Incorporating neck biomechanics in helmet testing: Evaluation of commercially available WaveCel helmets

BACKGROUND

Cycling helmets often incorporate elements aimed to dissipate rotational energies, which is widely acknowledged to play a key role in concussion mechanics. In this study, we investigated the mechanics of an oblique helmet test protocol that induced helmet rotation while using it to evaluate the effectiveness of three helmet models: two standard expanded polystyrene helmets and a commercially-available helmet equipped with a liner designed to mitigate linear and rotational energies.

METHODS

Helmets equipped with WaveCel were tested against two expanded polystyrene helmet models through guided drops using a Hybrid III (HIII) head-and-neck surrogate. The three helmet models were tested across four impact conditions (n = 5) of different speeds and impact surface angles.

FINDINGS

Across all tests, a similar sequence of head motion was observed - first a flexion phase followed by an extension phase. The extension phase lacked evidence of biofidelity and was likely attributable to the energy stored in the neckform during the flexion phase; it was therefore neglected from analysis. Results showed WaveCel reduced the probability of AIS2 head injury across all tests (3 to 27% reductions in 4.8 m/s impacts; 36 to 37% reductions in 6.2 m/s impacts).

INTERPRETATION

The two-phased response of the HIII suggests that boundary condition selection can influence results and should thus be reported in studies using similar methods. While this protocol involved both axial and tangential impact components and were thus representative of real-world collisions, the efficacy of WaveCel should be further investigated through additional laboratory studies and tracking real-world cycling injury statistics.

Incidence of Electric Scooter-Associated Injuries in Finland From 2019 to 2021

This cross-sectional study examines the incidence of injuries associated with the use of electric scooters in Finland.

Collision versus loss-of-control motorcycle accidents: Comparing injuries and outcomes

OBJECTIVE

Motorcycles are a common mode of transport, especially in low-middle-income countries like Pakistan. The pattern and severity of injuries in motorcycle trauma depends on the mechanism of accident, which may be classified as collision accidents (CAs) or loss-of-control accidents (LOCAs). In this study, we aimed to investigate patterns of trauma due to motorcycle CAs and LOCAs, with a focus on injuries, management, complications, and outcomes.

METHODS

A retrospective cohort study was conducted at the Aga Khan University Hospital (AKUH), Pakistan (a level 1 trauma facility), enrolling all patients presenting with motorcycle trauma between January 2018 and March 2019.

RESULTS

The most common sites of major injury were the lower limb (40.9%), head and neck (38.1%), and upper limb (27.5%). A significantly higher percentage of CA victims had head and neck injuries (43.4% vs. 30.5%), abdominal injuries (5.5% vs. 1.1%), pelvic fracture (5.9% vs. 0%), and polytrauma (22.8% vs. 11.1%). Compared to LOCA victims, CA victims had a significantly higher incidence of acute kidney injury (AKI; 25.7% vs. 15.8%; P < .011), longer hospital lengths of stay (LOSs; 3 [2-6] days vs. 2.5 [2-4] days; P = .019), and long-term disability (P = .002). When adjusted for age and gender on multivariable logistic regression with mechanism of accident as the dependent variable, CA was significantly associated with male gender (odds ratio [OR] = 2.045, 95% confidence interval [CI] [1.038-4.026]), abdominal injury (OR = 5.748, 95% CI [1.285-25.702]), head and neck injury (OR = 1.492, 95% CI [1.007-2.211]), polytrauma (OR = 2.368, 95% CI [1.383-4.055]), AKI (OR = 1.937, 95% CI [1.183-3.171]), and LOS (OR = 1.041, 95% CI [1.004-1.079]).

CONCLUSIONS

Though both motorcycle CAs and LOCAs stress trauma systems in developing countries, the dynamics of CAs mean that they result in worse injuries and outcomes. Specific measures to reduce CAs and LOCAs are urgently indicated in developing countries to reduce the burden of morbidity and mortality of motorcycle accidents.

SHEL5K: An Extended Dataset and Benchmarking for Safety Helmet Detection

Wearing a safety helmet is important in construction and manufacturing industrial activities to avoid unpleasant situations. This safety compliance can be ensured by developing an automatic helmet detection system using various computer vision and deep learning approaches. Developing a deep-learning-based helmet detection model usually requires an enormous amount of training data. However, there are very few public safety helmet datasets available in the literature, in which most of them are not entirely labeled, and the labeled one contains fewer classes. This paper presents the Safety HELmet dataset with 5K images (SHEL5K) dataset, an enhanced version of the SHD dataset. The proposed dataset consists of six completely labeled classes (helmet, head, head with helmet, person with helmet, person without helmet, and face). The proposed dataset was tested on multiple state-of-the-art object detection models, i.e., YOLOv3 (YOLOv3, YOLOv3-tiny, and YOLOv3-SPP), YOLOv4 (YOLOv4 and YOLOv4_pacsp-x-mish), YOLOv5-P5 (YOLOv5s, YOLOv5m, and YOLOv5x), the Faster Region-based Convolutional Neural Network (Faster-RCNN) with the Inception V2 architecture, and YOLOR. The experimental results from the various models on the proposed dataset were compared and showed improvement in the mean Average Precision (mAP). The SHEL5K dataset had an advantage over other safety helmet datasets as it contains fewer images with better labels and more classes, making helmet detection more accurate.

The Governance of Helmet Safety to Prevent Traumatic Brain Injury in the Caribbean

BACKGROUND

The Caribbean is a unique region of islands and cays home to nearly 43 million people. A significant challenge facing this population is the burden of traumatic brain injury, which disproportionately affects younger individuals and carries a significant economic burden. A preventive measure to reduce this burden is consistent wearing of helmets. This study aims to assess TBI prevention through helmet safety in Caribbean nations in order to demonstrate the regional impact of public health solutions.

METHODS

We assess the member states of the Caribbean Community (CARICOM) and sought to evaluate CARICOM nations' TBI prevention through helmet safety with relation to public health, policy, laws, infrastructure, and regulations. We produced the Rolle Scoring System (RSS) to ascertain the influence of governance around helmet safety for TBI prevention. The RSS aims to provide a quantifiable method of how well a CARICOM nation is performing in efforts to reduce TBI. The RSS is broken down into 2 categories, with scores ranging from 1 (worst) to 5 (best). The range of possible scores a CARICOM nation could receive was 8 to 40.

RESULTS

Fourteen CARICOM nations were ultimately incorporated into our analysis. From the initial cohort, 3 were removed. These nations were Anguilla, Saint Kitts & Nevis, and Montserrat. We analyzed values derived from the RSS, finding a mean Rolle score of 22. We further subdivided the nations into low Rolle score (8-24) and high Rolle score (>24). Trinidad and Tobago had the highest Rolle score at 29. Haiti was found to have the lowest Rolle score at 8.

CONCLUSION

Several Caribbean nations have demonstrated leadership pertaining to TBI prevention through helmet safety. The regional momentum of helmet safety in the Caribbean can serve as a model for other geographical regional blocs that share interests and culture to consider comprehensive approaches to public health challenges.

