Secular trends in the incidence and severity of injuries sustained by riders of electric bikes and powered scooters: The experience of a level 1 adult trauma center

BACKGROUND

The incidence of injuries caused by electric bicycles (E-bikes) and powered scooters (P-scooters) continues to increase. Data on the severity of those injuries is conflicting. The purpose of this study was to explore secular trends in the incidence and severity characteristics of patients following E-bike and P-scooter injuries and predictors for major trauma.

METHODS

A retrospective cohort study of patients aged ≥16 years following E-bike and P-scooter injuries was performed at a level 1-trauma center between 2017 and 2022. We explored secular trends in major trauma cases (primary outcome), emergency department (ED) visits, hospitalizations, and surgical interventions (secondary outcomes). Major trauma was defined by either an injury severity score (ISS) >15 or the patient's need for acute care, defined by any of the following: Intensive care unit admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death. Primary and secondary outcomes were compared between two time frames (2017-2018 vs.2019-2022).

RESULTS

In total, 9748 patients were presented following P-scooter and E-bike injuries. Of them, 1183 patients (12.1%) were hospitalized (854 males [72.2%],median age 33 years, median ISS 9).During the study period, the number of ED visits increased by 21-fold, with a parallel increase hospitalizations and surgical interventions numbers, which increased by 3.4-and 3.8-fold, respectively. Numbers of patients with ISSs >15 and patients who required acute care sharply increased during the study period, but no significant differences were found in the percentages of patients with ISSs >15 (p = 0.78) or patients' need for acute care (p = 0.32) between early and late periods. A severity analysis revealed that male sex (adjusted odds ratio [aOR] 1.7 [95% confidence interval (CI): 1.2-2.4], p = 0.001) and E-bike riders compared to P-scooter riders (aOR 1.5 [95% CI:1.1-2.0], p = 0.005) were independent predictors for severe trauma.

CONCLUSIONS

The incidence of E-bike and P-scooter injuries sharply increased over time, with a parallel elevation in numbers of hospitalizations, surgical interventions, and major trauma cases. Major trauma percentages did not increase during the study period. Male sex and E-bikes emerged as independent predictors for major trauma.

Comparison of single bicycle crashes and collisions among severely injured cyclists-A 16-year analysis based on the Helsinki Trauma Registry (HTR)

OBJECTIVE

The Finnish national Traffic Safety Strategy 2022-2026 seeks to halve the number of road fatalities and serious injuries from 2020 to 2030. The strategy states that better information on bicycle crashes is needed for safety promotion. The aim of this study was to describe the demographics, injury characteristics, alcohol involvement, and helmet use of severely injured cyclists and to compare single bicycle crashes (falling alone or hitting a fixed object) to collisions.

MATERIAL AND METHODS

We identified all bicycle crashes between 2006 and 2021 from the Helsinki Trauma Registry (HTR). Variables analysed were basic patient demographics, Abbreviated Injury Scale (AIS) codes, AIS 3+ injuries, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS), 30-day in-hospital mortality, ICU length of stay, injury mechanism, alcohol use by the injured cyclists, and helmet use.

RESULTS

Of the 325 severe (NISS >15) cycling injury patients in the HTR, 53.5 % were injured in single crashes and 46.5 % in collisions with a moving object. Most (71.4 %) patients were men and mean age of all patients was 54.1 years (SD 16.7). Alcohol was detected in 23.1 % of cases and more often in single crashes (32.8 %) than in collisions (11.9 %). Less than a third (29.2 %) of all cyclists wore a helmet; those who wore a helmet had fewer serious (AIS 3+) head injuries than those who did not. Cyclists injured in collisions had higher ISS and NISS scores than those injured in single crashes. Serious (AIS 3+) injuries in extremities or in pelvic girdle were more common in collisions than in single crashes.

CONCLUSIONS

Among severely injured cyclists, single bicycle crashes were more common; alcohol was more often detected in single bicycle crashes than in collisions. Overall injury severity was higher in collisions than in single crashes. Helmet users had less AIS 3+ head injuries than non-users. Attention should be focused on preventing alcohol-related cycling injuries, promoting use of bicycle helmets, and more precise and comprehensive documentation of bicycle crashes in health care units.

On a collision course: fatal motorcycle and bicycle accidents of adolescents in Finland from 2008 to 2019

BACKGROUND

Transport injuries are a major cause of mortality among adolescents. Our aim was to evaluate the circumstances and trauma associated with fatal accidents involving adolescents and two-wheeled vehicles.

METHODS

We analyzed retrospective data from the Finnish Crash Data Institute from 2008 to 2019 involving 10- to 24-year-old victims of fatal traffic accidents who were injured while riding a bicycle, moped or motorcycle. We collected data on patient characteristics, accident circumstances and possible treatment. These fatalities were compared with national mortality rates among the respective age groups.

RESULTS

We identified 147 fatalities over the 12-year period involving 20 bicycle, 50 moped and 77 motorcycle riders. Most accidents involved males (n = 121, 82%). Less than half of vehicles were in good condition (46%); motorized vehicles were often illegally tuned (37%) or had tire problems (31%). Most of the accidents were collisions with another vehicle (n = 99, 67%) or other objects (n = 35, 24%). In 94% of cases, the Injury Severity Score was >25. Head injury was the most common cause of death (62%). Among 15-year-olds, every fifth death was due to accidents on two-wheeled vehicles.

CONCLUSIONS

Fatal transport accidents among adolescents comprise several elements that should be incorporated into driver's education and in case of minors, also communicated to parents. These include the condition of the vehicle, proper helmet use and effects of speed on both control of the vehicle and the consequences of a possible collision.

The role of public policy in reducing moped and scooter injuries in South Carolina

INTRODUCTION

Mopeds and electric scooters have grown in popularity in recent years. A South Carolina (SC) law was passed on November 19, 2018, aimed to regulate mopeds and scooters. This study aims to evaluate whether this SC law was associated with a decrease in the moped injury rate in a Level 1 Trauma Center.

METHODS

A retrospective review of trauma registry data was used to identify a cohort of patients 14 years and older who came to a Level 1 trauma center for a moped/scooter accident between January 2014 - December 2022. The proportion of moped injuries before and after the passing of the law was calculated. The chi-square test and Wilcoxon Rank Sum test were used to compare differences in proportions for categorical factors and continuous factors, respectively.

RESULTS

A total of 350 moped injury cases were identified. There was a significant decrease in the moped injury rate after the passing of the 2018 SC law (0.9 % vs 1.8 %, p<0.001). Additionally, those treated post-law implementation were significantly older (47.4 vs 43.2 years, p = 0.013) and more likely to be male (95.5 % vs 87.9 %, p = 0.025) than those treated pre-law. Patients treated post-law were significantly more likely to be uninsured (45.1 % vs 42.7 %, p = 0.009) and less likely to have commercial (16.2 % vs 20.1 %, p = 0.009), or government (29.7 % vs 35.6 %, p = 0.009) health insurance compared to those treated pre-law. There was no significant difference between the two groups in Glascow Coma Scale, Injury severity score, Trauma Injury Severity Score, or rate of fatalities.

CONCLUSION

After the implementation of a SC law, we found that the local proportion of injuries due to moped and scooter accidents was significantly lower than pre-law proportions. These findings suggest that public policies aimed at increasing regulations for mopeds may decrease the rate of injury, but not severity, from moped use.

Bicycle-related accidents in Rome: Investigating clinical patterns, demographics, injury contexts, and health outcomes for enhanced public safety

INTRODUCTION

This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents.

METHODS

Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated.

RESULTS

Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients.

CONCLUSIONS

Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages.

The impact of electric scooters in Melbourne: data from a major trauma service

BACKGROUND

The proliferation of electric scooters globally has been associated with an increase in related injuries and consequent economic burden. This study aims to assess the injury patterns and the economic impact associated with electric scooter use in Melbourne, Australia.

METHODS

A retrospective cohort study was conducted using hospital and registry data from January 2022 to January 2023. Data collected included demographic details, alcohol and helmet use, injury type and severity, operative treatment provided, and direct medical costs. The economic impact (in AUD) of the patient's emergency presentation and hospital admission was calculated.

RESULTS

During the study period, 256 electric scooter related injuries were recorded, comprising 247 riders and nine pedestrians. The majority of patients were males (69%) with a median age of 29.5 (15-78). Alcohol use was reported by 34% and helmet use by 33%. Injuries most commonly affected the upper limb (53%) and head (50%), with abrasions (75%) and fractures (48%) being the most common type of injury sustained. The total hospital cost was $1 911 062, and the median cost was $1321.66 per patient (IQR: $479.37-$5096.65).

