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Cittadini F, Aulino G, Petrucci M, Raguso L, Oliveri ES, Beccia F, Novelli A, Strano-Rossi S, Franceschi F, Covino M. Bicycle-related accidents in Rome: Investigating clinical patterns, demographics, injury contexts, and health outcomes for enhanced public safety. Injury 2024; 55:111464. [PMID: 38452698 DOI: 10.1016/j.injury.2024.111464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/03/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents. METHODS Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated. RESULTS Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients. CONCLUSIONS Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages.
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Affiliation(s)
- Francesca Cittadini
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Giovanni Aulino
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Martina Petrucci
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Luigi Raguso
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A, Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Elena Sofia Oliveri
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Flavia Beccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Novelli
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Sabina Strano-Rossi
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Francesco Franceschi
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marcello Covino
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Largo A. Gemelli 8, 00168 Rome, Italy
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Stassen HS, Atalik T, Haagsma JA, Wolvius EB, Verdonschot RJCG, Rozeboom AVJ. Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:28-35. [PMID: 37031014 DOI: 10.1016/j.ijom.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 04/10/2023]
Abstract
Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.
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Affiliation(s)
- H S Stassen
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T Atalik
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A Haagsma
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R J C G Verdonschot
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A V J Rozeboom
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
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Meng S, Ivarsson P, Lubbe N. Evaluation of full-face, open-face, and airbag-equipped helmets for facial impact protection. ACCIDENT; ANALYSIS AND PREVENTION 2023; 191:107181. [PMID: 37418868 DOI: 10.1016/j.aap.2023.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/21/2023] [Accepted: 06/17/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Two-wheeler riders frequently sustain injuries to the head and face in real-world crashes, including traumatic brain injury, basilar skull fracture, and facial fracture. Different types of helmets exist today, which are recognized as preventing head injuries in general; however, their efficacy and limitations in facial impact protection are underexplored. Biofidelic surrogate test devices and assessment criteria are lacking in current helmet standards. This study addresses these gaps by applying a new, more biofidelic test method to evaluate conventional full-face helmets and a novel airbag-equipped helmet design. Ultimately, this study aims to contribute to better helmet design and testing standards. METHODS Facial impact tests at two locations, mid-face and lower face, were conducted with a complete THOR dummy. Forces applied to the face and at the junction of the head and neck were measured. Brain strain was predicted by a finite element head model taking both linear and rotational head kinematics as input. Four helmet types were evaluated: full-face motorcycle and bike helmets, a novel design called a face airbag (an inflatable structure integrated into an open-face motorcycle helmet), and an open-face motorcycle helmet. The unpaired, two-sided student's t-test was performed between the open-face helmet and the others, which featured face-protective designs. RESULTS A substantial reduction in brain strain and facial forces was found with the full-face motorcycle helmet and face airbag. Upper neck tensile forces increased slightly with both full-face motorcycle (14.4%, p >.05) and bike helmets (21.7%, p =.039). The full-face bike helmet reduced the brain strain and facial forces for lower-face impacts, but not for mid-face impacts. The motorcycle helmet reduced mid-face impact forces while slightly increasing forces in the lower face. SIGNIFICANCE OF RESULTS The chin guards of full-face helmets and the face airbag protect by reducing facial load and brain strain for lower face impact; however, the full-face helmets' influence on neck tension and increased risk for basilar skull fracture need further investigation. The motorcycle helmet's visor re-directed mid-face impact forces to the forehead and lower face via the helmet's upper rim and chin guard: a thus-far undescribed protective mechanism. Given the significance of the visor for facial protection, an impact test procedure should be included in helmet standards, and the use of helmet visors promoted. A simplified, yet biofidelic, facial impact test method should be included in future helmet standards to ensure a minimum level of protection performance.