Computational prediction of head-ground impact kinematics in e-scooter falls

E-scooters are the fastest growing mode of micro-mobility with important environmental benefits. However, there are serious concerns about injuries caused by e-scooter accidents. Falls due to poor road surface conditions are a common cause of injury in e-scooter riders, and head injuries are one of the most common and concerning injuries in e-scooter falls. However, the head-ground impact biomechanics in e-scooter falls and its relationship with e-scooter speed and design, road surface conditions and wearing helmets remain poorly understood. To address some of these key questions, we predicted the head-ground impact force and velocity of e-scooter riders in different falls caused by potholes. We used multi-body dynamics approach to model a commercially available e-scooter and simulate 180 falls using human body models. We modelled different pothole sizes to test whether the pothole width and depth influences the onset of falls and head-ground impact velocity and force. We also tested whether the e-scooter travelling speed has an influence on the head-ground impact velocity and force. The simulations were carried out with three human body models to ensure that the results of the study are inclusive of a wide range of rider sizes. For our 10 in. diameter e-scooter wheels, we found a sudden increase in the occurrence of falls when the pothole depth was increased from 3 cm (no falls) to 6 cm (41 falls out of 60 cases). When the falls occurred, we found a head-ground impact force of 13.2 ± 3.4kN, which is larger than skull fracture thresholds. The head-ground impact speed was 6.3 ± 1.4 m/s, which is the same as the impact speed prescribed in bicycle helmet standards. All e-scooter falls resulted in oblique head impacts, with an impact angle of 65 ± 10° (measured from the ground). Decreasing the e-scooter speed reduced the head impact speed. For instance, reducing the e-scooter speed from 30 km/h to 20 km/h led to a 14% reduction in the mean impact speed and 12% reduction in the mean impact force, as predicted by the models. The models also showed that the median male riders were sustaining higher head-ground impact force and speed compared with the small female and large male riders. The findings of this study can assist authorities and e-scooter hiring companies to take more informed actions about road surface conditions and speed limits. These results can also help define representative impact test conditions for assessing the performance of helmets used by e-scooter riders in order to reduce head and brain injuries in e-scooter falls.

Pediatric injuries related to electric scooter use: a national database review

Electric scooter (e-scooter) use and resulting injuries have grown exponentially since expansion into ridesharing in 2017. No study has described pediatric e-scooter injuries and focused on their impact in an adolescent cohort. Our primary purpose was to describe the epidemiology of admitted pediatric e-scooter injuries and compare them with existing literature on adults. We queried the National Electronic Injury Surveillance System for e-scooter injuries between 2015 and 2019 in patients 0-18 years old. Injuries caused by an e-scooter to a nonrider were removed. Patients admitted to the hospital were analyzed and weighted national estimates were calculated. A P value of <0.05 was considered significant. Nine hundred and two pediatric patients were treated for an e-scooter injury at an emergency department (ED) between 2015 and 2019. Among those admitted (n = 47), 72.3% were men, and the average age at injury was 11.3 years. Among all injuries (n = 56), the most common diagnosis was fracture (24/56, 42.9%). The 19% (9/47) of patients that experienced polytrauma were significantly older than those with single injuries (P < 0.001). ED admissions grew by 616% from 2017 to 2018. Children experience a greater rate of fractures and polytrauma from e-scooters compared to adults, but fewer facial injuries despite a similar rate of head trauma. The incidence of pediatric head injuries indicates a lack of helmet use similar to adults. Lawmakers should consider bolstering e-scooter regulations to decrease pediatric injuries.

Alcohol intoxication and lack of helmet use are common in electric scooter-related traumatic brain injuries: a consecutive patient series from a tertiary university hospital

PURPOSE

Clinicians have increasingly encountered traumatic brain injuries (TBI) related to electric scooter (ES) accidents. In this study, we aim to identify the modifiable risk factors for ES-related TBIs.

METHODS

A retrospective cohort of consecutive patients treated for ES-related traumatic brain injuries in a tertiary university hospital between May 2019 and September 2021 was identified and employed for the study. The characteristics of the accidents along with the clinical and imaging findings of the injuries were collected from the patient charts.

RESULTS

During the study period, 104 TBIs related to ES accidents were identified. There was a high occurrence of accidents late at night and on Saturdays. In four cases, the patient's helmet use was mentioned (3.8%). Seventy-four patients (71%) were intoxicated. At the scene of the accident, seventy-seven (74%) of the patients had a Glasgow Coma Scale score of 13-15, three patients (3%) had a score of 9-12, and two patients (2%) had a score of 3-8. The majority (83%) of TBIs were diagnosed as concussions. Eighteen patients had evidence of intracranial injuries in the imagining. Two patients required neurosurgical procedures. The estimated population standardized incidence increased from 7.0/100,000 (95% CI 3.5-11/100,000) in 2019 to 27/100,000 (95% CI 20-34/100,000) in 2021.

CONCLUSIONS

Alcohol intoxication and the lack of a helmet were common in TBIs caused by ES accidents. Most of the accidents occurred late at night. Targeting these modifiable factors could decrease the incidence of ES-related TBIs.

Impact of Helmet-Wearing Policy on E-Bike Safety Riding Behavior: A Bivariate Ordered Probit Analysis in Ningbo, China

At present, Chinese authorities are launching a campaign to convince riders of electric bicycles (e-bikes) and scooters to wear helmets. To explore the effectiveness of this new helmet policy on e-bike cycling behavior and improve existing e-bike management, this study investigates the related statistical distribution characteristics, such as demographic information, travel information, cycling behavior information and riders’ subjective attitude information. The behavioral data of 1048 e-bike riders related to helmet policy were collected by a questionnaire survey in Ningbo, China. A bivariate ordered probit (BOP) model was employed to account for the unobserved heterogeneity. The marginal effects of contributory factors were calculated to quantify their impacts, and the results show that the BOP model can explain the common unobserved features in the helmet policy and cycling behavior of e-bike riders, and that good safety habits stem from long-term safety education and training. The BOP model results show that whether wearing a helmet, using an e-bike after 19:00, and sunny days are factors that affect the helmet wearing rate. Helmet wearing, evenings during rush hour, and picking up children are some of the factors that affect e-bike accident rates. Furthermore, there is a remarkable negative correlation between the helmet wearing rate and e-bike accident rate. Based on these results, some interventions are discussed to increase the helmet usage of e-bike riders in Ningbo, China.

Characteristics of crashes and injuries on delivery motorcycles: A retrospective cohort study

Objectives: The food delivery market is growing rapidly. As most delivery riders use motorcycles, motorcycle crashes will increase along with the growing delivery market size. This study aimed at examining the proportions of motorcycle crashes and characteristics of injuries incurred while using motorcycles for occupational purposes.Methods: This retrospective analysis included motorcycle crash patients aged 16 years or older, who were treated in 23 emergency rooms in Korea, between 2014 and 2018. Patients were divided into two groups: delivery riders (delivery group) and others (nondelivery group). Crash and injury characteristics were compared between the two groups. In addition, trends of patients in the delivery group were compared from 2014 to 2018.Results: This study examined 26,982 motorcycle crash patients, including 3894 (14.43%) patients in the delivery group and 23,088 (85.57%) in the nondelivery group. The number of patients in the delivery group increased drastically from 583 in 2014 to 1029 in 2018, whereas the number of patients in the nondelivery group did not considerably increase (4411 in 2014 and 4462 in 2018). The delivery group had a higher proportion of crashes caused by collisions with cars or other motorcycles (p < 0.001); however, injury severity was lower. The delivery group had a lower proportion of head and face injuries but a higher proportion of extremity injuries. Furthermore, 39.9% of all crashes in this group occurred between 17:00 and 21:00. Over time, there were neither any changes in the injury severities, nor any changes in the characteristics of the delivery group, with the exception of increases in both the proportion of motorist insurance and the proportion of wearing a helmet.Conclusions: The results indicated differences in characteristics between delivery motorcycle crashes and other motorcycle crashes. Although delivery motorcycle crash severity was low compared to other motorcycle crashes, the number of patients increased significantly. Therefore, to prevent crashes, it is necessary to improve the working environment. In addition, to prevent the extremity injuries of delivery riders, the policy of wearing extremity protective gears should be considered.