CONCLUSION

Electric scooter usage, as observed through patient presentations to the Royal Melbourne Hospital, is associated with a considerable number of injuries, primarily among young males, and an ensuing substantial economic burden. The findings underscore the urgent need for improved safety measures to minimize electric scooter-related injuries and their clinical and economic repercussions.

Histological Observation of Helmet Development in the Treehopper Poppea capricornis (Insecta: Hemiptera: Membracidae)

The treehoppers (Hemiptera, Membracidae) are known for possessing a large three-dimensional structure called a helmet. Although some ecological functions of the helmet have already been elucidated, the developmental mechanisms underlying the complex and diverse morphology of the helmet are still largely unknown. The process of helmet formation was first described in Antianthe expansa, which possesses a simple roof-shaped helmet. However, the developmental process in species with more complex helmet morphologies remains largely unexplored. Hence, in this study, we used Poppea capricornis, which possesses a more complex helmet structure than A. expansa, to investigate the helmet development using paraffin sections, micro-CT, and scanning electronic microscopy. Our focus was on the overall helmet developmental process common to both species and formation of structures unique to Poppea and its comparison to Antianthe. As a result, we discovered that miniature structures were also formed in Poppea, similar to Antianthe, during the helmet formation. Common structures that were shared between the two species were discernible at this stage. Additionally, we observed that suprahumeral horns and posterior horns, two morphological traits specific to the Poppea helmet that are apparently similar anatomically, are formed through two distinctly different developmental mechanisms. The suprahumeral horns appeared to be formed by utilizing the nymphal suprahumeral bud as a mold, while we could not detect any nymphal structures potentially used for a mold in the posterior horns formation. Our findings suggest that the helmet formation mechanisms of Antianthe and Poppea employ a common mechanism but form species-specific structures by multiple mechanisms.

An Assessment of Sikh Turban's Head Protection in Bicycle Incident Scenarios

Due to religious tenets, Sikh population wear turbans and are exempted from wearing helmets in several countries. However, the extent of protection provided by turbans against head injuries during head impacts remains untested. One aim of this study was to provide the first-series data of turbans' protective performance under impact conditions that are representative of real-world bicycle incidents and compare it with the performance of bicycle helmets. Another aim was to suggest potential ways for improving turban's protective performance. We tested five different turbans, distinguished by two wrapping styles and two fabric materials with a size variation in one of the styles. A Hybrid III headform fitted with the turban was dropped onto a 45 degrees anvil at 6.3 m/s and head accelerations were measured. We found large difference in the performance of different turbans, with up to 59% difference in peak translational acceleration, 85% in peak rotational acceleration, and 45% in peak rotational velocity between the best and worst performing turbans. For the same turban, impact on the left and right sides of the head produced very different head kinematics, showing the effects of turban layering. Compared to unprotected head impacts, turbans considerably reduce head injury metrics. However, turbans produced higher values of peak linear and rotational accelerations in front and left impacts than bicycle helmets, except from one turban which produced lower peak head kinematics values in left impacts. In addition, turbans produced peak rotational velocities comparable with bicycle helmets, except from one turban which produced higher values. The impact locations tested here were covered with thick layers of turbans and they were impacted against flat anvils. Turbans may not provide much protection if impacts occur at regions covered with limited amount of fabric or if the impact is against non-flat anvils, which remain untested. Our analysis shows that turbans can be easily compressed and bottom out creating spikes in the headform's translational acceleration. In addition, the high friction between the turban and anvil surface leads to higher tangential force generating more rotational motion. Hence, in addition to improving the coverage of the head, particularly in the crown and rear locations, we propose two directions for turban improvement: (i) adding deformable materials within the turban layers to increase the impact duration and reduce the risk of bottoming out; (ii) reducing the friction between turban layers to reduce the transmission of rotational motion to the head. Overall, the study assessed Turbans' protection in cyclist head collisions, with a vision that the results of this study can guide further necessary improvements for advanced head protection for the Sikh community.

Evaluating helmet-wearing of single-vehicle overspeeding motorcycle crashes: Insights from temporal instability in parsimonious pooled framework

OBJECTIVE

A lower helmet-wearing rate and overspeeding in Pakistan are critical risk behaviors of motorcyclists, causing severe injuries. To explore the differences in the determinants affecting the injury severities among helmeted and non-helmeted motorcyclists in motorcycle crashes caused by overspeeding behavior, single-vehicle motorcycle crash data in Rawalpindi city for 2017-2019 is collected. Considering three possible crash injury severity outcomes of motorcyclists: fatal injury, severe injury and minor injury, the rider, roadway, environmental, and temporal characteristics are estimated.

METHODS

To provide a mathematically simpler framework, the current study introduces parsimonious pooled random parameters logit models. Then, the standard pooled random parameters logit models without considering temporal effects are also simulated for comparison. By comparing the goodness of fit measure and estimation results, the parsimonious pooled random parameters logit model is suitable for capturing the temporal instability. Then, the non-transferability among helmeted and non-helmeted overspeeding motorcycle crashes is illustrated by likelihood ratio tests and out-of-sample prediction, and two types of models provide robust results. The marginal effects are also calculated.

RESULTS

Several variables, such as age, cloudy and weekday indicators illustrate temporal instability. Moreover, several variables are observed to only show significance in non-helmeted models, showing non-transferability across helmeted and non-helmeted models.

CONCLUSIONS

More educational campaigns, regulation and enforcement, and management countermeasures should be organized for non-helmeted motorcyclists and overspeeding behavior. Such findings also provide research reference for the risk-compensating behavior and self-selected group issues under overspeeding riding considering the usage of helmets.

Research on helmet wearing detection method based on deep learning

The vigorous development of the construction industry has also brought unprecedented safety risks. The wearing of safety helmets at the construction site can effectively reduce casualties. As a result, this paper suggests employing a deep learning-based approach for the real-time detection of safety helmet usage among construction workers. Based on the selected YOLOv5s network through experiments, this paper analyzes its training results. Considering its poor detection effect on small objects and occluded objects. Therefore, multiple attention mechanisms are used to improve the YOLOv5s network, the feature pyramid network is improved into a BiFPN bidirectional feature pyramid network, and the post-processing method NMS is improved into Soft-NMS. Based on the above-improved method, the loss function is improved to enhance the convergence speed of the model and improve the detection speed. We propose a network model called BiFEL-YOLOv5s, which combines the BiFPN network and Focal-EIoU Loss to improve YOLOv5s. The average precision of the model is increased by 0.9% the recall rate is increased by 2.8%, and the detection speed of the model does not decrease too much. It is better suited for real-time safety helmet object detection, addressing the requirements of helmet detection across various work scenarios.

Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation

BACKGROUND

Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities.

OBJECTIVE

We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance.

METHODS

A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test.

RESULTS

Of the 26 patients enrolled, 12 (46%) were female, 18 (69%) were on anticoagulants, and 25 (96%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age (χ12=4.27; P=.04) but not sex (χ12=1.58; P=.23) or race (χ12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit.

CONCLUSIONS

The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population.

Endoscopy-Assisted Craniosynostosis Surgery without Postoperative Helmet Molding Therapy

OBJECTIVE

Endoscopy-assisted craniosynostosis surgery (EACS) yields excellent surgical outcomes by minimizing blood loss, operative time, and hospital stays. Postoperative helmet therapy (PHT), commonly employed for head shape correction, involves frequent adjustments, potential complications, and high costs. Given the rising cost of helmet therapy, reduced insurance coverage, and limited availability in low- and middle-income countries, understanding success rates without helmet use is crucial. The present study analyses the anthropometric results of the first EACS series without PHT.

METHODS

A retrospective analysis of a single-center series involving 90 consecutive patients who underwent EACS without PHT from 2012 to 2022 was conducted, with a follow-up exceeding 3 years. The study exclusively included patients with nonsyndromic isolated sagittal synostosis, with 33 meeting the criteria. Craniometric measurements were obtained from preoperative, 1-year postoperative, and the latest computed tomography scans. For isolated sagittal synostosis cases, the cephalic index (CI) was calculated (CI >75 for excellent results, CI 70-75 for good results, and <70 for poor results). Collected data encompassed patient sex, age, and follow-up time.