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Affiliation(s)
- Shiyang Meng
- Autoliv Research, Wallentinsvägen 22, 447 37 Vårgårda, Sweden.
| | | | - Nils Lubbe
- Autoliv Research, Wallentinsvägen 22, 447 37 Vårgårda, Sweden; Department of Mechanics and Maritime Sciences, Chalmers University of Technology, 412 96 Gothenburg, Sweden
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Wei W, Petit Y, Arnoux PJ, Bailly N. Head-ground impact conditions and helmet performance in E-scooter falls. ACCIDENT; ANALYSIS AND PREVENTION 2023; 181:106935. [PMID: 36571970 DOI: 10.1016/j.aap.2022.106935] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Head injuries are common injuries in E-scooter accidents which have dramatically increased in recent years. The head impact conditions and helmet performance during E-scooter accidents are barely investigated. This study aims to characterize the head-ground impact biomechanics and evaluate bicycle helmet protection in typical E-scooter falls. METHOD The finite element (FE) model of a hybrid III dummy riding an E-scooter was developed and validated. The FE model with and without a bicycle helmet was used to reproduce twenty-seven E-scooter falls caused by the collision with a curb, in which different riding speeds (10, 20, and 30 km/h), curb orientations (30, 60, and 90°), and E-scooter orientations (-15, 0, and 15°) were simulated. Head-ground impact velocities and locations were evaluated for the unhelmeted configurations while the helmet performance was evaluated with the reduction of head injury metrics. RESULTS E-scooter falls always resulted in an oblique head-ground impact, with 78 % on the forehead. The mean vertical and tangential head-ground impact velocities were respectively 5.7 ± 1.5 m/s and 3.7 ± 2.0 m/s. The helmet significantly (p < 0.1) reduced the head linear acceleration, angular velocity, HIC_36, and BrIC, but not the angular acceleration. However, even with the helmet, the head injury metrics were mostly above the thresholds of severe head injuries. CONCLUSION Typical E-scooter falls might cause severe head injuries. The bicycle helmet was efficient to reduce head injury metrics but not to prevent severe head injuries. Future helmet standard evaluations should involve higher impact energy and the angular acceleration assessment in oblique impacts.
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Affiliation(s)
- Wei Wei
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France.
| | - Yvan Petit
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France; École de technologie supérieure, Canada
| | - Pierre-Jean Arnoux
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Nicolas Bailly
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
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Chalathadka M, Dengody PK, Ram B, Pasha AK, Madala G, Rao C. Patterns of maxillofacial trauma in helmet vs. non helmet wearing two wheeler drivers in a tertiary care center. Dent Traumatol 2022; 38:314-318. [PMID: 35482898 DOI: 10.1111/edt.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIMS The frequency and patterns of maxillofacial fractures vary by country, based on demographic, socioeconomic, cultural and environmental factors. Wearing a helmet is an efficient form of head protection for two-wheeler drivers and is now required in the vast majority of countries. The aim of this study was to compare the patterns of maxillofacial trauma in patients who wore helmets and those who did not. MATERIALS AND METHODS The data were gathered from clinical records of patients presenting with maxillofacial trauma between January 2019 and February 2022. The inclusion criteria were met by subjects involved in two-wheeler accidents with comprehensive case records and radiological investigations. RESULTS A total of 177 people presented following maxillofacial trauma. The mean age was 34.2 ± 12.7 years. There were 151 (85.3%) males and 26 (14.6%) females. One hundred and two patients had not been wearing a helmet, while 75 patients were wearing a helmet at the time of the accident. Mandible fractures were the most common injury in both groups, followed by zygomatic arch fractures (which were more common in non-helmet users) and dentoalveolar fractures in helmet users. CONCLUSION There was a significant difference in the pattern and severity of maxillofacial trauma in helmet users and non-helmet users.
