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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Lacchè E, Pelotti S, Fais P. Motorcycle injuries: a systematic review for forensic evaluation. Int J Legal Med 2024; 138:1907-1924. [PMID: 38763926 PMCID: PMC11306388 DOI: 10.1007/s00414-024-03250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
The intricate interplay of exposure and speed leave motorcyclists vulnerable, leading to high mortality rates. During the collision, the driver and the passenger are usually projected away from the motorcycle, with variable trajectories or final positions. Injuries resulting from the crash can exhibit distinct and specific characteristics depending on the circumstances of the occurrence.The aim of this study is to provide a systematic review of the literature on injuries sustained by motorcyclists involved in road accidents describing and analyzing elements that are useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to June 2023. Eligible studies have investigated issues of interest to forensic medicine about during traffic accidents involving motorcycle. A total of 142 studies met the inclusion criteria and were classified and analyzed based on the anatomical regions of the body affected (head, neck, thoraco-abdominal, pelvis, and limb injuries). Moreover, also the strategies for preventing lesions and assessing injuries in the reconstruction of motorcycle accidents were examined and discussed.This review highlights that, beyond injuries commonly associated with motorcycle accidents, such as head injuries, there are also unique lesions linked to the specific dynamics of accidents. These include factors like the seating position of the passenger or impact with the helmet or motorbike components. The forensic assessment of injury distribution could serve as support in reconstructing the sequence of events leading to the crash and defining the cause of death in trauma fatalities.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
| | - Maria Paola Bonasoni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, 42122, Italy
| | - Elena Lacchè
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
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Rauer T, Klingebiel FKL, Lühring A, Küffer A, Hofer AS, Ferrari RM, Kupka M, Pape HC. Cranio-cervical and traumatic brain injury patterns-do they differ between electric bicycle, bicycle, and motorcycle-induced accidents? Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02510-1. [PMID: 38592466 DOI: 10.1007/s00068-024-02510-1] [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: 02/08/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE With the growing technical options of power transmission and energy-saving options in electric drives, the number of E-bike-related accidents especially in an elderly population has increased. The aim of the current study was to compare if the increased velocity in comparison to conventional bikes translates into different injury patterns in the cranio-cervical and head region. METHODS A retrospective cohort study was performed in patients admitted to our level one trauma center between 2009 and 2019 after being involved in an accident with either an E-bike, bicycle, or motorcycle and suffered cranio-cervical or traumatic brain injury. OUTCOMES cranio-cervical/intracranial injury pattern. Data interpretation was conducted in an interdisciplinary approach. RESULTS From 3292 patients treated in this period, we included 1068 patients. E-bikers were significantly older than bicyclists (or motorcyclists) and lay between the other two groups in terms of helmet use. Overall injury patterns of E-bikers resembled those found in motorcyclists rather than in bicyclists. E-bikers had a higher incidence of different cerebral bleedings, especially if no helmet was worn. Helmet protection of E-bikers resulted in a comparable frequency of intracranial bleeding to the helmeted bicyclists. CONCLUSION The overall pattern of head and cervical injuries in E-bikers resembles more to that of motorcyclists than that of bicyclists. As they are used by a more senior population, multiple risk factors apply in terms of complications and secondary intracranial bleeding. Our study suggests that preventive measures should be reinforced, i.e., use of helmets to prevent from intracranial injury.
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Affiliation(s)
- Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland.