An analysis of the novice motorcyclist crashes in Taiwan

OBJECTIVE

Motorcycles comprised over 60% of motor vehicles in Taiwan. There were still many motorcycle crashes in Taiwan, especially among young riders. This study investigated the characteristics of novice motorcyclist crashes in Taiwan over the period January 2011 to December 2016. Various risk factors affecting the severity of novice motorcyclist crashes, such as the rider characteristics, licensing conditions, and the environment, were examined.

METHODS

To model the count data with multiple crash severities, several regression models were considered. The multinomial logit (MNL) model, ordered logit (OL) model, and partial proportional odds (PPO) model were chosen and investigated for the relationships between the severity of novice motorcyclist crashes and potential risk factors.

RESULTS

The results showed that the novice rider who was underage or unlicensed had a higher probability of a fatal crash. Male sex, helmet use, drinking, college student, frontal impact, urban or dry road, and daytime all played significant roles in novice motorcyclist crashes.

CONCLUSIONS

Taiwan traffic safety needs further policy adjustments and public education toward novice motorcycle crashes. Adequate driving training and providing a user-friendly environment for novice riders could help. Taiwan should consider graduated driver licensing systems for skill-building and riding supervision for new motorcyclists.

Injuries and Overuse Injuries in Show Jumping—A Retrospective Epidemiological Cross-Sectional Study of Show Jumpers in Germany

This retrospective cross-sectional epidemiological study deals with sport-specific injury patterns in show jumping. A total of 363 show jumpers of all levels (S) answered a retrospective questionnaire about injuries and overuse damages which occurred in the course of their careers. Demographic data and information on injuries in various body regions were collected. In addition to descriptive analysis, significance tests were performed. For better statistical comparability with other sports, exposure time was extrapolated with total career duration and weekly training hours, and injuries per 1000 jumping hours were calculated. The study included 251 (69%) women and 112 (31%) men, who were on average 26.9 ± 10.9 years old. The injury rate for the entire collective was 3.7 per 1000 h of exposure. The most frequently affected body region was the head (31%). Overuse complaints play a subordinate role and mainly affect the upper extremities (65%). The riders of the professional lower performance levels are less likely to injure themselves per 1000 h than riders of the higher performance levels. Riders who often or always wore a helmet suffered significantly fewer head injuries (p = 0.008) and had a significantly lower total injury duration than riders who did not wear a helmet (p = 0.006). Similarly, the study showed that riders who often or always wore a safety vest suffered significantly fewer spinal injuries (p = 0.017) and had significantly fewer injuries per 1000 riding hours (p = 0.031) than riders who did not wear a safety vest. Based on the present results, there should be an extension of the general helmet requirement and a requirement to wear safety vests in show jumping in general.

An empirical investigation of firefighting personal protective equipment and burn injuries in Korea

This study aimed to investigate the current situation of firefighting burn injuries and personal protective equipment (PPE) in Korea using a questionnaire. A questionnaire was constructed and then distributed to fire stations via the Fire & Disaster Headquarters of Korea. Responses from a total of 536 firefighters who were currently responsible for suppressing fire or doing rescue work were analysed (39.2 ± 8.58 y in age, 173.8 ± 5.0 cm in height, 73.4 ± 8.9 kg in body weight). The results showed that 22% of firefighters had experienced burns but of these 93% of were burns of less than 1% of total body surface area. The most common body site of burn injury was the hands (37%) and the head (face and neck) (34%). There were significant relationships between PPE non-compliance and career years, especially for the hood and boots. According to firefighters their gloves were the most vulnerable part of their PPE. We also elucidated relationships between the body sites most vulnerable to burn injuries and PPE wear compliance by item. The present results suggest that officially-undisclosed minor burn injuries but prevailing among firefighters can be reduced through improving firefighters' protective helmet, hoods and gloves.

Multilevel analysis of injury severity of elderly motorcycle riders: The role of regional transport development

OBJECTIVE

Research specifically focusing on the elderly segment of motorcycle riders remains largely scarce, which represents a serious lack in understanding given the fast-growing trend of aging societies around the world. This article examines factors affecting the injury severity of elderly motorcycle riders in Taiwan using a multilevel model consisting of both individual and municipality levels. In particular, this study emphasized the role of municipality-level factors closely related to the municipality characteristics and policy considerations in directing local governments' policies and implementing crash-prevention strategies and measures.

METHODS

A multilevel logistic regression model was specified and estimated by using crash data of elderly motorcycle riders across 20 municipalities in Taiwan between 2012 and 2018. Principal component analysis was employed to identify the municipality-level factors.

RESULTS

Individual-level factors such as being male, old age, no valid license, drunk driving, not wearing a helmet, turning or overtaking others, early morning and evening riding, errors in traffic signaling, and exceeding the speed limit have significant effects on injury severity. The highlighted municipality-level factor, the transport development index, demonstrates its significant effect on mitigating injury severity across municipalities.

CONCLUSIONS

Apart from considering individual factors such as driver-related, vehicle-related and road-side-related variables, this paper shed light on the role of transport development level of a municipality in analyzing the injury severity of elderly motorcycle riders. Policy implications in directing local governments' policies and implementing crash-prevention strategies and measures are discussed and provided.

Helmet noninvasive ventilation for COVID-19 patients (Helmet-COVID): statistical analysis plan for a randomized controlled trial

BACKGROUND

Noninvasive respiratory support is frequently needed for patients with acute hypoxemic respiratory failure due to coronavirus disease 19 (COVID-19). Helmet noninvasive ventilation has multiple advantages over other oxygen support modalities but data about effectiveness are limited.

METHODS

In this multicenter randomized trial of helmet noninvasive ventilation for COVID-19 patients, 320 adult ICU patients (aged ≥14 years or as per local standards) with suspected or confirmed COVID-19 and acute hypoxemic respiratory failure (ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 200 despite supplemental oxygen with a partial/non-rebreathing mask at a flow rate of 10 L/min or higher) will be randomized to helmet noninvasive ventilation with usual care or usual care alone, which may include mask noninvasive ventilation, high-flow nasal oxygen, or standard oxygen therapy. The primary outcome is death from any cause within 28 days after randomization. The trial has 80% power to detect a 15% absolute risk reduction in 28-day mortality from 40 to 25%. The primary outcome will be compared between the helmet and usual care group in the intention-to-treat using the chi-square test. Results will be reported as relative risk  and 95% confidence interval. The first patient was enrolled on February 8, 2021. As of August 1, 2021, 252 patients have been enrolled from 7 centers in Saudi Arabia and Kuwait.

DISCUSSION

We developed a detailed statistical analysis plan to guide the analysis of the Helmet-COVID trial, which is expected to conclude enrollment in November 2021.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04477668 . Registered on July 20, 2020.

Evaluation of the head protection effectiveness of cyclist helmets using full-scale computational biomechanics modelling of cycling accidents

INTRODUCTION

Cycling is a popular choice for urban transportation. Helmets are important and the most popular means of head protection for cyclists. However, a debate about the effectiveness of helmets in protecting a cyclist's head from injury continues.

METHOD

We employed computational biomechanics methods to analyze the head protection effectiveness of nine off-the-shelf-helmets for two typical impact scenarios that occur in cycling accidents: cyclist's head impacting a kerb (kerb-impact) and cyclist skidding (skidding impact) on the road surface. We conducted drop tests for all nine analyzed helmets, and used the test data for validation of the corresponding helmet finite element (FE) models created in this study. The validated helmet models were then used in the full-scale computer simulations (FE analysis for the skull, brain and helmet, and multibody dynamics for the remaining segments of the cyclist's body) of the cycling accidents for cyclists wearing a helmet and without a helmet.

