Helmet wearing behavior where people often ride motorcycle in Ethiopia: A cross-sectional study.

BACKGROUND: Road traffic accidents are a major global concern that affects all people regardless of their age, sex, wealth, and ethnicity. Injuries and deaths due to motorcycles are increasing, especially in developing countries. Wearing helmet is effective in reducing deaths and injuries caused by motorcycle accidents. OBJECTIVES: To assess the magnitude of helmet wearing behavior and its determinants among motorcycle riders in Sawula and Bulky towns, Gofa zone, Southern Ethiopia. METHODS: A community-based cross-sectional study was conducted from April, 15 to May 25, 2020, among 422 motorcycle drivers in Sawula and Bulky towns, where people often drive motorcycles. A stratified sampling technique was used to recruit sampled drivers in a face-to-face interview. Data were entered into EPI-data version 3.1 software and exported to SPSS version 23 software to manage analysis. Descriptive analyses such as frequency, percentage, mean and standard deviation were performed as necessary. Logistic regression models were fitted to identify the predictors of helmet wearing behavior. Adjusted odds ratios (AOR) with 95% confidence interval (CI) were used to determine the magnitude and strength of the association. RESULTS: A total of 403 motorcycle drivers participated in the study which gave a 95.5% response rate. Among 403 motorcycle riders, only 12.4% (95% CI, 9.2 to 15.6%) wore helmets while driving motorcycles. Having license [AOR 3.51(95% C.I 1.56-7.89)], driving distance >10Km [AOR 2.53(95% C.I 1.08-5.91)], History of exposure to accident [AOR 2.71(95% C.I 1.32-5.55)], driving experience of ≥10 years [AOR 2.98 (95% C.I 1.25-7.09)] and high perceived susceptibility to accident [AOR 3.10(95% C.I 1.29-7.46)] had statistically significant association with helmet wearing compared to their counterparts. CONCLUSIONS: This study found that helmet-wearing behavior was very low. Having a license, driving distance, exposure to accidents, driving experience, and accident risk perception were determinants of helmet wearing behavior. These determinants imply the need for interventions that focus on behavioral change communications such as awareness creation campaigns and mandatory helmet wearing laws.

Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department.

STUDY OBJECTIVE: To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED). METHODS: Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate. RESULTS: 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 ± 3.07 to 25.43 ± 3.11 bpm and fCPAP: from 33.46 ± 3.35 to 27.01 ± 3.19 bpm), heart rate (hCPAP: from 114.76 ± 15.5 to 96.17 ± 16.50 bpm and fCPAP: from 115.07 ± 14.13 to 101.19 ± 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 ± 12.13 to 83.72 ± 12.91 and fCPAP: from 16.01 ± 11.76 to 76.62 ± 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 ± 8.06 mmHg to 166.38 ± 30.17 mmHg in hCPAP and 68.99 ± 7.68 mmHg to 184.49 ± 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 ± 13.4 to 273.4 ± 49.5 in hCPAP and 115.0 ± 12.9 to 307.7 ± 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP. CONCLUSION: In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate.

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 χ2p-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.

Injuries related to electric scooter and bicycle use in a Washington, DC, emergency department.

