Effect of Italy's motorcycle helmet law on traumatic brain injuries

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.

The immediate impact of mandatory helmet law on maxillo-facial trauma: A comparative study in a major trauma center, Uttar Pradesh

Aim

To analyze the effect of the mandatory helmet rule in helmet usage among motorcycle riders and on facial trauma and to determine the significance of difference in the possibility of facial trauma between the helmeted and non-helmeted motorcycle riders.

Setting and Design

A retrospective comparative study conducted in a major trauma center at Uttar Pradesh.

Material and Method

Data for the present study was obtained from records of the Emergency Department of Trauma Center, for a period of two months before and after the implementation of The Motor Vehicles Act in UP. The study included patients with a history of non-fatal motorcycle accidents who sustained facial injuries regardless of the presence of injuries to other areas of the body during the study period. Information regarding helmet usage during the accident was also recorded. The results were compared between the pre-law period and post-law period.

Statistical Analysis Used

Sample t-test was applied to find the level of significance.

Results

Out of 219 injured patients, 152 (69.40%) subjects were not wearing helmets, whereas only 67 (30.59%) subjects were wearing helmets. It was observed that around 68.18% of people stated wearing helmets after law implementation with a statistical significance (P value < 0.05).

Conclusion

Our study shows that the mandatory helmet rule with elevated penalty rates has significantly increased the usage of helmet among the motorcycle riders, and it also proves that the possibility of facial trauma is significantly higher in non-helmeted riders when compared to helmeted riders.

Health Promotion Interventions on Helmet Use: A Systematic Review and Meta-Analysis of Pre-Test and Post-Test Studies

Background

We aimed to review the effectiveness of health promotion interventions in the use of helmet and to identify the types of effective health promotion strategies among the examined studies.

Methods

A systematic search was performed on the PubMed, Scopus, Cochrane, and Embase databases up to 1 Aug 2022 to find the studies evaluated the effectiveness of health promotion interventions for helmet use among target population. In this systematic review and meta-analysis, interventions with pre- post-test design were included. The dependent variable of the study is the percentage of participants who responded positively toward helmet use in the baseline and after the interventions. Random-effects models were used to pool study results.

Results

Overall, 1,675 articles were found in the initial search and entered into the Endnote software. Of these, 917 duplicate articles were removed, leaving 758 articles were screened based on title and abstract. Finally, 12 eligible articles were included in the review and five with pre and post-test design were included in the meta-analysis. The overall random-effects pooled estimation of persons wearing helmets before and after interventions was 70% (95%CI 21 -119; P<0.001), without a heterogeneity (I2 =0%; P=0.94), which means that the average percentage of changing to helmet use is 70%. Community-based education program was the most commonly applied for interventional studies. The next most commonly used approaches were campaign designing.

Conclusion

Wearing helmet approximately increased 70% among participant. Health promotion strategies may target helmet-wearing behavior to reduce head injuries in motorcyclist road traffic accidents.

The Role of Substance P Within Traumatic Brain Injury and Implications for Therapy

This review examines the role of the neuropeptide substance P within the neuroinflammation that follows traumatic brain injury. It examines it in reference to its preferential receptor, the neurokinin-1 receptor, and explores the evidence for antagonism of this receptor in traumatic brain injury with therapeutic intent. Expression of substance P increases following traumatic brain injury. Subsequent binding to the neurokinin-1 receptor results in neurogenic inflammation, a cause of deleterious secondary effects that include an increased intracranial pressure and poor clinical outcome. In several animal models of TBI, neurokinin-1 receptor antagonism has been shown to reduce brain edema and the resultant rise in intracranial pressure. A brief overview of the history of substance P is presented, alongside an exploration into the chemistry of the neuropeptide with a relevance to its functions within the central nervous system. This review summarizes the scientific and clinical rationale for substance P antagonism as a promising therapy for human TBI.

Perceptions, barriers, and strategies regarding helmet use by female pillion riders in Pakistan: A qualitative study

INTRODUCTION

Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders.

METHODS

Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach.

RESULTS

Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though "safety" was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers.

CONCLUSION

Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan.

Over 30-year retrospective analyses of moped-motorcycle fatal road accidents in the northern area of the Italian region of Emilia Romagna and review of the literature: Aiming for further preventive measures in the future

Road traffic injuries are a major cause of morbidity and mortality worldwide, with pedestrians and riders of two-wheeled motor vehicles being the most vulnerable. The present study aims to determine the epidemiological characteristics of fatal motorcycle crashes in a portion of the Italian region of Emilia Romagna, and to compare them with the data available in literature. Data were retrieved from autopsy reports on 350 subjects who died following road accidents involving moped or motorcycle in the cities of Parma, Piacenza, and Reggio Emilia. Two types of data were extrapolated: circumstantial and traumatological. The population was divided into subgroups according to gender, crash time, alcohol positivity, presence or absence of the helmet, and the period elapsed between the accident and death. Most of the considered road accidents occurred during the day and on weekends. 25.5 % of the victims tested positive for alcohol. As far as traumas are concerned, the limbs resulted to be the most affected body segment, followed by the head (87.4 %), the thorax (85.7 %), the abdomen (65.7 %), and lastly the neck (50.3 %). According to similar studies, the sample victim of a moped/ motorcycle accident is a young male subject. The results obtained allow us to demonstrate that the mandatory use of the helmet has reduced skull and brain injury over the years. At present, no law regulates the use of protections for other body parts. Regulatory interventions in this sense would be desirable given the ever more rapid technical evolutions in the field of motorcycles.

Do motorcycle helmets reduce road traffic injuries, hospitalizations and mortalities in low and lower-middle income countries in Africa? A systematic review and meta-analysis

BACKGROUND

Studies in Africa have examined the association between helmet use and injury prevention, however, there has been no systematic review to synthesize the literature within an African context nor has there been any meta-analysis examining the effect of helmet use on injury prevention.

METHODS

The review was performed in accordance with the Joanna Briggs Institute for Systematic Reviews. Articles were searched using several databases (e.g. CINAHL, OVID Medline) and select gray literature (e.g. TRID) sources. Articles were included if they were quantitative studies published in English between 2000 and 2019 and examined the association between motorcycle helmet use with head injuries, hospitalizations, and deaths in low- and lower-middle income countries in Africa with comprehensive motorcycle helmet laws. A meta-analysis was performed using pooled effect sizes assessing the impact of helmet use on reducing head injuries.