RESULTS

The results indicate that helmets can reduce both the peak linear acceleration of the cyclist head center of gravity (COG) and the risk of cyclist skull fracture. However, higher rotational acceleration of the head COG was predicted for cyclists wearing helmets. The results obtained using the injury criteria that rely on the brain deformations (maximum shear strain MPS and cumulative strain damage measure CSDM) suggest that helmets may offer protection in all the analyzed cyclist impact scenarios. However, the predicted level of protection varies for different helmets and impact scenarios with appreciable variations in the predictions obtained using different injury criteria. Reduction in the maximum principal strain (MPS_0.98) for helmeted cyclists was predicted for both impact scenarios. In contrast, wearing the helmet reduced the CSDM only for the skidding impact scenario. For the kerb-impact scenario, no clear influence of the helmet on the predicted CSDM was observed.

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.

Head Impact Exposure of a Youth Football Team over Eight Consecutive Seasons

PURPOSE

This study examined HIE of middle school football players over multiple seasons.

METHODS

Head impact exposure was evaluated in 103 football players (11-14 yr) who participated in a community-based youth tackle football program, up to 2 yr, with the same coaching staff over eight consecutive seasons (2012-2019). Head impact exposure was assessed using the Head Impact Telemetry System. Median of individual mean head impacts per session (HIPS) and median of individual 50th and 95th percentile head impact magnitudes were compared across seasons.

RESULTS

There were 33,519 head impacts measured throughout the study. Median HIPS for all sessions decreased every year, with a significant reduction from 2012 to 2019 (11.1 vs 2.3 HIPS; P < 0.05). Median game HIPS were significantly reduced in 2019 compared with 2012-14 (5.00 vs 16.30-17.75 HIPS; P < 0.05). Median practice HIPS were reduced by 81.3%, whereas median game HIPS were reduced by 69.3%. Median 50th and 95th percentile linear and rotational acceleration were lower in 2019 compared with some earlier years but remained unchanged during games.

CONCLUSIONS

Head impacts incurred by youth football players decreased substantially over eight seasons, with players in the final year sustaining approximately one fifth the HIPS as players experienced during the first year. The most prominent decline occurred in practices, although players also had much fewer head impacts in games. These results suggest that coaches' and/or players' behavior can be modified to greatly reduce the head impact burden in youth football.

[Dooring Bicycle Accidents with Severe Injury Patterns: 10-Year Study of a Level 1 Trauma Center]

Dooring Bicycle Accidents with Severe Injury Patterns: 10-Year Study of a Level 1 Trauma Center Abstract. Studies in Switzerland, Germany and Austria have shown that, contrary to popular belief, dooring accidents are among the most common bicycle accidents. The resulting injuries are often serious and often lead to hospital admission. All dooring accidents of the Inselspital Emergency Department in Bern between 2012 and 2021 were identified and evaluated retrospectively. The data were generated from the database of the management system (Ecare) of the University Hospital Bern by means of a search query with the German keywords: "Autotüre", "Autotuere", "Dooring" and were anonymised. Most patients were female and on average 34 years old; most injuries occurred to the head and the extremities. Treatment was mostly done on an outpatient basis. The ISS (Injury Severity Score) was an average of 3.5. One of the patients needed emergency surgery. This is the first Swiss study to systematically record and evaluate dooring accidents. Since cycling is a trend, especially in urban areas, and consequently the number of cyclists is constantly increasing, it can be assumed that the number of dooring injuries will also increase and corresponding prevention measures will have to be taken. The current COVID-19 pandemic tends to aggravate the problem, as in the context of infection control the number of cyclists and, consequently, accidents is increasing, especially in urban areas, in the context of infection control. This said, it is crucial to gain more information about the time slots of the accidents and the casualties through appropriate studies in order to take adequate preventive and protective measures.

Evaluation of Protective Properties of Commercially Available Medical Helmets: Are Medical Helmets Protective?

OBJECTIVES

The aims of the study were to evaluate and to compare protective properties of commercially available medical helmets for a set of standardized head injury risk measures.

METHODS

Eleven helmet types were evaluated to represent the variety of commercially available medical helmet designs and manufacturers. A test mannequin and sensor apparatus were used to simulate a backward-standing fall. The head/neck size, mass, and "standing" height of the mannequin (5'9″) were representative of a 50th percentile male. A triaxial array was placed at the head center of mass to position 3 linear accelerometers and 3 angular rate sensors. Data were collected for 5 single trials for each helmet, as well as 5 repeated trials. Five trials were also collected with no helmet scenarios. Three head injury risk measures were examined (linear acceleration, angular acceleration, and head injury criterion). Data were analyzed by clinical cutoff thresholds and continuous values.

RESULTS

Helmets varied in their performance across head injury risk measures. All helmets provided higher levels of protection compared with no helmet scenarios. No helmets were protective for subdural hematoma (measured by angular acceleration). All helmets lost protective properties with repeated falls. Results for skull fracture risk were inconsistent between linear acceleration and head injury criterion injury risk measures.

CONCLUSIONS

No helmets were protective across all head injury risk measures. Medical helmets may reduce some fall injury severity but may not prevent all types of head injury. All helmets exhibited worsening of protective properties with repeated falls. We recommend medical helmets be replaced after each fall incident where the helmet impacts another surface.

A cranio-encephalic trauma due to electric-scooter accident: could the wearing of a helmet reduce this risk?

Nowadays, one of the most important health and social policy issues concerning all countries is the problem of road accident rates. Traffic is one of the most important risk factors. For this reason, ridesharing companies have been launching electric scooters in Rome since June 2019 with the aim of reducing car traffic. In the absence of relevant legislations, the risk is that of facing an increase in deaths due to electric scooter crashes. We report the case of an electric scooter accident victim with cranio-encephalic trauma associated with limb injuries that caused immediate death. This case report emphasizes how the obligation of using helmets must be extended to all ages, in order to reduce the risk of increasing the number of deaths. Compulsory helmet use can reduce fatalities in all cases where high-speed crashes are not involved.

Comparison of injuries among motorcycle, moped and bicycle traffic accident victims

OBJECTIVE

Motorcycles, moped scooters and bicycles are commonly involved in traffic accidents and riders often suffer significant morbidity and mortality. The aim of this study is to compare and categorize the different injury patterns and fractures suffered by riders of each vehicle type after a traffic accident.

METHODS

Data from a level 1 trauma center in Las Vegas, Nevada were analyzed. Traffic accident victims riding a motorcycle, moped, or bicycle from 2013 to 2017 were included. Injury location and fracture location were assigned to six and sixteen categorical locations, respectively. Descriptive statistics, including frequency counts for categorical data and mean for continuous data, were calculated for the full sample and for each of the vehicle types. Logistic regression was performed on race, categorized age, vehicle type and helmet use to calculate adjusted odds ratios for injury type between the three groups.

RESULTS

Of the 2115 patients, 1372 were motorcyclists, 356 were moped scooter riders and 387 were bicyclists. Overall the vast majority of injuries reported were of the extremities or pelvic girdle (62.2%), and this was true regardless of vehicle type. Head and neck injuries were significantly more common in bicyclists (39.5%) and moped riders (34.6%), than in motorcyclists (22.7%). Helmet use was substantially lower in the moped (34%) and bicycle (20%) groups compared to the motorcycle group (85%). The most common fractures regardless of vehicle type were of the skull/face, rib, vertebral, and tibia/fibula with slight variations between vehicle groups.

CONCLUSION

Similarities were seen in the most common fracture and injury patterns between the three groups. Head and neck injuries were much more common in moped and bicycle riders compared to motorcyclists. This is most likely due to the significantly higher percentage of motorcycle riders who wore a helmet. Counseling regarding helmet and protective equipment use, especially among moped and bicycle riders is essential to reduce head injuries.

