal population, whereas there was a knowledge gap regarding the management of excessive crying infants. Prevention programmes should mainly focus on male caregivers during postnatal care.

Evaluation of an Elastomeric Honeycomb Bicycle Helmet Design to Mitigate Head Kinematics in Oblique Impacts.

Head impacts in bicycle accidents are typically oblique to the impact surface and transmit both normal and tangential forces to the head, causing linear and rotational head kinematics, respectively. Traditional expanded polystyrene (EPS) foam bicycle helmets are effective at preventing many head injuries, especially skull fractures and severe traumatic brain injuries (TBIs) (primarily from normal contact forces). However, the incidence of concussion from collisions (primarily from rotational head motion) remains high, indicating need for enhanced protection. An elastomeric honeycomb helmet design is proposed herein as an alternative to EPS foam to improve TBI protection and be potentially reusable for multiple impacts, and tested using a twin-wire drop tower. Small-scale normal and oblique impact tests showed honeycomb had lower oblique strength than EPS foam, beneficial for diffuse TBI protection by permitting greater shear deformation and had the potential to be reusable. Honeycomb helmets were developed based on the geometry of an existing EPS foam helmet, prototypes were three-dimensional-printed with thermoplastic polyurethane and full-scale flat and oblique drop tests were performed. In flat impacts, honeycomb helmets resulted in a 34% higher peak linear acceleration and 7% lower head injury criteria (HIC15) than EPS foam helmets. In oblique tests, honeycomb helmets resulted in a 30% lower HIC15 and 40% lower peak rotational acceleration compared to EPS foam helmets. This new helmet design has the potential to reduce the risk of TBI in a bicycle accident, and as such, reduce its social and economic burden. Also, the honeycomb design showed potential to be effective for repetitive impact events without the need for replacement, offering benefits to consumers.

Health problems among elite Dutch youth long track speed skaters: a one-season prospective study.

OBJECTIVES: To describe the frequency, type, and severity of health problems in long-track speed skating to inform injury prevention strategies. METHODS: We prospectively collected weekly health and sport exposure data on 84 highly trained Dutch athletes aged 15-21 years during the 2019/2020 season using the Oslo Sports Trauma Research Centre questionnaire on Health Problems and the trainers' documentation. We categorised health problems into acute or repetitive mechanisms of injury or illness and calculated incidences (per 1000 sports exposure hours), weekly prevalence and burden (days of time loss per 1000 sports exposure hours) related to the affected body region. RESULTS: We registered 283 health problems (187 injuries, 96 illnesses), yielding an average weekly prevalence of health problems of 30.5% (95% CI 28.7% to 32.2%). Incidence rates were 2.0/1000 hours for acute mechanism injuries (95% CI 1.5 to 2.5) and 3.2/1000 hours for illnesses (95% CI 2.6 to 3.9). For acute mechanism injuries the head, shoulder and lumbosacral region had the highest injury burden of 5.6 (95% CI 4.8 to 6.5), 2.9 (95% CI 2.3 to 3.5) and 2.2 (95% CI 1.7 to 2.8) days of time loss/1000 hours, respectively. For repetitive mechanism injuries, the knee, thoracic spine, lower leg and lumbosacral region had the highest injury burden, with 11.0 (95% CI 9.8 to 12.2), 6.8 (95% CI 5.9 to 7.7), 3.9 (95% CI 3.2 to 4.6) and 2.5 (95% CI 1.9 to 3.1) days of time loss/1000 hours, respectively. CONCLUSION: Our study demonstrated a high prevalence of acute and repetitive mechanism injuries in speed skating. These results can guide future research and priorities for injury prevention.

Quantitative analysis of the protective performance of bicycle helmet with multi-direction impact protection system in oblique impact tests.

