An evidence-based review: helmet efficacy to reduce head injury and mortality in motorcycle crashes: EAST practice management guidelines

Riding practices of e-bike riders after the implementation of electric bike management regulations: An observational study in Hangzhou, China

Objective

This study aimed to understand the riding behaviors of electric bike (e-bike) users in Hangzhou after the "Regulations of Zhejiang Province on the Administration of Electric Bicycles".

Methods

The study consisted of two parts, including a questionnaire survey of local e-bike users in Shangcheng District and Jiande County in Hangzhou City, and a cross-sectional observational study of 16 intersections.

Results

A total of 789 e-bike riders participated in the questionnaire survey, and the riding behavior of 99,407 e-bike users was observed. The main purpose of using e-bike was work and daily life, 46.0% of them used e-bikes more than 5 days a week, and 58.5% used e-bikes for less than 30 min each time. A vast majority (81.7%) of e-bike riders believe that the implementation of Zhejiang Regulations has significantly improved the safety level of e-bike riding in the region. The field survey found that the correct rates of helmet wearing by e-bike riders and passengers were 78.83% and 42.27%. The main violations were invalid/non-helmet wearing (21.17%), followed by carrying passengers and running red lights (7.94% and 4.26%). The rates of invalid/non-helmet wearing and running red lights were significantly higher during non-morning rush hour, weekends, and roads without separate non-motorized vehicle lanes than in other conditions (all P < 0.05). Additionally, sunny days and crossroads were risk factors for passenger-carrying and invalid/non-helmet wearing compared to rainy/cloudy days and T-intersections.

Conclusions

The phenomenon that e-bike users' correct practice lags far behind the awareness of various violations has shown some improvement. To further enhance safety measures for e-bike riders, it is necessary to promote education, improve infrastructure, and strengthen law enforcement, in support of the "Zhejiang Regulations" and behavioral interventions.

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Unveiling the road to safety: Understanding the factors influencing motorcycle accidents among riders in rural Chiang Mai, Thailand

Background

Motorcycle accidents pose a significant threat to traffic safety in Thailand, particularly in rural areas where the severity of these accidents often results in prolonged medical treatment and a reduction in the quality of life of the affected individual.

Objectives

To investigate the prevalence and the factors associated with motorcycle accidents among motorcycle riders in rural areas in Chiang Mai, Thailand.

Method

A cross-sectional study was conducted from December 2022 to March 2023 via an anonymous survey in Chiang Mai, Thailand. A total of 308 participants engaged with the survey. The data about background information, motorcycle details, personal protective equipment, risky behaviors, attitude toward riding, and history of motorcycle accidents in the prior six months were collected and analyzed by binary logistic regression.

Results

Of 308 participants, the mean age was 56 years old (SD = 14.2), females were 56.8 % (N = 175), 51 % had co-morbidity, and 40.6 % were active alcohol drinkers. The prevalence of individuals who experienced a motorcycle accident within the previous six months was 57.1 %. Notably, the most unsafe riding behavior was not wearing a helmet while riding, which had a prevalence of more than 80 % in both the accident and non-accident groups. The study found significant associated factors for motorcycle accidents in rural communities, including the history of alcohol consumption (aOR 1.71, 95 % CI: 1.05,2.79), changing lanes without using turn signals (aOR 1.93, 95 % CI: 1.07,3.48) and those who strongly disagree with the notion that listening to music while riding is dangerous (aOR 2.80, 95 % CI: 1.06, 7.43).

Conclusion

Over half of motorcycle riders have been in accidents. These findings emphasize the need to enforce drunk-driving and traffic laws. Comprehensive motorcycle rider education and safety training are needed to encourage responsible riding.

Parental beliefs regarding adult and child motorcycle helmet-wearing practices in Vietnam

From a global perspective, low helmet-wearing rates in children are an ongoing concern. International studies show adult helmet-wearing rates are consistently higher than those of children. Research also shows parents are highly influential in promoting healthy behavior in their children. Parent-focused helmet-wearing campaigns are a practical way to actively feature parents influencing helmet-wearing in children. The current study obtained anonymous parent-focused survey data on parent and child helmet-wearing practices, perceived affects of helmet use on children's health, and beliefs about brain injury prevention from a sample of Vietnams parents. Findings from this study are consistent with previous international research that shows adults wear helmets at higher rates than children. Data from this study may help those responsible for child helmet safety campaigns develop more effective child helmet-wearing campaigns, particularly in Southeast Asian countries.

Motorcycle-related trauma in Ireland

Introduction

Motorcyclists are over-represented in collision statistics in Ireland. There is a lack of descriptive studies assessing the impact and injury pattern of this trauma cohort. This study examines this trauma subset using data collected by the Major Trauma Audit (MTA) by the National Office of Clinical Audit (NOCA) to identify patient demographics, injury mechanism and type, treatments received, and outcomes.

Methods

All motorcycle-related trauma cases recorded on the MTA, NOCA in Ireland for the period 2014 to 2019 were gathered and analysed.

Results

There were 704 cases identified; 94% of cases were male. The median (interquartile range (IQR)) age was 38.2 (26.7–49.7). There were 6.4% ( n = 45) aged 0–18 years, 88.2% ( n = 621) aged 18–64 and 5.4% ( n = 38) greater than 65 years. The median injury severity score (ISS) overall of this trauma cohort was 13 (IQR 9–24) but 306 patients (43.5%) had an ISS > 15. The most severe injury body region with 35.4% ( n = 249) was the limbs. Most patients arrived during the summer months with Sunday the highest day of attendance ( n = 181, 25.7%). May to August were the months with the most attendance ( n = 366, 52%). Most patients were discharged home ( n = 372, 52.8%) and 43.8% ( n = 308) required transfer to at least one other hospital for definitive care. There were 19 patients (2.7%) who died after arrival to hospital.

Conclusion

Motorcycle trauma predominantly affects a young male population with moderate severity injury characteristics. A significant proportion of patients present at weekends during the summer months, likely the result of recreational riding. A large cohort of patients requires transfer for definitive care, which has significant implications for trauma care pathways. National policies to enforce safety measures and public awareness for recreational motorcycle use may improve traffic safety and ultimately population health.

When the Helmet Is Not Enough: Forensic Multidisciplinary Reconstruction of a Deadly Motorcycle Accident

We report the case of a 54-year-old man who died in a motorcycle accident due to loss of control of the vehicle on a viaduct. No other vehicles were apparently involved, except for a car hit by the motorcycle after it fell. A post-mortem CT scan (computed tomography scan) was performed showing complex head trauma with a subarachnoid hemorrhage and multiple skull and facial bone fractures. A forensic cinematic reconstruction performed by an engineer was needed to exclude other incident causes other than the loss of control. The multidisciplinary approach that included autopsy findings, a cinematic reconstruction, a helmet test and an examination played a key role in clarifying the dynamics of the accident, allowing us to explain how the death occurred despite the motorcyclist’s helmet use. The cause of death was identified as a penetrating head trauma with cerebral material exposure, produced by the impact of the head against a fixed bolt in the guardrail base. Despite the use of the helmet, the impact force was enough to render the protection ineffective and allowed the bolt to penetrate through the helmet and the skull.