RESULTS

After screening 491 articles, eight studies met the inclusion criteria. Helmet use ranged from 0 to 43%. The mean age of being involved in a crash was 30 years with males being two times more likely to be involved in motorcycle crashes than females. Drivers (riders) were more likely to be involved in a crash, followed by passengers and then pedestrians. Helmet use reduced injury severity and provided an 88% reduction in serious head injuries (OR 0.118, 95% CI: 0.014-0.968, p = 0.049).

CONCLUSIONS

In our study, helmet usage significantly reduced the likelihood of fatal head injuries. African countries with no helmet laws should consider adopting helmet use policies to reduce severe head related injuries from motorcycle crashes.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Association of Helmet Use with the Occurrence of Maxillofacial Injuries Following Bicycle or Scooter Accidents: A Retrospective Cohort Study

Study Design

Retrospective Cohort Study.

Objective

Yearly, bicycle and scooter accidents in the Netherlands amount to 90 thousand emergency department visits. Maxillofacial injuries are common after cycling or scooter accidents. To prevent these injuries, helmet use might be beneficial. However, the effect of helmet use on maxillofacial injuries remains unclear. The aim of this retrospective study is to assess the effect of helmet use on maxillofacial injuries in patients who had a bicycle or scooter accident.

Methods

We collected data from the emergency department of the Erasmus Medical Center in the period from October 2017 to October 2019. Patients that were involved in a bicycle or scooter accident and subsequently received a CT scan of the head were included. We compared the incidence of maxillofacial injuries in helmeted cyclists and scooter users to non-helmeted users. Descriptive and analytic statistics were computed. Level of statistical significance was set at p < 0.05.

Results

Helmet use among scooter users was associated with a significant reduction in maxillofacial fractures (p < 0.001) and soft tissue injuries (p < 0.001). Helmet use among cyclists was not associated with a reduction in maxillofacial fractures (p = 0.17) or soft tissue injuries (p = 0.30). Helmet use was not associated with a reduction in soft tissue injuries of the lower face in both cyclists (p = 0.47) and scooter users (p = 0.24).

Conclusions

Helmet use should be considered among cyclists and scooter users to prevent maxillofacial injuries. Especially unhelmeted scooter users might benefit from helmet use as this is associated with a lower incidence of maxillofacial injuries.

An Assessment of Global Neurotrauma Prevention and Care Delivery: The Provider Perspective

BACKGROUND

Neurotrauma is a leading cause of morbidity and mortality around the world. Assessment of injury prevention and prehospital care for neurotrauma patients is necessary to improve care systems.

METHODS

A 29-question electronic survey was developed based on the Enhancing the Quality and Transparency Of health Research (EQUATOR) checklist to assess neurotrauma policies and laws related to safety precautions. The survey was distributed to members of World Health Organization regions that were considered to be experienced medical authorities in neurosurgery and traumatic brain injury.

RESULTS

There were 82 (39%) responses representing 46 countries. Almost all respondents (95.2%) were within the neurosurgical field. Of respondents, 40.2% were from high-income countries (HICs), and 59.8% were from low- and middle-income countries (LMICs). Motor vehicle accidents were reported as the leading cause of neurotrauma, followed by workplace injury and assault. Of respondents, 84.1% reported having a helmet law in their country. HICs (4.38 ± 0.78) were ranked more likely than LMICs (2.88 ± 1.34; P = 0.0001) to enforce helmet laws on a scale of 1-10. Effectiveness of helmet laws was rated as 3.94 ± 0.95 out of 10. Measures regarding prehospital care varied between HICs and LMICs. Patients in HICs were more likely to use public emergency ambulance transportation (81.8% vs. 42.9%; P = 0.0004). All prehospital personnel having emergency training was also reported to be more likely in HICs than LMICs (60.6% vs. 8.7%; P = 0.0001).

CONCLUSIONS

When injuries occur, timely access to neurosurgical care is critical. A focus on prehospital components of the trauma system is paramount, and policymakers can use the information presented here to implement and refine health care systems to ensure safe, timely, affordable, and equitable access to neurotrauma care.

Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis

BACKGROUND

The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels.

METHODS AND FINDINGS

A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present.

CONCLUSIONS

In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.

The Prevalence of Helmet Use and Predictive Factors Among Motorcyclists in Shahrekord, Iran in 2018

Background and aims: Motorcycle accidents are a major concern for countries. One of the most important risk factors for motorcyclists is the lack of helmet use. This study aimed to measure the rate of the helmet use and predictive factors in Shahrekord, Iran. Methods: Using simple random sampling method, this cross-sectional study was conducted in 2018 with a sample size of 350 motorcyclists. A researcher-made questionnaire was used to collect data, and the SPSS software version 24 was used to analyze the data. Results: The mean age of participants was 28.8 ± 10.1 years. Out of 350 participants, 15.1% and 1.4% of motorcyclists and their passengers used helmets. The most important predictors of helmet use were age more than 35 years, high education, and having a driving license. The most important reason for using the helmet was protection against injuries in accidents. Conclusion: According to our results, the rate of helmet use was low. Thus, more efforts should be made to intervene and train for the helmet use among community members with an emphasis on younger people, individuals with governmental jobs, and people with lower education level.

Helmet shielding effect in mandibular fractures during road traffic accident

Objective:

The objectives of this study are to evaluate the proportion of helmeted and nonhelmeted patients sustaining mandibular fractures.

Materials and Methods:

A retrospective study was conducted on 200 patients reporting to oral and maxillofacial surgery (OMFS) unit, trauma center, and department of OMFS. A predesigned questionnaire was used to collect the necessary data. Patients were evaluated for age, gender, mode of transport (2/4 wheeler), presence of safety measure at the time of accident (helmet/seatbelt), maxillofacial injury in two wheeler (with helmet and without helmet), type of impact, and its association to maxillofacial fractures, particularly site of maxillofacial fractures. The association between mode of injury, presence of safety measures, impact type, and site of maxillofacial injuries was assessed using the Chi-square test. P < 0.5 was considered statistically significant.