RESULTS

The mean age was 84.8 ± 45.3 days (2.79 ± 1.49 months) within a range of 3-172 days. The preoperative mean CI was 68 ± 42, increasing to 76 ± 6 1 year postoperatively (mean difference +8 ± 6.3; P = 0.0001). Seventy-one percent of patients achieved excellent results, 23% good (CI = 70-75), and 6% poor. Reintervention was unnecessary.

CONCLUSIONS

EACS without PHT demonstrates favorable anthropometric results, cost reduction, and simplified postoperative management.

Injury patterns and outcomes in motorcycle driver crashes in the United States: The effect of helmet use

BACKGROUND

Motorcycle crashes pose a persistent public health problem with disproportionate rates of severe injuries and mortality. This study aims to analyze injury patterns and outcomes with regard to helmet use. We hypothesized that helmet use is associated with fewer head injuries and does not increase the risk of cervical spine injuries.

METHODS

The National Trauma Data Bank was queried for all motorcycle driver crashes between 2007-2017. Univariable analysis was used to compare demographics, clinical data, injury patterns using abbreviated injury scale, and outcomes between helmeted motorcycle drivers and non-helmeted motorcycle drivers who were injured in traffic crashes. Independent factors associated with mortality were determined by regression analysis after adjustment for potential confounders.

RESULTS

A total of 315,258 patients were included for analysis, 66 % of these patients were helmeted. The sample was 92.5 % male and the median age was 41 years. Non-helmeted motorcycle drivers were more likely to sustain severe head trauma (head abbreviated injury scale ≥ 3: 28.5 % vs. 13.3 %, p < 0.001), had higher intensive care unit-admission (38 % vs. 30.2 %, p<0.001), mechanical ventilation (20.1 % vs. 13 %, p<0.001) and overall mortality rates (6.2 % vs. 3.9 %, p<0.001). Cervical spine injuries occurred in 10.6 % of non-helmeted motorcycle drivers and in 9.5 % of helmeted motorcycle drivers (p<0.001). Helmet use was identified as an independent factor associated with lower mortality [OR 0.849 (0.809-0.891), p<0.001].

CONCLUSION

Helmet use is protective for severe head injuries and associated with decreased mortality. Helmet use was not associated with increased rates of cervical spine injuries. On the contrary, fewer injuries were observed in helmeted motorcycle drivers. Public health initiatives should be aimed at enforcement of universal helmet laws within the United States and across the world.

Development of a Helmet-Shape Dual-Channel RF coil for brain imaging at 54 mT using inverse boundary element method

Very-low field (VLF) magnetic resonance imaging (MRI) offers advantages in term of size, weight, cost, and the absence of robust shielding requirements. However, it encounters challenges in maintaining a high signal-to-noise ratio (SNR) due to low magnetic fields (below 100 mT). Developing a close-fitting radio frequency (RF) receive coil is crucial to improve the SNR. In this study, we devised and optimized a helmet-shaped dual-channel RF receive coil tailored for brain imaging at a magnetic field strength of 54 mT (2.32 MHz). The methodology integrates the inverse boundary element method (IBEM) to formulate initial coil structures and wiring patterns, followed by optimization through introducing regularization terms. This approach frames the design process as an inverse problem, ensuring a close fit to the head contour. Combining theoretical optimization with physical measurements of the coil's AC resistance, we identified the optimal loop count for both axial and radial coils as nine and eight loops, respectively. The effectiveness of the designed dual-channel coil was verified through the imaging of a CuSO4 phantom and a healthy volunteer's brain. Notably, the in-vivo images exhibited an approximate 16-25 % increase in SNR with poorer B1 homogeneity compared to those obtained using single-channel coils. The high-quality images achieved by T1, T2-weighted, and fluid-attenuated inversion-recovery (FLAIR) protocols enhance the diagnostic potential of VLF MRI, particularly in cases of cerebral stroke and trauma patients. This study underscores the adaptability of the design methodology for the customization of RF coil structures in alignment with individual imaging requirements.

Motorcycle-related crashes before and during the COVID-19 pandemic: A comparative retrospective observational study from the Middle East

BACKGROUND

During the COVID-19 pandemic, there was a boom in the delivery sector, with a significant increase in the demand and number of motorcycle delivery drivers in Qatar, which made them vulnerable to injury. We aimed to evaluate the incidence, pattern, and outcome of patients injured by motorcycle-related crashes (MCC) before and during the pandemic.

METHODS

A retrospective observational study included all adult patients admitted with motorcycle-related injuries before the pandemic (March 2018 to February 2020) and during the pandemic (March 2020 to March 2022). Comparative analyses were performed based on (work versus non-work related MCCs) and (pre- versus during the pandemic injuries).

RESULTS

510 patients with MCC were identified, of which 172 (33.7 %) were admitted in the pre-pandemic and 338 (66.3 %) during the pandemic. The mean age of patients was 29.2±7.8 years; 56 % were aged 20-29 years, and 99.4 % were males. Work-related MCCs were more frequent among the younger age group (60.9 % vs. 52.1 %; p=0.001) during the early evening, i.e., 6:00 to 9:00 p.m. (21.9 % vs. 13.9 %; p=0.004). However, non-work related MCC occurred more frequently between midnight and 3:00 am (20.2 % vs. 10.9 %; p=0.004), and such patients were more likely non-compliant for protective devices use (19.3 % vs. 6.1 %; p=0.001) and ride under the influence of alcohol (13.2 % vs. 7.4 %; p=0.03). During the pandemic, the proportion of alcohol consumers (13 % vs. 5.8 %; p=0.01) and work-related MCC (50.9 % vs. 22.7 %; p=0.001) increased significantly compared to the pre-pandemic period.

CONCLUSION

The overall burden of MCC increased during the pandemic, and the frequency of MCC involving commercial drivers surged significantly during the pandemic period as opposed to the non-work MCC, which predominated in the pre-pandemic period. Work-related MCCs were more frequent among younger age groups, mainly involving South Asians with frequent accidents in the evening time. However, recreation-related MCCs occurred more frequently at midnight, and victims were non-compliant with the protective gear. Furthermore, there is a need for prospective studies to examine the broader scope of risk factors that are associated with the work-related MCC, especially involving food deliveries, and for focused safety programs for motorcycle delivery drivers and recreational motorcyclists.

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.

Biomechanical Response of Head Surrogate With and Without the Helmet

Measurements of brain deformations under injurious loading scenarios are actively sought. In this work, we report experimentally measured head kinematics and corresponding dynamic, two-dimensional brain simulant deformations in head surrogates under a blunt impact, with and without a helmet. Head surrogates used in this work consisted of skin, skull, dura, falx, tentorium, and brain stimulants. The head surrogate geometry was based on the global human body models consortium's head model. A base head surrogate consisting of skin-skull-brain was considered. In addition, the response of two other head surrogates, skin-skull-dura-brain, and skin-skull-dura-brain-falx-tentorium, was investigated. Head surrogate response was studied for sagittal and coronal plane rotations for impactor velocities of 1 and 3 m/s. Response of head surrogates was compared against strain measurements in PMHS. The strain pattern in the brain simulant was heterogenous, and peak strains were established within ∼30 ms. The choice of head surrogate affect the spatiotemporal evolution of strain. For no helmet case, peak MPS of ∼50-60% and peak MSS of ∼35-50% were seen in brain simulant corresponding to peak rotational accelerations of ∼5000-7000 rad/s2. Peak head kinematics and peak MPS have been reduced by up to 75% and 45%, respectively, with the conventional helmet and by up to 90% and 85%, respectively, with the helmet with antirotational pads. Overall, these results provide important, new data on brain simulant strains under a variety of loading scenarios-with and without the helmets.

National Trends and Clinical Outcomes after Scooter Injury in the US: 2016 to 2020

BACKGROUND

In recent years, the adoption of electric scooters has been accompanied by a surge of scooter-related injuries in the US, raising concerns for their severity and associated healthcare costs. This study aimed to assess temporal trends and outcomes of scooter-related hospital admissions compared with bicycle-related hospitalizations.

STUDY DESIGN

This was a retrospective cohort study using the 2016 to 2020 National Inpatient Sample for patients younger than 65 years who were hospitalized after bicycle- and scooter-related injuries. The Trauma Mortality Prediction Model was used to quantify injury severity. The primary outcomes of interest were temporal trends of micromobility injuries. In-hospital mortality, rates of long bone fracture, traumatic brain injury, paralysis, length of stay, hospitalization costs, and nonhome discharge were secondarily assessed.