Temporal Instability of Factors Affecting Injury Severity in Helmet-Wearing and Non-Helmet-Wearing Motorcycle Crashes: A Random Parameter Approach with Heterogeneity in Means and Variances

Not wearing a helmet, not properly strapping the helmet on, or wearing a substandard helmet increases the risk of fatalities and injuries in motorcycle crashes. This research examines the differences in motorcycle crash injury severity considering crashes involving the compliance with and defiance of helmet use by motorcycle riders and highlights the temporal variation in their impact. Three-year (2017-2019) motorcycle crash data were collected from RESCUE 1122, a provincial emergency response service for Rawalpindi, Pakistan. The available crash data include crash-specific information, vehicle, driver, spatial and temporal characteristics, roadway features, and traffic volume, which influence the motorcyclist's injury severity. A random parameters logit model with heterogeneity in means and variances was evaluated to predict critical contributory factors in helmet-wearing and non-helmet-wearing motorcyclist crashes. Model estimates suggest significant variations in the impact of explanatory variables on motorcyclists' injury severity in the case of compliance with and defiance of helmet use. For helmet-wearing motorcyclists, key factors significantly associated with increasingly severe injury and fatal injuries include young riders (below 20 years of age), female pillion riders, collisions with another motorcycle, large trucks, passenger car, drivers aged 50 years and above, and drivers being distracted while driving. In contrast, for non-helmet-wearing motorcyclists, the significant factors responsible for severe injuries and fatalities were distracted driving, the collision of two motorcycles, crashes at U-turns, weekday crashes, and drivers above 50 years of age. The impact of parameters that predict motorcyclist injury severity was found to vary dramatically over time, exhibiting statistically significant temporal instability. The results of this study can serve as potential motorcycle safety guidelines for all relevant stakeholders to improve the state of motorcycle safety in the country.

10 city analysis of child passenger helmet use

INTRODUCTION

Road traffic injuries are the leading cause of death in children over age five. Most of these deaths occur in low- and middle-income countries. Vulnerable road users, such as motorcyclists and their passengers, are at higher risk. Helmets have significantly decreased morbidity and mortality for motorcyclists; however, they are often unused. The second phase of the Bloomberg Philanthropies Initiative for Global Road Safety was launched in 2015 to improve road safety in 10 cities. This study focuses on child passenger helmet use data from that study to understand the prevalence of helmet use and factors that are associated with helmet use.

METHODS

The 10 cities selected were Accra, Addis Ababa, Bandung, Bangkok, Bogota, Fortaleza, Ho Chi Minh City, Mumbai, Sao Paulo, and Shanghai. Eight rounds of roadside observational data were collected from February 2015 to April 2019. Observers noted correct child motorcycle passenger helmet use and other site observations including weather patterns, traffic volume, and road surface conditions. A multivariable Poisson regression model was used to examine correct helmet use trends over time. A multivariable logistic regression model was fitted for correct child passenger helmet use in all cities controlling for weather, observation time, number of passengers, and driver's correct helmet use.

RESULTS

This dataset contained 99,846 motorcycle child passenger observations across the 10 cities. The highest prevalence of correct child passenger helmet use was in Sao Paulo at 97.33%. Six cities had under 25% correct helmet use for child passengers. Examining helmet use over time, only five cities had a significant increase, four cities had no change, and Ho Chi Minh City demonstrated a decrease. In the multivariable regression model, child passengers had higher odds of wearing helmets in adverse weather conditions, early mornings, if the driver wore a helmet, and if there were fewer passengers.

CONCLUSIONS

The prevalence of correct child passenger helmet utilization shows large variation globally and is concerningly low overall. Enhanced enforcement in combination with media campaigns may have contributed to increasing helmet use prevalence over time. Further research is needed to understand reasons for low child passenger helmet use in most cities.

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

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

The Influence of Headform/Helmet Friction on Head Impact Biomechanics in Oblique Impacts at Different Tangential Velocities

Oblique impacts of the helmet against the ground are the most frequent scenarios in real-world motorcycle crashes. The combination of two factors that largely affect the results of oblique impact tests are discussed in this work. This study aims to quantify the effect of the friction at the interface between the headform and the interior of a motorcycle helmet at different magnitudes of tangential velocity. The helmeted headform, with low friction and high friction surface of the headform, was dropped against three oblique anvils at different impact velocities resulting in three different magnitudes of the tangential velocity (3.27 m/s, 5.66 m/s, 8.08 m/s) with the same normal component of the impact velocity (5.66 m/s). Three impact directions (front, left-side and right-side) and three repetitions per impact condition were tested resulting in 54 impacts. Tangential velocity variation showed little effect on the linear acceleration results. On the contrary, the rotational results showed that the effect of the headform’s surface depends on the magnitude of the tangential velocity and on the impact direction. These results indicate that a combination of low friction with low tangential velocities may result into underprediction of the rotational headform variables that would not be representative of real-world conditions.

The effectiveness of different types of motorcycle helmets - A scoping review

BACKGROUND

Protective helmets may reduce the risk of death and head injury in motorcycle collisions. However, there remains a large gap in knowledge regarding the effectiveness of different types of helmets in preventing injuries.

OBJECTIVE

To explore and evaluate the effectiveness of different types of motorcycle helmets; that is the association between different helmet types and the incidence and severity of head, neck, and facial injuries among motorcyclists. Also, to explore the effect of different helmet types on riders.

METHODS

A systematic search of different scientific databases was conducted from 1965 to April 2019. A scoping review was performed on the included articles. Eligible articles were included regarding defined criteria. Study characteristics, helmet types, fixation status, retention system, the prevention of injury or reduction of its severity were extracted.

RESULTS

A total of 137 studies were included. There was very limited evidence for the better protection of full-face helmets from head and facial injury compared to open-face and half-coverage helmets. There was however scarce evidence for the superiority of a certain helmet type over others in terms of protection from neck injury. The retention system and the fixation status of helmets were two important factors affecting the risk of head and brain injury in motorcyclists. Helmets could also affect and limit the riders in terms of vision, hearing, and ventilation. Multiple solutions have been discussed to mitigate these effects.

CONCLUSION

Full-face helmets may protect head and face in motorcycle riders more than open-face and half-coverage helmets, but there is not enough evidence for better neck protection among these three helmet types. Helmets can affect the rider's vision, hearing, and ventilation. When designing a helmet, all of these factors should be taken into account.

A review of common motorcycle collision mechanisms of injury

Injuries sustained in motorcycle collisions can be organized into distinct patterns to improve recognition and treatment.

