Head injury patterns in helmeted and non-helmeted cyclists admitted to a London Major Trauma Centre with serious head injury

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.

Evaluation of an Elastomeric Honeycomb Bicycle Helmet Design to Mitigate Head Kinematics in Oblique Impacts

Head impacts in bicycle accidents are typically oblique to the impact surface and transmit both normal and tangential forces to the head, causing linear and rotational head kinematics, respectively. Traditional expanded polystyrene (EPS) foam bicycle helmets are effective at preventing many head injuries, especially skull fractures and severe traumatic brain injuries (TBIs) (primarily from normal contact forces). However, the incidence of concussion from collisions (primarily from rotational head motion) remains high, indicating need for enhanced protection. An elastomeric honeycomb helmet design is proposed herein as an alternative to EPS foam to improve TBI protection and be potentially reusable for multiple impacts, and tested using a twin-wire drop tower. Small-scale normal and oblique impact tests showed honeycomb had lower oblique strength than EPS foam, beneficial for diffuse TBI protection by permitting greater shear deformation and had the potential to be reusable. Honeycomb helmets were developed based on the geometry of an existing EPS foam helmet, prototypes were three-dimensional-printed with thermoplastic polyurethane and full-scale flat and oblique drop tests were performed. In flat impacts, honeycomb helmets resulted in a 34% higher peak linear acceleration and 7% lower head injury criteria (HIC15) than EPS foam helmets. In oblique tests, honeycomb helmets resulted in a 30% lower HIC15 and 40% lower peak rotational acceleration compared to EPS foam helmets. This new helmet design has the potential to reduce the risk of TBI in a bicycle accident, and as such, reduce its social and economic burden. Also, the honeycomb design showed potential to be effective for repetitive impact events without the need for replacement, offering benefits to consumers.

Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.

It's in the game: A review of neurological lesions associated with sports

INTRODUCTION

The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature.

METHODS

Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included.

RESULTS

A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma.

CONCLUSION

Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.

A Review of Cyclist Head Injury, Impact Characteristics and the Implications for Helmet Assessment Methods

Head injuries are common for cyclists involved in collisions. Such collision scenarios result in a range of injuries, with different head impact speeds, angles, locations, or surfaces. A clear understanding of these collision characteristics is vital to design high fidelity test methods for evaluating the performance of helmets. We review literature detailing real-world cyclist collision scenarios and report on these key characteristics. Our review shows that helmeted cyclists have a considerable reduction in skull fracture and focal brain pathologies compared to non-helmeted cyclists, as well as a reduction in all brain pathologies. The considerable reduction in focal head pathologies is likely to be due to helmet standards mandating thresholds of linear acceleration. The less considerable reduction in diffuse brain injuries is likely to be due to the lack of monitoring head rotation in test methods. We performed a novel meta-analysis of the location of 1809 head impacts from ten studies. Most studies showed that the side and front regions are frequently impacted, with one large, contemporary study highlighting a high proportion of occipital impacts. Helmets frequently had impact locations low down near the rim line. The face is not well protected by most conventional bicycle helmets. Several papers determine head impact speed and angle from in-depth reconstructions and computer simulations. They report head impact speeds from 5 to 16 m/s, with a concentration around 5 to 8 m/s and higher speeds when there was another vehicle involved in the collision. Reported angles range from 10° to 80° to the normal, and are concentrated around 30°-50°. Our review also shows that in nearly 80% of the cases, the head impact is reported to be against a flat surface. This review highlights current gaps in data, and calls for more research and data to better inform improvements in testing methods of standards and rating schemes and raise helmet safety.

Prevalence of post-concussion syndrome and associated factors among patients with traumatic brain injury at Debre Tabor Comprehensive Hospital, North Central Ethiopia

Introduction

The occurrence of three or more of the following signs and symptoms, such as headache, dizziness, exhaustion, irritability, sleeplessness, difficulties in concentrating, or memory problems, following a head injury is referred to as post-concussion syndrome (PCS). Even though post-concussion syndrome has not been studied in Ethiopia, the productive age group is frequently affected by health issues related to head trauma, which either directly or indirectly affect the growth of the nation.

Objective

To assess the prevalence and associated factors of post-concussion syndrome among patients with traumatic brain injury at Debre Tabor Comprehensive Hospital, Debre Tabor, North Central Ethiopia.

Methods

A successive sampling technique was used to conduct a hospital-based cross-sectional study on 405 traumatic brain injury patients at Debre Tabor Comprehensive Hospital from January 1, 2022, to May 30, 2022. SPSS version 25 was used to analyze the data. The factors connected to post-concussion syndrome were found using bivariate and multivariable logistic regression analysis. Statistical significance was determined by a P-value of ≤ 0.05.