RESULTS

Among 92,815 patients included in the study, 6,125 (6.6%) had scooter-related injuries. Compared with patients with bicycle-related injuries, patients with scooter-related injuries were more commonly younger than 18 years (26.7% vs 16.4%, p < 0.001) and frequently underwent major operations (55.8% vs 48.1%, p < 0.001). After risk adjustment, scooter-related injuries were associated with greater risks of long bone fracture (adjusted odds ratio 1.40, 95% CI 1.15 to 1.70) and paralysis (adjusted odds ratio 2.06, 95% CI 1.16 to 3.69) compared with bicycle-related injuries. Additionally, patients with bicycle- or scooter-related injuries had comparable index hospitalization durations of stay and costs.

CONCLUSIONS

The prevalence and severity of scooter-related injuries have significantly increased in the US, thereby attributing to a substantial cost burden on the healthcare system. Multidisciplinary efforts to inform safety policies and enact targeted interventions are warranted to reduce scooter-related injuries.

Capturing Head Impacts in Boxing: A Video-Based Comparison of Three Wearable Sensors

Wearable sensors are used to quantify head impacts in athletes, but recent work has shown that the number of events recorded may not be accurate. This study aimed to compare the number of head acceleration events recorded by three wearable sensors during boxing and assess how impact type and location affect the triggering of acceleration events. Seven boxers were equipped with an instrumented mouthguard, a skin patch, and a headgear patch. Contacts to participants' heads were identified via three video cameras over 115 sparring rounds. The resulting 5168 video-identified events were used as reference to quantify the sensitivity, specificity, and positive predictive value (PPV) of the sensors. The mouthguard, skin patch, and headgear patch recorded 695, 1579, and 1690 events, respectively, yielding sensitivities of 35%, 86%, and 78%, respectively, and specificities of 90%, 76%, and 75%, respectively. The mouthguard, skin patch, and headgear patch yielded 693, 1571, and 1681 true-positive events, respectively, leading to PPVs for head impacts over 96%. All three sensors were more likely to be triggered by punches landing near the sensor and cleanly on the head, although the mouthguard's sensitivity to impact location varied less than the patches. While the use of head impact sensors for assessing injury risks remains uncertain, this study provides valuable insights into the capabilities and limitations of these sensors in capturing video-verified head impact events.

The Impact of the City of Miami's Decision to Revoke Electric Scooter Company Permits on Orthopedic Trauma at a Level I Trauma Center

BACKGROUND

Since the introduction of electric-scooter (e-scooter) mobile applications, there has been a marked increase in e-scooter-related injury. On January 19, 2022, the City of Miami revoked permits to five major mobile applications for violation of safety protocols.

OBJECTIVES

The purpose of our study was to assess the effects of this notice on the orthopedic patients seen at our corresponding Level I trauma center.

METHODS

Institutional Review Board approval was obtained for this study. A retrospective chart review was performed including all patients with orthopedic injuries at our Level I trauma center between July 19, 2021 and July 19, 2022. These dates include 6 months prior to and after the major e-scooter operators ceased use in Miami. SPSS statistical software version 28.0.0 (SPSS, IBM, Armonk, NY) was utilized for all statistical analysis.

RESULTS

There were 2558 patients in the prenotice cohort, and 2492 patients in the postnotice cohort. After the notice, there was a significant decrease in the number of patients that presented to our institution due to injuries caused by e-scooters (2.8% vs. 1.8% patients; p = 0.021). Patients with injuries caused by e-scooters had a significantly lower age (38 vs. 42, respectively; p = 0.034) and were more likely to be male (79.3% vs. 67.4% male, respectively; p = 0.007) than patients with other orthopedic injuries.

CONCLUSION

This study demonstrates that the 2022 notice revoking the major mobile application operators from the City of Miami resulted in a significant decrease in the number of orthopedic cases due to e-scooter-related injury at the corresponding Level I trauma center.

Cervical Spine Motion Requirements From Night Vision Goggles May Play a Greater Role in Chronic Neck Pain than Helmet Mass Properties

BACKGROUND

Chronic Neck Pain (CNP) among rotary-wing aircrew is thought to stem from night vision goggles (NVG) and counterweight (CW) systems which displace the centre of mass of the head. This investigation aimed to quantify the loads acting on the neck as a function of movement magnitude (MM), helmet conditions, and movement axes in rapid movements.

METHODS

Cervical spine kinematics during rapid head repositioning tasks for flexion-extension (FE) and axial rotation (AR) movements were measured from 15 males and 15 females. Participants moved in either a 35° (Near MM) or 70° arc (Far MM), while donning a helmet, helmet with NVG, helmet with NVG and a typical CW, and a CW Liner (CWL). Measured EMG from three muscles bilaterally and used to drive a biomechanical model to quantify the compression and shear acting at the C5-C6 joint.

RESULTS

In AR, the NVGs were associated with the largest compression magnitudes, 252 (24) N. CW conditions decreased the maximum compression to 249 (53) N. For FE, the compression was 340 N for the Far MM trials and 246 N for Near MMs. Changing the helmet configuration only modestly influenced these magnitudes in FE.

CONCLUSION

Every 30° of MM increased compression by 57 to 105 N. The reduction of the moment of inertia by 16% in the CWL did not reduce reaction forces. Joint loads scaled proportionately with head-supported weight by a factor of 2.05. The magnitudes of loads suggest a cumulative loading pathway for CNP development.

Analysis of increased motorcycle accidents during the COVID-19 pandemic: a single-center study from Türkiye

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic has led to a unique set of circumstances, straining health-care systems and affecting the way of life in societies around the world. Measures such as social isolation, travel restrictions, and workplace closures have led to an increase in motorcycle use. Consequently, motorcycle accidents have become a significant problem during this period. This study presents detailed research conducted to examine motorcycle accidents during the COVID-19 pandemic and to understand the causes and consequences of the increase in these accidents.

METHODS

This research evaluated records from a single health examination and used various models to analyze motorcycle acci-dents within a specified time period. Additionally, retrospective analyses were conducted to examine associations between motorcycle use and crashes in our country before and after the pandemic. The records of 386 patients who were injured in motorcycle accidents and followed up, received treatment, and were recorded at Biruni University Hospital between November 2015 and April 2023 were retrospectively examined. Noted details included the victims' age, gender, injury mechanism, injury site, injury severity, helmet use, presence and location of fractures, time distribution of the accident, and the severity of other important tissue injuries. The relationship between the injury site, fractures, and accident details, and the "Injury Severity Score" (ISS) was also investigated.

RESULTS

Among the 386 injured victims in motorcycle accidents, 333 were male and 53 were female. Of these, 168 (43.5%) were motorcycle drivers, 137 (35.5%) were motorcycle couriers, and 81 (21%) were pedestrians. A total of 186 (48%) injuries occurred before the pandemic (November 2015-March 2020), while 200 (52%) were sustained during the pandemic. The study indicates a noticeable increase in motorcycle injuries, particularly among motor couriers, especially during the pandemic quarantine periods. Post hoc analysis revealed that motor couriers had significantly lower ISS compared to other professions (p=0.009 and p=0.045, respectively). Motorcyclists who wore helmets were found to have significantly lower ISS than those who did not wear helmets (p<0.05). Furthermore, it was found that the ISS was positively correlated with the number of bone fractures, total soft tissue injury, and significant clinical characteristics (r=0.758, r=0.756, and p<0.001, respectively).

CONCLUSION

This clinical study's findings demonstrate that the measures implemented during the pandemic to limit society's mobility have led to an increase in motorcycle accidents. Notably, there has been a significant rise in the number of accidents, particularly involving individual motorcycle use and motorcycle courier services.