Lowside, highside, topside, and collision are the four main categories of motorcycle crash types.

Within those four crash types, mechanisms of injury include head-leading collisions, direct vertical impact, motorcycle radius, motorcycle thumb, fuel tank injures, limb entrapment, tyre-spoke injury, and crash modifying manoeuvre.

Cite this article: EFORT Open Rev 2020;5:544-548. DOI: 10.1302/2058-5241.5.190090

Influences of impact scenarios and vehicle front-end design on head injury risk of motorcyclist

Motorcycle to vehicle collision is one of the most common accidents in the world and usually leads to serious or fatal head injuries to motorcyclists. This study aims to investigate the influences of impact scenarios and vehicle front-end design parameters on head injury risk of the motorcyclist. Five general vehicle types and different impact scenarios were selected for a parametric analysis. Impact scenarios were set according to ISO, 13232 regulation considering impact angles and impact speeds. Five vehicle types of Sedan, MPV (Multi-Purpose Vehicle), SUV (Sport Utility Vehicle), EV (Electric Vehicle) and 1-Box vehicle were included. HIC₁₅ (Head Injury Criterion), head angular acceleration and CSDM (Cumulative Strain Damage Measure) were calculated to evaluate head injury risk of the motorcyclist. The results show that the critical impact speed for HIC₁₅ and head angular acceleration was around 15 m/s, while the critical speed for CSDM was approximately 10 m/s. Impact angle of 45° show extremely high injury risk to the motorcyclist head. Bonnet leading edge height and its combination with other parameter present high influences on motorcyclist head injuries, and the increasing the bonnet leading edge height can potentially reduce head injury risk of motorcyclists. In summary, the present research results provide some theoretic bases for determining the test speed in motorcycle-vehicle crash regulation and design consideration for typical vehicle front end shape.

Results of a Campaign for Motorcycle Helmets Advocacy in a City in Southwest of Iran; A Population-Based Intervention Study

Objective:

We conducted a triple phase project for motorcycle helmets advocacy in Darab, a city in southwest Iran. The aim of this study was to evaluate the effect of the project on decreasing the hazards of motorcycle accidents.

Methods:

Using a questionnaire, data for ICU admission rates, hospital costs for patients who required ICU admission, rate of helmet usage, mortality and the duration of ICU care for patients admitted to Darab hospital due to motorcycle accidents in Winter 2015 (before conducting the project) and Winter 2016 (after conducting the project) were gathered and compared. This feature was also separately done for patients younger than 17 years.

Results:

The rate of wearing helmets increased significantly in winter 2016 (from 3.4 % to 33%). Also ICU admission rate due to head trauma was significantly decreased after the project was done (from 14.5 % to 4%). However, hospital costs for patients required ICU admission were increased in winter 2016. This increase, though not significant, seems to be due to an increase in health service expenses in the year 2016 as compared with the year 2015. The mortality rate was not significantly changed between the two mentioned years results. For patients younger than 17 years, no ICU admissions were needed in winter 2016.

Conclusion:

Even a short period of intervention can have positive effects on increasing the safety of motorcycle drivers.

Comparison of Urban Off-Road Vehicle and Motorcycle Injuries at a Level 1 Trauma Center

BACKGROUND

Recently, there has been an increase in the usage of dirt bikes and all-terrain vehicles in urban environments. Previously, it has been shown that crashes involving these urban off-road vehicles (UORVs) resulted in different injury patterns from crashes that occurred in rural environments. The aim of this study was to compare injury patterns of patients involved in crashes while riding UORVs versus motorcycles (MCs).

METHODS

A retrospective review (2005-2016) of patients who presented to our urban level I trauma center as a result of any MC or UORV crash was performed. Patients who presented after 48 h from the time of accident were excluded. A P < 0.05 was considered significant.

RESULTS

We identified 1556 patients who were involved in an MC or UORV crash resulting in injury (MC: n = 1324 [85%]; UORVs: n = 232 [15%]). Patients in UORV crashes were younger (26.2 y versus 39.6 y), less likely to be helmeted (39.6% versus 90.2%), required fewer emergent trauma bay procedures (28.4% versus 36.7%), and needed fewer operative interventions (45.9% versus 54.2%) (all P < 0.05). Both groups had a similar Injury Severity Score (12.2 versus 12.6; P = 0.54) and Glasgow Coma Score (13.8 versus 13.5; P = 0.46). UORV patients had a lower mortality (0.9% versus 4.7%; P < 0.05) compared to MC crash patients despite similar injury patterns.

CONCLUSIONS

Our data demonstrate that patients sustaining UORV injuries were younger and less likely to be helmeted but have a lower mortality rate after a crash, despite sustaining similar injuries as motorcyclists. This study provides an overview of how crashes involving UORV usage is a unique phenomenon and not entirely comparable to MC crashes.

Prevention of all-terrain vehicle injuries: A systematic review from The Eastern Association for the Surgery of Trauma

BACKGROUND

Despite increasing usage since their introduction, there exist no evidence-based guidelines on all-terrain vehicles (ATVs) and injury prevention. While the power and speed of these vehicles has increased over time, advancements in ATV safety have been rare.

METHODS

A priori questions about ATV injury pattern and the effect of helmet and safety equipment use and legislation mandating use were developed. A query of MEDLINE, PubMed, Cochrane Library, and Embase for all-terrain vehicle injury was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. Grading of Recommendations Assessment, Development, and Evaluation methodology was used to perform a systematic review and create recommendations.

RESULTS

Twenty-eight studies were included. Helmet use reduced traumatic brain injury (TBI). However, studies examining whether legislation mandating helmet use reduced TBI had mixed results. When ATV safety legislation was enforced, overall injury rates and mortality decreased. However, enforcement varied widely and lack of enforcement led to decreased compliance with legislation and mixed results. There was not enough evidence to determine the effectiveness of non-helmet-protective equipment.

CONCLUSION

Helmet use when riding an ATV reduced the rate of TBI. ATV safety legislation, when enforced, also reduced morbidity and mortality. Compliance with laws is often low, however, possibly due to poor enforcement. We recommend helmet use when riding on an ATV to reduce TBI. We conditionally recommend implementing ATV safety legislation as a means to reduce ATV injuries, noting that enforcement must go hand in hand with enactment to ensure compliance.

Helmets Matter: Kentucky Motorcycle Crash Victims Seen at a Tennessee Trauma Center

OBJECTIVES

Motorcycle helmet laws vary by state, with Kentucky requiring helmets only for younger riders. We hypothesized that motorcyclists injured in Kentucky and seen at a Tennessee trauma center would be more likely to be unhelmeted, have more severe head injuries, and sustain more fatal injuries than those injured in Tennessee or Virginia.

METHODS

A Trauma Registry review of 729 injured motorcyclists from January 2005 through June 2015 examined state location of crash, demographics, helmet use, and clinical outcomes. Multivariate logistic regression analysis evaluated predictors for head injury severity and death.