Results

During the data collection period, 405 cases in total were interviewed, with a 98% response rate. More than half (60.7%) of patients were married, with the majority of patients (39.8%) falling between the ages of 18 and 29. At least three post-concussion syndrome symptoms were present in 42.8% of subjects. A history of comorbidities, GCS levels of 8 or below, 9 to 12 at the time of presentation, brain neuroimaging findings, and having fair or poor social support were found to be substantially linked with PCS in multivariate logistic regression.

Conclusion

About 41.5% of study participants had at least three symptoms of PCS. The Glasgow coma scale level at the time of presentation, the reason for the injury, social support, and the site of the injury were all significantly associated with the occurrence of PCS.

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.

Epidemiology of paediatric moderate and severe traumatic brain injury in the Netherlands

INTRODUCTION

Traumatic brain injury (TBI) is the main cause of death in children around the world. The last Dutch epidemiological study described the incidence over 10 years ago. Mechanism of injury seems to change with the age of the child, therefore it is important to appreciate different age groups. To be able to lower the impact of childhood TBI, an understanding of current incidence, mechanism of injury and outcome is necessary.

METHODS

A nationwide retrospective cohort study was conducted. The Dutch National Trauma Database was used to identify all patients 18 years and younger who were admitted to a Dutch hospital with moderate-severe TBI (Abbreviated Injury Score≥3) in the Netherlands, from January 2015 until December 2017. Subanalyses were done for different age groups.

RESULTS

In total, 1413 patients were included, of whom 5% died. The incidence rate of moderate-severe TBI was 14/100,000 person years. Median age was 10.4 years. Largest age group was patients <5 years, incidence rate was highest in patients ≥16 years. Falls were more common than road traffic accidents (RTA), but RTAs occurred far more frequently amongst children over 10. RTAs predominantly consisted of bicycle accidents. Mortality rates increased from youngest to oldest age groups, as did the chances of a Glasgow Outcome Scale score of 3.

CONCLUSION

Paediatric moderate-severe TBI represents a significant problem in the Netherlands. Falls are the most common mechanism of injury amongst younger children and RTAs amongst older children. Unique for the Netherlands is the vast amount of bicycle accident related injuries.

Severity and predictors of head injury due to bicycle accidents in Western Australia

BACKGROUND

Head and face injuries are the second most frequently reported injuries among bicyclists. Recently, helmet usage has increased, and in some countries, helmet laws have been introduced. However, subsequent changes in the incidence and severity of traumatic brain injury (TBI) are unknown, and data on neurosurgical interventions are lacking. Therefore, we analyzed a cohort of bicyclists with TBI, in a state with an enforced helmet law, and compared our results with the available literature.

METHODS

Patient data of bicycle accidents that occurred between January 2008 and January 2015 were extracted from the state trauma registry, and the corresponding patient files and CT scans were comprehensively reviewed.

RESULTS

Of the 1019 patients admitted due to bicycle accidents, 187 patients suffered from TBI. Most cases were mild; however, 72 involved intracranial hemorrhages. Of the TBI patients, 113 were wearing helmets. CT scans were performed on 168 TBI patients, 120 of whom had a Rotterdam CT score of 1, with no difference between helmeted and non-helmeted patients. Open head injury (p < 0.05) and epidural hematomas were significantly less frequent among helmet wearers (p = 0.03). Ten patients required surgery; helmet use and neurosurgical involvement were not significantly correlated.

CONCLUSIONS

Patients who wore helmets were significantly less likely to suffer from epidural hematomas and open head injuries. While TBI severity was not significantly different between helmeted and non-helmeted bicyclists, the overall occurrence of TBI and moderate to severe TBI among all admissions was lower than that seen in comparable studies from countries without helmet laws.