Results:

The mean age of patients was 30 years, and approximately 92.5% of accidents patients were male. In this study, 35% nonhelmeted riders were reported head injury and 5% of the helmeted rider reported head injury. 54.5% of the patients suffered frontal impact, 28% collision, and 17.5% lateral slide collision. Head injuries are the main cause of death among the riders of all two wheelers. Lateral sliding collision injuries (17.5%) resulted 60.6% of the fractures mandible, 24.2% midface injury, and associated injury (15.15%).

Conclusion:

The use of helmet is strongly recommended to prevent head injuries and facial injuries. In the nonhelmeted riders in motorcycle accidents, the incidence of mandible fractures increases proportionally.

Determinants of Outcome in Traumatic Head Injuries: A South East Nigeria Experience

OBJECTIVES

The objectives of this study were to ascertain factors significantly responsible for mortality from traumatic head injuries and prescribe measures necessary to circumvent such outcome.

METHODS

A retrospective cohort study of all traumatic head injuries seen at our facility from October 2013 to September 2015 was done utilizing data from patient's case notes, ward registers, and casualty department. Extracted data were analyzed using descriptive statistics.

RESULTS

A total of 221 patient records were analyzed with 161 men and 60 women. It was observed that although the younger age group (19-30 years) was the most frequently affected by traumatic head injuries (36.2%), the elderly (>60 years) were 4.6 times more likely to die from traumatic head injuries than any other age group. Also, those with severe head injuries were 58 times more likely to die than any other category of head injury, even though the commonest category of head injuries seen were mild head injuries (68.7%). Patients with traumatic head injury from road traffic accidents were 5.8 times more likely to die than any other cause. The sex of the patient and the length of hospital stay had no significant influence on mortality from traumatic head injuries.

CONCLUSIONS

The postresuscitation Glasgow Coma Scale score, age of the patient, and mechanism of head injuries are important determining factors of outcome in traumatic head injuries, with the Glasgow Coma Scale score being the single most important determining factor. Efforts should be made at preventing such causes, with prompt and aggressive care instituted for cases at risk of unfavorable outcome.

The bases of targeting behavior in health promotion and disease prevention

OBJECTIVE

Health behaviors shape more than 30% of one's physical and mental health, as well as overall well-being. Yet, changing behavior is difficult. This paper aims first at operationalizing the concept of health behavior by focusing on its main components and determinants. Second, it gives insights into how to influence health behavior by providing an overview of some of the most commonly used approaches to the design of behavioral interventions.

METHODS

This is a position paper that presents a selection of evidence-based theories, models and approaches to understand and address behavior.

RESULTS

A health behavior broadly refers to every individual action affecting health, disease, disability, or mortality. Behavior is shaped by factors within the skin (biological, psychological) and outside the skin (interpersonal, environmental, policy). Behavior change has therefore to be addressed from an ecological perspective. Specifically, behavior change can be influenced by changing capability, opportunity and motivation. Depending on the specific determinants of the behavior at stake, there are numerous approaches that can be taken. The main steps to design interventions are: defining the problem, selecting and analyzing the target audience, setting objectives, designing the intervention, planning and implementing an evaluation.

CONCLUSION

Behaviors should not be targeted in isolation but within a socio-ecological approach that accounts for both their individual and environmental determinants.

PRACTICE IMPLICATIONS

This paper provides practitioners with the bases of behavior change. It offers a road-map of the main factors to consider and shows how to address behavior by planning an intervention in all its main steps.

Prevalence and factors associated with effective helmet use among motorcyclists in Mysuru City of Southern India

BACKGROUND

Helmet use reduces the risk and severity of head injury and death due to road traffic crash among motorcyclists. The protective efficacy of different types of helmets varies. Wearing firmly fastened full-face helmet termed as effective helmet use provides greatest protection. This study estimates the prevalence and factors associated with effective helmet use among motorcyclists in Mysuru, a tier II city in Southern India.

METHODS

Cross-sectional road side observational study of 3499 motorcyclists (2134 motorcycle riders and 1365 pillion riders) at four traffic intersections was done followed by interview of random sample of 129 of the above riders. Effective helmet use proportion and effective helmet use per 100 person-minute of observation was calculated. Multivariate logistic regression analysis was done to identify factors associated with effective helmet use.

RESULTS

Prevalence of effective helmet use was 28 per 100 riders and 19.5 per 100 person-minute of observation in traffic intersections. Prevalence rates of effective helmet use was higher among riders (34.5% vs pillion riders 18.1%), female riders (51.3% vs male riders 26.8%), and male pillion riders (30.5% vs female pillion riders 13.7%). Riders commuting for work and school and those ever stopped by the police in the past 3 months had significantly higher odds of effective helmet use.

CONCLUSION

Despite helmet use being compulsory by law for motorcyclists, the effective helmet use was low in Mysore. Strict enforcement and frequent checks by the police are necessary to increase the effective helmet use.

Primary prevention of road traffic accident-related traumatic brain injuries in younger populations: a systematic review of helmet legislation

OBJECTIVE

Road traffic accidents are the most frequent cause of severe traumatic brain injury (TBI), particularly among young populations worldwide. Helmets are proven to prevent injuries; however, estimates of helmet compliance are low globally. Surgical/critical care management of TBI is often used to treat these injuries, but primary prevention should be recommended. A key component in promoting TBI prevention among pediatric and young populations is through helmet legislation. The authors investigated helmet policies for motorcycles and bicycles globally to provide recommendations for how related legislation may impact TBI and guide advocacy in pediatric neurosurgery.

METHODS

The authors conducted a systematic review of helmet laws and/or policies by using the National Library of Medicine PubMed and SCOPUS databases. Additional articles were identified using citation searches of key publications. Abstracts from articles of all sources were read and selected for full-text review. Details of relevant full articles were extracted and analyzed for the following: bibliographic data, study aim, design and duration, study participants, intervention characteristics, and intervention effect data.

RESULTS

Of 618 search results, 53 full-text articles were analyzed for recommendations. Helmet legislation is associated with increased helmet use among bicyclists and decreased road traffic accident-related head injuries and fatalities among motorcyclists and bicyclists. Laws are more effective if comprehensive and inclusive of the following: both primary riders and passengers, all age groups, all modes of transportation made safer by helmets, a proper use clause, and standardized helmet quality measures. Cultural, socioeconomic, and infrastructural circumstances are important as well, and legislation must consider enforcement mechanisms with penalties significant enough to incentivize behavioral changes, but proportional to community socioeconomic status.