RESULTS

Unhelmeted motorcycle rider status predicted more severe head injuries (relative risk 15.3, P < 0.001) and death (relative risk 4.2, P < 0.001). Motorcyclists injured in the state of Kentucky were more likely to be unhelmeted, require an operative procedure, have more severe head injuries, have longer lengths of stay, and sustain more fatal injuries (all with < 0.001) than motorcyclists injured in Tennessee or Virginia.

CONCLUSIONS

This study lends support for maintaining and enforcing current universal motorcycle helmet laws for all ages in states where they are in effect and for upgrading helmet laws that apply only to some riders.

Anatomic Location and Mechanism of Injury Correlating with Prehospital Deaths in Sub-Saharan Africa

INTRODUCTION

Trauma is a large contributor to morbidity and mortality in developing countries. We sought to determine which anatomic injury locations and mechanisms of injury predispose to prehospital mortality in Malawi to help target preventive and therapeutic interventions. We hypothesized that head injury would result in the highest prehospital mortality.

METHODS

This was a retrospective analysis of all trauma patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, from 2008 to 2015. Independent variables included baseline characteristics, anatomic location of primary injury, mechanism of injury, and severity of secondary injuries. Multivariable logistic regression was used to assess the effect of primary injury location and injury mechanism on prehospital death, after adjusting for confounders. Effect measure modification of the primary injury site/prehospital death relationship by injury mechanism (stratified into intentional and unintentional injury) was assessed.

RESULTS

Of 85,806 patients, 701 died in transit (0.8%). Five hundred and five (72%) of these patients sustained a primary head injury. After adjustment, head injury was the anatomic location most associated with prehospital death (OR 11.81 (95% CI 6.96-20.06, p < 0.0001). The mechanisms of injury most associated with prehospital death were gunshot wounds (OR 38.23, 95% CI 17.66-87.78, p < 0.0001) and pedestrian hit by vehicle (OR 2.62, 95% CI 1.92-3.55, p < 0.0001). Among head injury patients, the odds of prehospital mortality were higher with unintentional injuries.

CONCLUSIONS

Head injuries are the most common causes of prehospital death in Malawi, while pedestrians hit by vehicles are the most common mechanisms. In a resource-poor setting, preventive measures are critical in averting mortality.

Helmet retention system types as a risk factor to properly attach the chin strap

OBJECTIVES

This study aimed to determine the factors associated with the incorrect use of a helmet retention system (loose or open) and how often this happens.

METHODS

This was an observational transversal study conducted in Curitiba, Brazil. Trained observers positioned at traffic lights collected information about the helmet fixation mode, the helmet model (full-face, open-face, modular, half), and the helmet retention system model (micrometric, double-D, fast-release). Additional data including position on the motorcycle, gender, and function of the motorcycle (as a work vehicle) were collected. The observers, collection site, and periods were randomly selected by lots.

RESULTS

From a total of 3,050 motorcyclists, 1,807 (59.2%) had their helmets fastened correctly, 907 (29.7%) had the retention system fastened loosely, and in 336 (11.0%), the retention system was completely open. Increased odds of incorrect use were observed for the fast-release and double-D buckles compared to the micrometrics buckles, with a fixed odds ratio (OR) of 4.62 (95% confidence interval [CI], 3.89-5.51) and 3.54 (95% CI, 2.46-5.09), respectively (P <.0001). Full-face helmets had a higher chance of incorrect use (P <.0001), and passengers had a higher incidence of incorrect use of the helmet than drivers (P <.0001).

CONCLUSION

An important risk factor related to the incorrect use of the helmet was the type of retention system. The helmet model and being a passenger had a secondary influence on incorrect use of helmets.

Preventive effects of motorcycle helmets on intracranial injury and mortality from severe road traffic injuries

INTRODUCTION

Road traffic injuries caused by motorcycle crashes are one of the major public health burdens leading to high mortality, functional disability, and high medical costs. The helmet is crucial protective equipment for motorcyclists. This study aimed to measure the protective effect of motorcycle helmets on clinical outcomes and to compare the effects of high- and low-speed motorcycle crashes.

METHODS

A cross-sectional observational study was conducted using a nationwide registry of severe trauma patients treated by emergency medical services (EMS) providers in Korea. The study population consisted of severe trauma patients injured in motorcycle crashes between January and December 2013. The primary and secondary outcomes were intracranial injury and in-hospital mortality. We calculated adjusted odds ratios (AORs) of helmet use and motorcycle speeds for study outcomes after adjusting for potential confounders.

RESULTS

Among 495 eligible patients, 105 (21.2%) patients were wearing helmets at the time of the crash, and 256 (51.7%) patients had intracranial injuries. The helmeted group was less likely to have an intracranial injury compared with the un-helmeted group (41.0% vs. 54.6%, AOR: 0.53 (0.33-0.84)). However, there was no significant difference in in-hospital mortality between the two groups (16.2% vs. 16.9%, AOR: 0.91 (0.49-1.69)). In the interaction analysis, there was a significant preventive effect of motorcycle helmet use on intracranial injury when the speed of the motorcycle was <30km/h (AOR: 0.50 (0.27-0.91)).

CONCLUSION

Wearing helmets for severe trauma patients in motorcycle crashes reduced intracranial injuries. The preventive effect on intracranial injury was significant in low-speed motorcycle crashes.

Pediatric moped-related injuries in the United States from 2002 to 2014: Age-related comparisons of mechanisms and outcomes

Mopeds are a popular means of transportation, especially in urban areas. However, few studies have investigated moped-related injuries in the United States. This study's goal was to compare the crash mechanisms and injuries suffered in moped-related crashes involving youth versus adults, as well as between younger and older children.

INTRODUCTION

Mopeds are a popular means of transportation, especially in urban areas. However, few studies have investigated moped-related injuries in the United States. This study's goal was to compare the crash mechanisms and injuries suffered in moped-related crashes involving youth versus adults, as well as between younger and older children.

METHODS

Descriptive and comparative analyses were performed using National Electronic Injury Surveillance System (NEISS) data and additional variables coded from injury narratives. Multivariate regression analyses were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for categorical outcomes, controlling for significant covariates.

RESULTS

From 2003 to 2014, there were 779 youth (17 years or younger) and 2,453 adult moped-related emergency department visits in the database. The number of youth injured remained relatively constant over time, while the number of adult victims doubled. Relative to 14- to 17-year olds, victims younger than 14 years were more commonly female (p = 0.037) and non-Caucasian (p = 0.008). Victims 14 to 17 years of age had a higher proportion of brain injuries (p = 0.012) and were more commonly in motor vehicle collisions (p = 0.02), as compared to younger victims. Relative to adults, youth crashes occurred more commonly in the summer (p < 0.0001), and off the street/road (p < 0.0001). Logistic regression analysis showed crashes on streets/roads were two and a half times more likely to involve victims who were 14 to 17 years of age as compared to those younger (aOR, 2.55; CI, 1.64-3.97). Additionally, male youths were twice as likely as females to have a motor vehicle collision (aOR, 1.97; CI, 1.19-3.24), and pediatric crashes were approximately twice as likely to result in extremity injuries as compared to adult crashes (aOR, 1.95; CI, 1.19-3.20).