PURPOSE: The current study aimed to assess the protective performance of helmets equipped with multi-directional impact protection system (MIPS) under various oblique impact loads. METHODS: Initially, a finite element model of a bicycle helmet with MIPS was developed based on the scanned geometric parameters of an actual bicycle helmet. Subsequently, the validity of model was confirmed using the KASK WG11 oblique impact test method. Three different impact angles (30°, 45°, and 60°) and 2 varying impact speeds (5 m/s and 8 m/s) were employed in oblique tests to evaluate protective performance of MIPS in helmets, focusing on injury assessment parameters such as peak linear acceleration (PLA) and peak angular acceleration (PAA) of the head. RESULTS: The results demonstrated that in all impact simulations, both assessment parameters were lower during impact for helmets equipped with MIPS compared to those without. The PAA was consistently lower in the MIPS helmet group, whereas the difference in PLA was not significant in the no-MIPS helmet group. For instance, at an impact velocity of 8 m/s and a 30° inclined anvil, the MIPS helmet group exhibited a PAA of 3225 rad/s2 and a PLA of 281 g. In contrast, the no-MIPS helmet group displayed a PAA of 8243 rad/s2 and a PLA of 292 g. Generally, both PAA and PLA parameters decreased with the increase of anvil angles. At a 60° anvil angles, PAA and PLA values were 664 rad/s2 and 20.7 g, respectively, reaching their minimum. CONCLUSION: The findings indicated that helmets incorporating MIPS offer enhanced protection against various oblique impact loads. When assessing helmets for oblique impacts, the utilization of larger angle anvils and rear impacts might not adequately evaluate protective performance during an impact event. These findings will guide advancements in helmet design and the refinement of oblique impact test protocols.

Toppling television injuries in children and adolescents: a systematic review and meta-analysis.

CONTEXT: Toppling televisions (TVs) are a source of childhood injury but meta-analysis has not assessed the likelihood of TV injuries in children. OBJECTIVE: To present pooled results for injuries, following a systematic review. DATA SOURCES: MEDLINE, Scopus, Google Scholar and EMBASE databases were searched to 5 December 2022. STUDY SELECTION: Included studies met the following criteria: (1) assessed toppling TV injuries in paediatric populations; (2) reported point estimates as an OR or enabled its calculation and (3) used a comparison group. DATA EXTRACTION: A standardised form was used to include information on publication year, study design, population type, country, sample size, mean age, risk factors, point estimates or data used to calculate ORs. RESULTS: A total of 12 803 TV injuries were identified (five studies). Head and neck injuries (OR: 2.13, 95% CI: 1.21 to 3.75) and hospital admission (OR: 2.28, 95% CI: 1.80 to 2.90) were more likely in children aged under 6 years than over 6 years. Conversely, torso injuries were less likely in younger children (OR: 0.60, 95% CI: 0.51 to 0.70). Children under 6 were two and a half times more likely to die or be admitted to an intensive care unit (ICU) as a result of toppling TVs, although this was not statistically significant. Males did not sustain more TV injuries than females. CONCLUSIONS: Children aged under 6 years are more likely to die, sustain head injuries and require hospital treatment from toppling TVs. Strategies for injury prevention must go beyond warning labels to include community education, promotion and use of tip restraint devices, mandatory safety standards and a commitment from manufacturers to improve TV sets stability.

Effect of different helmet types in head injuries: a case-control study in northern Ghana.

BACKGROUND: Motorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana. METHODS: A prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury. RESULTS: After adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35). CONCLUSION: Even in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs.

Tackling sport-related concussion: effectiveness of lowering the maximum legal height of the tackle in amateur male rugby - a cross-sectional analytical study.

OBJECTIVE: Rugby union ('rugby') is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby. DESIGN: Cross-sectional analytical study: 2018 (control-standard tackle height) and 2019 (intervention-lowered legal tackle height) seasons. SETTING: South African collegiate student rugby competition. PARTICIPANTS: Between 800 and 900 male amateur student players (age: 20±1.6 years) in each year. INTERVENTION: Maximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit. OUTCOME MEASURES: Number of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables). RESULTS: There was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle. CONCLUSIONS: Despite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.