CONCLUSIONS

Compulsory use laws are the optimal primary intervention; however, concurrent programs to support financial access to helmets, change cultural attitudes, increase health literacy, and improve road infrastructure will augment legislative benefits. Pediatric neurosurgeons are caretakers of children suffering from TBI. Although extensive study has explored the surgical management of TBI, the authors believe that primary prevention is instrumental to improving outcomes and reducing injury. All helmet laws are not equal; based on these findings, a comprehensive, context-specific approach is the key to success, especially in resource-limited countries.

Safety of motorized two-wheeler riders in the formal and informal transport sector

Road fatalities are largely preventable problem with large socioeconomic impact. Due to the rapidly increasing population, transport systems and road infrastructure have not met the demand. The use of motorized two-wheeler vehicles has increased, as informal transport. However, evidence on their safety is scarce. The aim of this article is to examine the safety and social equity issues in MTW in the informal transport sector. Factors can be used to explain traffic collisions in MTW in the formal/informal transport sectors: design, rider behavior, road design, enforcement, and regulation of the informal transport sector. Evidence suggests that MTWs could be a common related to pedestrian fatalities. Informal transport drivers are typically poor, uneducated, young men who due to lack of other employment options move into the informal sector. Their vehicles are old, unmaintained and have a lack of protective equipment for themselves and their passengers. Young, male drivers speed, take risks and not use protective equipment. Users of informal transport live in the poorer peripheries of cities, which, have limited, inefficient or unaffordable public transport. The provision of transport has therefore become an often unrecognized, important social equity issue and studies are urgently needed on MTW in the informal transport sector.

Can helmet decrease mortality of craniocerebral trauma patients in a motorcycle accident?: A propensity score matching

A helmet is critical for preventing head injuries during motorcycle accidents. However, South Korean motorcyclists have a lower prevalence of wearing a helmet, compared to developed countries. Therefore, we aimed to evaluate whether helmet wearing was associated with the clinical outcomes in Korean motorcycle accidents. Data were obtained from the Emergency Department-based Injury In-depth Surveillance database 2011-2015. We considered the patients had experienced a motorcycle accident and were only diagnosed with a craniocerebral trauma (CCT). The primary outcome was mortality and the secondary outcomes were the severity and hospitalization duration. The patients were separated whether they were wearing a helmet and the outcomes were compared using multivariate logistic regression after propensity score matching (PSM). Among 1,254,250 patients in the database, 2,549 patients were included. After PSM, 1,016 patients in each group were matched. The univariate analyses revealed that helmet wearing was associated with lesser severity (P < 0.001) and shorter hospitalization (P < 0.001). The regression analysis revealed that mortality was also lower in a helmet-wearing group (odds ratio: 0.34, 95% confidence interval: 0.21-0.56). In conclusion, wearing a helmet may reduce the mortality from a CCT after a motorcycle accident and associated with lesser severity and shorter hospitalization.

Epidemiological and clinical characteristics of 3327 cases of traffic trauma deaths in Beijing from 2008 to 2017: a retrospective analysis

We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ± 17.43 years old (46.19, 0.43-100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ± 89.57 h (36.90, 0-720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.

Severity and injury characteristics among matched hospitalized motorcycle drivers and their passengers

PURPOSE

After car accident, motorcycle accident ranks as the second leading cause of traffic fatality in Iran. This study aimed to compare the severity and clinical presentations between drivers and passengers under the same injury circumstance.

METHODS

This study was conducted in the trauma center of Shiraz, Iran in 2017. Data on demographics, triage level, blood pressure, respiratory rate, Glasgow coma scale (GCS), injured body region, injury severity score (ISS), revised trauma score (RTS), and result of accident were compared between pairs of drivers and passengers. The agreement of any type of injury between drivers and passengers evaluated by Kappa test.

RESULTS

This study included 143 matched pairs of drivers and passengers. Most of the pairs (84.5%) did not use helmet and 77.2% of the riders do not have driving license. ISS was significantly higher in drivers than passengers. In the unmatched pairs, drivers and passengers showed no difference in sustaining injuries in the face, head & neck, chest and soft tissue, but drivers were found more likely to suffer from injuries in the abdomen, extremities, pelvis and spine than passengers. Once one part of the matched pair suffered injury in the head & neck, face, chest, abdomen, extremities and soft tissue & skin injury, the probability that the other part had an injury in the same region was 50%, 9%, 13%, 7%, 22% and 34% respectively. Kappa value for these body regions was 0.006, 0.009, -0.006, 0.068, 0.063 and 0.001, respectively, which was significant in abdomen and extremities.

CONCLUSION

Although drivers had higher level of injury severity and some different injury distributions, we recommend equal treatment to drivers and passengers. We also recommend related authorities to develop policies on helmet use, driving license and third-party insurance.

Beliefs and performances of elementary school students to prevent road traffic injuries, using Health Belief Model: a study from Hamadan, Iran

BACKGROUND

Road traffic injuries (RTIs) are important health problems and increasing knowledge on their prevention-related issues can be credible. This study aims to assess beliefs and performances of students to prevent road traffic injuries and their related factors, using Health Belief Model (HBM).

METHODS

This cross-sectional study carried out on a random sample of 500 fourth and fifth grades students of elementary schools in Hamadan city, west of Iran. The data gathering tool was a self-administered questionnaire designed on the basis of HBM constructs and also the knowledge and performance of the students in relation to prevent RTIs. To increase the accuracy of this study, the students' road-crossing behaviors were observed in a simulated street in the school, using an observation checklist. Data were analyzed by SPSS 16.

RESULTS

The mean age of the participants was 10.51±0.50. About preventing RTIs, the mean scores of the students' knowledge was 64.139, and regarding HBM constructs, the mean scores of their perceived susceptibility, perceived severity, perceived benefits, perceived barriers and self-efficacy were 82.817, 82.453, 82.451, 89.917, 84.343 and 91.250, respectively. The mean score of the students' self-reported performances about traffic injury prevention was 48.750 and the mean score of their observed road-crossing behavior in the simulated street was 45.000. The final model of multiple linear regressions showed that the students' sex (p=0.001), their knowledge (p less than 0.001), perceived susceptibility (p=0.002), perceived barriers (p=0.032), self-efficacy (p=0.001), and their observed road-crossing behaviors (p=0.019) predict the students' self-reported injury prevention performances.