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Affiliation(s)
| | | | - Bhargav Ram
- Department of Oral and Maxillofacial Surgery, KVGDCH, Sullia, India
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Døving M, Naess I, Galteland P, Ramm-Pettersen J, Dalby M, Utheim TP, Skaga NO, Helseth E, Sehic A. Anatomical distribution of mandibular fractures from severe bicycling accidents: A 12-year experience from a Norwegian level 1 trauma center. Dent Traumatol 2022; 38:424-430. [PMID: 35481880 PMCID: PMC9544727 DOI: 10.1111/edt.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Background/Aim The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible because conventional helmets provide little protection to the lower part of the face. In addition, some studies indicate that helmets may lead to an increased risk of mandibular fractures. Thus, the aim of this study was to examine the anatomic distribution of mandibular fractures in injured cyclists and to assess if helmet use influenced the fracture locations. Material and Methods Data from a Norwegian Level 1 trauma center were collected in the Oslo University Hospital Trauma Registry over a 12‐year period. Of 1543 injured cyclists, the electronic patient charts of 62 cyclists with fractures of the mandible were retrospectively evaluated in detail. Demographic data, helmet use, and fracture type were assessed. Results Sixty‐two patients (4%) had fractures of the mandible, and women had an increased risk (OR 2.49, 95% CI 1.49–4.16, p < .001). The most common fracture site was the mandibular body, followed by the condyle. Isolated mandibular fractures occurred in 45% of the patients and 55% had other concomitant facial fractures. There were 42% of the patients with fractures in multiple sites of the mandible, and 42% had a concomitant dentoalveolar injury. Half of the cyclists were wearing a helmet at the time of the accident and 39% were not. There was no significant difference in fracture distribution between the helmeted and non‐helmeted groups. Conclusions Fracture of the mandibular body was the most prevalent mandibular fracture type following bicycle accidents. Women had an increased risk of mandibular fractures compared with men, whereas helmet wearing did not affect the anatomical fracture site.
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Affiliation(s)
- Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ingar Naess
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Ramm-Pettersen
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Marius Dalby
- Department of Ophtalmology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Stanford-Moore GB, Niyigaba G, Tuyishimire G, Yau J, Kulkrani A, Nyabyenda V, Ncogoza I, Shaye DA. Effect of Delay of Care for Patients with Craniomaxillofacial Trauma in Rwanda. OTO Open 2022; 6:2473974X221096032. [PMID: 35480144 PMCID: PMC9036345 DOI: 10.1177/2473974x221096032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Craniomaxillofacial (CMF) trauma represents a significant proportion of global surgical disease burden, disproportionally affecting low- and middle-income countries where care is often delayed. We investigated risk factors for delays to care for patients with CMF trauma presenting to the highest-volume trauma hospital in Rwanda and the impact on complication rates. Study Design This prospective cohort study comprised all patients with CMF trauma presenting to the University Teaching Hospital of Kigali, Rwanda, between June 1 and October 1, 2020. Setting Urban referral center in resource-limited setting. Methods Epidemiologic data were collected, and logistic regression analysis was undertaken to explore risk factors for delays in care and complications. Results Fifty-four patients (94.4% men) met criteria for inclusion. The mean age was 30 years. A majority of patients presented from a rural setting (n = 34, 63%); the most common cause of trauma was motor vehicle accident (n = 18, 33%); and the most common injury was mandibular fracture (n = 28, 35%). An overall 78% of patients had delayed treatment of the fracture after arrival to the hospital, and 81% of these patients experienced a complication (n = 34, P = .03). Delay in treatment was associated with 4-times greater likelihood of complication (odds ratio, 4.25 [95% CI, 1.08-16.70]; P = .038). Conclusion Delay in treatment of CMF traumatic injuries correlates with higher rates of complications. Delays most commonly resulted from a lack of surgeon and/or operating room availability or were related to transfers from rural districts. Expansion of the CMF trauma surgical workforce, increased operative capacity, and coordinated transfer care efforts may improve trauma care.