OBJECTIVE: E-scooter use has grown rapidly in the United States. Its rise in popularity has coincided with the promotion of cycling in many cities, but more needs to be known about how these transportation modes compare to determine if cycling should serve as an appropriate benchmark for policy decisions and safety expectations regarding e-scooters. METHODS: We examined characteristics of adults seeking treatment in a Washington, DC, emergency department (ED) for injuries associated with riding e-scooters during 2019 (n = 99) or bicycles during 2015-2017 (n = 337). RESULTS: E-scooter incidents less frequently involved moving vehicles (13.1% vs. 37.7%) or occurred on roads (24.5% vs. 50.7%) than cycling incidents. A smaller proportion of injured e-scooter riders were ages 30-49 (32.3% vs. 48.4%) and a larger proportion were 50 and older (34.3% vs. 22.6%) or female (45.5% vs. 29.1%). Distal lower extremity injuries were more common among e-scooter riders (13.1% vs. 3.0%; RR, 2.76; 95% CI, 1.79-3.54), and injuries to the proximal upper extremity (9.1% vs. 20.5%; RR, 0.49; 95% CI, 0.24-0.92) or chest, abdomen, and spine (3.0% vs. 14.0%; RR, 0.24; 95% CI, 0.07-0.70) were less common. Head injury rates were similar, but e-scooter riders more often experienced concussion with loss of consciousness (4.0% vs. 0.6%; RR, 3.03; 95% CI, 1.20-4.09) and were far less likely to wear helmets (2.0% vs. 66.4%). Estimated ED presentation rates per million miles traveled citywide were higher among e-scooter riders than cyclists (RR, 3.76; 95% CI, 3.08-4.59). CONCLUSIONS: E-scooters and bicycles are both popular forms of micromobility, but the characteristics of riders injured on them, the ways in which they become injured, and the types of injuries they sustain differ substantially. E-scooter rider injury rates, though currently high, may decrease as they gain experience; however, if the number of new users continues to climb, they will persist in using the ED more often than cyclists per mile that they travel.

Postoperative helmet therapy following fronto-orbital advancement and cranial vault remodeling in patients with unilateral coronal synostosis.

Out of all the synostotic corrective surgeries, fronto-orbital advancement and cranial vault remodeling for patients with unilateral coronal synostosis is one of the hardest to maintain symmetric and proportional correction without some amount of relapse. Over the course of 20 years operating on these patients, the senior author has made multiple adjustments to compensate for relapse asymmetry, including overcorrection on the affected side, increased points of fixation, periosteal release, and scalp expansion with galeal scoring to minimize tension of the closure. As a result of these interventions, we have seen improved immediate results following surgery. However, we have continued to note clinically significant relapse postoperatively. As such, we have started to implement postoperative helmet therapy (PHT) to help maintain the surgical correction, improve secondary brachycephaly, and increase overall symmetry. PHT is a reasonable low-risk complement to fronto-orbital advancement and cranial vault remolding. Clinically, PHT appears to help minimize relapse and improve overall head symmetry. Further investigation and increased patient enrollment are required to determine the true benefits of PHT in this patient population.

Motorcycle helmet selection and usage for improved safety: A systematic review on the protective effects of helmet type and fastening.

OBJECTIVE: Motorcycle helmets are the most common and effective protective device to reduce head injuries and mortality in crashes among powered two-wheeler riders. Even if they are globally recognized as effective, there are still concerns regarding their correct use, which is necessary to achieve maximum head protection. The goal of this systematic review is to assess which characteristics of helmet design and use showed a positive influence on rider safety, in order to provide insights to improve end-user helmet usage. METHODS: A literature search was carried out combining two sets of keywords, one related with either motorcycle or rider and the other referring to either protective equipment or injuries. After the exclusion of duplicates, 977 papers were screened by reviewers, thus identifying 32 papers that were analyzed in group discussions. RESULTS: Among the papers included in this study, no strong conflicting conclusions emerged in their results. The studies focusing on the use of different types of helmets highlighted that full-face helmets, compared with other standard helmets, have a positive influence on head injuries and facial injuries. Correct fastening was clearly beneficial for head and facial injuries, induced injuries, and helmet ejection. CONCLUSIONS: This systematic review provides important insights to improve the usage of helmets by end-users. Correct fastening is a crucial factor to avoid helmet roll-off during a crash. Most studies agreed that full-face helmets provide higher protection in comparison with other standard helmets, especially for facial injuries, and no negative influence with respect to neck and spinal injuries.

Subconcussive Head Impacts and Neurocognitive Function Over 3 Seasons of Youth Football.