CONCLUSION

Differences in crash mechanism and injuries sustained between two youth age groups and between youths and adults indicate the importance of targeted injury prevention efforts. This would include improved operator training and standardized, evidence-based, well-enforced safety legislation.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Differential protective effects of motorcycle helmets against head injury

BACKGROUND

Although numerous observational studies have demonstrated a protective effect of motorcycle helmets against head injury, the degree of protection against specific head injury types remains unclear. Experimental biomechanics studies involving cadavers, animals, and computer models have established that head injuries have varying etiologies. This retrospective cross-sectional study compared helmet protection against skull fracture, cerebral contusion, intracranial hemorrhage, and cerebral concussion in a consecutive series of motorcycle operators involved in recent traffic crashes in Kentucky.

METHODS

Police collision reports linked to hospital inpatient and emergency department (ED) claims were analyzed for the period 2008 to 2012. Motorcycle operators with known helmet use who were not killed at the crash scene were included in the study. Helmet use was ascertained from the police report. Skull fracture, cerebral contusion, intracranial hemorrhage, and cerebral concussion were identified from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes on the claims records. The relative risks of each type of head injury for helmeted versus unprotected operators were estimated using generalized estimating equations.

RESULTS

Helmets offer substantial protection against skull fracture (relative risk [RR] = 0.31, 95% confidence interval [CI], 0.23, 0.34), cerebral contusion (RR = 0.29, 95% CI, 0.16, 0.53), and intracranial hemorrhage (RR = 0.47, 95% CI, 0.35, 0.63). The findings pertaining to uncomplicated concussion (RR = 0.80, 95% CI, 0.64, 1.01) were inconclusive. A modest protective effect (20% risk reduction) was suggested by the relative risk estimate, but the 95% confidence interval included the null value.

CONCLUSIONS

Motorcycle helmets were associated with a 69% reduction in skull fractures, 71% reduction in cerebral contusion, and 53% reduction in intracranial hemorrhage. This study finds that current motorcycle helmets do not protect equally against all types of head injury. Efforts to improve rotational acceleration management in motorcycle helmets should be considered.

Motorcycle-related hospitalizations of the elderly

Background

To investigate the injury pattern, mechanisms, severity, and mortality of the elderly hospitalized for treatment of trauma following motorcycle accidents.

Methods

Motorcycle-related hospitalization of 994 elderly and 5078 adult patients from the 16,548 hospitalized patients registered in the Trauma Registry System between January 1, 2009 and December 31, 2013.

Results

The motorcycle-related elderly trauma patients had higher injury severity, less favorable outcomes, higher proportion of patients admitted to the intensive care unit (ICU), prolonged hospital and ICU stays and higher mortality than those adult motorcycle riders. It also revealed that a significant percentage of elderly motorcycle riders do not wear a helmet. Compared to patients who had worn a helmet, patients who had not worn a helmet had a lower first Glasgow Coma Scale (GCS) score, and a greater percentage presented with unconscious status (GCS score ≤8), had sustained subdural hematoma, subarachnoid hemorrhage, cerebral contusion, severe injury (injury severity score 16–24 and ≥25), had longer hospital stay and higher mortality, and had required admission to the ICU.

Conclusions

Elderly motorcycle riders tend to present with a higher injury severity, worse outcome, and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

Differences between the sexes in motorcycle-related injuries and fatalities at a Taiwanese level I trauma center

Background

Female patients present with unique physiological and behavioral characteristics compared to male patients. The aim of this study was to investigate and compare the injury patterns, injury characteristics, and mortality of male and female patients hospitalized for treatment of motorcycle accident-related trauma in a level I trauma center.

Methods

Retrospective analysis of motorcycle-related injuries from the Trauma Registry System was performed to identify and compare 4028 male and 2919 female patients hospitalized for treatment between January 1, 2009 and December 31, 2013.

Results

The female patients were younger, less often drunken, more often wore helmets, were transported by emergency medical services, and arrived at the emergency department between 7 a.m. and 5 p.m. compared to male patients. Analysis of Abbreviated Injury Scale scores revealed that female patients sustained significantly higher rates of injuries to the extremities, but lower rates of injuries to the head/neck, face, and thorax than male patients did. Female patients had a significant lower Injury Severity Score (ISS) and adjusted odds ratio of in-hospital mortality (AOR 0.83, 95% CI: 0.83–0.86) after adjustment by ISS. However, the logistic regression analysis of propensity score-matched patients with adjusted confounders including helmet-wearing status and alcohol intoxication revealed that the gender did not significantly influence mortality (OR 0.82, 95% CI 0.47–1.43; p = 0.475), implying the an associated risky behaviors may attribute to the difference of odds of mortality between the male and female patients. In addition, a significantly fewer female patients were admitted to the intensive care unit (ICU), and female patients had a significantly shorter hospital and ICU length of stay.

Conclusion

Female motorcycle riders have different injury characteristics, lower ISS and in-hospital mortality, and present with a bodily injury pattern that differs from that of male motorcycle riders.

Level of evidence

Epidemiologic study, level III.

Examination of factors associated with use rates after transition from a universal to partial motorcycle helmet use law

OBJECTIVES

Motorcycle riders account for a disproportionately high number of traffic injuries and fatalities compared to occupants of other vehicle types. Though research has demonstrated the benefits of helmet use in preventing serious and fatal injuries in the event of a crash, helmet use has remained relatively stable in the United States, where the most recent national estimates show a 64% use rate. Use rates have been markedly lower among those states that do not have a universal helmet law for all riders. In 2012, the state of Michigan repealed its longstanding mandatory helmet use law. In order to gain insights as to the effects of this legislative change, a study was conducted to examine short-term changes in helmet use and identify factors associated with use rates.

METHODS

A statewide direct observation survey was conducted 1 year after the transition from a universal helmet law to a partial helmet law. A random parameters logistic regression model was estimated to identify motorcyclist, roadway, and environmental characteristics associated with helmet use. This modeling framework accounts for both intravehicle correlation (between riders and passengers on the same motorcycle) as well as unobserved heterogeneity across riders due to important unobserved factors.

RESULTS

Helmet use was shown to vary across demographic segments of the motorcyclist population. Use rates were higher among Caucasian riders, as well as among those age 60 and above. No significant difference was observed between male and female riders. Use was also found to vary geographically, temporally, and with respect to various environmental characteristics. Geographically, helmet use rates tended to be correlated with historical restraint use trends, which may be reflective of riding environment and general differences in the riding population. To this end, rates were also highly variable based upon the type of motorcycle and whether the motorcyclist was wearing high-visibility gear.