Mechanical characterization of athletic helmet shells

Our purpose was to compare the mechanical properties of the protective outer shells of various athletic helmets in their final, fully manufactured form. Sections were taken from 3 different helmet shells (Bauer RE-AKT hockey helmet, Cascade R lacrosse helmet, and Riddell Speedflex football helmet) at 4 different locations (front, side, top, and rear) for a total of 12 test specimens. The 4 specimens from each helmet shell were potted together in epoxy resin moulds and mechanically polished. The hardness, elastic modulus and phase angle were measured using dynamic nanoindentation performed at 100 Hz with an oscillation amplitude of 1 nm (rms). Repeated ANOVA analysis was used to compare each of the dependent variables for each of the 3 helmets across the 4 different locations. The interaction between helmet type and location was significant for hardness (F6,63 = 2.84, P = 0.032, Pη2 = 0.21), elastic modulus (F6,63 = 6.412, P < 0.001, Pη2 = 0.38), and phase angle (F6,63 = 7.65, P < 0.001, Pη2 = 0.42). Polycarbonate has a higher ability to dissipate mechanical energy making it the recommended superior choice for helmet shells. In addition, the results lead us to speculate that manufacturing causes changes in the molecular weight or the distribution of fillers across locations for polyethylene but not for polycarbonate since mechanical properties are fairly uniform over the surface of football helmets, at least within a given helmet.

Analysis of dental traumatic patterns in standing electric scooter-related accidents

BACKGROUND

There have been several studies about the increasing accident risks and injuries of standing electric scooters, but there is no study about the dental traumatic injuries related with standing electric scooter so far.

OBJECTIVES

The purpose of this study is to report the overall dental traumatic patterns, and compare the patterns of standing electric scooter-related dental trauma with other traumatic causes. Also, considerations about minimizing the risks of electric scooter-related trauma will be discussed.

METHODS

Data on patients who visited Region Trauma Center of Wonju Severance Christian Hospital with dental emergency from January 2020 to December 2022 were collected.

RESULTS

The crown-root fracture and avulsion occurred significantly higher in electric scooter-related accidents than others. Furthermore, relatively minor dental injuries including concussion and subluxation showed higher percentage to be occurred as combined injuries in electric scooter-related accidents. The prevalence of traumatized posterior teeth was significantly higher in electric scooter-related trauma than others. Most of patients were teenagers and twenties. Also, the electric scooter-related accidents mostly occurred at evening and night. Furthermore, the number of patients wearing a helmet in electric scooter accidents was 1 out of 33.

CONCLUSION

The standing electric scooter-related dental trauma resulted in an increased prevalence of relatively severe dental trauma. Supplementation and reinforcement of the related policies as well as strict enforcement of the laws on electric scooter users will be needed to prevent severe dental and craniofacial trauma.

Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme

The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.

A retrospective comparative study of maxillofacial injury patterns caused by electric scooters and bicycles

BACKGROUND/AIM

The emergence of shared stand-up electric scooters has led to an increase in their usage and, subsequently, an increase in the incidence of maxillofacial trauma. This study aimed to investigate the trauma pattern associated with the use of stand-up electric scooters compared with that related to the use of bicycles, which was a popular mode of personal mobility before the emergence of stand-up electric scooters.

MATERIALS AND METHODS

This study investigated the medical records of patients who visited Wonju Christian Hospital for maxillofacial trauma due to the use of stand-up electric scooter and bicycles between November 1, 2017 and October 31, 2022. Maxillofacial trauma was analyzed based on medical records, including those in the evaluation results of teeth, maxillofacial bones, and soft tissues.

RESULTS

Crown fractures and tooth avulsions were observed more frequently with the use of stand-up electric scooters than with the use of bicycles. In contrast, crown-root fractures, tooth subluxation, and extrusive luxation were more commonly observed in bicycle riders. Additionally, the proportion of root fractures was similar between the two groups. However, no vertical root fractures were observed in patients who rode bicycles. The maxillofacial bone fracture rates between the two groups were similar, although the fracture patterns were different.

CONCLUSION

The number of patients using stand-up electric scooters is increasing, and they are likely to have a worse prognosis compared with those using existing personal mobility devices.

Evaluating child helmet protection and testing standards: A study using PIPER child head models aged 1.5, 3, 6, and 18 years

The anatomy of children's heads is unique and distinct from adults, with smaller and softer skulls and unfused fontanels and sutures. Despite this, most current helmet testing standards for children use the same peak linear acceleration threshold as for adults. It is unclear whether this is reasonable and otherwise what thresholds should be. To answer these questions, helmet-protected head responses for different ages are needed which is however lacking today. In this study, we apply continuously scalable PIPER child head models of 1.5, 3, and 6 years old (YO), and an upgraded 18YO to study child helmet protection under extensive linear and oblique impacts. The results of this study reveal an age-dependence trend in both global kinematics and tissue response, with younger children experiencing higher levels of acceleration and velocity, as well as increased skull stress and brain strain. These findings indicate the need for better protection for younger children, suggesting that youth helmets should have a lower linear kinematic threshold, with a preliminary value of 150g for 1.5-year-old helmets. However, the results also show a different trend in rotational kinematics, indicating that the threshold of rotational velocity for a 1.5YO is similar to that for adults. The results also support the current use of small-sized adult headforms for testing child helmets before new child headforms are available.

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.

The frequency of bicycle helmet use among college students and health beliefs for bicycle helmet attitude

Objective: The aim of this study is to determine the frequency of bicycle helmet use among college students and health beliefs about bicycle helmet attitude. Participants: Turkish university students (n = 799). Methods: This descriptive and cross-sectional study was conducted over the period 2019. A sociodemographic and cycling related questionnaire form and the Bicycle Helmet Attitudes Scale were used in the data collection. Descriptive statistics, t-test, Anova and Kruskal Wallis tests were used in the statistical analysis. Results: Only 10.4% of students wear a bicycle helmet. Students who using bicycle helmets had higher benefit health belief scores compared to those who didn't, while barrier health belief scores were lower. There is a significant relationship between health belief scores for bicycle helmet attitude and gender, obeying traffic rules, thinking about helmet (unnecessary/disturbing/expensive/ridiculous) and helmet use. Conclusion: In this study, the frequency of using bicycle helmets is very low.

Patients' recollections of helmet-CPAP treatment during COVID-19 pandemic: A qualitative study

BACKGROUND

During the pandemic outbreak, helmet continuous positive airway pressure (CPAP) was widely used as respiratory support for COVID-19 patients, inside and outside of intensive care units. The available literature suggests specific interventions to improve the comfort of patients treated with helmet-CPAP. Few reports are available on the experiences of patients undergoing this treatment.

AIM

This qualitative study aimed to explore the views and recollections of COVID-19 patients undergoing helmet-CPAP.

STUDY DESIGN

We conducted semi-structured interviews with thematic analysis. Participants were recruited from the follow-up programme for COVID-19 patients discharged from an Italian general intensive care unit. Participants were interviewed by telephone. Data analysis followed the principles of thematic synthesis approach.

FINDINGS

We conducted 29 phone calls in patients eligible for the study. Five participants declared that they did not remember the time spent in hospital on helmet-CPAP. Twenty-four patients were then included. Two themes and six subthemes were generated from their interview data: (1) The helmet-CPAP as a life-saving treatment (subthemes: recognition of the usefulness of treatment and resilience); (2) the negative feelings related to helmet-CPAP application (subthemes: communication problems, entrapment, mental confusion, fear of dying). Each patient's experience was unique, but some discomfort elements such as noise, gas flow turbulence, choking sensation and thirst were found to be very common.

CONCLUSIONS

The application of helmet-CPAP treatment generated positive and negative memories and feelings in COVID-19 patients during the pandemic. The patients' experience has provided an overview of the main factors of discomfort. This can be a starting point for taking corrective measures to promote greater helmet tolerance and subsequent treatment success.

RELEVANCE TO CLINICAL PRACTICE

This study has provided an insight into the patient's recollections about helmet-CPAP treatment during a worldwide pandemic. The findings suggested strict applications of interventions aimed to reduce some issues that participants reported, to improve their compliance to treatment. Results from this study could help nurses in understanding the needs of patients treated with helmet-CPAP and may foster a care focused on patient-centred outcomes.

The effects of head mounted weight on comfort for helmets and headsets, with a definition of "comfortable wear time"

BACKGROUND

There are difficult tradeoffs when designing head-mounted equipment such as helmets, lights, cameras, or virtual or augmented reality displays. Increased functionality and battery life adds weight, which in turn reduces comfort. A successful product must balance both comfort and functionality to achieve its product engagement goals.

OBJECTIVE

This study defines "comfortable wear time" as a new metric, and applies it to the domain of headsets in determining the relationship between headset weight and comfort.

METHODS

Sixteen study participants wore four otherwise identical headsets weighted between 500g-600 g for up to two hours each in an office environment. If participants experienced more than "mild discomfort" (>3 on an NRS-11 discomfort scale), the trial ended early, and the comfortable wear time was recorded. Intensity and location of discomfort was rated at trial conclusion, and qualitative feedback collected.