| | - Felix Karl-Ludwig Klingebiel
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Adrian Lühring
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
- Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Alexander Küffer
- Department of Neurosurgery, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Anna-Sophie Hofer
- Department of Neurosurgery, University Hospital Zurich, 8091, Zurich, Switzerland
- Department of Neurosurgery, Medical University Innsbruck, 6020, Innsbruck, Austria
| | - Raphael Marco Ferrari
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Michael Kupka
- Department of Neuroradiology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
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Singh A, Kumar D, Ganpule S. Biomechanical Response of Head Surrogate With and Without the Helmet. J Biomech Eng 2024; 146:031001. [PMID: 37470487 DOI: 10.1115/1.4062968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
Measurements of brain deformations under injurious loading scenarios are actively sought. In this work, we report experimentally measured head kinematics and corresponding dynamic, two-dimensional brain simulant deformations in head surrogates under a blunt impact, with and without a helmet. Head surrogates used in this work consisted of skin, skull, dura, falx, tentorium, and brain stimulants. The head surrogate geometry was based on the global human body models consortium's head model. A base head surrogate consisting of skin-skull-brain was considered. In addition, the response of two other head surrogates, skin-skull-dura-brain, and skin-skull-dura-brain-falx-tentorium, was investigated. Head surrogate response was studied for sagittal and coronal plane rotations for impactor velocities of 1 and 3 m/s. Response of head surrogates was compared against strain measurements in PMHS. The strain pattern in the brain simulant was heterogenous, and peak strains were established within ∼30 ms. The choice of head surrogate affect the spatiotemporal evolution of strain. For no helmet case, peak MPS of ∼50-60% and peak MSS of ∼35-50% were seen in brain simulant corresponding to peak rotational accelerations of ∼5000-7000 rad/s2. Peak head kinematics and peak MPS have been reduced by up to 75% and 45%, respectively, with the conventional helmet and by up to 90% and 85%, respectively, with the helmet with antirotational pads. Overall, these results provide important, new data on brain simulant strains under a variety of loading scenarios-with and without the helmets.
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Affiliation(s)
- Abhilash Singh
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
| | - Devendra Kumar
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
| | - Shailesh Ganpule
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India; Department of Design, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
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Rashid J, Wu S, Abdelrahman A, McMillan K. Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme. Br J Oral Maxillofac Surg 2024; 62:157-163. [PMID: 38238115 DOI: 10.1016/j.bjoms.2023.11.008] [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: 07/05/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.
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Affiliation(s)
- J Rashid
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
| | - S Wu
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
| | - A Abdelrahman
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
| | - K McMillan
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom.
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Terranova P, Perez MA. Developing a motorcycle injury risk model for planar collisions: Insights from the Motorcycle Crash Causation Study. ACCIDENT; ANALYSIS AND PREVENTION 2023; 193:107292. [PMID: 37742440 DOI: 10.1016/j.aap.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Affiliation(s)
- P Terranova
- Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; Virginia Tech Transportation Institute, Blacksburg, VA 24061, USA.
| | - Miguel A Perez
- Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; Virginia Tech Transportation Institute, Blacksburg, VA 24061, USA
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Hu L, Song Y, Wang F, Lin M. Exploring the differences in rider injury severity in vehicle-two-wheelers accidents with dissimilar fault parties. TRAFFIC INJURY PREVENTION 2023; 25:78-84. [PMID: 37722821 DOI: 10.1080/15389588.2023.2255332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
Objective: The division of responsibility in vehicle-two-wheelers accidents reflects the extent to which different fault parties contributed to the occurrence of the accident, with significant differences in the injuries sustained by the riders in accidents where diverse parties were primarily responsible. We want to explore the difference in the severity of injury of riders in different fault parties of accidents so that we can make targeted protection improvements.Methods: In this study, three generalized ordered logit models were established for the total sample (n = 1204), the sample with drivers as the primary fault party (n = 607), and the sample with riders as the primary fault party (n = 597), respectively, to explore the differential impact factors on rider injury severity in vehicle-two-wheelers accidents involving different fault parties. Inter-group difference tests were conducted on the mean rider injury severity caused by differential factors in different accidents. Combining the impact effect trends and mean differences in the model, the differences in rider injury severity in accidents involving different fault parties were analyzed from the standpoints of human, vehicle, and road factors.Results: It was found that the effects of curve on injury severity was sheerly opposite in accidents with different fault parties and that factors, such as visual obstruction, road surface condition, gender, and helmet wearing differed in their effects on rider injury severity under different fault parties accidents. This reveals the driving tendencies and states of both parties in different environments.Conclusion: Based on the differential impact factor analysis and rider injury characteristics in accidents involving different fault parties, suggestions for improvement were made from the perspectives of road facilities, and safety awareness of drivers and riders, which are beneficial for improving rider safety and providing a theoretical reference for future regulations on liability allocation.