CONCLUSIONS

Regarding prevention of RTIs, knowledge and performance of the studied students are undesirable. The study findings can help designing more appropriate prevention programs for them.

Beliefs and performances of elementary school students to prevent road traffic injuries, using Health Belief Model: a study from Hamadan, Iran

BACKGROUND

Road traffic injuries (RTIs) are important health problems and increasing knowledge on their prevention-related issues can be credible. This study aims to assess beliefs and performances of students to prevent road traffic injuries and their related factors, using Health Belief Model (HBM).

METHODS

This cross-sectional study carried out on a random sample of 500 fourth and fifth grades students of elementary schools in Hamadan city, west of Iran. The data gathering tool was a self-administered questionnaire designed on the basis of HBM constructs and also the knowledge and performance of the students in relation to prevent RTIs. To increase the accuracy of this study, the students' road-crossing behaviors were observed in a simulated street in the school, using an observation checklist. Data were analyzed by SPSS 16.

RESULTS

The mean age of the participants was 10.51±0.50. About preventing RTIs, the mean scores of the students' knowledge was 64.139, and regarding HBM constructs, the mean scores of their perceived susceptibility, perceived severity, perceived benefits, perceived barriers and self-efficacy were 82.817, 82.453, 82.451, 89.917, 84.343 and 91.250, respectively. The mean score of the students' self-reported performances about traffic injury prevention was 48.750 and the mean score of their observed road-crossing behavior in the simulated street was 45.000. The final model of multiple linear regressions showed that the students' sex (p=0.001), their knowledge (p less than 0.001), perceived susceptibility (p=0.002), perceived barriers (p=0.032), self-efficacy (p=0.001), and their observed road-crossing behaviors (p=0.019) predict the students' self-reported injury prevention performances.

CONCLUSIONS

Regarding prevention of RTIs, knowledge and performance of the studied students are undesirable. The study findings can help designing more appropriate prevention programs for them.

Fatal motorcycle crashes in wide urban area of Zagreb, Croatia-A 10-year review

Objective: The objective of our study was to determine the prevalence of alcohol and drug intoxication among fatally injured motorcyclists in a wide urban area of Zagreb, Croatia. Methods: We conducted a single-center observational retrospective study over a 10-year period (2007-2016) in 3 counties covering an area including 1.2 million residents. We reviewed the records on fatally injured motorcyclists, collecting information relating to sex, age, cause of death, time of death in relation to the time of the crash, and the circumstances of the crash (time of day, day of the week, season). Blood alcohol concentration (BAC) and toxicology analysis results were collected and analyzed. Results: We identified 163 deaths (95.7% males, 4.3% females). Overall, 64.2% of the victims were 20 to 39 years old. The majority (50.9%) of those fatally injured were responsible for causing the traffic crash; the rest were determined not to be responsible or the responsibility could not be determined. The most frequent causes of death were multiple injuries (55.8%) and isolated head trauma (23.3%). The rider's BAC was above the legal limit for driving (>0.50 g/kg) in 53.8% of cases, with a mean BAC of 1.91 g/kg. There was no difference in riding a motorcycle with a BAC above the legal limit between groups defined as younger (≤39 years of age) and older (≥40 years of age). The number of people with an illegal BAC was significantly higher during weekends than during the work week. The BAC of riders who were responsible for the crash was significantly higher than that of those who were not responsible or whose responsibility could not be determined. Use of illegal drugs or nontherapeutic use of legal drugs was not common and was detected in 10.4% of fatally injured riders. Conclusions: Alcohol intoxication has a major role in motorcycle crash-related mortality. A significant difference in BAC between fatally injured riders responsible for the accident and those who were not responsible implies that measures directed toward prevention of drinking and driving behavior could lower the number of fatal motorcycle crashes. Weekend measures, especially during spring and summer, could have particularly significant effects.

The Role of a Community-Based Intervention in Promoting Helmet Use in a Non-probability Sample of Rural Motorcyclists in Iran

Although the use of helmets is known to prevent the majority of mortalities by head injuries, it is ignored by a large number of motorcyclists. The present study was conducted to promote helmet use in an attempt to reduce injuries among motorcyclists in a rural area by adopting a community-based participation approach. The one-group pretest-posttest pre-experimental design was conducted in northwest Iran. The study was conducted in three phases: (1) baseline measurement, (2) implementation of the intervention, and (3) assessment of the outcomes. The intervention included the distribution of learning tools, education of various community groups, tightening of driving laws for offending motorcyclists, promotional programs at community level, and utilizing all opportunities to discuss the benefits of helmets. Due to the non-experimental nature of the study, no causal inferences were drawn. After the intervention, the percentage of the awareness of the benefits of helmet use was increased by 28%, positive attitudes towards benefits of helmet use was increased by 32.6%, and supporting helmet use was increased by 58.6%. Moreover, helmet sale and use increased by 147.0% and 32.0%, respectively. Additionally, motorcycle accidents, head injuries, and mortalities were decreased by 71.8, 55.5, and 60.0%, respectively. Community-based participation approach may positively influence health promoting behaviors and motorcyclists' decisions to wear helmet in rural areas.

Evaluation of injuries sustained by motorcyclists in approach-turn crashes in Taiwan

OBJECTIVES

In western countries, a typical car-motorcycle crash occurs at an intersection where a car manoeuvres into the path of an oncoming motorcycle, which involves a car driver violates motorcycle's right of way (ROW). In Taiwan, however, a unique type of crash (approach-turn crash) occurs when a turning (including U-turn) motorcycle frequently infringes upon a car's ROW. The primary objective of this study was to examine injuries sustained by motorcyclists in this unique type of crash.

METHOD

Using the linked data from the National Taiwan Crash Database and the National Health Insurance Research Data from 2003 to 2015, this study examined several anatomical injuries (e.g., head and face, neck, chest and abdomen, spine, and lower extremities), as well as the resulting injury severity (e.g., death within 30 days, hospitalisation, and emergency visit only/outpatient, and length of hospital stay). Variables examined include demographic data (sex, age, alcohol use, license status, and helmet use), vehicle attributes (engine size, type of crash partner, and crash type), road and environmental factors (curvature, crash location, day of week and time of crash). Injuries sustained by motorcyclists in an approach-turn motorcycle-turning crash (motorcycle is a ROW violator) were compared with those sustained by motorcyclists in an approach-turn car-turning crash (car is the ROW violator).