Effective factors of improved helmet use in motorcyclists: a systematic review.

BACKGROUND: Road traffic injuries (RTI) are one of the most prominent causes of morbidity and mortality, especially among children and young adults. Motorcycle crashes constitute a significant part of RTIs. Policymakers believe that safety helmets are the single most important protection against motorcycle-related injuries. However, motorcyclists are not wearing helmets at desirable rates. This study systematically investigated factors that are positively associated with helmet usage among two-wheeled motorcycle riders. METHODS: We performed a systematic search on PubMed, Scopus, Web of Science, Embase, and Cochrane library with relevant keywords. No language, date of publication, or methodological restrictions were applied. All the articles that had evaluated the factors associated with helmet-wearing behavior and were published before December 31, 2021, were included in our study and underwent data extraction. We assessed the quality of the included articles using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. RESULTS: A total of 50 articles were included. Most evidence suggests that helmet usage is more common among drivers (compared to passengers), women, middle-aged adults, those with higher educations, married individuals, license holders, and helmet owners. Moreover, the helmet usage rate is higher on highways and central city roads and during mornings and weekdays. Travelers of longer distances, more frequent users, and riders of motorcycles with larger engines use safety helmets more commonly. Non-helmet-using drivers seem to have acceptable awareness of mandatory helmet laws and knowledge about their protective role against head injuries. Importantly, complaint about helmet discomfort is somehow common among helmet-using drivers. CONCLUSIONS: To enhance helmet usage, policymakers should emphasize the vulnerability of passengers and children to RTIs, and that fatal crashes occur on low-capacity roads and during cruising at low speeds. Monitoring by police should expand to late hours of the day, weekends, and lower capacity and less-trafficked roads. Aiming to enhance the acceptance of other law-abiding behaviors (e.g., wearing seat belts, riding within the speed limits, etc.), especially among youth and young adults, will enhance the prevalence of helmet-wearing behavior among motorcycle riders. Interventions should put their focus on improving the attitudes of riders regarding safety helmets, as there is acceptable knowledge of their benefits.

Review of Mechanisms and Research Methods for Blunt Ballistic Head Injury.

Head injuries account for 15%-20% of all military injuries and pose a high risk of causing functional disability and fatality. Blunt ballistic impacts are one of the threats that can lead to severe head injuries. This review aims to examine the mechanisms and injury risk assessment associated with blunt ballistic head injury (BBHI). The review further discusses research methods and instrumentation used in BBHI studies, focusing on their limitations and challenges. Studies on the mechanisms of focal and diffuse brain injuries remain largely inconclusive and require further effort. Some studies have attempted to associate BBHIs with head mechanics, but more research is required to establish correlations between head mechanics and injury severity. Limited access to experimental models and a lack of instrumentation capable of measuring the mechanics of brain tissue in situ are potential reasons for the lack of understanding of injury mechanisms, injury correlations, and injury tolerance levels specific to this loading regime. Targeted research for understanding and assessing head injuries in blunt ballistic impacts is a necessary step in improving our ability to design protection systems to mitigate these injuries.

Head injuries caused by contact with teeth during sports and exercise activities in Japanese schools during the period 2012-2018.

BACKGROUND/AIM: During sports activities, teeth-related contact can cause injury to both ally and opponent players, which can lead to potential infections and aesthetic problems. However, the extent of such injuries remains unclear. This study aimed to clarify the frequency and situation of head injuries caused by teeth (HICBT) occurring under the supervision of schools in Japan. MATERIAL AND METHODS: HICBT records were extracted from the Japan Sport Council data on head injuries occurring reported during the 7-year period from 2012 to 2018 under the supervision of schools in Japan. RESULTS: Of the total 463,527 head injury cases during the study period, 4495 cases (approximately 1%) were HICBT. Of the HICBT cases, 3650 (81.20%) were related to sports and athletic activity. Such injuries were reported to occur most often during basketball with a rate of 57.07% and 50.43%; soccer/futsal was the next most common sport with a rate of 13.38% and 24.01% in junior high school and high school students. Tag games were responsible for a similar number of HICBT cases at 22.73% and 39.03% in kindergartens and elementary school students. CONCLUSIONS: A total of 4495 cases of HICBT were identified, accounting for about 1% of all head injuries under the supervision of schools in Japan during the study period. This result reminds us that our teeth could be the weapon against the players during sports events. HICBTs occurring during basketball and soccer/futsal, in which mouthguards are not mandatory, were conspicuous among junior and senior high school students. Active use of mouthguards in various sports will protect players as well as their teammates and opponents. Sports dentists should encourage the revision of rules, such as mandating the use of mouthguards, in popular sports with a high incidence of HICBT, such as basketball and soccer/futsal.