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Affiliation(s)
- Lin Hu
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, China
- Hunan Province Key Laboratory of Safety Design and Reliability Technology for Engineering Vehicle, Changsha University of Science and Technology, Changsha, China
| | - Yahao Song
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, China
- Hunan Province Key Laboratory of Safety Design and Reliability Technology for Engineering Vehicle, Changsha University of Science and Technology, Changsha, China
| | - Fang Wang
- School of Automotive and Mechanical Engineering, Changsha University of Science and Technology, Changsha, China
- Hunan Province Key Laboratory of Safety Design and Reliability Technology for Engineering Vehicle, Changsha University of Science and Technology, Changsha, China
| | - Miao Lin
- Traffic Accident Research, Institute of Vehicle Safety and Identification Technology, China Automobile Technology Research Center, Beijing, China
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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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Mousavi-Shalmaei SMA, Hosseinnia M, Mohtasham-Amiri Z, Rad EH, Khodadadi-Hassankiadeh N. Helmet Use and Jaw and Tooth Injuries in Motorcyclists Admitted to a Referral Hospital. J Maxillofac Oral Surg 2023:1-6. [PMID: 37362880 PMCID: PMC10199431 DOI: 10.1007/s12663-023-01934-3] [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: 02/14/2023] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
Background and Aim The use of helmets has been reported to reduce the incidence and severity of head injuries in motorcyclists. However, there remains a significant gap in knowledge regarding the effectiveness of helmets, especially in preventing jaw and tooth injuries. Patients and Methods In this retrospective analytical study record, all traffic accidents that occurred continuously from 2017 to 2019 in which the motorcyclists were on at least one side of the collision based on inclusion criteria. Data from injury variables in medical records were merged with data related to helmet use in the trauma registration system in Excel software. Then, the final analysis was performed with STATA software version 14 at a significance level of < 0.05. Results In total, 1807 people participated in the study, and 160 (9.37) people used helmets. The incidence rate of jaw and tooth injuries was 86 (5.04%). Logistic regression implied that the odds ratio for helmet use was 0.7, which considering the p value of 0.419, shows no significant relationship between wearing helmets and jaw and tooth injuries. Conclusion Helmets alone cannot prevent jaw and tooth injuries, and designers should design helmets that protect the head and the jaw and tooth. In prevention programs and campaigns for motorcyclists, every age, gender, job, grade group and marital status are target groups.
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Affiliation(s)
| | - Marjan Hosseinnia
- School of Pharmacy, Department of Clinical and Administrative Sciences, Notre Dame of Maryland University, Baltimore, USA
| | - Zahra Mohtasham-Amiri
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Adjei BN, Nakua EK, Donkor P, Amissah J, Gyaase D, Enuameh Y, Mock C. Determinants of motorcycle helmet availability and cost in retail outlets: outcomes of a market survey in northern Ghana. BMC Public Health 2023; 23:771. [PMID: 37101192 PMCID: PMC10131362 DOI: 10.1186/s12889-023-15695-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Morbidity and mortality from road traffic crashes are steadily increasing globally and they remain a major public health challenge. This burden is disproportionately borne by low-and middle-income countries, especially Sub-Saharan Africa where motorcycle helmet use is low and where there are challenges of affordability and availability of standard helmets. We sought to assess the availability and cost of helmets in retail outlets in northern Ghana. METHODS A market survey of 408 randomly sampled automobile-related retail outlets in Tamale, northern Ghana was conducted. Multivariable logistic regression was used to identify factors associated with helmet availability and gamma regression was used to identify factors associated with their cost. RESULTS Helmets were available in 233 (57.1%) of surveyed retail outlets. On multivariable logistic regression, street vendors were 48% less likely and motorcycle repair shops 86% less likely to sell helmets than automobile/motorcycle shops. Outlets outside the Central Business District were 46% less likely to sell helmets than outlets inside that district. Nigerian retailers were five times more likely to sell helmets than Ghanaian retailers. Median helmet cost was 8.50 USD. Helmet cost decreased by 16% at street vendors, 21% at motorcycle repair shops, and 25% at outlets run by the owner. The cost increased by older age of retailer (1% per year of age), education level of retailer (12% higher for secondary education, 56% higher for tertiary education, compared to basic education), and sex (14% higher for male retailer). CONCLUSION Motorcycle helmets were available in some retail outlets in northern Ghana. Efforts to improve helmet availability should address outlets in which they are less commonly sold, including street vendors, motorcycle repair shops, outlets run by Ghanaians, and outlets outside the Central Business District.