Changes in shared and private e-scooter use in Brisbane, Australia and their safety implications

Shared electric scooter (e-scooter) schemes debuted in US cities in 2017 and have spread to many cities worldwide. Rider inexperience and the inexperience of other road users in interacting with e-scooters may be contributing to injuries. Shared e-scooters came to Brisbane, Australia, in November 2018 and our observational study in February 2019 found a high level of non-compliance with regulations by riders of shared, but not private, e-scooters. This paper examines whether e-scooter safety improved over time by comparing the numbers and behaviors of shared and private e-scooter riders with a follow-up observational study conducted in October 2019. Riders of e-scooters (and bicycles) were counted at six sites in inner-city Brisbane by trained observers over four weekdays. Type of e-scooter (private, Lime, Neuron), helmet use, gender, age group, riding location, time of day and presence of passengers were recorded. The number of shared e-scooters observed dropped from 711 in February to 495 in October but the number of private e-scooters increased from 90 to 269, resulting in a slight reduction in the total number of e-scooters. The correct helmet wearing rate increased non-significantly from 61.4% to 66.8% for shared e-scooters and remained high for riders of private e-scooters (95.5% in February and 94.3% in October). The percentage of e-scooters ridden on the road (which is illegal in central Brisbane) remained roughly the same (shared: 6.6% in February, 4.2% in October; private: 4.5% in February, 4.9% in October). The percentage of children and adolescents (illegally) riding shared e-scooters fell from 10.3% to 6.7%. The prevalence of any of these illegal behaviors among shared e-scooter riders fell significantly for shared e-scooter riders from 49.6% to 39.1% while the prevalence of illegal behaviors by other riders remained lower and did not change. The reduction in illegal behavior among shared e-scooter riders accompanied by the tripling of usage of private e-scooters suggests that e-scooter safety is likely to have improved.

Head protection in electric micromobility: A critical review, recommendations, and future trends

Traffic jams are a burden in urban areas, being time-consuming and contributing to stressful driving and CO₂ emissions. To implement the United Nations' 2030 agenda for sustainable development, governmental strategies aim to accelerate the shift to sustainable and smart mobility. Consequently, e-micromobility (EMM) appeared as a practical solution for short-distance commuters, and it is growing at upsetting rates thanks to the introduction of sharing services. In fact, urban mobility has drastically changed over the last decade, and electric mobility and micromobility changed the panorama in larger metropolises, given their accessibility, large availability, and the potential to be a time saver in short trips and a potentially sustainable alternative in particular scenarios. The downside of portable e-transportation is the rapid increase in injuries and fatalities. Focusing on standing e-scooters, head injuries are becoming one of the most common as shown by research conducted in different urban emergency departments, alongside bone fractures, skin abrasions, and lacerations. In this work, a comprehensive review is carried out focusing on head protection for EMM, mostly for e-scooters, and the respective target markets, safety measures, and existing regulations. In the end, a critical assessment is given with recommendations for legislators and future research. Users are mostly males from 18 to 40 years old, upper-to-middle income, with elevated levels of educational attainment. Their motivation to use e-scooters is mainly to replace short walking trips. EMM, in particular e-scooters, will continue to grow thanks to its potential to substitute other micromobility alternatives. The evolution of safety measures and regulations did not keep pace with such a drastic change in mobility trends. This is evident considering how some countries are struggling with vehicle categories and regulations for helmet use and testing. The lack of legal obligation to wear a helmet and the absence of an adequate and feasible concept of protective equipment for sharing services are the main barriers to helmet use among riders. Mitigation measures have been implemented by the EMM sharing companies to improve the safety of its users by checking if they wear helmets and by offering vehicle-integrated solutions.

Noise characteristics of the Kirby Morgan 37 surface-supplied diving helmet under simulated diving conditions

Divers are exposed to noise from a variety of sources, including their breathing apparatus. Furthermore, there is a significant body of information that suggests divers are susceptible to hearing loss that worsens faster than the general population. This study measured the noise characteristics of a commonly used diving helmet, the Kirby Morgan 37 (Kirby Morgan Dive Systems, Inc., Santa Maria, CA) under simulated diving conditions that included variations in depth, breathing rate, and breathing gas. Depth was varied from 0 to 165 feet sea water (fsw) and breathing rates were varied from 22.5 to 90 liters per minute (lpm). Air and an 80% helium/20% oxygen mixture (heliox) were considered as diving gases. Measured noise levels increased with increases in both diving depth and breathing rate. Using heliox as the breathing gas produced lower noise levels than air under the same conditions. It was observed that the spectral characteristics of inhalation and exhalation were considerably different due to different flow paths through the apparatus. Exhalation produced mostly low frequency noise (below 600 Hz), while inhalation was responsible for most of the noise between 600 Hz and 20 kHz.

Electric scooters accidents: Analyses of two Swedish accident data sets

Since august 2018 electric scooters (e-scooters) are available in selected cities in Sweden, operated by several different operators. There is a growing concern regarding their safety as they grow in popularity. The aim with this study was to investigate injuries associated with e-scooters in Sweden and to identify accident characteristics. In addition, the aim was to observe how different data collection procedures and samples may influence the results. Two complementary data sets were used; insurance data including all reported injuries to Folksam Insurance Group during the period January 2019 to May 2020 and the Swedish Traffic Accident Data Acquisition database (STRADA), the national system for road traffic injury data collection, was used to study accident related to e-scooter use in the Stockholm city area between May and the end of August 2019. Most of the injuries associated with e-scooters occurred in single crashes, but in 13% of the accidents another road user was injured, either due to interactions with e-scooters or due to a parked e-scooter being a hazard. In both data sets more than half of the accidents occurred during weekends. In total 46% of all who had visited an emergency department the accident occurred during night-time (10 pm to 6 am). The overall large proportion of injuries to the head and face indicates the need for actions aimed to increase helmet use among e-scooter riders. Local authorities should take a wider responsibility since one third of all accidents primarily occurred due to lack of maintenance or that the rider hit a curb stone. In comparison to hospital data, insurance claims include riders with all types of injuries irrespectively what type of healthcare the rider was seeking. Hence, to better understand the consequences and to make the right decisions regarding countermeasures aimed to improve the safety of e-scooter riding, data from different data source are needed.

The unintended impact of helmet use on bicyclists' risk-taking behaviors

INTRODUCTION

Safety is a critical factor in promoting sustainable urban non-motorized travel modes like bicycles. Helmets have shown to be effective in reducing injury severity in bicycle crashes, however, their effects on bicyclists' behaviors still requires deeper understanding, especially amid the emerging trend of using shared bicycles. Risk compensation effects suggest that bicyclists may offset perceived gains in safety from wearing a helmet by increasing risk-taking behaviors. A better understanding of these compensation effects can be useful in assessing various bicycle safety related programs.

METHOD

Using a sample of 131 bicyclists from the San Francisco Bay area, this research studies how bicyclists respond with respect to risk-taking behaviors under various urban-street conditions, as a function of helmet use. Study participants were each shown 12 videos, shot in Berkeley, California, from the perspective of a bicyclist riding behind another bicyclist. A fractional factorial experiment design was used to systematically vary contextual attributes (e.g., speed, bike lane facilities, on-street parking, passing vehicles) across the videos. After each video, participants were asked to indicate if they would overtake the bicyclist in the video. With the help of data adaptive estimation techniques, targeted maximum likelihood estimation (TMLE) was applied to estimate the average risk difference between helmeted users and non-users, controlling for self-selection effects. Individual-based nonparametric bootstrap was performed to assess the uncertainty associated with the estimator.

RESULTS

Our findings suggest, on average, individuals more likely to wear a helmet are 15.6% more likely to undertake a risky overtaking maneuver. Practical Applications: This study doesn't try to oppose mandatory helmet laws, but rather serves as a cautionary warning that road safety programs may need to consider strategies in which unintended impact of bicycle helmet use can be mitigated. Moreover, our findings also provide additional evaluation component when it comes to the cost-benefit assessment of helmet-related laws.