OBJECTIVE: To determine the association between repetitive subconcussive head impacts and neurobehavioral outcomes in youth tackle football players. METHODS: Using helmet-based sensors, we measured head impacts for 3 consecutive seasons of play in 29 male players age 9-11. Cumulative impact g's were calculated. Players completed a battery of outcome measures before and after each season, including neuropsychological testing, vestibular-ocular sensitivity, and self- and parent-reported measures of symptoms and attention-deficit hyperactivity disorder (ADHD). RESULTS: Average cumulative impact over 3 seasons was 13 900g. High-intensity hits predicted worse change for self-reported social adjustment (P = .001). Cumulative impact did not predict change in any of the outcome measures. History of ADHD, anxiety, and depression predicted worse change for self-reported symptoms and social adjustment, independent of head impacts. When players were stratified into 3 groups based on cumulative impact across all 3 seasons, differences in outcome measures existed prior to the start of the first season. These differences did not further increase over the course of the 3 seasons. CONCLUSION: Over 3 consecutive seasons of youth tackle football, we found no association between cumulative head impacts and neurobehavioral outcomes. Larger sample sizes and longer follow-up times would further assist in characterizing this relationship.

Composite performance indicators for helmet and seat-belt enforcement as imprecise data.

OBJECTIVES: Composite road safety performance indicators (RSPIs) are useful tools in regional road safety planning. Among the indicators and data calculated by the World Health Organization (WHO), information on the effectiveness of law enforcement on various risk factors for road casualties were provided, which can be considered as qualitative indicators. The purpose of this study is to analyze the performance indicators related to the percentage of helmet and seat-belt use versus the qualitative enforcement scores attributed by WHO. METHODS: This analysis was performed for 30 member states of WHO and will show how and with what degree of efficiency the qualitative output of the enforcement score acts versus the input percentage of seat-belt and helmet use. The qualitative nature of the output index has led us to depart the traditional analysis of crisp numerical indicators related to road safety performance and to consider data as imprecise or fuzzy indices. In this study we used two methods including imprecise DEA-based CIs and fuzzy DEA-based CIs, respectively. RESULTS: Results show that the clear score achieved by the Imprecise DEA-based CI model is easy to interpret and use. Whereas, in the Fuzzy DEA-based CI model, the fuzzy indicator scores obtained based on the level of several probabilities are strong in capturing the uncertainties related to human behavior. CONCLUSIONS: Both RSPIs are applicable with slight differences that were in the order of countries and the ease of reading the results. We also found that each method has different strengths and that the FDEA-based CIs method is more accurate and more in line with the inputs than the IDEA-based CIs method.

Orthopedic injuries associated with use of electric scooters in the UK: A dangerous trend? Case series and review of the literature.

BACKGROUND: Electric scooters (e-scooters) are becoming increasingly common in major urban areas worldwide. Cities in some countries have even piloted programmes to promote their use to reduce general vehicular traffic. There have, however, been widespread media reports outlining concerns about their safety. We decided to investigate these concerns by reviewing the records of patients who presented to our center, a Level 1 Major Trauma Center in the United Kingdom, with orthopedic injuries associated with e-scooter use. METHODS: We reviewed the electronic medical records of all patients who presented to our center from January 2018 to January 2020 with e-scooter associated fractures. Demographic, injury, and surgical data were collected to characterize the types of e-scooter-related fractures and to investigate the frequency of such injuries over the duration of our search. A literature review of MEDLINE and EMBASE was performed to investigate specifically orthopedic injuries caused by electric scooter use. RESULTS: Six patients were identified (3 male, 3 female; mean age 35.43 years) who had sustained a variety of injuries. The presentation and clinical outcomes are presented. Three patients required operative management, and three patients were managed conservatively. CONCLUSION: This case series demonstrates an increasing frequency of significant orthopedic injury associated with e-scooter use treated at our center over the course of two years. This small series highlights an important problem given that this increase has occurred despite electric scooter usage in public spaces being illegal. Legalization might result in further increase in the incidence of injury.

Adolescent noncompliance with age-specific versus universal US motorcycle helmet laws: Systematic review and meta-analysis.