CONCLUSIONS

The study results demonstrate the short-term reduction in helmet use following transition from a universal to partial motorcycle helmet law. The reduction in use is somewhat less pronounced than has been experienced in other states, which may be reflective of general differences among Michigan motorcyclists because the state has also generally exhibited higher use rates of seat belts and other forms of occupant protection. The study results also highlight potential target areas for subsequent education and public awareness initiatives aimed at increasing helmet use.

Injury epidemiology in Iran: a systematic review

Background:

Injuries are the second greatest cause of mortality in Iran. Information about the epidemiological pattern of injuries is effective in decision-making. In this regard, the aim of the current study is to elaborate on the epidemiology of injuries in Iran through a systematic review.

Methods:

Required data were collected searching the following key words and their Persian equivalents; trauma, injury, accident, epidemiology, prevalence, pattern, etiology, risk factors and Iran. The following databases were searched: Google Scholar, PubMed, Scopus, MagIran, Iranian scientific information database (SID) and Iran Medex. Some of the relevant journals and web sites were searched manually. The lists of references from the selected articles were also investigated. We have also searched the gray literature and consulted some experts.

Results:

Out of 2747 retrieved articles, 25 articles were finally included in the review. A total of 3234481 cases have been investigated. Mean (SD) age among these cases was 30 (17.4) years. The males comprised 75.7% of all the patients. Only 31.1% of patients were transferred to hospital by ambulance. The most common mechanism of injuries was road traffic accidents (50.1%) followed by falls (22.3%). In road traffic accidents, motorcyclists have accounted for the majority of victims (45%). Roads were the most common accident scene for the injuries (57.5%). The most common injuries were to the head and neck. (47.3%). The mean (SD) Injury Severity Score (ISS) was 8.1(8.6%). The overall case-fatality proportion was 3.8% and 75% of all the mortalities related to road traffic accidents.

Conclusions:

The main priorities in reducing the burden of injuries include: the young, male target group, improving pre-hospital and ambulance services, preventing road traffic accidents, improving road safety and the safety of motorcyclists (compulsory helmet use, safer vehicles, dedicated motorcycle lanes).

Trends in helmet use by motorcycle riders in the decades following the repeal of mandatory helmet laws

Several US states repealed universal motorcycle helmet laws in the 1990s and 2000s. The purpose of this study was to examine national trends in helmet use among adult trauma patients with motorcycle-related injuries. We hypothesized that motorcycle helmet use declined over time. We retrospectively analyzed the National Trauma Data Bank's National Sample Program for 2003-2010. We also obtained data on US motorcycle fatalities reported in the Fatality Analysis Reporting System and population data from the U.S. Census Bureau to calculate motorcycle-related fatality rates over time. A total of 255,914 patients met inclusion criteria, of whom 148,524 (58%) were helmeted. During the study period, helmet use increased from 56% in 2003 to 60% in 2010 (p < 0.001). However, motorcycle-related fatality rates also increased in states with and without universal helmet laws. Nationally, rates of helmet use have increased. However, fatalities due to motorcycle crashes have also increased during the same period.

Patterns of injury among motorized two-wheeler pillion riders in New Delhi, India

BACKGROUND

Motorized two-wheelers (MTWs) such as scooters and motorcycles place drivers and passengers at significant risk of injury and death in the event of a road traffic accident. In India, where road traffic is poorly regulated and consists of vehicles ranging from semitrucks to animal carts, the MTW pillion rider (backseat passenger) is particularly vulnerable. Annually, approximately 140,000 Indians are injured or killed in MTW road traffic accidents. In 2011, the city of New Delhi renewed a mandatory helmet use exemption for its 8 million women. We sought to identify the patterns of injury among MTW pillion riders in the city of New Delhi, including differences between helmeted and unhelmeted male and female pillion riders.

METHODS

All records of incoming trauma patients to the Jai Prakash Narayan Apex Trauma Center, New Delhi, were reviewed for the 23-mo period from April 1, 2009 until March 1, 2011. More than 3000 charts were reviewed selecting for patients who were MTW pillion riders involved in road traffic accidents. Data including Glasgow Coma Scale score, number of surgical procedures performed, length of stay, and demographic information were collected from charts that met the criteria. Fisher's exact test was used for categorical variables and Kruskal-Wallis test for continuous variables.

RESULTS

A total of 466 charts of MTW pillions in road traffic accidents were identified with 108 helmeted males, 161 unhelmeted males, three helmeted females, and 194 unhelmeted females. Females, both unhelmeted and helmeted, were more likely to have head and neck injury than unhelmeted males or helmeted males (66.0% and 66.7% versus 53.4% and 27.8%, P < 0.001). Unhelmeted females were most likely to suffer inhospital mortality (17.6%, P = 0.008) and require intensive care unit admission (40.0%, P = 0.004). Unhelmeted pillions, both male and female, had significantly lower Glasgow Coma Scale scores than helmeted pillions (12.6 and 12.8 versus 13.8 and 15, P = 0.04).

CONCLUSIONS

Female pillions are more likely to have head and neck injury than male pillions, and unhelmeted pillions are more likely to have injuries resulting in their death. This firmly establishes the protective benefit of helmet use for pillions. Encouraging helmet use among all pillions may prevent a significant number of injuries and deaths, and mandatory helmet laws may decrease morbidity and mortality of MTW road traffic accidents for the women of New Delhi and all of India.

Traumatic tentorial hematoma in two-wheeler riders: Correlation with helmet use

BACKGROUND

Tentorial hematoma is frequently seen in traumatic brain injury (TBI) patients, especially in motorized two-wheeler riders following head injury. However its relevance and prognostic significance are not known.

OBJECTIVE

To evaluate patients of TBI with tentorial hematoma using a simple grading system and attempt to correlate this grading with factors like helmet use and neurological outcome.

MATERIALS AND METHODS

This prospective study over a 1-year period included patients with TBI who had tentorial hematoma in the initial plain head. Patients were divided into three grades based on the initial CT findings: Grade I: Isolated tentorial hematoma, grade II: tentorial hematoma with midline shift but open cisterns and grade III: Tentorial hematoma with effaced cisterns. Clinical and radiological records of patients including admission GCS and GOS at discharge were assessed in all cases.