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Affiliation(s)
- Benjamin Noble Adjei
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Emmanuel K Nakua
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Amissah
- Department of Environmental, Occupational Health and Safety, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Gyaase
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yeetey Enuameh
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
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Baffour Appiah A, Akweongo P, Sackey SO, Morna MT, Kenu E, Buunaaim ADBI, Debrah SAY, Ojo TK, Donkor P, Mock CN. Effect of different helmet types in head injuries: a case-control study in northern Ghana. Inj Prev 2023; 29:50-55. [PMID: 36198481 DOI: 10.1136/ip-2022-044683] [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: 06/14/2022] [Accepted: 09/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Motorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana. METHODS A prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury. RESULTS After adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35). CONCLUSION Even in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs.
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Affiliation(s)
- Anthony Baffour Appiah
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana .,Injury Epidemiology and Prevention Unit, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Patricia Akweongo
- Department of Health Policy, Planning, and Management, University of Ghana, Legon, Ghana
| | - Samuel Oko Sackey
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana
| | - Martin Tangnaa Morna
- Department of Surgery, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana.,Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | | | | | - Thomas K Ojo
- Department of Geography and Regional Planning, University of Cape Coast College of Humanities and Legal Studies, Cape Coast, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles N Mock
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA
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Ocular injuries associated with two-wheeled electric transportation devices and motorcycle accidents. Sci Rep 2022; 12:20546. [PMID: 36446787 PMCID: PMC9708672 DOI: 10.1038/s41598-022-23860-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined the types and risk factors for ocular and periocular injuries associated with electric devices compared to motorcycle accidents. The study was conducted on the National Trauma Registry database from 20 trauma centers, including patients involved in accidents with electric bicycles, scooters, and motorcycles between 2014 to 2019. Injured riders were assigned into two groups: motorcycle group (M) and electric bicycle & scooter group (E). Data such as gender, age, protective gear use, ocular injury type, injury severity score (ISS), and ocular surgery were captured. Logistic regression models were conducted for injury types and the need for surgery. 8181 M-riders and 3817 E-riders were involved in an accident and hospitalized. E-riders suffered from ocular injury more than M-riders. Males were most vulnerable and the ages of 15-29. Orbital floor fracture was the most common injury, followed by ocular contusion, eyelid laceration, and other ocular wounds. Electric bicycle and scooter riders are more likely to suffer from ocular injury than motorcycle riders. Riders without helmets are at greater risk for injuries, specifically orbital floor fractures. ISS of 16 + was associated with injury demanding ocular surgery.
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Salmi LR, Noël L, Saillour-Glénisson F. [Decision-making process and evaluation of public health interventions]. Rev Epidemiol Sante Publique 2022; 71:101384. [PMID: 35831220 PMCID: PMC9271323 DOI: 10.1016/j.respe.2022.06.307] [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: 03/28/2022] [Revised: 05/07/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022] Open
Abstract
Objectif Nous proposons un cadre méthodologique destiné aux experts impliqués dans l'appui à la décision concernant les interventions de santé publique. Méthodes Le cadre méthodologique comprend quatre éléments : 1) une série de neuf questions, formulées en termes non techniques, pertinentes pour juger de l'utilité d'une intervention, considérée à un moment donné dans un contexte donné ; 2) une traduction de ces questions en concepts liés à l'évaluation des interventions (définition de l'intervention, de sa cible et de son objectif, efficacités potentielle et réelle, sécurité, efficience et équité) ; 3) une organisation logique des informations nécessaires pour répondre aux questions ; 4) un algorithme permettant de traduire les informations disponibles en recommandations sur l'utilité réelle de l'intervention dans le contexte où les questions ont été posées. Résultats Chaque étape est illustrée par des questions posées sur des interventions de sécurité routière, le dépistage, la transfusion sanguine et des mesures proposées pendant la pandémie de COVID-19. Conclusion La décision peut être facilitée si les experts fournissent aux décideurs un résumé formel des forces et faiblesses des connaissances, fondé sur une analyse de toutes les facettes de l'utilité potentielle d'une intervention.