RESULTS

A total of 21,919 motorcyclists were enrolled, of whom 18,041 and 3878 were motorcyclists involved in approach-turn car-turning and motorcycle-turning crashes, respectively. The percentage of death within 30 days; hospitalisation; length of hospital stay; and injuries to the head and face, neck, and chest and abdomen were significantly higher for motorcyclists in approach-turn motorcycle-turning crashes. Results of logistic regression models revealed that riding under the influence of alcohol and riding without a licence were associated with death/hospitalisation, and injuries to particular body regions (head and face, neck, and chest and abdomen). Helmet use was associated with a decreased likelihood of head and face and neck injuries.

CONCLUSION

Motorcyclists tended to be more severely or fatally injured and had increased head and face, neck, and chest and abdomen injuries when they were ROW violators than when their ROWs were violated at an intersection. Efforts to curb drunk riding and unlicensed riding may constitute effective intervention points.

Crash Characteristics and Pattern of Motorcycle Related Facial Bone Fractures in a Sub-Urban Nigerian Teaching Hospital

Context:

Recent studies indicated that significant proportion of facial fractures attributed to road traffic mishaps in the middle- and low-income countries are caused by motorcycle (MC) crashes. However, there is limited information on crash characteristics of such injuries. This study was designed to examine the crash characteristics, pattern of fracture, and sociodemographics of patients with facial bone fractures due to MC crashes in our institution.

Subjects and Methods:

Data on patients’ sociodemographics, pattern of presentation, type(s) of fracture, patient status, crash characteristics, level of consciousness, and treatment offered were collected and analyzed.

Results:

A total of 151 patients, aged 7–59 years were reviewed during the study period. A male preponderance was observed (M:F = 4:1) and the patients were predominantly motorcyclists (64.8%, n = 98). The most common mechanism of crash was collision with another MC (51.6%, n = 78). A total of 194 fractures were reviewed and the mandible (58.8%, n = 114) was more commonly affected than the midface (41.2%, n = 80). The predominant site on the mandible was the body (31.6%) while zygoma (32.5%) was the most affected part of the midface. Patient status was found to have a statistically significant relationship with loss of consciousness (P = 0.02). Eighty-two fracture sites (42.3%) were managed with open reduction and internal fixation.

Conclusions:

Facial bone fractures occur in a significant proportion of MC crashes and riders are predominantly affected. In addition, a larger proportion of commuters rarely wear crash helmet which could have offered protection. Continual advocacy on preventive measures and enforcement of road safety regulations is hereby advised.

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.

State helmet laws and helmet use among fatally injured moped riders in the United States, 2011-2015

OBJECTIVE

Research has found that mandatory motorcycle helmet laws increase helmet use and reduce motorcycle-related fatalities. However, the association between state moped helmet laws and helmet use in the United States has not been examined. This study investigated this association among a census of fatally injured moped riders in the United States.

METHODS

A logistic regression model was constructed to analyze data extracted from the Fatality Analysis Reporting System (FARS) to examine risk factors for helmet nonuse among 572 moped riders fatally injured between 2011 and 2015.

RESULTS

Fatally injured moped riders in states with universal helmet laws had 69 times the odds of wearing a helmet (P < .001).

CONCLUSIONS

Findings suggest that universal moped helmet laws increase helmet use. However, additional research is needed to examine helmet laws and use among nonfatally injured moped riders.

Comparison of traffic-injury related hospitalisation between bicyclists and motorcyclists in Taiwan

OBJECTIVES

Bicyclists and motorcyclists contribute substantially to the morbidity and mortality rates of road crash casualties. The objective of the study was to investigate the crash characteristics of bicyclist and motorcyclist casualties presented to hospitals in Taiwan resulting from crashes.

METHODS

By using linked data from The National Traffic Crash Dataset and the National Health Insurance Database between 2003 and 2012, logistic regression models were used to examine the determinants of hospitalisation among motorcyclist and bicyclist casualties. The examined variables include demographic characteristics, road and weather conditions, and vehicle characteristics.

RESULTS

A total of 1,998,606 two-wheelers were enrolled in the study, of whom 216,600 were hospitalised: 203,623 were motorcyclists and 12,964 were bicyclists. Bicyclists were more likely to be hospitalised than motorcyclists were (14.0% vs. 10.7%). The pooled logistic regression model shows that bicyclists had higher odds of hospitalisation than motorcyclists (adjusted odds ratio [AOR] = 1.11, 95% confident interval [CI] = 1.08-1.14). In the motorcyclist and bicyclist models, helmet non-use appears to be a determinant of hospitalisation for motorcyclists (AOR = 1.14, CI = 1.12-1.16), although insignificant for cyclists (AOR = 1.03, CI = 0.94-1.12). Other important determinants of hospitalisation for motorcyclists and cyclists include female riders, elderly riders, rural roadways, unlicensed riding (for motorcyclists only), curved roadways, defective roadways, alcohol consumption (only for motorcyclists), and single-vehicle crashes (for motorcyclists only).

CONCLUSIONS

The result that bicyclists had an increased probability of being hospitalised than motorcyclists is particularly noteworthy, because there have recently been much more users of bikesharing systems in metropolitan cities where cycle helmets are not provided. We further found that helmet non-use was also a risk factor for motorcyclists, but insignificant for cyclists, possibly due to lower helmet utilization rates among bicyclists. Our findings regarding the increased hospitalisation percentage emphasize the importance of helmet use.

A population-based case-control study of hospitalisation due to head injuries among bicyclists and motorcyclists in Taiwan

INTRODUCTION

According to official statistics in Taiwan, the main body region of injury causing bicyclist deaths is the head, and bicyclists are 2.6 times more likely to be fatally injured than motorcyclists. There is currently a national helmet law for motorcyclists but not for bicyclists.

OBJECTIVES

The primary aim of this study was to determine whether bicyclist casualties have higher odds of head-related hospitalisation than motorcyclists. This study also aims to investigate the determinants of head injury-related hospitalisation among bicyclists and motorcyclists.