OBSERVATIONS

A total of 1786 patients of TBI were admitted during the study period. Of these, 106 (5.9%) patients had tentorial hematoma. 84.9% (n = 90) were male and 15.1% (n = 16) were female with the mean age being 36.5 years (range 2-66 years). The mean admission GCS was 13, 11 and 8 in patients with grade I, II and III tentorial hematoma respectively. 43.4% (n = 46) of the patients had grade I, 32.1% (n = 34) had grade II and 24.5% (n = 26) patients had grade III tentorial hematoma. Seventy-one patients (84.5%) were riding motorized two wheelers with 63 (89%) wearing helmets. The majority of the patients wearing helmets (58.8%) had grade I hematoma with 35% (n = 22) having grade II hematoma and only 6.3% (n = 4) having grade III hematoma. Overall, there were 20 deaths. 50% (n = 10) of the deaths were in patients with grade III hematoma and 40% (n = 8) of the deaths were in patients with grade II hematoma. There were two (10%) deaths in patients with grade I hematoma (both unrelated to head injury). The mean GOS at the time of discharge was 5, 4.1 and 2.2 in patients with grade I, II and III tentorial hematoma, respectively.

CONCLUSIONS

Tentorial hematomas are very common in two-wheeler riders with TBI and could be a marker for indirect forces such as rotational forces experienced while wearing helmets.

The scourge of head injury among commercial motorcycle riders in Kampala; a preventable clinical and public health menace

BACKGROUND

Trauma is an increasingly important cause of disease globally. Half of this trauma is from road traffic injuries with motorcycles contributing 21-58%. Low protective gear use, lack of regulation and weak traffic law enforcement contribute to unsafe nature of commercial motorcycles also known as "boda boda" in Uganda.

OBJECTIVES

To determine the prevalence of protective gear use, the occurrence of head injury and the relationship between the two among commercial motorcycle riders in Kampala.

METHODS

Following ethical approval we recruited consecutive consenting participants to this analytical cross-sectional study. Data was collected using pretested interviewer administered questionnaires, double entered in Epidata and analyzed with STATA. Proportions and means were used to summarize data. Odds ratios were calculated for association between wearing helmets and occurrence and severity of head injury.

RESULTS

All 328 participants recruited were male. Of these, 18.6% used Protective gear and 71.1 % sustained head injury. Helmets protected users from head injury (OR 0.43, 95% CI, 0.23-0.8) and significantly reduced its severity when it occurred.

CONCLUSION

Protective gear use was low, with high occurrence of head injury among commercial motorcycle riders in Uganda. More effective strategies are needed to promote protective gear use among Uganda's commercial motorcycle riders.

Motorcycle-related hospitalization of adolescents in a Level I trauma center in southern Taiwan: a cross-sectional study

BACKGROUND

The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center.

METHODS

Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion.

RESULTS

Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet.

CONCLUSION

Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

Motorcycle-Related Traumatic Brain Injuries: Helmet Use and Treatment Outcome

Summary. With increasing use of motorcycle as means of transport in developing countries, traumatic brain injuries from motorcycle crashes have been increasing. The only single gadget that protects riders from traumatic brain injury is crash helmet. Objective. The objectives were to determine the treatment outcome among traumatic brain injury patients from motorcycle crashes and the rate of helmet use among them. Methods. It was a prospective, cross-sectional study of motorcycle-related traumatic brain injury patients managed in our center from 2010 to 2014. Patients were managed using our unit protocol for traumatic brain injuries. Data for the study were collected in accident and emergency, intensive care unit, wards, and outpatient clinic. The data were analyzed using Environmental Performance Index (EPI) info 7 software. Results. Ninety-six patients were studied. There were 87 males. Drivers were 65. Only one patient wore helmet. Majority of them were between 20 and 40 years. Fifty-three patients had mild head injuries. Favorable outcome among them was 84.35% while mortality was 12.5%. Severity of the injury affected the outcome significantly. Conclusion. Our study showed that the helmet use by motorcycle riders was close to zero despite the existing laws making its use compulsory in Nigeria. The outcome was related to severity of injuries.

Correlates and Barriers Associated with Motorcycle Helmet Use in Wa, Ghana

OBJECTIVE

This study was conducted to investigate the correlates and barriers to helmet use among motorcycle riders in Wa, a motorcycle-predominant town in Ghana. An additional objective was to determine the association between helmet use and riders' knowledge, attitudes, and beliefs toward helmets.

METHODS

Cross-sectional surveys including both observation of helmet use and interviews were conducted among motorcycle riders at 6 randomly selected fuel stations and 4 motorcycle service centers within and outside the Central Business District of Wa. Questions covered riders' sociodemographic and riding characteristics, helmet use, reasons for use or nonuse of helmets, and knowledge, attitudes, and beliefs about helmets. Analyses were based on frequencies and testing of strength of association using adjusted odds ratios (with 95% confidence intervals) in binary logistic regression.

RESULTS

The prevalence of helmet use among the 271 sampled riders was 46% (95% confidence interval [CI], 40.2-52.0). Gender, age, marital status, and occupation were significant sociodemographic correlates of helmet use in Wa. Compared to currently married riders, unmarried riders were 5 times less likely to use a helmet. No significant association existed between riders' educational attainment and helmet use. Helmet use was also positively correlated with helmet ownership and license holding. The leading reasons stated for helmet nonuse among nonusers were not traveling a long distance and helmets block vision and hearing. Protection from injury, legal requirement, and coping with the police for fear of being accosted for helmet nonuse were identified as common reasons for helmet use. Positive attitudes and beliefs were also significantly correlated with helmet use.

CONCLUSIONS

Despite the existence of a legislation mandating the use of helmets on all roads as well as the high level of awareness among riders on this legislation and the benefits of helmets, the incidence of helmet use among motorists continue to be low in Wa, Ghana. This means that efforts to identify strategies to increase helmet use need to continue. The evidence provided by this study suggests that stakeholders in road safety need to put in interventions to ensure a rigorous enforcement of the helmet use legislation and improvement in helmet design. These should be combined with the development of targeted educational programs with the aim of changing unfavorable attitudes and beliefs toward helmet use.

Alcohol-related hospitalizations of adult motorcycle riders

OBJECTIVE

To provide an overview of the demographic characteristics of adult motorcycle riders with alcohol-related hospitalizations.

METHODS

Data obtained from the Trauma Registry System were retrospectively reviewed for trauma admissions at a level I trauma center between January 1, 2009 and December 31, 2013. Out of 16,548 registered patients, detailed information was retrieved regarding 1,430 (8.64%) adult motorcycle riders who underwent a blood alcohol concentration (BAC) test. A BAC level of 50 mg/dL was defined as the cut-off value for alcohol intoxication.

RESULTS

In this study, alcohol consumption was more frequently noted among male motorcycle riders, those aged 30-49 years, those who had arrived at the hospital in the evening or during the night, and those who did not wear a helmet. Alcohol consumption was associated with a lower percentage of sustained severe injury (injury severity score ≥25) and lower frequencies of specific body injuries, including cerebral contusion (0.6; 95% confidence interval [CI] = 0.42-0.80), lung contusion (0.5; 95% CI = 0.24-0.90), lumbar vertebral fracture (0.1; 95% CI = 0.01-0.80), humeral fracture (0.5; 95% CI = 0.27-0.90), and radial fracture (0.6; 95% CI = 0.40-0.89). In addition, alcohol-intoxicated motorcycle riders who wore helmets had significantly lower frequencies of cranial fracture (0.4; 95% CI = 0.29-0.67), epidural hematoma (0.5; 95% CI = 0.29-0.79), subdural hematoma (0.4; 95% CI = 0.28-0.64), subarachnoid hemorrhage (0.5; 95% CI = 0.32-0.72), and cerebral contusion (0.4; 95% CI = 0.25-0.78).