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Affiliation(s)
- L-R Salmi
- Université de Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, F-33000 Bordeaux, France.
| | - L Noël
- Consultant, F-74940 Annecy-Le-Vieux, France
| | - F Saillour-Glénisson
- Université de Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de Santé Publique, Service d'information médicale, F-33000 Bordeaux, France
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13
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Urréchaga EM, Kodadek LM, Bugaev N, Bauman ZM, Shah KH, Abdel Aziz H, Beckman MA, Reynolds JM, Soe-Lin H, Crandall ML, Rattan R. Full-face motorcycle helmets to reduce injury and death: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg 2022; 224:1238-1246. [PMID: 35821175 DOI: 10.1016/j.amjsurg.2022.06.018] [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: 05/05/2022] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death. METHODS We searched for studies without exclusion based on: age, language, date, or randomization. Case reports, professional riders, and studies without original data were excluded. Pooled results were reported as OR (95% CI). Risk of bias and certainty was assessed. (PROSPERO #CRD42021226929). RESULTS Of 4431 studies identified, 3074 were duplicates, leaving 1357 that were screened. Eighty-one full texts were assessed for eligibility, with 37 studies (n = 37,233) eventually included. Full-face helmets reduced traumatic brain injury (OR 0.40 [0.23-0.70]); injury severity for the head and neck (Abbreviated Injury Scale [AIS] mean difference -0.64 [-1.10 to -0.18]) and face (AIS mean difference -0.49 [-0.71 to -0.27]); and facial fracture (OR 0.26 [0.15-0.46]). CONCLUSION Full-face motorcycle helmets are conditionally recommended to reduce traumatic brain injury, facial fractures, and injury severity.
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Affiliation(s)
| | | | | | | | - Kaushal H Shah
- Department of Emergency Medicine, Weill Cornell Medicine, USA.
| | | | | | | | - Hahn Soe-Lin
- Department of Surgery, St. Joseph's Medical Center, USA.
| | - Marie L Crandall
- Department of Surgery, University of Florida, Jacksonville, USA.
| | - Rishi Rattan
- Department of Surgery, University of Miami, USA.
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14
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FE Analysis of Motorcycle Helmet Performance under Severe Accidents. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A helmet is essential protective equipment for the safety of motorcyclists and their passengers. However, motorcycle accidents can cause severe injuries and fatalities, even when wearing helmets, because the strength of motorcycle helmets lacks head protectability in actual impact accidents. Thus, this research investigates the structural performance of commercial motorcycle helmets in Thailand for head injury prevention using finite element analysis via LS-DYNA. The helmet structural model was firstly validated under impact analysis by comparing with the test according to the TIS 369-2557 standard. The finite element results showed that the difference in maximum acceleration was only 4.8%. The protective efficacy of the helmet structure was then studied and analyzed by simulation under various velocities and impact angles according to three cases of accidents. The structural strength was investigated by assessing energy absorption, HIC, and AIS. The worst case was caused when high impact speeds and angles were applied, which showed the highest impact force and HIC. It also enabled a 100% probability of head damage according to AIS 2+, which causes fatality to passengers during impact accidents. The safest conditions in terms of head injury severity occurred when the impact angle was 45 degrees. Finally, at least 75% energy absorption of foam was further recommended for safety design to reduce head injury from motorcycle accidents.