RESULTS

Higher weights were associated with shorter comfortable wear times. Not everyone could wear even the lightest headset (500 g) for the full two hours. Qualitatively, discomfort took many forms beyond the expected neck fatigue or contact pressure and included symptoms commonly associated with motion sickness, such as headache and dizziness. Finally, there were pronounced gender differences with females experiencing more severe discomfort with earlier onset.

CONCLUSION

Heavier headsets were less comfortable for the lower quartile of participants -yielding an average of 11 fewer minutes of comfortable wear time per 33 g of weight added. Understanding the discomfort costs from adding weight empowers product teams to find the correct balance to meet their product engagement targets.

Is Postoperative Helmet Molding Therapy Necessary for Craniectomy for Sagittal Suture Synostosis?

Endoscopic strip craniectomy followed by postoperative remodeling helmet therapy for scaphocephaly is widely accepted, but the requirement of several helmets might burden patients or their families. This study examined whether craniectomy via a bicoronal approach without molding helmet therapy is worth considering. The authors retrospectively reviewed patients with nonsyndromic sagittal suture synostosis who underwent the modified Renier H technique between 2016 and 2021. We collected data on preoperative and postoperative cephalic index (CI), operative time, estimated blood loss, and blood transfusion rates. The authors also examined all related literature in English describing endoscopic craniectomy with postoperative helmet molding therapy for sagittal suture craniosynostosis. Among 17 patients, the average operative time was 92.2±15.6 minutes, the mean estimated blood loss was 35.8±22.4 mL, and a blood transfusion was needed for 9 patients (52.9%). The mean preoperative and postoperative CIs were 69.1±2.6 and 78.4±2.2, respectively. A comparison of the literature review with the authors' results showed that their procedures required a slightly longer operative time and a higher frequency of blood transfusions. There are no significant differences in blood loss or preoperative and postoperative CIs reported in the literature. The open procedure required a higher operative time than endoscopic suturectomy. However, dealing with bleeding is more challenging with endoscopic suturectomy. The cost of the helmets and the duration patients have to wear them, which might be burdensome for the patients or their families when determining the optimal minimally invasive treatment, should also be considered.

Unpowered scooter injuries in children and risk factors for traumatic brain injuries: An 8-year cross-sectional study using a national registry in South Korea

INTRODUCTION

Head trauma accounts for a large proportion of unpowered scooter injuries in children. Traumatic brain injury (TBI) is the leading cause of considerable mortality and morbidity in children, who are the main users of unpowered scooters. The aim of this study was to explore the characteristics of unpowered scooter injuries in children and to identify predictors of the occurrence of TBI.

METHODS

A multicentre observational retrospective study was conducted using the Emergency Department-based Injury In-depth Surveillance (EDIIS) database in South Korea. Children aged 2 to 18 years old with unpowered scooter injuries between 2011 and 2018 were eligible for inclusion in this study, and the primary outcome was TBI defined based on the International Classification of Diseases, 10th Revision (ICD-10) code.

RESULTS

The annual rate of unpowered scooter injuries per 1,000 injured patients increased throughout the study period from 1.4 in 2011 to 16.4 in 2018 (P for trend < 0.001). Of the 3,892 children who had unpowered scooter injuries, 353 (9.2 %) had TBI. Children were at a higher risk of unpowered scooter TBI if they were aged between 2 and 5 years (adjusted odds ratio [aOR]: 1.37; 95 % confidence interval (CI): 1.09-1.73), were male (aOR: 1.45; 95 % CI: 1.14-1.86), were injured either on sidewalks (aOR: 1.80; 95 % CI: 1.20-2.70) or on driveways (aOR: 2.31; 95 % CI: 1.41-3.79), and experienced a fall (aOR: 1.98; 95 % CI: 1.15-3.43). Additionally, children injured after a blunt force were at a lower risk of TBI (aOR: 0.28; 95 % CI: 0.15-0.53).

CONCLUSION

Unpowered scooter injuries in children are increasing in South Korea. It is essential for younger children riding unpowered scooters to wear helmets and for caregivers to actively supervise their children to prevent TBI.

Pediatric Fractures Associated With Riding Bicycles: A National 20-year Analysis

BACKGROUND

Biking is a popular childhood activity with an intrinsic risk of injury. While advocacy groups have promoted protective equipment to help mitigate these risks, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth.

METHODS

The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged 18 years or below with fractures presenting to US emergency departments associated with riding bicycles. The patient narratives were analyzed to exclude patients not actively riding bicycles and to note helmet use and collisions with motor vehicles (MVs).

RESULTS

A total of 33,955 fractures were identified in the database, representing an estimated 1,007,714 fractures from 2001 to 2020, or 50,331 fractures annually. Linear regression noted a significant decrease in fractures over the period ( R2 =0.899; P <0.001). Most fractures occurred in patients who were male (71.8%, 95% CI: 70.4% to 73.2%), White (53.1%, 46.0% to 60.0%), and aged 10 to 12 (30.6%, 29.6% to 31.7%) or 13 to 15 years (24.8%, 23.4% to 26.2%). Fractures occurred most frequently in the forearm (25.2%, 22.8% to 27.8%), wrist (21.2%, 19.5% to 22.9%), and shoulder (10.5%, 9.7% to 11.3%). Patients who sustained fractures after being struck by a MV were >6 times more likely to be admitted to the hospital (36.0%, 28.6% to 44.2%) compared with patients not struck by a MV (5.4%, 4.3% to 6.8%). When helmet use was recorded in patients with skull fractures, most patients were not wearing helmets at the time of injury (85.7%, 74.6% to 92.5%).

CONCLUSIONS

Although the national burden of fractures associated with riding bicycles in pediatric populations has steadily decreased, it remains a significant cause of injury for children. Fractures involving MV more often require hospitalization, and an alarming number of skull fractures are noted in children not wearing helmets. These data support continued efforts to promote consistent helmet use and safer riding environments around MV in all children, but especially among 10- to 15-year-old males.

LEVEL OF EVIDENCE

Level III-prognostic.

Feasibility of Customized Thermoplastic Patient-Specific Helmet Bolus for Scalp Irradiation Using Volumetric-Modulated Arc Therapy Planning

Introduction: In this study, we sought to develop a thermoplastic patient-specific helmet bolus that could deliver a uniform therapeutic dose to the target and minimize the dose to the normal brain during whole-scalp treatment with a humanoid head phantom. Methods: The bolus material was a commercial thermoplastic used for patient immobilization, and the holes in the netting were filled with melted paraffin. We compared volumetric-modulated arc therapy treatment plans with and without the bolus for quantitative dose distribution analysis. We analyzed the dose distribution in the region of interest to compare dose differences between target and normal organs. For quantitative analysis of treatment dose, OSLD chips were attached at the vertex (VX), posterior occipital (PO), right (RT), and left temporal (LT) locations. Results: The average dose in the clinical target volume was 6553.8 cGy (99.3%) with bolus and 5874 cGy (89%) without bolus, differing by more than 10% from the prescribed dose (6600 cGy) to the scalp target. For the normal brain, it was 3747.8 cGy (56.8%) with bolus and 5484.6 cGy (83.1%) without bolus. These results show that while the dose to the treatment target decreased, the average dose to the normal brain, which is mostly inside the treatment target, increased by more than 25%. With the bolus, the OSLD measured dose was 102.5 ± 1.2% for VX and 101.5 ± 1.9%, 95.9 ± 1.9%, and 81.8 ± 2.1% for PO, RT, and LT, respectively. In addition, the average dose in the treatment plan was 102%, 101%, 93.6%, and 80.7% for VX, PO, RT, and LT. When no bolus was administered, 59.6 ± 2.4%, 112.6 ± 1.8%, 47.1 ± 1.6%, and 53.1 ± 2.3% were assessed as OSLD doses for VX, PO, RT, and LT, respectively. Conclusion: This study proposed a method to fabricate patient-specific boluses that are highly reproducible, accessible, and easy to fabricate for radiotherapy to the entire scalp and can effectively spare normal tissue while delivering sufficient surface dose.