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Affiliation(s)
- Gaelen B. Stanford-Moore
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Gilbert Niyigaba
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gratien Tuyishimire
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jenny Yau
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Amol Kulkrani
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Victor Nyabyenda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Isaie Ncogoza
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - David A. Shaye
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
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Al Saffar MMA, Verdonschot RJCG, Stassen HS, Wolvius EB, Rozeboom AVJ. The Association of Helmet Use with the Occurrence of Maxillofacial Injuries Following Bicycle or Scooter Accidents: A Retrospective Cohort Study. Craniomaxillofac Trauma Reconstr 2022; 15:21-27. [PMID: 35265273 PMCID: PMC8899353 DOI: 10.1177/1943387521998199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design Retrospective Cohort Study. Objective Yearly, bicycle and scooter accidents in the Netherlands amount to 90 thousand emergency department visits. Maxillofacial injuries are common after cycling or scooter accidents. To prevent these injuries, helmet use might be beneficial. However, the effect of helmet use on maxillofacial injuries remains unclear. The aim of this retrospective study is to assess the effect of helmet use on maxillofacial injuries in patients who had a bicycle or scooter accident. Methods We collected data from the emergency department of the Erasmus Medical Center in the period from October 2017 to October 2019. Patients that were involved in a bicycle or scooter accident and subsequently received a CT scan of the head were included. We compared the incidence of maxillofacial injuries in helmeted cyclists and scooter users to non-helmeted users. Descriptive and analytic statistics were computed. Level of statistical significance was set at p < 0.05. Results Helmet use among scooter users was associated with a significant reduction in maxillofacial fractures (p < 0.001) and soft tissue injuries (p < 0.001). Helmet use among cyclists was not associated with a reduction in maxillofacial fractures (p = 0.17) or soft tissue injuries (p = 0.30). Helmet use was not associated with a reduction in soft tissue injuries of the lower face in both cyclists (p = 0.47) and scooter users (p = 0.24). Conclusions Helmet use should be considered among cyclists and scooter users to prevent maxillofacial injuries. Especially unhelmeted scooter users might benefit from helmet use as this is associated with a lower incidence of maxillofacial injuries.
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Affiliation(s)
- M. M. A. Al Saffar
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands,M. M. A. Al Saffar, Department of Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015GD Rotterdam, The Netherlands.
| | - R. J. C. G. Verdonschot
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H. S. Stassen
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E. B. Wolvius
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A. V. J. Rozeboom
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Alcohol and Drug Use While Cycling Significantly Increases the Likelihood of Facial Fractures. J Craniofac Surg 2021; 32:2087-2090. [PMID: 34191776 DOI: 10.1097/scs.0000000000007792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Substance use, including alcohol and drugs, has been found to amplify the risks associated with cycling. Our purpose was to determine the relationship between alcohol or drug use and facial injuries in a nationwide population of patients experiencing cycling trauma. METHODS The authors report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System from January 1, 2019 to December 31, 2019, in the United States. Patients were included in our study if they were evaluated in the emergency department for a cycling-related injury. Primary outcome was facial injury. RESULTS There were a total of 6499 adult patients who experience an injury after cycling trauma reported by the National Electronic Injury Surveillance System-participating emergency departments during the study period. A total of 553 (553/6499; 8.5%) patients had a facial injury and 82 patients with facial injuries had alcohol/drug use recorded (82/553; 14.8%). The proportion of males with facial injuries was higher in the alcohol/drug group than the no alcohol/drug group (86.6% versus 76.4%, respectively; P = 0.04). Injured cyclists in the alcohol/drug group experienced greater odds of sustaining a facial injury (odds ratio: 2.21, 95% confidence interval: 1.71-2.84, P < 0.0001) and a facial fracture (odds ratio: 2.75, 95% confidence interval: 1.83-4.13, P < 0.0001) than injured cyclists in the no alcohol/drug group. CONCLUSIONS Substance use while cycling is not safe and significantly increases the likelihood of a facial injury and of facial fractures. This prevalence of injuries would suggest that cycling under the influence should always be illegal, and the law strictly enforced.