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

INTRODUCTION

Bicycle riding is a common activity for children, but they are prone to bicycle-related injuries. It is well-established that injury prevention measures such as wearing a helmet and correctly riding a bicycle can reduce the severity of an injury and the likelihood of having an accident. However, how to increase bicycle injury prevention behaviors among children, who collectively fail to engage in injury prevention behaviors, is less well understood. Self-efficacy is consistently predictive of injury prevention behavior, making it an important approach to understanding injury prevention skills among this key population. The objective of this study was to explore and identify factors internal to the child as well as factors about his or her environment that predict a child's self-efficacy for injury prevention skills.

METHOD

Two generalized linear mixed effects models were created from survey data collected from elementary school students (n = 2,255) as part of a school-based bicycle education program. Models focused on self-efficacy for riding a bicycle and self-efficacy for wearing a helmet correctly.

RESULTS

In both models, road safety knowledge, opportunity for skill building through owning appropriate equipment (a bicycle or helmet), and situation through perception of neighborhood safety were predictive. The analyses reveal these variables as key factors for greater confidence, with feeling safe riding in the neighborhood, in particular, emerging as highly predictive of self-efficacy for injury prevention skills.

CONCLUSIONS

These findings highlight the interplay of individual and environmental factors within confidence for injury prevention behavior. Given self-efficacy's strong relationship to prevention behavior, these findings indicate actionable strategies. Practical Applications: The key factors highlighted in this study can be used by policymakers to target specific areas (e.g., neighborhood safety) to promote self-efficacy and thus improve injury prevention. These factors can also inform strategies for establishing safety skills in bicycle-safety education programs.

Iatrogenic Contamination With a Surgical Helmet System in Orthopedic Surgery

Surgical helmet systems (SHSs) have been used to decrease iatrogenic contamination to prevent periprosthetic joint infections. However, the use of SHSs has been controversial. Therefore, the purpose of this study was to investigate iatrogenic contamination of traditional surgical attire (TSA), SHSs, and SHSs with delayed ventilation (SHS-DV) (helmet fan not turned on until surgeon gowned and gloved). A total of 180 orthopedic surgical procedures were prospectively enrolled and randomized into one of three cohorts. The TSA cohort included any orthopedic procedures, while the SHS and SHS-DV cohorts included arthroplasty procedures. Cultures were obtained from bilateral forearms, axillae, the sternum, and face shields for SHS groups. There were 60 surgeries in each group. The rate of positive cultures was calculated for each cohort and stratified by location and type of microorganism. The positive culture rates were 15% in the TSA, 25% in the SHS, 18% in the SHS-DV cohorts. The positive swab culture rates were 6% in the TSA, 7% in the SHS, and 4% in the SHS-DV cohorts. The positive culture rate was highest from the forearms in the TSA cohort (10%), the face shield in the SHS cohort (20%), and the chest in the SHS-DV cohort (7%). Coagulase-negative Staphylococcus was the most common bacteria cultured. The overall bacterial contamination rates were similar between the TSA and the SHS cohorts, with a lower rate in the SHS-DV cohort. Waiting to initiate airflow in SHSs and treating the shields as contaminated may reduce iatrogenic contamination. [Orthopedics. 2021;44(6):e753-e756.].

Risks for bicycle-related injuries in Al Ain city, United Arab Emirates: An observational study

Traffic-related injuries are a serious health problem. Traffic safety is a priority reflected in the United Nations Sustainable Development Goals. Data on current hazards for bicycle-related injuries from the United Arab Emirates are lacking. The aim of our observational study was to assess the behavior of bicyclists on the roads in Al Ain City, United Arab Emirates and compare our current results with a previous study from 2004.We adapted and tested a structured data collection form. Different sectors of Al Ain were randomly selected to cover the whole city during different times. Bicyclists were observed without direct contact.Out of 1129 bicyclists, 97.6% were males and 13.2% children. 39.4% were cycling on main roads with high-density traffic, 33.1% were cycling against the traffic, 39.3% were cycling at night, and 96.8% of them were not using lights. Only 2.1% of the bicyclists used helmets. A higher proportion of female than male cyclists used helmets (25.9% vs 1.5%; P < .001, Fisher exact test). There was an increase in cycling with the traffic (P < .001) and in use of helmets (P < .025) compared with the previous study.Unsafe practices of bicyclists and low use of helmets despite legislation persist in Al Ain. There is a need to raise bicycle safety awareness and improve enforcement of bicycle helmet legislation. This should be directed toward expatriate workers, children, parents, and maids. Environmental changes, namely building separate bicycle lanes, can increase safety for cycling.

Do Mountain Bikers Know When They Have Had a Concussion and, Do They Know to Stop Riding?

OBJECTIVE

To establish the prevalence of concussions in mountain bikers and to determine factors that increase their risk of concussion. Secondary objectives include determination of whether mountain bikers have undiagnosed concussions, continue to ride after experiencing concussion symptoms, and if they knowingly ride with a broken helmet.

DESIGN

Retrospective survey.

SETTING

Seven-day mountain bike stage race.

PARTICIPANTS

Two hundred nineteen mountain bikers.

MAIN OUTCOME MEASURES

Number of rider concussions diagnosed, number of riders experiencing concussion symptoms without diagnosed concussions, number of riders who continue to ride after experiencing a concussion symptom, and number of riders who rode with a broken helmet.

INDEPENDENT VARIABLES

The independent variables studied included age, gender, nationality, number of times riding in past year, style of riding (cross-country, downhill, or freeride), years mountain biking, years mountain bike racing, whether they are a sponsored cyclist, and whether they also ride a road bike.

RESULTS

Fifteen of 219 mountain bikers (6.9%) had a diagnosed concussion after being hit in the head while mountain biking within the past year, with older riders having a decreased risk [odds ratio (OR), 0.91; P = 0.04], and sponsored riders having a 5-fold increased risk compared with nonsponsored riders (OR, 4.20; P = 0.05). Twenty-eight riders (12.8%) experienced a concussion symptom without being diagnosed with a concussion and 67.5% of the riders who experienced a concussion symptom continued to ride afterward. Overall, 29.2% of riders reported riding with a broken helmet.

CONCLUSIONS

The yearly prevalence of diagnosed concussions in mountain bikers is 6.9%. More than one-third of mountain bikers do not recognize when they have had a concussion and continue riding after experiencing concussion symptoms or with a broken helmet. These behaviors increase their risk of worsening concussion symptoms and acquiring a second injury.

3D-printed external cranial protection following decompressive craniectomy after brain injury: A pilot feasibility cohort study

OBJECTIVES

3D-printed (3DP) customized temporary cranial protection solutions following decompressive craniectomy (DC) are currently not widely practiced. A pilot trial of a 3DP customized head protection prototype device (HPPD) on 10 subjects was conducted during the subacute rehabilitation phase.

MATERIALS AND METHODS

Subjects > 30 days post-DC with stable cranial flaps and healed wounds were enrolled. HPPD were uniquely designed based on individuals' CT scan, where the base conformed to the surface of the individual's skin covering the cranial defect, and the lateral surface three-dimensionally mirrored, the contralateral healthy head. Each HPPD was fabricated using the fused deposition modeling method. These HPPD were then fitted on subjects using a progressive wearing schedule and monitored over 1, 2, 4, 6 and 8 follow-up (FU) weeks. Outcomes during FU included; reported wearing time/day (hours), subjective pain, discomfort, pruritus, dislodgment, cosmesis ratings; and observed wound changes. The primary outcome was safety and tolerability without pain or wound changes within 30 minutes of HPPD fitting.