Electric scooter-related accidents: a possible protective effect of helmet use on the head injury severity.

Despite electric scooter use has proliferated in Italy since 2019, actionable data regarding injury incidence and patterns associated with electric scooter accidents are limited. This study aims at analyzing the rate, clinical, and demographic features of electric scooter accidents accessed to the Emergency Department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). This retrospective study included all patients older than 18 years riding an electric scooter in the ED from June 2019 to April 2022. Personal data, injury circumstances, helmet use, and health data were collected. Abbreviated Injury Scale (AIS) codes of all diagnoses were recorded, and the Injury Severity Score (ISS) was calculated for each patient. The analysis includes 92 patients admitted to the ED due to an e-scooter accident during the study period, with an increase in years. Thirty-two patients presented bone fractures especially concerning the extremities and the face districts. The median Injury Severity Score in the study cohort was 3, with the highest AIS represented by AIS Pelvic-Extremity and AIS External. Moreover, statistical significance was found between AIS Head-Neck and severity of trauma. E-scooters have become a familiar sight in cities worldwide recently, with many new companies renting them for use. But their arrival has also brought new safety concerns. Although most injuries reported are minor, the meager rate of helmet use is critical. Implementing compulsory helmet use for electric scooters for all ages could be a protective factor for being patient with head trauma on urban streets.

Do motorcycle helmets reduce road traffic injuries, hospitalizations and mortalities in low and lower-middle income countries in Africa? A systematic review and meta-analysis.

BACKGROUND: Studies in Africa have examined the association between helmet use and injury prevention, however, there has been no systematic review to synthesize the literature within an African context nor has there been any meta-analysis examining the effect of helmet use on injury prevention. METHODS: The review was performed in accordance with the Joanna Briggs Institute for Systematic Reviews. Articles were searched using several databases (e.g. CINAHL, OVID Medline) and select gray literature (e.g. TRID) sources. Articles were included if they were quantitative studies published in English between 2000 and 2019 and examined the association between motorcycle helmet use with head injuries, hospitalizations, and deaths in low- and lower-middle income countries in Africa with comprehensive motorcycle helmet laws. A meta-analysis was performed using pooled effect sizes assessing the impact of helmet use on reducing head injuries. RESULTS: After screening 491 articles, eight studies met the inclusion criteria. Helmet use ranged from 0 to 43%. The mean age of being involved in a crash was 30 years with males being two times more likely to be involved in motorcycle crashes than females. Drivers (riders) were more likely to be involved in a crash, followed by passengers and then pedestrians. Helmet use reduced injury severity and provided an 88% reduction in serious head injuries (OR 0.118, 95% CI: 0.014-0.968, p = 0.049). CONCLUSIONS: In our study, helmet usage significantly reduced the likelihood of fatal head injuries. African countries with no helmet laws should consider adopting helmet use policies to reduce severe head related injuries from motorcycle crashes.

Traumatic head injury due to child maltreatment: epidemiology, cost analysis, and impact of prevention.