Laboratory Reconstructions of Real-world Bicycle Helmet Impacts

The best way to prevent severe head injury when cycling is to wear a bike helmet. To reduce the rate of head injury in cycling, knowing the nature of real-world head impacts is crucial. Reverse engineering real-world bike helmet impacts in a laboratory setting is an alternative to measuring head impacts directly. This study aims to quantify bike helmet damage using computed tomography (CT) and reconstruct real-world damage with a custom, oblique test rig to recreate real-world impacts. Damaged helmets were borrowed from a helmet manufacturer who runs a helmet warranty program. Each helmet was CT-scanned and the damage metrics were quantified. Helmets of the same model and size were used for in-lab reconstructions of the damaged helmets where normal velocity, tangential velocity, peak linear acceleration (PLA) and peak rotational velocity (PRV) could be measured. The damage metrics of the in-lab dropped helmets were quantified using the same CT scanning process. For each case, a multiple linear regression (MLR) equation was created to define a relationship between the quantified damage metrics of the in-lab tested helmets and the associated measured impact velocities and kinematics. These equations were used to predict the impact kinematics and velocities from the corresponding real-world damaged helmet based on the damage metrics from the original damaged helmet. Average normal velocity (3.5 m/s), tangential velocity (2.5 m/s), PLA (108.0 g), PRV (15.7 rad/s) were calculated based on a sample of 23 helmets. Within these head impact cases, five notes reported a concussion. The difference between the average PLA and PRV for concussive cases versus other impacts were not significantly different, although the average impact kinematics for the concussive cases (PLA = 111.4 g, PRV = 18.5 rad/s) were slightly higher than the remaining cases (PLA = 107.1 g, PRV = 15.0 rad/s). The concussive cases were not indicative of high magnitude impact kinematics.

Sports & exercise related traumatic brain injury in the Republic of Ireland - The neurosurgical perspective

BACKGROUND

While the concerns regarding the long-term cognitive effects of repeated sports related head injury have become a major source of debate, it is not uncommon for these patients to require neurosurgical interventions in the acute setting. The aim of this study was to provide a unique insight into the acute nature and neurosurgical management of sports and exercise related traumatic brain injury.

METHODS

We retrospectively analysed electronic records of all referrals made between July 2016 and December 2018 to the National Neurosurgical Centre at Beaumont Hospital to identify instances of sport and exercise related traumatic brain injuries (TBI). A sub-group analysis was carried out on patients transferred to the tertiary centre requiring neurosurgical/neuro-critical care.

RESULTS

Over the 30-month period, 194 patients (mean age: 36) were referred withsports and exercise related TBI, of which 56 were transferred to our unit (26 adults, 30 paediatrics). The most frequently encountered sporting activities were cycling, gaelic football, horse riding and rugby. Injuries included cerebral contusions, subdural haematomas, extradural haematomas and skull fractures. Neurosurgical intervention via intracranial pressure monitoring (ICP), decompressive craniectomy and elevation of depressed skull fracture was required in 28 out of 194 patients (14.4%). 85.7% (n = 48) of patients had a discharge Glasgow Coma Scale (GCS) of 15. 4 patients had a tracheostomy in place at discharge and there were 4 mortalities.

CONCLUSIONS

Sports and exercise activities, ranging from contact team sports to individual activities, are a common cause of traumatic brain injury and maybe associated with a significant morbidity and mortality.

Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011-2017)

PURPOSE

Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran.

METHODS

In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used.

RESULTS

Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%).

CONCLUSION

Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.

Collect the Bones, Avoid the Cones: A Game-Based App for Public Engagement

Game-based applications (apps) and serious games enable educationalists to teach complex life sciences topics. Gamification principles (i.e. challenges, problem solving, critical thinking) improve learners' motivation and can also help science communicators discuss important scientific subjects and their real-world context in an effective, enjoyable manner. The aim of this study was to design, develop and evaluate a science communication game-based app, entitled Collect the Bones, Avoid the Cones, on human skull anatomy for use in public engagement activities with younger audiences. Specifically, the app contextualised three-dimensional (3D) skull anatomy within a narrative about cycling and helmet safety. The app was tested at the Glasgow Science Centre, with ethical approval from the Glasgow School of Art, to assess its potential pedagogical value, in terms of pre- and post-app knowledge and confidence, and general user evaluation. In total, 50 participants were recruited (mean age 15.6 ± 1.647, range 7-64) with 62% of participants aged 7-12. Usability and educational value were rated highly with 70% of participants agreeing they could use the app without any external instructions and 90% agreeing they understand the anatomy of the skull better after app use. The enjoyability of the game was also positively perceived with 94% of participants agreeing they enjoyed the game. Although there was no statistical significance in pre- and post-app knowledge scores, there was a statistically significant increase in players' confidence relating to skull anatomy (pre-app: 3.00 ± 1.265, post-app: 4.00 ± 1.00, Z = -5.111, p < 0.001). These results provide promising insight into the potential of game-based apps for public engagement in anatomical sciences. Future research on how the app influences attitudes towards helmet use in different demographic groups would be valuable in identifying its full pedagogical potential.