METHODS

Using linked data from the National Traffic Accident Dataset and the National Health Insurance Research Database for the period 2003-2012, this study investigates the crash characteristics of bicyclist and motorcyclist casualties presenting to hospitals due to motor vehicle crashes. Head injury-related hospitalisation was used as the study outcome for both road users to evaluate whether various factors (eg, human attributes, road and weather conditions, vehicle characteristics) are related to hospital admission of those who sustained serious injuries.

RESULTS

Among 1 239 474 bicyclist and motorcyclist casualties, the proportion of bicyclists hospitalised for head injuries was higher than that of motorcyclists (10.0% vs 6.5%). However, the multiple logistic regression model shows that, after adjustment of this result for other factors such as helmet use, bicyclists were 18% significantly less likely to be hospitalised for head injuries than motorcyclists (AOR 0.82, 95% CI 0.79 to 0.85). Other important determinants of head injury-related hospitalisation for bicyclists and motorcyclists include female riders, elderly riders, crashes occurring in rural areas, moped riders, riding unhelmeted, intoxicated bicyclists and motorcyclists, unlicensed motorcyclists, dusk and dawn conditions and single-vehicle crashes.

CONCLUSIONS

Our finding underscores the importance of helmet use in reducing hospitalisation due to head injuries among bicyclists while current helmet use is relatively low.

How motorcycle helmets affect trauma mortality: Clinical and policy implications

BACKGROUND

Motorcycles are the most popular vehicles in Taiwan, where more than 14.8 million motorcycles (1 motorcycle per 1.6 people) are in service. Despite the mandatory helmet law passed in 1997, less than 80% of motorcyclists in Taiwan wear helmets.

OBJECTIVE

The objective of this study was to analyze the effect of using motorcycle helmets on fatality rates.

METHODS

A clinical data set including 2,868 trauma patients was analyzed; the cross-sectional registration database was administered by a university medical center in Central Taiwan. A path analysis framework and multiple logistic regressions were used to estimate the marginal effect of helmet use on mortality.

RESULTS

Using a helmet did not directly reduce the mortality rate but rather indirectly reduced the mortality rate through intervening variables such as the severity of head injuries, number of craniotomies, and complications during therapeutic processes. Wearing a helmet can reduce the fatality rate by 1.3%, the rate of severe head injury by 34.5%, the craniotomy rate by 7.8%, and the rate of complications during therapeutic processes by 1.5%. These rates comprise 33.3% of the mortality rate for people who do not wear helmets, 67.3% of the severe head injury rate, 60.0% of the craniotomy rate, and 12.2% of the rate of complications during therapeutic processes.

DISCUSSION

Wearing a helmet and trauma system designation are crucial factors that reduce the fatality rate.

Universal Motorcycle Helmet Laws to Reduce Injuries: A Community Guide Systematic Review

CONTEXT

Motorcycle crashes account for a disproportionate number of motor vehicle deaths and injuries in the U.S. Motorcycle helmet use can lead to an estimated 42% reduction in risk for fatal injuries and a 69% reduction in risk for head injuries. However, helmet use in the U.S. has been declining and was at 60% in 2013. The current review examines the effectiveness of motorcycle helmet laws in increasing helmet use and reducing motorcycle-related deaths and injuries.

EVIDENCE ACQUISITION

Databases relevant to health or transportation were searched from database inception to August 2012. Reference lists of reviews, reports, and gray literature were also searched. Analysis of the data was completed in 2014.

EVIDENCE SYNTHESIS

A total of 60 U.S. studies qualified for inclusion in the review. Implementing universal helmet laws increased helmet use (median, 47 percentage points); reduced total deaths (median, -32%) and deaths per registered motorcycle (median, -29%); and reduced total injuries (median, -32%) and injuries per registered motorcycle (median, -24%). Repealing universal helmet laws decreased helmet use (median, -39 percentage points); increased total deaths (median, 42%) and deaths per registered motorcycle (median, 24%); and increased total injuries (median, 41%) and injuries per registered motorcycle (median, 8%).

CONCLUSIONS

Universal helmet laws are effective in increasing motorcycle helmet use and reducing deaths and injuries. These laws are effective for motorcyclists of all ages, including younger operators and passengers who would have already been covered by partial helmet laws. Repealing universal helmet laws decreased helmet use and increased deaths and injuries.

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.

The Preventive Effect of Head Injury by Helmet Type in Motorcycle Crashes: A Rural Korean Single-Center Observational Study

Introduction. The goal of this study was to determine the preventive effect on head injury by helmet type: full face helmet (FFH), open face helmet (OFH), and half-coverage helmet (HCH). Methods. This is a retrospective observational study of motorcycle crash victims between June 2012 and May 2015 in a rural town in Korea. We performed multiple linear regression to predict the effect of each type of helmet compared to unhelmeted status in preventing head injury using dependent variables based on the Abbreviated Injury Scale (AIS) and applied logistic regression modeling to compare the incidence of head injury. Results. Of the 738 patients, the number of FFH patients was 33.5%, followed by unhelmeted (27.8%), OFH (17.6%), and HCH (13.0%) patients. The FFH and OFH group had a lower head maximum AIS than unhelmeted group (coefficient: -0.368, 95% CI: -0.559 to -0.177 and coefficient: -0.235, 95% CI: -0.459 to -0.010, resp.) and only FFHs experienced a reduction effect of severe and minor head injury (OR: 0.206, 95% CI: 0.080 to 0.533 and OR: 0.589, 95% CI: 0.377 to 0.920, resp.). Conclusions. FFHs and OFHs reduce the risk of head injury, and FFHs have a more preventive effect on head injury in motorcycle crashes.

Association Between Adult Attention Deficit Hyperactivity Disorder and Helmet Use Among Motorcycle Riders

Background

Use of helmets plays a major role in preventing injuries or decreasing injury severity among motorcycle riders. Use of helmets may depend on personal factors such as psychological factors.

Objectives

The aim of this study was to independently assess the association between helmet use among motorcycle riders and ADHD scores, with controlling the accident history and was taken more sensitive measures if helmet use was different between motorcycle riders, according to their ADHD scores.