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15
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Mohammadi E, Azadnajafabad S, Keykhaei M, Shakiba A, Ebrahimi Meimand S, Hosseini Shabanan S, Mahdavi Sharif P, Asgardoon MH, Shafieian M, Ghodsi Z, Heydari ST, Atlasi R, Ansari-Moghaddam A, Sharif-Alhoseini M, O'Reilly GM, Rahimi-Movaghar V. Barriers and factors associated with the use of helmets by Motorcyclists: A scoping review. ACCIDENT; ANALYSIS AND PREVENTION 2022; 171:106667. [PMID: 35413615 DOI: 10.1016/j.aap.2022.106667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 03/10/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
Road Traffic Injuries (RTIs) have imposed a great global burden on public health. Motorcyclists and pedestrians comprise the most significant proportion of this burden. Several studies have demonstrated a link between helmet wearing and a decline in the impact of RTIs in motorcyclists. In this study, we aimed to review the barriers to helmet utilization by motorcyclists. This scoping review has been conducted in accordance with the guidelines for the systematic review of observational studies and the PRISMA Checklist. The search was conducted by using related keywords in EMBASE, PubMed, Scopus, and Cochrane Library. Four independent reviewers carried out the screening. The main outcomes of interest were barriers to helmet usage among motorcyclists, drawn from the finally included studies. Fifty-three records were selected for data extraction. According to these reports, the barriers and factors associated with helmet usage among motorcyclists were categorized into five entities as: legislations/enforcement strategies, helmet disadvantages (discomfort, visual/auditory blockage, and thermal dysregulation), risky behaviors (riding while drunk or high on drugs), sex and/or age factors, and the location and time of the injury event (rural vs. urban locations, day vs. night riding). From the perspective of policymakers, the findings of this review are of utmost importance and could be used in addressing the challenge of inadequate compliance with helmet use.
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Affiliation(s)
- Esmaeil Mohammadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL 60611, USA
| | - Ali Shakiba
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Ebrahimi Meimand
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pouya Mahdavi Sharif
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Asgardoon
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Student Society for Immunodeficiencies, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.; Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mehdi Shafieian
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rasha Atlasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gerard M O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network (USERN), Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; Visiting Professor, Spine Program, University of Toronto, Toronto, Canada.
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16
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Chung Y. An application of in-vehicle recording technologies to analyze injury severity in crashes between taxis and two-wheelers. ACCIDENT; ANALYSIS AND PREVENTION 2022; 166:106541. [PMID: 34958978 DOI: 10.1016/j.aap.2021.106541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/04/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
Conventionally, the crash data used in traffic safety analysis have been collected by the police dispatched to the crash scene. Therefore, crash information inevitably includes errors that influence traffic safety analysis. Such errors can include the crash speed, crash time, crash location, and other crash characteristics. The advances in in-vehicle video recording (IVVR) technologies have recently enabled traffic safety professionals to use more accurate crash information based on crash data reconstruction methods. Although a few studies have been conducted to identify the factors affecting the crash injury severity using such detailed crash data, there was no effort to analyze the factors affecting the injury severity in crashes between taxis and two-wheelers (TWs), including bicycles and motorcycles. Therefore, this study analyzes the injury severity of TW riders in taxi-TW crashes with the accurate crash data collected by taxis equipped with IVVR devices in Incheon, Korea. Two hundred and forty-eight crash data from two years (2010-2011) were used to perform this objective. The factors affecting the injury severity to TW riders were identified based on a partial proportional odds model for these data. Seven variables were found to affect the injury severity significantly: crash speed, second collision, third collision, Delta-V, crashes that occurred with a non-helmeted motorcycle rider, crashes where the collision type was sideswipe, and crashes under rainy or snowy weather conditions. On the other hand, two variables regarding crashes, where the taxi driver behavior helped reduce visible and severe injuries, were changing lanes and the young TW riders (<18 years).