Cycling related major trauma in Ireland

INTRODUCTION

Cycling as a means of transport or recreational activity is increasing in popularity in Ireland. However, increasing numbers of cyclists may lead to an increased number of bicycle collisions and fatalities. The Road Safety Authority is the statutory body for road safety in Ireland but uses police data alone to collate cycling collision statistics. This may lead to an underestimation of cycling injuries in Ireland. Using hospital statistics may provide a greater understanding of cycling trauma in Ireland.

OBJECTIVE

The present study examines cycling related trauma in Ireland using the Major Trauma Audit (MTA) data collected via the Trauma and Research Network (TARN) from hospitals in Ireland for the period 2014 to 2016. The database was interrogated for demographics, mechanism of injury, injury characteristics and patient outcomes.

RESULTS

There were 410 cycling collisions recorded in the TARN database which represented 4.4% of trauma captured by TARN for the study period. Of this cohort 79% were male compared with 58% in the overall (TARN) trauma cohort (p < 0.001) and the median (IQR) age was 43.8 years (31.0, 55.7) which is younger than the median (IQR) of 58.9 (36.2, 76.0) years for the overall trauma cohort (p < 0.001). Cycling collisions had a median (IQR) injury severity score (ISS) of 10 (9, 20) which was higher than the overall trauma cohort ISS of 9 (9, 17). Of the mechanisms observed for cycling trauma, 31.7% (n = 130) had a collision with a motor vehicle. Of those who did not wear a helmet, 52.2% (n = 47) sustained a head injury compared with 27.5% (n = 44) in the group who were wearing a helmet (p < 0.001).

CONCLUSION

The TARN data presented in this paper builds a more complete overview of the burden of cycling collisions in Ireland. Particular points of focus are that serious cycling injuries occur in a predominantly male population, and that only around 30% of cases are recorded as involving a motor vehicle, with the majority having an unknown mechanism of injury. There was an association between helmets and head injuries in this study, but there are likely other contributing factors such as mechanism of injury, velocity or cycling infrastructure. Using hospital data such as the MTA provides valuable information on the injuries sustained by cyclists, but more prospective studies to capture injury mechanism and contributing factors are needed.

Neurosurgical management of head injuries incurred during sports: a single centre experience

Introduction: Accidents during sporting activities are a common cause of head injury, particularly in children and young adults. Whilst most sporting head injuries are minor, there remains a proportion which is associated with high morbidity and mortality. The epidemiology of sports associated head injuries is variable based on geographical region so the aim of this study was to review the management and outcomes of sporting head injuries managed by a single neurosurgical unit in the South of England.Method: A retrospective review of the Trauma Audit and Research Network database was conducted for all patients admitted to a tertiary neurosurgical centre over a six-year period (January 2011-December 2016). Case notes were reviewed for demographics, mechanism of injury, injury severity score, intensive care admission, surgical interventions and Glasgow Outcome Score at discharge.Results: Seventy-six patients (mean age: 37.6 ± 18.4 years, male gender n = 43; 56.6%) were eligible for inclusion in this series. Horse riding accidents were identified as the most common cause of head injury (n = 31; 40.8%). Fifteen patients (19.7%) in this series had a severe head injury (GCS 3-8 on admission). Twenty-eight (36.8%) patients required admission to an intensive care unit and 26 (34.2%) patients underwent neurosurgical intervention. At discharge, 68 (89.5%) patients had a Glasgow Outcome Score 4-5.Conclusion: The majority of patients with head injuries admitted to a neurosurgical unit can expect a good functional outcome despite the need for intensive care or neurosurgical intervention. The range of sports resulting in head injury is likely influenced by geographic location; however, further national study is required for wider comparison.

Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset

OBJECTIVES

In the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.

SETTING

The NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).

PARTICIPANTS

11 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.

OUTCOME MEASURES

TARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.

RESULTS

Data on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%-6.6%) versus helmeted cyclists 1.8% (1.4%-2.2%) (p<0.001). Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%-20.4%) versus 47.6% (1211, 45.6%-49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%-20.8%) versus 27.1% (691, 25.4%-28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%-3.1%) versus 8.5% (217, 7.5%-9.7%) (p<0.001). There was a statistically significant increase in chest, spinal, upper and lower limb injury in the helmeted group in comparison to the un-helmeted group (all p<0.001), though in a subsequent analysis of these anatomical injury patterns, those cyclists wearing helmets were still found to have lower rates of TBI. In reviewing TARN injury codes for specific TBI and facial injuries, there was a highly significant decrease in rates of impact injury between cyclists wearing helmets and those not.