INTRODUCTION: The U.S. experience with motorcycle helmets affords an important insight into the responses of adolescents to age-specific laws. Political contention has led to a number of U.S. state law changes back and forth between universal and age-specific laws. Because both kinds of law require adolescent motorcyclists to wear helmets, relatively few studies have focused on how the law type affects their behavior. METHOD: Differential behavior is tested by a systematic review of literature, leading to a meta-analysis, in relation to the experience of various states' motorcycle helmet laws. An electronic search was conducted for before-and-after studies in U.S. states that include data on adolescent helmet usage - both with a universally applicable motorcycle helmet law, and with an age-restricted law (usually, under-21 or under-18) - from observational, injury or fatality records for a certain period (e.g., 12 months) pre and post the state law change. RESULTS: The search yielded ten studies, including two that compared a set of age-specific law states with a set of universal law states over the same time period. Heterogeneity analysis of seven single-state studies with raw data revealed an acceptable fit for a random-effects model. Additional noncompliance with age-restricted laws was indicated by an attributable percentage among exposed of over 65% and odds ratio exceeding 4. CONCLUSIONS: About two-thirds of adolescent noncompliance with age-restricted motorcycle helmet usage laws disappears with universal applicability. Evidence from numerous international studies of youth reaction to helmet laws suggests that a large part of the greater compliance with universal laws is due to their conveying a more convincing message that helmets afford protection against injury. Practical Applications: The meta-analysis provides fresh, young-rider perspective on the continuing debate over motorcycle-helmet laws. Broader insight into adolescent psychology suggests considering alternatives to age-restricted laws more widely in safety and health policy.

Shared electric scooter injuries admitted to Auckland City Hospital: a comparative review one year after their introduction.

AIM: E-scooters were introduced to New Zealand in 2018 as a means of city transport. Since their introduction, their use has resulted in high injury rates. No studies have directly compared e-scooters to other forms of transport. METHOD: The Auckland City Hospital trauma registry was retrospectively searched for patients admitted with an e-scooter injury. A comparison group of patients admitted with an injury secondary to cycling during the same period was collected. RESULTS: 178 patients were identified: 69 with e-scooter injuries and 109 with injuries sustained while cycling. The hospitalisation rate for e-scooter injuries was 326 hospitalisations per million hours. There was a significant difference found in blood ethanol levels (18.6 vs 6.4% positive, p-value=0.01), mechanism of injury (isolated falls: 87 vs 60.6%), time of injury (55.1 vs 40.4% between 5pm-8am) and protective gear use (worn in 10.1 vs 78.9%). No differences were found in injury severity, ICU admissions, length of stay or mortality. CONCLUSION: This study demonstrates a concerningly high e-scooter-related hospitalisation rate and suggests e-scooters are currently not as safe as cycling. Strategies to improve e-scooter safety are needed and could include zero tolerance for alcohol, mandatory protective gear, restricted operating times and changes in road laws.

Severity and predictors of head injury due to bicycle accidents in Western Australia.

BACKGROUND: Head and face injuries are the second most frequently reported injuries among bicyclists. Recently, helmet usage has increased, and in some countries, helmet laws have been introduced. However, subsequent changes in the incidence and severity of traumatic brain injury (TBI) are unknown, and data on neurosurgical interventions are lacking. Therefore, we analyzed a cohort of bicyclists with TBI, in a state with an enforced helmet law, and compared our results with the available literature. METHODS: Patient data of bicycle accidents that occurred between January 2008 and January 2015 were extracted from the state trauma registry, and the corresponding patient files and CT scans were comprehensively reviewed. RESULTS: Of the 1019 patients admitted due to bicycle accidents, 187 patients suffered from TBI. Most cases were mild; however, 72 involved intracranial hemorrhages. Of the TBI patients, 113 were wearing helmets. CT scans were performed on 168 TBI patients, 120 of whom had a Rotterdam CT score of 1, with no difference between helmeted and non-helmeted patients. Open head injury (p < 0.05) and epidural hematomas were significantly less frequent among helmet wearers (p = 0.03). Ten patients required surgery; helmet use and neurosurgical involvement were not significantly correlated. CONCLUSIONS: Patients who wore helmets were significantly less likely to suffer from epidural hematomas and open head injuries. While TBI severity was not significantly different between helmeted and non-helmeted bicyclists, the overall occurrence of TBI and moderate to severe TBI among all admissions was lower than that seen in comparable studies from countries without helmet laws.