Patients and Methods

A cross-sectional study was done on 205 motorcycle riders referred to Kerman Referral Injury Hospital after a motorcycle traffic accident. Friends and family members possessing motorcycles who visited the patient in this facility were included in our sample. The Persian version of the Conner’s Adult ADHD Rating Scale (CAARS) self-report (screening version) was used in order to screen for adult ADHD. CAARS scores were compared between those who usually used helmets and those who did not.

Results

Univariable analysis showed the mean of the age variable was significantly higher in the helmeted group, 26.94 ± 7.72 vs. 23.08 ± 7.7.32, (P < 0.001). The majority of the non-helmeted group was single (P < 0.001). Subjects with secondary educational level were more often in the helmeted group (P = 0.007). Daily and weekly driving hours were higher in the non-helmeted group (P = 0.002 and P = 0.004). Most of the subjects in the helmeted group had a driving license in comparison with the other group (P < 0.001). There was not a significant association between SES and having hyperactive children and helmet use (P = 0.159). In all ADHD subscales, a significant association was found and scores were higher in the non-helmeted group (P < 0.05). Nevertheless, multivariable analysis did not confirm the association of the ADHD screening score with helmet use.

Conclusions

The result of this study did not find an independent association between ADHD and helmet use.

The prevalence and effective factors of crash helmet usage among motorcyclists in Iran

BACKGROUND

Crash helmet plays an important role in protecting the deriver's head during crashes and reduces the rate of severe injuries and fatalities. Although it has been proved that wearing the crash helmet can save the deriver's life by around 42%; previous studies showed that the rate of wearing crash helmet has not been acceptable in Iran. Due to the huge number of motorcyclists on the roads in Iran, the use of crash helmet is an important area of research. The aim of this study was to assess the factors that could possibly relate to or affect the use of crash helmet by the motorcyclists.

METHODS

This is an observational study on 414 motorcyclists in Shiraz, Southern Iran. All participants completed a questioner containing demographic features, crash helmet use, motorcycle license, and the reasons for using motorcycles.

RESULTS

All the participants were males and aged from 16 to 64 years with mean age 27±9.28. The results of logistic regression model revealed that only the drivers who had motorcycle license (OR=2.73, C.I: 1.40-7.24), employed the motorcycle for reasons other than pleasure (OR=3.18, C.I: 1.42-7.37) and been driving for 10 or more years (OR=1.92 95% C.I: 1.12-3.30) had greater rate of wearing crash helmet. Interestingly, educational levels, age, and other demographical variables had no relationship with crash helmet usage.

CONCLUSIONS

It is believed that in order to increase the rate of crash helmet use, it is necessary to enact obligatory requirement for driving license by motorcyclists and increase the legal age for motorcycle driving.

Prevalence of alcohol and drugs among motorcycle riders killed in road crashes in Norway during 2001-2010

The aim of the study was to examine the prevalence of alcohol and drugs in blood samples from motorcycle riders who died in road crashes in Norway from 2001 to 2010. An additional aim was to compare the prevalence of alcohol and drugs in blood samples from fatally injured motorcycle riders and car drivers who died during the same time period. Blood samples from motorcycle riders who died within 24h after the accident (n=207, 63% of all killed riders), were analysed for alcohol, psychoactive drugs (medicinal and illicit drugs). The cut-off concentrations for alcohol and drugs findings in blood samples (i.e., the drug concentrations above which a finding was regarded as positive) were set according to the legislative limits under the Norwegian Road Traffic Act. Results were assessed in relation to age, sex, time of the day and week, and single versus multiple-vehicle accidents. Alcohol or drugs were found in 27.1 percent of all investigated riders. For riders killed in single or multiple-vehicle accidents, alcohol or drugs were found in 44.6 and 15.3 percent, respectively. Alcohol was the most frequently found substance for all age groups and most prevalent in samples from riders below 25 years who died in single-vehicle accidents (45.8 percent). Drugs were most often found among riders between 25 and 34 years (19.6 percent in total and 25.9% for those killed in single-vehicle crashes). The prevalence of alcohol or drugs was highest among riders killed in single-vehicle accidents during weekend days and nights (60.9 and 65.2 percent). Alcohol and drugs were less often found in samples from killed motorcycles riders than in samples from car and van drivers (40.2 percent). For single-vehicle accidents, the total prevalence of alcohol or drugs among killed motorcycles riders and car drivers was 44.6 percent and 63.8 percent, respectively. The same pattern of alcohol and drugs was found among the two groups, except that the prevalence among motorcycle riders was lower compared to car drivers in all age groups and time periods, which may be related to the fact that they are more vulnerable for fatal injury compared to car drivers in similar accidents.

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.

Factors affecting motorcycle helmet use: size selection, stability, and position

OBJECTIVES

One of the main requirements of a protective helmet is to provide and maintain appropriate and adequate coverage to the head. A helmet that is poorly fitted or fastened may become displaced during normal use or even ejected during a crash.

METHODS

Observations and measurements of head dimensions, helmet position, adjustment, and stability were made on 216 motorcyclists. Helmet details were recorded. Participants completed a questionnaire on helmet usability and their riding history. Helmet stability was assessed quasistatically.

RESULTS

Differences between the dimensions of ISO headforms and equivalent sized motorcyclists' heads were observed, especially head width. Almost all (94%) of the helmets were labeled to be compliant with AS/NZS 1698 (2006). The majority of riders were satisfied with the comfort, fit, and usability aspects of their helmets. The majority of helmets were deemed to have been worn correctly. Using quasistatic pull tests, it was found that helmet type (open-face or full-face) and the wearing correctness were among factors that affected the loads at which helmets became displaced. The forces required to displace the helmet were low, around 25 N.

CONCLUSIONS

The size of the in-use motorcycle helmets did not correspond well to the predicted size based on head dimensions, although motorcyclists were generally satisfied with comfort and fit. The in vivo stability tests appear to overpredict that helmets will come off in a crash, based on the measured forces, tangential forces measured in the oblique impact tests, and the actual rate of helmet ejection.

Analysis of Road Traffic Crashes-Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan

The objective of this study was to determine the prevalence of road traffic crashes (RTC)-related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the severity of maxillofacial injury and head, ocular and polytrauma. This study further emphasizes the need for thorough examination of patients presenting with RTC-related maxillofacial injuries.

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.