CONCLUSIONS

This study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.

Protective effects of helmets on bicycle-related injuries in elderly individuals

OBJECTIVE

The increasing frequency of bicycle-related injuries is due to the growing elderly population and their increasing physical activity. This study aimed to compare the protective effects of helmets on bicycle-related injuries in elderly individuals compared with those in younger adults.

METHODS

Data from the Korean emergency department-based Injury In-depth Surveillance database from eight emergency departments during 2011-2016 were retrospectively analysed. The subjects sustained injuries while riding bicycles. Cases with unknown clinical outcomes were excluded. Covariates included mechanism, place and time of injury. The primary outcome was traumatic brain injury (TBI) incidence, and the secondary outcomes were in-hospital mortality and severe trauma. The effects of helmets on these outcomes were analysed and differences in effects were determined using logistic regression analysis. Subsequently, the differences in the effects of helmets use between age groups were examined by using interaction analysis RESULTS: Of 7181 adults, 1253 were aged >65 years. The injury incidents showed a bimodal pattern with peaks around ages 20 and 50 years. Meanwhile, the helmet-wearing rate showed a unimodal pattern with its peak at age 35-40 years; it decreased consistently with age. By multivariate analysis, helmet-wearing was associated with a reduced TBI incidence (OR 0.76; 95% CI 0.57 to 0.99) and severe trauma (OR 0.78; 95% CI 0.65 to 0.93). The effects of helmets increased in elderly individuals (TBI (p=0.022) and severe trauma (p=0.024)).

CONCLUSION

The protective effects of helmets on bicycle-related injuries are greater for elderly individuals, thus reducing TBI incidence.

Bicycle helmets - To wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries

A meta-analysis has been conducted of the effects of bicycle helmets on serious head injury and other injuries among crash involved cyclists. 179 effect estimates from 55 studies from 1989-2017 are included in the meta-analysis. The use of bicycle helmets was found to reduce head injury by 48%, serious head injury by 60%, traumatic brain injury by 53%, face injury by 23%, and the total number of killed or seriously injured cyclists by 34%. Bicycle helmets were not found to have any statistically significant effect on cervical spine injury. There is no indication that the results from bicycle helmet studies are affected by a lack of control for confounding variables, time trend bias or publication bias. The results do not indicate that bicycle helmet effects are different between adult cyclists and children. Bicycle helmet effects may be somewhat larger when bicycle helmet wearing is mandatory than otherwise; however, helmet wearing rates were not found to be related to bicycle helmet effectiveness. It is also likely that bicycle helmets have larger effects among drunk cyclists than among sober cyclists, and larger effects in single bicycle crashes than in collisions with motor vehicles. In summary, the results suggest that wearing a helmet while cycling is highly recommendable, especially in situations with an increased risk of single bicycle crashes, such as on slippery or icy roads.

A Comparative Data Analysis of 1835 Road Traffic Accident Victims

AIMS AND OBJECTIVES

The purpose of the study was to analyze and compare the incidence of road traffic accidents (RTA) with head injuries and maxillofacial injuries in two arterial roads, Old Mahabalipuram road (OMR) and East Coast road (ECR), connecting with Chennai city and outlining the need of safety precautions to be followed to reduce the incidence of morbidity.

MATERIALS AND METHODS

This study involved the medical records of about 1835 trauma victims who reported to Chettinad Health city, kelambakkam, between August 2008 and June 2013. The data analyzed were, age of trauma victims, gender, type of trauma, type of vehicle, accident time, accident zone, presence of head injury, maxillofacial injury and history of alcohol consumption.

RESULTS

Trauma victims were predominantly male (84.3%), with majority of individuals in the age group of 21-40 yrs (56%). About 42% of the reported accidents occurred in OMR and 18.3% of accidents occurred in ECR. About 51.2% of the reported road traffic accidents occurred in the busy traffic hours, between 7am-10am and 5pm-9pm. About 66.4% of RTAs were due to two wheeler vehicles and 21.6% were due to four wheeler vehicles. The incidence of head injury was 47.5% and about 1417 (77.2%) patients reported with maxillofacial injuries.

CONCLUSION

RTAs are more common in OMR than in ECR, involving mostly male victims and two wheeler vehicles, during the peak traffic hours. Rash driving and over speeding of vehicles are the preventable causative factors. Wearing of Helmets by the two wheeler riders and seat belts by the four wheeler riders are essential to prevent morbidity. We stress the need of separate lane for Ambulance on the roads for faster transport of accident victims to nearby Hospital and trauma care centers.