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.

Managing head injury risks in competitive skateboarding: what do we know?

OBJECTIVES: The broad objective of this paper is to inform policy, practice and research regarding the management of head injury risks in competitive skateboarding. The main motivation for the current study was the question of mandating helmet use in competitive skateboarding. The specific aims are to present current knowledge on (A) head injury risks in skateboarding, (B) preliminary biomechanical data on falls and head injury risks in a selection of competitive skateboarding events similar to those planned for the Summer Olympics, (C) standards for skateboard-styled helmets and (D) impact performance of helmets commonly used in skateboarding. METHODS: A narrative review of the published literature on head injuries in skateboarding was conducted. Videos of skateboarding competitions from Vans Park Professional League, Street League Skateboarding and Dew Tour were reviewed to describe crashes and falls. Standards databases including the International Organization for Standardization (ISO), British Standards Institution (BSI), Snell, United States Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) were searched for skateboarding-styled helmet standards. A sample of helmets considered suitable for skateboarding was tested in standard impact tests. RESULTS: The majority of previous literature focused on the paediatric population in a recreational setting with little data from competitive skateboarding. Head injuries comprised up to 75% of all injuries and helmet use was less than 35%. Video analysis identified high rates of falls and crashes during competitive skateboarding, but also a capacity for the athletes to control falls and limit head impacts. Less than 5% of competitive skateboarders wore helmets. In addition to dedicated national skateboard helmet standards, there are several national standards for skateboard-styled helmets. All helmets, with the exception of one uncertified helmet, had similar impact attenuation performance; that is, at 0.8 m drop height, 114-148 g; at 1.5 m, 173-220 g; and at 2.0 m, 219-259 g. Impact performance in the second impact was degraded in all helmets tested. CONCLUSION: Helmets styled for skateboarding are available 'off the shelf' that will offer protection to the head against skull fractures and intracranial injuries in competitive skateboarding. There is an urgent need to commence a programme of research and development to understanding and control head injury risks.

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.

To helmet or not to helmet: a global perspective on the bicycle compulsory protective helmet law.

Child injury from bike accidents is a significant component of morbidity, mortality and health expenditure in many countries. Universal use of bicycle helmets by children could prevent between 135 and 155 deaths, and between 39,000 and 45,000 head injuries annually. Surprisingly, epidemiologic data indicate a worldwide low prevalence of helmet use. A global view on the law on the compulsory use of safety helmets involving 58 different countries is provided in order to bring this critical debate back to the table. A broad search using "bicycle-related injuries," "bicycle helmet," "bicycle helmet legislation" and "compulsory bicycle helmet law by countries" was performed in order to identify and select the most pertinent information on the issue as well as all the information available on bicycle helmet law by countries. The papers identified permitted us to assess the main topics related to the use of bicycle helmets discussed over the years which are still relevant and without consensus even today, as well as alphabetically enlist the approach of 58 countries to the compulsory helmet law. Our review on the many faces of the bicycle helmet use (pros and cons), personal aspects, head injuries, legislation, promotion, socioeconomic influence, and finally a global view on the law on the compulsory use of safety helmets allowed us to bring here many suggestions and a few conclusions, mainly because "to helmet or not to helmet" should not be a question anymore. A universal consensus on their compulsory use has to be achieved in order to improve children's safety.

The Pattern of Injuries Among Motorcyclists in Fatal Road Traffic Accidents: An Autopsy-Based Study.

