Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports

Baseline vulnerable road user injury risk in multiple U.S. dense urban driving environments

OBJECTIVE

Understanding and modeling baseline driving safety risk in dense urban areas represents a crucial starting point for automated driving system (ADS) safety impact analysis. The purpose of this study was to leverage naturalistic vulnerable road user (VRU) collision data to quantify collision rates, crash severity, and injury risk distributions in the absence of objective injury outcome data.

METHODS

From over 500 million vehicle miles traveled, a total of 335 collision events involving VRUs were video verified and reconstructed (126 pedestrians, 144 cyclists, and 65 motorcyclists). Data consisted of anonymized video and sensor data (Global Positioning System and accelerometer) from vehicles equipped with Nexar dash cameras. Each event was qualitatively evaluated to assess the collision geometries and other extrinsic collision factors (e.g., time of day, roadway location, presence of occlusions). Previously published injury risk models were utilized to provide estimates of Maximum Abbreviated Injury Scale MAIS2+ and MAIS3+ injury potential. Collision severity distributions and aggregated injury risk estimates were compared.

RESULTS

Vehicle speeds at the time of impact ranged from 0 to 39 mph, and VRU speeds ranged from 0 to 27 mph. In general, vehicles were traveling at lower speeds at the time of impact when turning in comparison to straight travel. Nearly all events (95%) were associated with MAIS3+ injury risk estimates below 10%. Collisions involving a potential occlusion or the vehicle responding to surprising behavior by the VRU were associated with higher estimates of injury risk than those without occlusion or with the vehicle initiating the conflict. Based on accumulated risk for each event, it can be estimated that approximately 55 persons could be moderately injured (MAIS2+) and approximately 6 persons could be seriously injured (MAIS3+).

CONCLUSION

These data indicate that responding to surprising VRU behavior, having visibility be potentially occluded, and vehicle travel behavior were associated with differences in collision speed and injury risk estimation. The specific comparisons made in this study are not intended to be comprehensive but serve as a starting point for considering baseline driving risk associated with VRU collisions in dense urban areas.

Firearms Are Now the Leading Cause of Traumatic Brain Injury-Related Mortality in Children

Recent studies have demonstrated a significant change in the epidemiology of injury fatalities in children, most notably a marked increase in firearm-related deaths. Few studies have specifically addressed pediatric TBI-related mortality trends. Studying these trends is important for both clinical preparedness and public health interventions. The purpose of this study therefore is to examine recent trends in mechanisms, intents, and rates of pediatric TBI fatalities. Data regarding fatalities from TBI for children <18 years of age from 2011 to 2021 were extracted from the Centers for Disease Control and Prevention, National Center for Health Statistics' web-based injury statistics query and reporting system. We found that firearms became the leading cause of TBI fatalities in children by 2021, most frequently attributable to self-harm. Taken together, the findings from this study underscore the importance in monitoring the changing epidemiology of pediatric TBI fatalities.

E-Bikes (Electrical Bicycles and Scooters) Related Neurosurgical Injuries in the Adult Population: A Single-Center Experience

E-bikes (electrical bicycles and scooters) have been increasingly used as a means of transportation, especially among young adults. E-bikers have more accidents, at higher velocities and more severe kinematics, increasing the rate of neurosurgical injuries. Severe neurosurgical injury patterns result in significant morbidity and mortality. We collected data regarding adult patients (>18 years old), who suffered e-bike-related neurosurgical injuries, in a single tertiary medical center in Israel, between July 2019 and June 2020. Fifty-eight consecutive patients were included in this study. The average age was 34.9, and the average Glasgow Coma Scale (GCS) score upon admission was 13.2 and was significantly lower in operated patients (10.75). Fifty-four patients were riders; 51 (94.5%!) were not wearing a helmet. Fifty percent of patients had multiple types of trauma. Six patients suffered a spinal injury. Sixteen patients required either cranial or spinal surgery. Three patients died, and 1 remained in a vegetative state. Median Glasgow Outcome Scale-Extended (GOS-E) score at follow-up was 7.1. Operated patients stayed significantly longer in the intensive care unit (ICU) and in the hospital, and their GOS-E scores at discharge and follow-up were significantly lower. Most spinal injuries underwent surgery. Patients who wore helmets had significantly higher GCS scores and a shorter stay in the ICU and hospital. The unacceptable reality of the careless use of this transportation and the unique kinematics lead to severe neurosurgical injuries, comorbidities, and even mortality. Our results reflect the risks of e-bikes in the adult population. Most of our patients were in the mid-age group, and almost none had used a helmet. The results of this study highlight the potential need for neurosurgical treatment, and the need for long-term rehabilitation and follow-up, reflecting the emotional and financial toll of these injuries. Once again, this study showed that helmets save lives and emphasized the importance of protecting our heads.

Changes in pediatric injuries sustained while engaged in activities where helmet usage is recommended during the COVID-19 pandemic

BACKGROUND

Unintentional injuries, including traumatic brain injuries (TBI), are the leading cause of pediatric morbidity and mortality in the USA. Helmet usage can reduce TBI incidence and severity; however, the epidemiology of pediatric TBI and helmet use is ever evolving. With lifestyle changes potentially accelerated by the pandemic, we predicted a decrease in helmet utilization with an associated increase in TBI during the pandemic compared to the pre-pandemic period.

RESULTS

There were 1093 patients that presented with AWHUR injuries from 2018 to 2020 with an annual increase from 263 patients in 2018 up to 492 in 2020. The most frequently implicated mechanisms included bicycles (35.9%), ATVs (20.3%), skateboards (11.6%), scooters (8.3%), and dirt bikes (7.4%). Unhelmeted patients increased from 111 (58.7%) in 2018 to 258 (64.8%) in 2020. There was not a significant difference in the proportion of injuries that were unhelmeted from 38.9% in 2018-2019 to 35.2% in 2020 (p = 0.30), as well as the proportion of head injuries from 2018 to 2019 (24.3%) to 2020 (29.3%) (p = 0.07). A significant increase was seen in neurosurgical consultation from 17 (6.5%) in 2018 to 87 (17.7%) in 2020 (p = 0.02). Notably, there was an increase in the percentage of publicly insured patients presenting with injuries from AWHUR during 2020 (p < 0.001); this group also had suboptimal helmet usage.

CONCLUSION

This study found an increase in patients presenting with injuries sustained while engaged in AWHUR in relation to the COVID-19 pandemic. Concerningly, there was a trend toward decreased helmet utilization and increased injury severity markers. Further analysis is needed into the communities impacted the most by AWHUR injuries.