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Sorenson TJ, Borad V, Schubert W. Facial Injuries Due to Cycling are Prevalent: Improved Helmet Design Offering Facial Protection is Recommended. J Oral Maxillofac Surg 2021; 79:1731.e1-1731.e8. [PMID: 33939961 DOI: 10.1016/j.joms.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Safety equipment for recreational cycling is commonly designed to protect the calvarium, but not the face, in the event of a crash. The purpose of this study is to identify the prevalence of facial injuries and their most common subcategories due to cycling injuries and to serve as an anatomical guide of what facial structures most need protection. METHODS We report a cross-sectional study of consecutive patients reported to the National Electronic Injury Surveillance System from January 1, 2010 to December 31, 2019. Patients were included in our study if they were evaluated in the emergency department (ED) for an injury due to cycling trauma. Primary outcome was injury to the face. Other variables of interest include age, sex, race, ED disposition, type of facial injury, location of facial injury, and presence of additional injuries. Descriptive and univariate statistics of the primary outcome were computed with these variables. RESULTS There were 138,078 total patients injured due to cycling trauma reported by National Electronic Injury Surveillance System -participating EDs during the study period and, of those, 14,326 patients experienced injury to the face, revealing a 10.4% prevalence of facial injury due to cycling trauma (14,326/138,078). Thirteen percent (1,987/14,326) of facial injuries were fractures, and the most involved structures were the nose (786/1987; 40%), orbit (459/1987; 23%), and mandible (405/1987; 20%). Compared to children, adults demonstrate a greater risk of facial fracture (23.5% versus 6.5%, P < .0001) and hospital admission after facial injury (8.9 vs 2.8%, P < .0001). CONCLUSIONS The prevalence of facial injury in the setting of cycling trauma is over 10%, and 13% of these injuries were facial fractures. With this high prevalence, there is a need for cycling helmets that include facial protection or faceguards, and we outline the commonly fractured anatomical areas that need the most protection.
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Affiliation(s)
- Thomas J Sorenson
- Medical Student, Medical School, University of Minnesota, Minneapolis, MN.
| | - Vedant Borad
- Resident, Division of Plastic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Warren Schubert
- Professor, Division of Plastic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN; Attending Surgeon, Department of Plastic and Hand Surgery, Regions Hospital, Saint Paul, MN
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Puolakkainen T, Murros OJ, Abio A, Thorén H, Virtanen K, Snäll J. Associated Injuries Are Common Among Patients With Bicycle-Related Craniofacial Fractures. J Oral Maxillofac Surg 2021; 79:1319-1326. [PMID: 33607009 DOI: 10.1016/j.joms.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ample evidence exists on the relationship between bicycle injuries and craniofacial fractures. However, as the mechanism behind these injuries is often multifactorial, the presence of associated injuries (AIs) in this study population requires further examination. We hypothesized that patients with craniofacial fracture injured in bicycle accidents are at high risk of sustaining severe AIs, especially those of the head and neck region. PATIENTS AND METHODS The investigators performed a retrospective study on all patients with bicycle-related craniofacial fracture admitted to a tertiary trauma centre during 2013 to 2018. The predictor variable was defined as any type of craniofacial fracture. The outcome variable was defined as any kind of AI. Other study variables included demographic and injury-related parameters. Variables were analyzed using bivariate and Firth's logistic regression analyses. RESULTS A total of 407 patients were included in the analysis. Our results revealed that AIs were present in 150 (36.9%) patients; there were multiple AIs in 47 cases. Traumatic brain injuries followed by upper limb injuries were the most frequent AIs. Severe head and neck injuries were present in 20.1% of all patients with craniofacial fracture. AIs were observed in 57.4% of patients with combined midfacial fractures (P < .001). Helmet use had a protective effect against traumatic brain injuries (P < .001). CONCLUSIONS Our results suggest that AIs are relatively common in this specific patient population. Close co-operation in multidisciplinary trauma centers allowing comprehensive evaluation and treatment can be recommended for patients with bicycle-related craniofacial fracture.