INTRODUCTION: In recent years, there has been a significant increase in mortality among motorcyclists, which warrants a need to analyze the epidemiology and pattern of injuries among road users in Malaysia. Hence, prioritizing road safety in the government policy by implementing targeted actions is justified to reduce injury and fatality. MATERIALS AND METHODS: Cases of road accident deaths in motorcyclists received by UKM Medical Centre were studied over a period of 10 years, that is, between 2010 and 2019. This study was based on forensic autopsy records database and forensic autopsy. RESULTS: The most affected age group by road fatalities were young men. The most common injuries were intracranial hemorrhage (74%), thoracic hemorrhage (73%), and lung laceration (85.7%). About 39 (31%) fatally injured riders were positive for illicit drug and/or alcohol. CONCLUSIONS: This study showed that men in the third decade of life are the major victims of motorcycle fatalities. Hence, urgent measures are necessary to establish road safety policy to reduce such fatalities.

Prevalence of unprotected motorcycle riding and its association with other risk behaviors among adolescents in Chiang Mai, Thailand.

OBJECTIVES: To determine the prevalence of helmet use in Chiang Mai province in Thailand and identify the association between helmet use, externalized behaviors, and other risk-taking behaviors. METHODS: A cross-sectional study was conducted using the Youth Risk Behavior Survey, Thai version. Risky motor vehicle behaviors and other risk-taking behaviors of 4,372 adolescents were measured. Behavioral problems from the Youth Self-Report were also obtained from all participants. RESULTS: A total of 2,981 adolescents (68.2%) reported motorcycle riding, of which, 36.3% reported unprotected riding. Females, younger age, attending secondary school, and those with academic underachievement were related to the unprotected riding group. Unprotected riding was significantly associated with other risky traffic behaviors and also related to other risk-taking behavior such as violence and substance use. Significantly higher behavioral problems scores were found in unprotected riding adolescents (p < 0.001). CONCLUSIONS: The prevalence of unprotected riding and other risk behaviors in Thai adolescents were high. Safety traffic riding campaigns should start in late primary school focusing on those females with poor academic achievement.

Are motorcycles really "donorcycles"? Examining organ donation rates between unhelmeted and helmeted motorcyclists.

INTRODUCTION: Motorcycles are colloquially referred to as "donorcycles" among medical staff. However, the actual impact of helmet laws and helmet use on organ donation is unknown. Michigan's 35-year-old universal helmet law (UHL) was repealed in April 2012 and replaced by a partial-helmet law. We hypothesized that there would be an increase in organ donation rates from unhelmeted motorcyclist fatalities. METHODS: Michigan's Gift of Life Michigan organ donation database was queried from April 2008 through May 2015 in conjunction with the Michigan Trauma Quality Improvement Program database from the same time period. All in-hospital motorcycle crash fatalities were examined. RESULTS: A three-fold increase was found in the rate of organ donation for unhelmeted motorcyclists compared to helmeted motorcyclists (p = 0.006). Motorcycle crash fatalities tended to be younger in age after the UHL repeal with an average age of 32.8 years versus 40.8, however, this finding was not statistically significant (p = 0.071). Additionally, there was no significant difference in organ donation rates pre-UHL repeal (2008-2012) versus post-repeal (2012-2015). CONCLUSIONS: This is the first study to demonstrate an increased rate of organ donation among unhelmeted motorcyclist fatalities compared to helmeted rider fatalities. There was no significant increase in the rate of organ donation following the Michigan UHL repeal. However, we identified that some motorcycle crash fatalities were from illegally unhelmeted riders in the past, prior to the repeal. Practical Application: Unhelmeted motorcyclists are three times more likely than helmeted riders to become organ donors, possibly due to the well documented increase in severe traumatic brain injuries in this population. From a public health perspective, helmets should be required for all motorcyclists and efforts to advocate in favor of helmet legislation should be supported by trauma systems and health professionals.

Motorcycle-related head and neck injuries: increased risk among ethnic minorities.

BACKGROUND: Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC. METHODS: The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling. RESULTS: Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12-1.65) and TBI (OR = 1.51,95%CI = 1.12-1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12-0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00-1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61-0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39-0.7). In-hospital mortality was not associated with ethnicity. CONCLUSIONS: Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.