BACKGROUND: Traumatic head injury due to child maltreatment (THI-CM), also known as abusive head trauma (AHT), is a significant public health problem due to the wide array of consequences affecting multiple domains of a child's health and development. Several studies have evaluated its cost on healthcare systems, families, and societies. Many jurisdictions have implemented caregiver education programs to prevent THI-CM. OBJECTIVES: This paper aims to provide a brief overview of the epidemiology and cost analysis of THI-CM and discuss its prevention and the intergenerational transmission of child maltreatment. METHODS: Although not systematic, a literature search of original articles published from 2000 to 2022 in English and French was undertaken using the following databases: PubMed, EMBASE (Ovid), and PsycINFO (OVID). The search combined terms related to traumatic head injury and child maltreatment, with terms related to its cost and prevention. Studies of children aged 0-5 years old were included. The authors completed a screen of the titles and abstracts to determine relevance with respect to this article. RESULTS: Globally, although THI-CM accounts for a small proportion of cases of child maltreatment, there is a high incidence of death and neurological sequelae compared to other causes of head trauma.The incidence of THI-CM is likely underestimated due to the lack of standardized definitions, differences in reporting, and challenges in identifying less severe cases. Cost analysis studies reveal the significant short- and long-term costs associated with THI-CM. Caregiver education programs have been studied and implemented in many centers and have shown varying but promising results. CONCLUSION: A multi-pronged approach to prevention efforts should be considered to support families and help to prevent THI-CM and maltreatment throughout childhood.

Helmets Protect Pediatric Bicyclists From Head Injury and Do Not Increase Risk of Cervical Spine Injury.

OBJECTIVES: Only 21 states have mandatory helmet laws for pediatric bicyclists. This study sought to determine the incidence of helmeted riders among pediatric bicyclists involved in a collision and hypothesized the risk of a serious head and cervical spine injuries to be higher in nonhelmeted bicyclists (NHBs) compared with helmeted bicyclists (HBs). METHODS: The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for pediatric (age <16 years) bicyclists involved in a collision. Helmeted bicyclists were compared with NHBs. A serious injury was defined by an abbreviated injury scale grade of greater than 2. RESULTS: From 3693 bicyclists, 3039 (82.3%) were NHBs. Compared with HBs, NHBs were more often Black (21.6% vs 3.8%, P < 0.001), Hispanic (17.5% vs 9.3%, P < 0.001), without insurance (4.6% vs 2.4%, P = 0.012), and had a higher rate of a serious head injury (24.6% vs 9.3%, P < 0.001). Both groups had similar rates of complications and mortality (P > 0.05). The associated risk of a serious head (odds ratio = 3.17, P < 0.001) and spine injury (odds ratio = 0.41, P = 0.012) were higher and lower respectively in NHBs. Associated risks for cervical spine fracture or cord injury were similar (P > 0.05). CONCLUSIONS: Pediatric bicyclists involved in a collision infrequently wear helmets, and NHBs was associated with higher risks of serious head injury. However, the associated risk of serious spine injury among NHBs was lower. The associated risks for cervical spine fracture or cervical cord injuries were similar. Nonhelmeted bicyclists were more likely to lack insurance and to be Black or Hispanic. Targeted outreach programs may help decrease the risk of injury, especially in at-risk demographics.

Influence of a Passenger Position Seating on Recline Seat on a Head Injury during a Frontal Crash.

Presently, most passive safety tests are performed with a precisely specified seat position and carefully seated ATD (anthropomorphic test device) dummies. Facing the development of autonomous vehicles, as well as the need for safety verification during crashes with various seat positions such research is even more urgently needed. Apart from the numerical environment, the existing testing equipment is not validated to perform such an investigation. For example, ATDs are not validated for nonstandard seatback positions, and the most accurate method of such research is volunteer tests. The study presented here was performed on a sled test rig utilizing a 50cc Hybrid III dummy according to a full factorial experiment. In addition, input factors were selected in order to verify a safe test condition for surrogate testing. The measured value was head acceleration, which was used for calculation of a head injury criterion. What was found was an optimal seat angle -117°-at which the head injury criteria had the lowest represented value. Moreover, preliminary body dynamics showed a danger of whiplash occurrence for occupants in a fully-reclined seat.

Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis.