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Affiliation(s)
- Tero Puolakkainen
- Resident, Post-Doctoral Student, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland.
| | - Olli-Jussi Murros
- Resident, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Anne Abio
- Doctoral Student, Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland; and Doctoral Student, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Hanna Thorén
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland; Professor, and Department of Oral and Maxillofacial Diseases, Turku University Hospital, Finland, Turku, Finland
| | - Kaisa Virtanen
- Chief Physician, Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Johanna Snäll
- Department Head, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland
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12
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Døving M, Galteland P, Eken T, Sehic A, Utheim TP, Skaga NO, Helseth E, Ramm-Pettersen J. Dentoalveolar injuries, bicycling accidents and helmet use in patients referred to a Norwegian Trauma Centre: A 12-year prospective study. Dent Traumatol 2020; 37:240-246. [PMID: 33220164 DOI: 10.1111/edt.12627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Despite its many benefits, bicycling carries the risk of accidents. Although numerous studies have reported the effect of helmet use on traumatic brain injury, it remains unclear if, and to what extent, helmet use reduces the risk of facial injuries. This is particularly true in regard to injuries of the lower face. In addition, there is limited evidence of the effect of helmet use on dentoalveolar injuries. Thus, the aim of this study was to determine the frequency and distribution of dentoalveolar injuries in bicycling accidents and to explore the influence of helmet use. MATERIAL AND METHODS A total of 1543 bicyclists were included from the trauma registry of a Norwegian tertiary trauma center over a 12-year period. Data were collected prospectively, including patient characteristics, type of injury, and helmet use. The prevalence of dentoalveolar injuries was assessed in conjunction with helmet use and facial fractures. RESULTS Twenty-five percent of the patients had maxillofacial injuries, and 18% of those with facial fractures exhibited concomitant dentoalveolar injuries. The most common type of dentoalveolar injury was tooth fracture (39%). The most frequent location of facial fractures with combined dentoalveolar injuries was the maxilla, which had fractured in 32 patients. Women had a higher risk of sustaining dentoalveolar injuries compared to men (odds ratio 1.50, 95% confidence interval 1.02-2.22). There were 1257 patients (81%) who had reliable registration of helmet use; 54% of these wore a helmet, while 46% did not. Helmet users had an increased risk of dentoalveolar injuries compared to non-helmeted bicyclists (adjusted odds ratio 1.54, 95% confidence interval 1.02-2.31). CONCLUSIONS Dentoalveolar injuries are fairly common in trauma patients admitted to a trauma center following bicycling accidents. Bicycling helmets are associated with an increased risk of dentoalveolar injuries.
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Affiliation(s)
- Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Torsten Eken
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Jon Ramm-Pettersen
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
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13
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Alfrey EJ, Tracy M, Alfrey JR, Carroll M, Aranda-Wikman ED, Arora T, Maa J, Minnis J. Helmet Usage Reduces Serious Head Injury Without Decreasing Concussion After Bicycle Riders Crash. J Surg Res 2020; 257:593-596. [PMID: 32932191 DOI: 10.1016/j.jss.2020.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/17/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The importance of bicycle helmets in reducing injuries is unclear. Our center receives a disproportionate number of bicycle crash victims. We sought to evaluate the types of injuries observed and the role of helmets in reducing head injuries. MATERIALS AND METHODS We evaluated demographic data and compared injuries between bicycle riders that crashed with and without helmets over a 9-year period. Categorical variables were compared using linear regression methods and nominal variables using ANOVA. Differences were considered significant for P ≤ 0.05. RESULTS There were 906 patients evaluated, 701 with helmets (77%) and 205 (23%) without helmets. The mean Injury Severity Score was 9.3 ± 6.4. The most common injuries were concussion (n = 385), rib fractures (n = 154), clavicle fractures (n = 139), facial fractures (n = 102), and cervical spine fractures (n = 89). There was no significant difference in the number of patients with a concussion in riders with or without helmets, [299/701, 42.6% versus 86/205, 42.0%, respectively, (P = NS)]. In helmet versus no helmet riders, there were significantly fewer patients with facial fractures, [67/701, 9.5%, versus 35/205, 17.0%, respectively, (P = 0.003)], skull fractures [8/701, 1.1% versus 9/205, 4.4%, respectively, (P = 0.003)], and serious head injuries [6/701, 0.85% versus 8/205, 3.9%, respectively, (P = 0.002)]. CONCLUSIONS Helmeted patients involved in bicycle crashes are less likely to sustain a serious head injury, a skull fracture, or facial fractures compared to riders without helmets. The most common injury in patients with a bicycle crash is a concussion. Helmets did not prevent concussion after bicycle rider's crash in our patient population.