The effect of a helmet type, home-use low-level light therapy device for chemotherapy-induced alopecia: study protocol for a randomized controlled trial

BACKGROUND

Alopecia is one of the most common adverse effects of chemotherapy. It reduces the patient's self-esteem and quality of life and the effect of therapy. Scalp cooling is the only verified current method for prevention but success is not guaranteed, particularly after receiving anthracycline-based combinations. Low-level light therapy has been clinically proven to inhibit the progress of androgenic alopecia. A previous study using human subjects shows limited benefits for low-level light therapy for patients who suffer chemotherapy-induced alopecia but an increase in the number of probes and the optimization of light sources may improve the efficacy. This study determines the efficacy of low-level light therapy for the prevention of chemotherapy-induced hair loss for patients with breast cancer using a randomized controlled trial.

METHODS

One hundred six eligible breast cancer patients were randomly distributed into a low-level light therapy group and a control group, after receiving chemotherapy. Subjects in the low-level light therapy group received 12 courses of intervention within 4 weeks. Subjects in the control group received no intervention but were closely monitored. The primary outcome is measured as the difference in the hair count in a target area between the baseline and at the end of week 4, as measured using a phototrichogram (Sentra scalp analyzer). The secondary outcomes include the change in hair count at the end of week 1, week 2, and week 3 and hair width at the end of week 1, week 2, week 3, and week 4, as measured using a phototrichogram, and the change in distress, the quality of life, and self-esteem due to chemotherapy-induced alopecia, at the end of week 4, as measured using a questionnaire.

DISCUSSION

This study improves cancer patients' quality of life and provides clinical evidence.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov- NCT05397457 on 1 June 2022.

Detection of safety helmet and mask wearing using improved YOLOv5s

With the advancement of society, ensuring the safety of personnel involved in municipal construction projects, particularly in the context of pandemic control measures, has become a matter of utmost importance. This paper introduces a security measure for municipal engineering, combining deep learning with object detection technology. It proposes a lightweight artificial intelligence (AI) detection method capable of simultaneously identifying individuals wearing masks and safety helmets. The method primarily incorporates the ShuffleNetv2 feature extraction mechanism within the framework of the YOLOv5s network to reduce computational overhead. Additionally, it employs the ECA attention mechanism and optimized loss functions to generate feature maps with more comprehensive information, thereby enhancing the precision of target detection. Experimental results indicate that this algorithm improves the mean average precision (mAP) value by 4.3%. Furthermore, it reduces parameter and computational loads by 54.8% and 53.8%, respectively, effectively striking a balance between lightweight operation and precision. This study serves as a valuable reference for research pertaining to lightweight target detection in the realm of municipal construction safety measures.

Computer vision-based helmet use registration for e-scooter riders - The impact of the mandatory helmet law in Copenhagen

PROBLEM

E-scooters are a new form of mobility used more frequently in urban environments worldwide. As there is evidence of an increased risk of head injuries, helmets are recommended and (less frequently) legislated. Denmark has enacted mandatory e-scooter helmet use legislation from January 1, 2022. So far, it is unclear how this newly implemented law influenced helmet use of e-scooter riders in Denmark immediately after its implementation.

METHOD

In this observational study, we register and compare e-scooter helmet use before the mandatory helmet use legislation (December 2021) and after (February 2022). As observational survey data collection in the field can be highly time-consuming, we conducted a video-based observation survey. We trained and applied a computer vision algorithm to automatically register e-scooter helmet use in the video data.

RESULTS

The trained algorithm produces accurate helmet use data, which does not differ significantly from human-registered helmet use. In applying the algorithm to video data collected in December 2021 and February 2022, we register an overall e-scooter helmet use of 4.4% in n = 1054 riders. Splitting the observation between the time before and after the implementation of the helmet use law reveals a significant increase in helmet use from 1.80% to 5.56%.

DISCUSSION

In this study, we successfully train and apply an object detection algorithm to register accurate helmet use data in videos collected in Copenhagen, Denmark. Using this algorithm, we find a significant impact of a new mandatory e-scooter helmet use law on e-scooter riders' helmet use behavior. Limitations of the study as well as future research needs, are discussed.

PRACTICAL APPLICATIONS

Computer vision algorithms can be used for accurate e-scooter helmet assessments. Implementing a mandatory helmet use law can increase helmet use of e-scooters at specific observation sites.

The forgotten protection factor: A nationwide score-based assessment of motorcycle eye protection legislation

INTRODUCTION

Motorcycle accidents cause millions of deaths and injuries globally. It is estimated that billions of dollars would be saved in the United States alone if safety equipment, such as helmets and eye protection, was ubiquitously worn. Legislation concerning eye protection specifically is understudied and poorly characterized.

METHOD

We reviewed all motorcycle-related safety equipment laws in all 50 states of the United States for information regarding eye protection. We graded the rigor of each statute using our six-category Eye Safety Metric and performed a comparative analysis of statutes across all jurisdictions.

RESULTS

Fourteen states did not have any statutes regarding eye protection. Among states that did, 23 states had weak statutes (0-2 points), 20 states had moderately stringent statutes (3-4 points), and 7 states had strong statutes (5-6 points). States in western United States tended to have less strict eye protection laws. Twenty-six states had eye protection exemptions for windshields, which are a poor form of eye protection. Six states that had universal helmet laws had no laws requiring eye protection.

CONCLUSIONS

We characterized eye protection legislation across the country and found great diversity in the stringency of laws across all jurisdictions. Despite only two states lacking helmet laws, we found that 14 states lacked eye protection laws. These findings from our Eye Safety Metric can be used as a springboard for future research, which can be used to determine the need for and significance of eye safety legislation for motorcyclists and to inform legislative decision-making.

PRACTICAL APPLICATIONS

With this research, we hope to further the understanding of legislation regarding eye protection for motorcyclists and help policymakers identify states that need improved eye safety standards.

Electric scooter-associated orthopedic injuries cause long absence from work, regret and are emerging as a major cause of hip fractures in young individuals: a comprehensive study from a regional trauma center in a densely populated urban setting

PURPOSE

This study aimed to give a full spectrum of orthopedic injuries associated with electric scooter (e-scooter) use and analyze related factors, report on follow-up data from the patient's perspective and make a comparative etiological analysis of young adult hip fractures.

METHODS

A total of 851 consecutive patients were admitted to the Emergency Department following e-scooter injuries between January 2021 and July 2022, of whom 188 had 214 orthopedic injuries. The demographics, injury, and incident characteristics of these patients were collected. All fractures were classified as per the AO/OTA classification. Two groups were created as operatively or conservatively treated patients and data were comparatively analyzed. Follow-up examination incorporated a survey using binary questions on patients' perspectives. An etiological comparative analysis of hip fractures in young adults admitted to the same center between 2016 and 2022 was conducted.

RESULTS

The median patient age was 25. Inexperienced drivers constituted 32% of the injured. The protective gear use rate was at 3%. Higher speed (p = 0.014) and age (p = 0.011) were significantly associated with operative treatment. A total of 39% of the operated patients could not return to preinjury physical function, while 74% regretted using an e-scooter. The most common etiological factor for traumatic young hip fractures was fall from a height between 2016 and 2020, whereas it became e-scooter accidents in 2021-2022.

CONCLUSION

The rate of e-scooter-related operative treatment is high and leaves the patient in regret (84%) and a physically limited condition (39%). A speed limit of ≤ 15 km/h could decrease the rate of operative injuries. The e-scooter was identified as the top etiological factor in the last 2 years for traumatic young hip fractures.

LEVEL OF EVIDENCE

II, Diagnostic cohort study.

Injury Pattern and Outcomes Following All-Terrain Vehicle Accidents in Kentucky Children: A Retrospective Study

PURPOSE

All-terrain vehicles (ATVs) pose a significant risk for morbidity and mortality amongst children. We hypothesize that current vague legislation regarding helmet use impacts injury patterns and outcomes in pediatric ATV accidents.

METHODS

The institutional trauma registry was queried for pediatric patients involved in ATV accidents from 2006 to 2019. Patient demographics and helmet wearing status were identified in addition to patient outcomes, such as injury pattern, injury severity score, mortality, length of stay, and discharge disposition. These elements were analyzed for statistical significance.

RESULTS

720 patients presented during the study period, which were predominantly male (71%, n = 511) and less than 16 years old (76%, n = 543). Most patients were not wearing a helmet (82%, n = 589) at time of injury. Notably, there were 7 fatalities. A lack of helmet use is positively associated with head injury (42% vs 23%, P < .01), intracranial hemorrhage (15% vs 7%, P = .03), and associated with lower Glasgow Coma Scale (13.9 vs 14.4, P < .01). Children 16 years and older were least likely to wear a helmet and most likely to incur injuries. Patients over 16 years had longer lengths of stay, higher mortality, and higher need for rehabilitation.