BACKGROUND: The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. METHODS AND FINDINGS: A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. CONCLUSIONS: In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.

Helmet Usage Reduces Serious Head Injury Without Decreasing Concussion After Bicycle Riders Crash.

BACKGROUND: The importance of bicycle helmets in reducing injuries is unclear. Our center receives a disproportionate number of bicycle crash victims. We sought to evaluate the types of injuries observed and the role of helmets in reducing head injuries. MATERIALS AND METHODS: We evaluated demographic data and compared injuries between bicycle riders that crashed with and without helmets over a 9-year period. Categorical variables were compared using linear regression methods and nominal variables using ANOVA. Differences were considered significant for P ≤ 0.05. RESULTS: There were 906 patients evaluated, 701 with helmets (77%) and 205 (23%) without helmets. The mean Injury Severity Score was 9.3 ± 6.4. The most common injuries were concussion (n = 385), rib fractures (n = 154), clavicle fractures (n = 139), facial fractures (n = 102), and cervical spine fractures (n = 89). There was no significant difference in the number of patients with a concussion in riders with or without helmets, [299/701, 42.6% versus 86/205, 42.0%, respectively, (P = NS)]. In helmet versus no helmet riders, there were significantly fewer patients with facial fractures, [67/701, 9.5%, versus 35/205, 17.0%, respectively, (P = 0.003)], skull fractures [8/701, 1.1% versus 9/205, 4.4%, respectively, (P = 0.003)], and serious head injuries [6/701, 0.85% versus 8/205, 3.9%, respectively, (P = 0.002)]. CONCLUSIONS: Helmeted patients involved in bicycle crashes are less likely to sustain a serious head injury, a skull fracture, or facial fractures compared to riders without helmets. The most common injury in patients with a bicycle crash is a concussion. Helmets did not prevent concussion after bicycle rider's crash in our patient population.

Adult Bicycle Collisions: Impact of Helmet Use on Head and Cervical Spine Injury.

BACKGROUND: No states currently require adult bicycle riders to wear helmets. Opponents of a universal helmet law argue that helmets may cause a greater torque on the neck during collisions, potentially increasing the risk of cervical spine fracture (CSF). This assumption has not been supported by data for motorcyclists. Therefore, we sought to evaluate the risk of CSF and cervical spinal cord injury (CSCI) in helmeted bicyclists (HBs) versus nonhelmeted bicyclists (NHBs) involved in collisions. We hypothesize that in adult HBs, there is an increased incidence of CSF and injury but lower rates of severe head injury and mortality than in NHBs. MATERIALS AND METHODS: The Trauma Quality Improvement Program (2010-2016) was queried for adult bicyclists involved in collisions, comparing HBs with NHBs. A multivariable logistic regression model was used for analysis. RESULTS: Of 25,047 bicyclists, 14,234 (56.8%) were NHBs. NHBs were more often black (13.3% versus 2.3%, P < 0.001) and screened positive for alcohol on admission (25.7% versus 4.6%, P < 0.001). NHBs had lower rates of CSF (17.7% versus 23.7%, P < 0.001) and CSCI (1.1% versus 1.9%, P < 0.001) but higher rates of mortality (4.9% versus 2.2%, P < 0.001) and a higher risk for severe head injury (odds ratio [OR]: 2.26, 2.13-2.40, P < 0.001). After adjusting for covariates, NHBs had a higher risk of mortality (OR: 2.38, 2.00-2.84, P < 0.001) but lower risk of CSF (OR: 0.66 0.62-0.71, P < 0.001) and CSCI (OR: 0.53, 0.42-0.68, P < 0.001). CONCLUSIONS: HBs involved in collisions have a higher risk of CSF and CSCI; however, NHBs have a higher risk of severe head injury and mortality. Consideration for a universal helmet law among bicyclists and ongoing research regarding helmet development is needed.

Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study.

BACKGROUND: Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma. MATERIALS AND METHODS: Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15). RESULTS: We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury. CONCLUSIONS: At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.