RESULTS

In all, 10 enrolled subjects received 12 HPPDs [5/10 male, mean (SD) age 46 (14) years, mean (SD) duration post-DC 110 days (76)] and all subjects tolerated 30 minutes of initial HPPD fitting without wound changes. The mean (SD) HPPD mass was 61.2 g (SD 19.88). During 8 weeks of FU, no HPPD-related skin dehiscence was observed, while 20% (2/10) had transient skin imprints, and 80% (8/10) reported self-limiting pressure and pruritis.

DISCUSSION

Findings from this exploratory study demonstrated preliminary feasibility and safety for a customized 3DP HPPD for temporary post-DC head protection over 8 weeks of follow-up. Monitoring and regular rest breaks during HPPD wear were important to prevent skin complications.

CONCLUSION

This study suggests the potential for wider 3DP technology applications to provide cranial protection for this vulnerable population.

Orthopedic Surgical Helmet Systems Significantly Impair Speech Intelligibility

Surgical suits provide protection to orthopedic surgeons, but the suits and fan noise may interfere with communication between operative team members. The goal of this study was to quantify the fan sound and effect of the suit, fan, and N95 mask. Sound levels were measured using a specialized manikin and evaluated using preferred speech interference levels (PSILs), noise criterion (NC) ratings, and comparison with speech sound levels from the literature. Additionally, sound blocking due to the surgical suit was measured and combined effects of the fan and suit were described using a signal to noise ratio (SNR). The noise with the fan at medium and high speed was louder than average speech and the PSILs at these speeds were significantly higher than with the fan off. The fan NC rating of 50 to 60 exceeded the recommended range of 25 to 30 for operating rooms. The N95 mask, space suit, and distance between speaker and receiver all reduced the sound signal at the receiver's ear, with the worst case being full personal protective equipment on both and speaker distanced from receiver. The estimated SNR for the suit and fan system was negative for many frequency bands used in speech, indicating more noise than signal. Multiple measures indicated that the fan noises were at levels associated with speech interference. This noise combined with sound blocking provided by the suit produced SNRs commonly associated with noisy to very noisy environments. This study suggests the combined effects of the suit, fan, and distance may negatively impact operating room communication. [Orthopedics. 2021;44(4):208-214.].

Injury patterns and circumstances associated with electric scooter collisions: a scoping review

BACKGROUND

Electric scooters are personal mobility devices that have risen in popularity worldwide since 2017. Emerging reports suggest that both riders and other road users, such as pedestrians and cyclists, have been injured in electric scooter-associated incidents. We undertook a scoping review of the current literature to evaluate the injury patterns and circumstances of electric scooter-associated injuries.

METHODS

A scoping review of literature published from 2010 to 2020 was undertaken following accepted guidelines. Relevant articles were identified in Medline, Embase, SafetyLit and Transport Research International Documentation using terms related to electric scooters, injuries and incident circumstances. Supplemental searches were conducted to identify relevant grey literature (non-peer-reviewed reports).

RESULTS

Twenty-eight peer-reviewed studies and nine grey literature records were included in the review. The current literature surrounding electric scooter-associated injuries mainly comprises retrospective case series reporting clinical variables. Factors relating to injury circumstances are inconsistently reported. Findings suggest that the head, upper extremities and lower extremities are particularly vulnerable in electric scooter falls or collisions, while injuries to the chest and abdomen are less common. Injury severity was inconsistently reported, but most reported injuries were minor. Low rates of helmet use among electric scooter users were noted in several studies.

CONCLUSION

Electric scooters leave riders vulnerable to traumatic injuries of varying severity. Future work should prospectively collect standardised data that include information on the context of the injury event and key clinical variables. Research on interventions to prevent electric scooter injuries is also needed to address this growing area of concern.

Effect of body size and enhanced helmet systems on risk for motorsport drivers

OBJECTIVE

Computational modeling has been shown to be a useful tool for simulating representative motorsport impacts and analyzing data for relative injury risk assessment. Previous studies have used computational modeling to analyze the probability of injury in specific regions of a 50th percentile male driver. However, NASCAR drivers can represent a large range in terms of size and female drivers are becoming increasingly more common in the sport. Additionally, motorsport helmets can be outfitted with external attachments, or enhanced helmet systems (EHS), whose effect is unknown relative to head and neck kinematics. The current study expands on this previous work by incorporating the F05-OS and M95-OS into the motorsport environment in order to determine correlations between metrics and factors such as PDOF, resultant ΔV occupant size, and EHS.

METHODS

A multi-step computational process was used to integrate the Global Human Body Models Consortium family of simplified occupant models into a motorsport environment. This family included the 5th percentile female (F05-OS), 50th percentile male (M50-OS), and 95th percentile male (M95-OS), which provide a representative range for the size and sex of drivers seen in NASCAR's racing series'. A series of 45 representative impacts, developed from real-world crash data, and set of observed on-track severe impacts were conducted with these models. These impacts were run in triplicate for three helmet configurations: bare helmet, helmet with visor, helmet with visor and camera. This resulted in 450 total simulations. A paired t-test was initially performed as an exploratory analysis to study the effect of helmet configuration on 10 head and neck injury metrics. A mixed-effects model with unstructured covariance matrix was then utilized to correlate the effect between five independent variables (resultant ΔV, body size, helmet configuration, impact quadrant, and steering wheel position) and a selection of 25 metrics. All simulations were conducted in LS-Dyna R. 9.1.

RESULTS

Risk estimates from the M50-OS with bare helmet were used as reference values to determine the effect of body size and helmet configuration. The paired t-test found significance for helmet configuration in select head-neck metrics, but the relative increase in these metrics was low and not likely to increase injury risk. The mixed-effects model analyzed statistical relationships across multiple types of variables. Within the mixed-effects model, no significance was found between helmet configuration and metrics. The greatest effect was found from resultant ΔV, body size, and impact quadrant.

CONCLUSIONS

Overall, smaller drivers showed statistically significant reductions in injury metrics, while larger drivers showed statistically significant increases. Lateral impacts showed the greatest effect on neck metrics and, on average, showed decreases for head metrics related to linear acceleration and increases for head metrics related to angular velocity. HBM parametric studies such as this may provide an avenue to assist injury detection for motorsport incidents, improve triage effectiveness, and assist in the development of safety standards.

The level and trend of road traffic injuries attributable mortality rate in Iran, 1990-2015: a story of successful regulations and a roadmap to design future policies

BACKGROUND

Road-Traffic-Injuries (RTIs) are predicted to rise up to the fifth leading cause of worldwide death by 2030 and Iran has the third highest RTIs mortality among higher-middle income countries. Although the high mortality of RTI in Iran is a warning, it provides the opportunity to indirectly assess the implemented RTI-related regulations' effectiveness via high-resolution relevant statistics and, hence, Iran could serve as a guide for countries with similar context. In order to do so, we utilized this study to report the time and spatial trends of RTIs-related mortality in different age and sex groups and road user classes in Iran.

METHODS

Based on the national death-registration-system (DRS), cemeteries data, and the demographic characteristics, and after addressing incompleteness, we estimated mortality rates using spatiotemporal and Gaussian process regression models. We assessed Pearson seatbelt and helmet use and RTIs-attributable Age-Standardized-Morality-Rate (ASMR) associations. We also predicted RTIs-death-numbers, 2012-2020, by fitting a Generalized Additive Model to assess the status of achieving relevant sustainable development goal (SDG), namely reducing the number of RTIs-related deaths by half.

RESULTS

Overall RTIs-attributable death and ASMR at the national level increased from 12.64 [95% UI, 9.52-16.86] to 29.1 [22.76-37.14] per 100,000 people in the time period of 1990-2015. The trend consisted of an increasing segment in 1990-2003 followed by a decreasing part till 2015. The highest percentage of death belonged to the three-or-more-wheels motorized vehicles. Pedestrian injuries percentage increased significantly and the highest mortality rate occurred in 85 years and older individuals. Low prevalence of seatbelt and helmet use were observed in provinces with higher than the median ASMR due to the relevant cause of each. RTIs-attributable death number is expected to reduce by 15.99% till 2020 which is lower than the established SDG goal.