CONCLUSION

Not wearing a helmet is directly correlated with injury severity and concerning rates of head injury. Children 16 years and older are at greatest risk for injury, but younger children are still at risk. Stricter state laws regarding helmet use are necessary to reduce pediatric ATV-related injury burden.

LEVEL OF EVIDENCE

level III retrospective comparative study.

Injury patterns and outcomes in motorcycle passengers

INTRODUCTION

Contemporary trauma literature on injuries to motorcycle passengers is scarce. The aim of this study was to examine the injury patterns and outcomes of motorcycle passengers with regard to helmet use. We hypothesized that helmet utilization affects both injury type and outcomes.

METHODS

The National Trauma Data Bank was queried for all motorcycle passengers who were injured in traffic accidents. Participants were stratified according to helmet utilization into helmeted (HM) and nonhelmeted (NHM) groups. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups.

RESULTS

A total of 22,855 patients were included for analysis, of which 57.1% (13,049) used helmet. The median age was 41 years (IQR 26-51), 81% were female, and 16% of patients required urgent operation. NHM had higher risk of major trauma (ISS > 15: 26.8% vs 31.6%, p < 0.001). The most frequently injured body region in NHM was the head (34.6% vs 56.9%, p < 0.001), whereas in HM patients was the lower extremities (65.3% vs 56.7%, p < 0.001). NHM patients were more likely to require admission to the ICU, mechanical ventilation, and had significantly higher mortality rate (3.0% vs 6.3%, p < 0.001). The strongest predictors of mortality were GCS < 9 on admission, hypotension on admission, and severe head injury. Helmet utilization was associated with decreased odds of death (OR 0.636; 95% CI 0.531-0.762; p < 0.001).

CONCLUSION

Motorcycle collisions can lead to significant injury burden and high mortality in motorcycle passengers. Middle-age females are disproportionally affected. Traumatic brain injury is the leading cause of death. Helmet use is associated with decreased risk of head injury and death.

The Impact of Protective Devices Across the Spectrum of Trauma Care and Across Racial Groupings

INTRODUCTION

Protective devices such as seat belts and helmets save lives. Most studies only address one aspect of the injury profile - compliance or mortality - not the entire spectrum of trauma care, and little attention is paid to racial differences in the use or impact of protective devices.

METHODS

Patients with blunt mechanisms where using protective devices would be expected were included and were divided into utilizing (P) vs not utilizing protection (Non-P). Chart review included demographics, injuries sustained, hemodynamics, and blood alcohol level. Outcomes included need for emergent operation, complications and death.

RESULTS

Non-P patients were more likely male, presented at night and intoxicated. Highest risk behavior (intoxicated Non-P) presented at night (25.7% of nighttime presentations), and rarely during daytime (6.7% daytime presentations). Non-P were more likely hypotensive and sustain a traumatic brain injury. No race related differences were noted among young patients. Among older (>/=50 years) patients, White patients were least likely Non-P and least likely presented at night. Non-P required more emergent operative intervention, ICU admission, and longer hospital stay. Overall, Non-P was associated with increased risk of death (OR = 1.6 (95% CI = 1.28 - 2.11).

CONCLUSION

Given unique age and racial differences, we advocate for culturally and age specific public service campaigns.

Increased bicycle helmet use in the absence of mandatory bicycle helmet legislation: Prevalence and trends from longitudinal observational studies on the use of bicycle helmets among cyclists in Denmark 2004-2022

INTRODUCTION

Using a bicycle helmet reduces the risk of serious head injuries among cyclists substantially. This makes it highly relevant to increase the use of helmets and to measure the prevalence of bicycle helmet use over time and across different groups.

METHOD

Since 2004, the use of bicycle helmets in Denmark has been measured observationally in two nationwide time series: one among cyclists in city traffic across all age groups, and one among cycling school children (aged 6-16) around schools. The observations have been conducted on a regular basis in different parts of the country following the same methodology over the years.

RESULTS

Bicycle helmet use among cyclists in city traffic in Denmark has increased from 6% in 2004 to 50% in 2022. Among cycling school children, helmet use has increased from 33% in 2004 to 79% in 2022. Throughout the years, helmet wearing rates have been highest among young children and lowest among young adults. Since 2015, female cyclists in city traffic have had a slightly higher helmet use than male cyclists.

DISCUSSION

Several factors might have affected bicycle helmet use in Denmark. One possible factor is a nationwide focus on traffic safety education and behavior change campaigns to encourage helmet wearing. Furthermore, among stakeholders on cycling safety there has been consensus on recommending bicycle helmet use and supporting the promotion of helmets while not recommending or promoting helmet legislation. Finally, more safety-oriented behavior in road traffic in general, and self-reinforcing effects of increased helmet use have plausibly been important factors.

PRACTICAL APPLICATIONS

Increasing bicycle helmet use in a country where cycling is popular is possible in the absence of mandatory bicycle helmet legislation. Persistent behavior change campaigning and education, stakeholder consensus, higher levels of road safety-oriented behaviors, and self-reinforcing processes could potentially be important factors.

Comparison of characteristics of kick- and electric-scooter-related dental and maxillofacial injuries: A retrospective study

BACKGROUND/AIM

Owing to the nearly three-year-long COVID-19 pandemic, small personal transportation devices that allow for greater freedom of movement within the cities have gained attention. Therefore, the number of people using kick or electric scooters has increased. This study aimed to compare the characteristics of kick and electric scooter-related dental and maxillofacial trauma and provide helpful information for preventing scooter accidents, appropriate treatment of patients with scooter-related trauma, and policy establishment.

MATERIALS AND METHODS

This retrospective observational study analysed the medical records of 310 patients who visited the emergency room of Ajou University Dental Hospital for kick and electric scooter-related oral and maxillofacial injuries between 1 January 2017 and 31 December 2022. Sex, age, scooter type, time, and mechanism of the accident, helmet use, alcohol consumption, dental and maxillofacial injury types, and treatment were analysed.

RESULTS

The average age in the kick-scooter group (5.71 ± 4.25) was lower than that in the electric-scooter group (28.24 ± 10.02) (p < .0001). There were more males in both groups. The helmet usage rates of the two groups were 2.80% and 7.88%, respectively. In the kick-scooter group, periodontal damage was more common than pulp injury, while in the electric-scooter group, pulp injury was more common than periodontal injury. There was no significant difference in soft-tissue damage between the two groups; however, bone fractures occurred significantly more frequently in the electric-scooter group (p < .0001).

CONCLUSIONS

Electric scooters cause more crown and bone fractures than kick scooters and require more active treatment of dental and maxillofacial injuries. Riders should use protective equipment to prevent dental and maxillofacial injury. Although there are regulations related to scooters, the effectiveness of both kick- and electric-scooter related laws needs to be evaluated.

Single-bicycle crashes in Finland - Characteristics and safety recommendations

PROBLEM

Increasing the role of cycling is necessary to reduce physical inactivity. While promoting cycling, attention should also be given to traffic safety. Hence, a better understanding on the underlying factors and safety recommendations of cyclist crashes is needed. This study aims to increase knowledge on fatal single-bicycle crashes (SBCs), where other road users are not collided with.

METHOD

Data from in-depth investigated fatal cyclist crashes in Finland is analyzed from 2010 to 2019. The study presents descriptive analysis of the characteristics, underlying factors, and safety recommendations of SBCs (n = 82) and other cyclist crashes (n = 151). Logistic regression analysis and chi-squared tests were performed to identify significant characteristics for SBCs.

RESULTS

Fatal SBCs commonly involved people aged 60 or older, males, and cyclist not wearing a helmet. Cyclist's health issues influenced the crash in 62.2% of the SBCs. Compared to other cyclist crashes, health issues, alcohol, males, other crash locations than intersections, and weekends were highlighted in SBCs. Safety recommendations emphasized human factors, such as informing cyclist about underlying factors and the use of safety equipment.

DISCUSSION

In addition to human factors, the safety recommendations included suggestions regarding the bicycle, the traffic environment, and traffic regulations. This highlights the need to focus on different safety improvement actions to reduce SBCs. This study identified key characteristics of SBCs, which may help traffic safety authorities address this road safety issue and ultimately help to promote cyclist safety.

PRACTICAL APPLICATIONS

Cooperation between the actors including health care providers and the police is also proposed to address cyclists' health issues that contribute to SBCs.