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Affiliation(s)
- Edward J Alfrey
- Adjunct Clinical Professor of Surgery, Stanford University, Stanford, California; Department of Surgery, Marin Health Medical Center (Formerly Marin General Hospital), Greenbrae, California; Chair, Department of Surgery, Medical Director for Trauma Services, Marin Health Medical Center, Greenbrae, California; Trauma Services, Marin Health Medical Center, Greenbrae, California.
| | - Michelle Tracy
- Trauma Services, Marin Health Medical Center, Greenbrae, California
| | | | - Meaghan Carroll
- Trauma Services, Marin Health Medical Center, Greenbrae, California
| | | | - Tarun Arora
- Department of Neurosurgery, University of California, San Francisco, California
| | - John Maa
- Department of Surgery, Marin Health Medical Center (Formerly Marin General Hospital), Greenbrae, California
| | - James Minnis
- Department of Surgery, Marin Health Medical Center (Formerly Marin General Hospital), Greenbrae, California
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14
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Alwani M, Jones AJ, Sandelski M, Bandali E, Lancaster B, Sim MW, Shipchandler T, Ting J. Facing Facts: Facial Injuries from Stand-up Electric Scooters. Cureus 2020; 12:e6663. [PMID: 32089971 PMCID: PMC7021242 DOI: 10.7759/cureus.6663] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Stand-up electric scooters (SES) are a popular public transportation method. Numerous safety concerns have arisen since their recent introduction. Methods A retrospective chart review was performed to identify patients presenting to the emergency departments in Indianapolis, who sustained SES-related injuries. Results A total of 89 patients were included in our study. The average patient age was 29 ± 12.9 years in a predominantly male cohort (65.2%). No patient was documented as wearing a helmet during the event of injury. Alcohol intoxication was noted in 14.6% of accidents. Falling constituted the leading trauma mechanism (46.1%). Injuries were most common on Saturday (24.7%) from 14h00 to 21h59 (55.1%). Injury types included: abrasions/contusions (33.7%), fractures (31.5%), lacerations (27.0%), or joint injuries (18.0%). The head and neck region (H&N) was the most frequently affected site (42.7%). Operative management under general anesthesia was necessary for 13.5% of injuries. Nonoperative management primarily included conservative orthopedic care (34.8%), pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) (34.8%) and/or opioids (4.5%), bedside laceration repairs (27.0%), and wound dressing (10.1%). Individuals sustaining head and neck injuries were more likely to be older (33.8 vs. 25.7 years, p=0.003), intoxicated by alcohol (29.0% vs. 3.9%, p=0.002), and requiring CT imaging (60.5% vs. 9.8%, p <0.001). Conclusion Although SESs provide a convenient transportation modality, unregulated use raises significant safety concerns. More data need to be collected to guide future safety regulations.
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Affiliation(s)
| | - Alexander J Jones
- Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Morgan Sandelski
- Otolaryngology, Indiana University School of Medicine, Indianapolis, USA
| | - Elhaam Bandali
- Public Health, Richard M. Fairbanks School of Public Health, Indianapolis, USA
| | - Benjamin Lancaster
- Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Michael W Sim
- Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Taha Shipchandler
- Otolaryngology, Indiana University School of Medicine, Indianapolis, USA
| | - Jonathan Ting
- Otolaryngology, Indiana University School of Medicine, Indianapolis, USA
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