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17
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Zhou J, Zheng T, Dong S, Mao X, Ma C. Impact of Helmet-Wearing Policy on E-Bike Safety Riding Behavior: A Bivariate Ordered Probit Analysis in Ningbo, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052830. [PMID: 35270522 PMCID: PMC8910625 DOI: 10.3390/ijerph19052830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Jibiao Zhou
- College of Transportation Engineering, Tongji University, Shanghai 200082, China;
- School of Civil and Transportation Engineering, Ningbo University of Technology, Ningbo 315211, China;
| | - Tao Zheng
- School of Civil and Transportation Engineering, Ningbo University of Technology, Ningbo 315211, China;
| | - Sheng Dong
- College of Transportation Engineering, Tongji University, Shanghai 200082, China;
- Correspondence:
| | - Xinhua Mao
- College of Transportation Engineering, Chang’an University, Xi’an 710064, China;
| | - Changxi Ma
- School of Traffic and Transportation, Lanzhou Jiaotong University, Lanzhou 730070, China;
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18
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Hula A, Fürnsinn F, Schwieger K, Saleh P, Neumann M, Ecker H. Deriving a joint risk estimate from dynamic data collected at motorcycle rides. ACCIDENT; ANALYSIS AND PREVENTION 2021; 159:106297. [PMID: 34280694 DOI: 10.1016/j.aap.2021.106297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/09/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
Making motorcycle rides safer by advanced technology is an ongoing challenge in the context of developing driving assistant systems and safety infrastructure. Determining which section of a road and which driving behaviour is "safe" or "unsafe" is rarely possible due to the individual differences in driving experience, driving style, fitness and potentially available assistant systems. This study investigates the feasibility of a new approach to quantify motorcycle riding risk for an experimental sample of bikers by collecting motorcycle-specific dynamic data of several riders on selected road sections. Comparing clustered dynamics with the observed dynamic data at known risk spots, we provide a method to represent individual risk estimates in a single risk map for the investigated road section. This yields a map of potential risk spots, based on an aggregation of individual risk estimates. The risk map is optimized to include most of the previous accident sites, while keeping the overall area classified as risky small. As such, with data collected on a large scale, the presented methodology could guide safety inspections at the highlighted areas of a risk map and be the basis of further studies into the safety relevant differences in driving styles.
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Affiliation(s)
- Andreas Hula
- Center for Low-Emission Transport, Austrian Institute of Technology, Giefinggasse 2, Vienna A-1210, Austria.
| | - Florian Fürnsinn
- Center for Low-Emission Transport, Austrian Institute of Technology, Giefinggasse 2, Vienna A-1210, Austria
| | - Klemens Schwieger
- Center for Low-Emission Transport, Austrian Institute of Technology, Giefinggasse 2, Vienna A-1210, Austria
| | - Peter Saleh
- Center for Low-Emission Transport, Austrian Institute of Technology, Giefinggasse 2, Vienna A-1210, Austria
| | - Manfred Neumann
- Vienna University of Technology - Institute of Mechanics and Mechatronics, E325, Getreidemarkt 9/325, Vienna A-1060, Austria
| | - Horst Ecker
- Vienna University of Technology - Institute of Mechanics and Mechatronics, E325, Getreidemarkt 9/325, Vienna A-1060, Austria
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19
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Novelli G, Moretti M, De Ponti E, Bozzetti A, Sozzi D, Canzi G. Analysis of different safety devices in the prevention of motorcycle-related craniofacial trauma - A retrospective study. Ann Maxillofac Surg 2021; 11:293-297. [PMID: 35265501 PMCID: PMC8848692 DOI: 10.4103/ams.ams_203_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Motorcycle accidents are one of the most frequent causes of trauma. Safety devices and helmets can influence the severity of injuries. Our retrospective study wants to evaluate the different effectiveness of Open-face and Full-face helmets in the prevention of craniofacial trauma. Materials and Methods: The sample consists of 440 patients admitted to two Level I Trauma Centres in Northern Italy, between January 2002 and February 2019, because of motorcycle-related craniofacial trauma. For each patient personal data were collected, as well as type and site of fractures, type of helmet, if worn, Comprehensive Facial Injury (CFI) score and Abbreviated Injury Score (AIS-Head) for head injuries. Inferential statistical analysis was then conducted. Results: Two hundred and eighty-eight patients wore Open-face helmets (69.7%) and 125 patients wore Full-face ones (30.3%). Mean CFI score (Standard deviation - SD) observed in patients with Open-face helmets was 7.0 (SD: 6.8) and surgery was required in 149 cases (51.7%); while it was 4.9 (SD: 6.0) in patients with Full-face helmets for whom surgery was required in 43 cases (34.4%) (P < 0.0001 and P = 0.002, respectively). Multivariate analysis shows that severity of facial trauma is a significant risk factor for head injury severity with OR 1.90 (95% confidence interval: 1.43 - 2.51) and P < 0.0001. Discussion: Full-face helmets are definitely considered to be more protective for facial trauma, which is also a significant risk factor for the severity of head injuries. The type of helmet chosen influences the need of surgical treatment in case of craniofacial trauma.
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