CONCLUSIONS

Despite the observed substantial moderation in the RTI-ASMR, Iran is till among the leading countries in terms of the highest mortality rates in the world. The enforced regulations including speed limitations (particularly for elder pedestrians) and mandatory use of seatbelt and helmet (for young adult and male drivers) had a considerable effect on ASMR, nevertheless, the RTI burden reduction needs to be sustained and enhanced.

Laboratory Validation of Instrumented Mouthguard for Use in Sport

Concussion is an inherent risk of participating in contact, combat, or collision sports, within which head impacts are numerous. Kinematic parameters such as peak linear and rotational acceleration represent primary measures of concussive head impacts. The ability to accurately measure and categorise such impact parameters in real time is important in health and sports performance contexts. The purpose of this study was to assess the accuracy of the latest HitIQ Nexus A9 instrumented mouthguard (HitIQ Pty. Ltd. Melbourne Australia) against reference sensors in an aluminium headform. The headform underwent drop testing at various impact intensities across the NOCSAE-defined impact locations, comparing the peak linear and rotational acceleration (PLA and PRA) as well as the shapes of the acceleration time-series traces for each impact. Mouthguard PLA and PRA measurements strongly correlated with (R² = 0.996 and 0.994 respectively), and strongly agreed with (LCCC = 0.997) the reference sensors. The root mean square error between the measurement devices was 1 ± 0.6g for linear acceleration and 47.4 ± 35 rad/s² for rotational acceleration. A Bland-Altman analysis found a systematic bias of 1% for PRA, with no significant bias for PLA. The instrumented mouthguard displayed high accuracy when measuring head impact kinematics in a laboratory setting.

Association between alcohol consumption, marijuana use and road traffic injuries among commercial motorcycle riders: A population-based, case-control study in Dares Salaam, Tanzania

BACKGROUND

Alcohol consumption and psychoactive drug use are well-recognised risk factors for road traffic injuries (RTIs). Both types of use may impair and affect drivers' performance. Yet, there is limited literature on their contribution to RTIs among commercial motorcycle riders, particularly in low- and middle-income settings. This study aimed to determine the association between alcohol consumption, marijuana use and RTIs among commercial motorcycle riders in the city of Dar es Salaam, Tanzania.

METHODS

We conducted a case-control study between July 2018 and March 2019. Cases (n = 164) were commercial motorcycle riders who had sustained an RTIs and attended at a hospital. Controls (n = 400) were commercial motorcycle riders who had not experienced an RTIs that led to hospital attendance during the past six months. Alcohol consumption was assessed using the Alcohol Use Disorder Identification (AUDIT) score, which classified participants as a non-drinker, normal drinker(1-7 scores) and risky drinker (scores ≥ 8). Marijuana use was assessed through self-reported use in the past year. We estimated odds ratios (ORs) using logistic regression adjusted for sociodemographic, driver-, and work-related factors.

RESULTS

Risky drinking was associated with close to six times the odds of RTIs compared to non-drinkers (OR = 5.98, 95% CI: 3.25 - 11.0). The association remained significant even after adjusting for sociodemographic, driving and work-related factors (OR = 2.41, 95% CI: 1.01 - 5.76). The crude odds ratios of RTIs were significantly higher among users of marijuana than non-users (OR = 2.33, 95% CI: 1.38 - 3.95). However, the association did not remain statistically significant after adjusting for confounders (OR = 1.11, 95% CI = 0.49-2.48).

CONCLUSION

Our findings confirm increased odds of RTIs among commercial motorcycle riders with risky drinking behaviour even after taking sociodemographic, driving and work-related factors into account. Unlike alcohol consumption the relationship between marijuana use and RTIs among commercial motorcycle riders was unclear. Since motorcycle riders are more susceptible to the effect of alcohol due to higher demands of balance and coordination and because commercial motorcyclist riders, in particular, they spend a considerable amount of time on the road, our results underscore the importance of addressing hazardous alcohol consumption and marijuana use in future prevention strategies to enhance road safety.

Analysis of Bicycle-Motor Vehicle Crashes in San Antonio, Texas

Bicycling is inexpensive, environmentally friendly, and healthful; however, bicyclist safety is a rising concern. This study investigates bicycle crash-related key variables that might substantially differ in terms of the party at fault and bicycle facility presence. Employing 5 year (2014-2018) data from the Texas Crash Record and Information System database, the effect of these variables on bicyclist injury severity was assessed for San Antonio, Texas, using bivariate analysis and binary logistic regression. Severe injury risk based on the party at fault and bicycle facility presence varied significantly for different crash-related variables. The strongest predictors of severe bicycle injury include bicyclist age and ethnicity, lighting condition, road class, time of occurrence, and period of week. Driver inattention and disregard of stop sign/light were the primary contributing factors to bicycle-vehicle crashes. Crash density heatmap and hotspot analyses were used to identify high-risk locations. The downtown area experienced the highest crash density, while severity hotspots were located at intersections outside of the downtown area. This study recommends the introduction of more dedicated/protected bicycle lanes, separation of bicycle lanes from the roadway, mandatory helmet use ordinance, reduction in speed limit, prioritization of resources at high-risk locations, and implementation of bike-activated signal detection at signalized intersections.

Influence of familiarity with traffic regulations on delivery riders' e-bike crashes and helmet use: Two mediator ordered logit models

Micro-mobility vehicles such as electric bicycles, or e-bikes, are becoming one of the essential transportation modes in metropolitan areas, and most deliveries in large cities are dependent on them. Due to the e-bike's popularity and vulnerability, e-bike crash occurrence has become a major traffic safety problem in many cities across the world; finding the most important human factors affecting e-bike safety has thus been an important recent issue in traffic safety analysis. Since delivery riders are a key group of e-bike users, and since helmet use plays a crucial role in reducing the severity of a crash, this study conducted a city-wide online survey to analyze the helmet usage of 6,941 delivery riders in Shanghai, China. To determine the in-depth mechanisms influencing helmet use and e-bike crash occurrence, including the direct and indirect effects of the relevant factors, two mediator ordered logistic regression models were employed. The mediator ordered logistic model was compared with the traditional logistic regression model, and was found to be superior for modeling indirect as well as direct influencing factors. Results indicate that riders' familiarity with traffic regulations (FTR) is an extremely important variable mediating between the independent variables of riders' educational level and age, and the dependent variables of helmet use and e-bike crashes. Improving riders' FTR can consequently increase helmet use and decrease crash occurrence. Authorities can apply these findings to develop appropriate countermeasures, particularly in legislation and rider training, to improve e-bike safety.

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 Non-Invasive Ventilation for COVID-19 Patients (Helmet-COVID): study protocol for a multicentre randomised controlled trial

INTRODUCTION

Non-invasive ventilation (NIV) delivered by helmet has been used for respiratory support of patients with acute hypoxaemic respiratory failure due to COVID-19 pneumonia. The aim of this study was to compare helmet NIV with usual care versus usual care alone to reduce mortality.

METHODS AND ANALYSIS

This is a multicentre, pragmatic, parallel randomised controlled trial that compares helmet NIV with usual care to usual care alone in a 1:1 ratio. A total of 320 patients will be enrolled in this study. The primary outcome is 28-day all-cause mortality. The primary outcome will be compared between the two study groups in the intention-to-treat and per-protocol cohorts. An interim analysis will be conducted for both safety and effectiveness.

ETHICS AND DISSEMINATION

Approvals are obtained from the institutional review boards of each participating institution. Our findings will be published in peer-reviewed journals and presented at relevant conferences and meetings.

TRIAL REGISTRATION NUMBER

NCT04477668.