CONCLUSIONS

Motorcycle riders who consumed alcohol presented different characteristics and bodily injury patterns relative to sober patients, suggesting the importance of helmet use to decrease head injuries in alcohol-intoxicated riders.

Use of Cognitive Work Analysis for exploration of safety management in the operation of motorcycles and scooters

The risk of accident, injury and death is disproportionately higher for motorcycle riders than for motorists. In this paper, we investigate strategies of safety management associated with operation of powered two-wheel vehicles (motorcycles and scooters). Accident prevention is most often driven by an epidemiological approach that investigates the risk factors associated with accidents. By focusing on risk factors, these types of studies fail to examine the strengths of the system in any depth. In this paper we employ an ethnographic approach structured by reference to the framework of Cognitive Work Analysis, to identify how riders of powered two-wheel vehicles manage their own safety and the safety of others. We anticipate that this research will open up a rich, relatively untapped, area for exploration of safety interventions.

Evaluation of the use and reasons for not using a helmet by motorcyclists admitted to the emergency ward of shahid bahonar hospital in kerman

Background:

Motorcycle crashes are the cause of severe morbidity and mortality especially because of head injuries. It seems that wearing a helmet has an effective role in protection against head injuries. Nevertheless, motorcyclists usually have no tendency to wear a helmet when driving in cities and have several reasons for this behavior.

Objectives:

This study aimed to evaluate the use and reasons for not using a helmet by motorcyclists admitted to an emergency ward of a trauma hospital due to accident in Kerman, Iran.

Patients and Methods:

This study was carried out by recoding the opinions of motorcyclists who had been transferred to the emergency ward of Shahid Bahonar Hospital (Kerman/Iran). Since no data was available on the frequency of the use of helmets, a pilot study was carried out and a sample size of 377 was determined for the main study. Then a researcher-made questionnaire was used to investigate the motorcyclists’ reasons for not using a helmet.

Results:

Only 21.5% of the motorcyclists had been wearing helmets at the time of the accident. The most frequent reasons for not using a helmet were the heavy weight of the helmet (77%), feeling of heat (71.4%), pain in the neck (69.4%), feeling of suffocation (67.7%), limitation of head and neck movements (59.6%) and all together, physical discomfort was the main cause of not wearing a helmet during motorcycle rides.

Conclusions:

In general, it appears that it is possible to increase the use of helmets by eliminating its physical problems, and increasing the knowledge of community members in relation to the advantages of helmet use, which will result in a significant decrease in traumas resulting from motorcycle accidents.

An evidence-based review: efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders

BACKGROUND

Approximately 600,000 ski- and snowboarding-related injuries occur in North America each year, with head injuries accounting for up to 20% of all injuries. Currently, there are no major institutional recommendations regarding helmet use for skiers and snowboaders in the United States, in part owing to previous conflicting evidence regarding their efficacy. The objective of this review was to evaluate existing evidence on the efficacy of safety helmets during skiing and snowboarding, particularly in regard to head injuries, neck and cervical spine injuries, and risk compensation behaviors. These data will then be used for potential recommendations regarding helmet use during alpine winter sports.

METHODS

The PubMed, Cochrane Library, and EMBASE databases were searched using the search string helmet OR head protective devices AND (skiing OR snowboarding OR skier OR snowboarder) for articles on human participants of all ages published between January 1980 and April 2011. The search yielded 83, 0, and 96 results in PubMed, Cochrane Library, and EMBASE, respectively. Studies published in English describing the analysis of original data on helmet use in relation to outcomes of interest, including death, head injury, severity of head injury, neck or cervical spine injury, and risk compensation behavior, were selected. Sixteen published studies met a priori inclusion criteria and were reviewed in detail by authors.

RESULTS

Level I recommendation is that all recreational skiers and snowboarders should wear safety helmets to reduce the incidence and severity of head injury during these sports. Level II recommendation/observation is that helmets do not seem to increase risk compensation behavior, neck injuries, or cervical spine injuries among skiers and snowboarders. Policies and interventions to increase helmet use should be promoted to reduce mortality and head injury among skiers and snowboarders.

CONCLUSION

Safety helmets clearly decrease the risk and severity of head injuries in skiing and snowboarding and do not seem to increase the risk of neck injury, cervical spine injury, or risk compensation behavior. Helmets are strongly recommended during recreational skiing and snowboarding.

Playing hockey, riding motorcycles, and the ethics of protection

Ice hockey and motorcycle riding are increasingly popular activities in the United States that are associated with high risks of head and facial injuries. In both, effective head and facial protective equipment are available. Yet the debates about safety policies regarding the use of head protection in these activities have taken different forms, in terms of the influence of epidemiological data as well as of the ethical concerns raised. I examine these debates over injury prevention in the context of leisure activities, in which the public health duty to prevent avoidable harm must be balanced with the freedom to assume voluntary risks.

Spinal cord injury and its treatment: current management and experimental perspectives

Clinical management of spinal cord injury (SCI) has significantly improved its general prognosis. However, to date, traumatic paraplegia and tetraplegia remain incurable, despite massive research efforts. Current management focuses on surgical stabilisation of the spine, intensive neurological rehabilitation, and the prevention and treatment of acute and chronic complications. Prevention remains the most efficient strategy and should be the main focus of public health efforts. Nevertheless, major advances in the understanding of the pathophysiological mechanisms of SCI open promising new therapeutic perspectives. Even if complete recovery remains elusive due to the complexity of spinal cord repair, a strategy combining different approaches may result in some degree of neurological improvement after SCI. Even slight neurological recovery can have high impact on the daily functioning of severely handicapped patients and, thus, result in significant improvements in quality of life.The main investigated strategies are: [1] initial neuroprotection, in order to decrease secondary injury to the spinal cord parenchyma after the initial insult; [2] spinal cord repair, in order to bridge the lesion site and reestablish the connection between the supraspinal centres and the deafferented cord segment below the lesion; and [3] re-training and enhancing plasticity of the central nervous system circuitry that was preserved or rebuilt after the injury.Now and in the future, treatment strategies that have both a convincing rationale and seen their efficacy confirmed reproducibly in the experimental setting must carefully be brought from bench to bedside. In order to obtain clinically significant results, their introduction into clinical research must be guided by scientific rigour, and their coordination must be rationally structured in a long-term perspective.