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Effectiveness of different types of motorcycle helmets and effects of their improper use on head injuries
Abstract
Differences among three helmet types and the ineffectiveness of improper helmet use in preventing head injuries are speculated about but are seldom explored with evidence. A case-control study was conducted to examine how different helmet types and improper helmet use affected protection against head injuries among motorcyclists in Taiwan.
Case motorcyclists comprised 435 persons who sought emergency care due to head injuries at a medical centre in west-central Taiwan over an 8-month period and 23 motorcyclists who died from head injuries at the scene of the crash; 458 motorcyclists who had non-head injuries were used as the control group, and their crashes occurred within 1 hour earlier or later than the corresponding cases. Information on helmet type was validated by interviewing motorcyclists who were refuelling at petrol stations.
A conditional logistic regression analysis showed that compared with helmeted motorcyclists, non-helmeted motorcyclists were more than four times as likely to have head injuries [odds ratio (OR) 4.54; 95% confidence interval (CI) 1.25-16.5] and ten times as likely to have brain injuries (OR 10.4; 95% CI 1.82-59.2). Compared with motorcyclists wearing full-face helmets, those wearing half-coverage helmets were more than twice as likely to have head injuries (OR 2.57; 95% CI 1.50-4.40) and brain injuries (OR 2.10; 95% CI 1.01-4.38). Compared with motorcyclists with firmly fastened helmets, those with loosely fastened helmets increased their risk of head injury (OR 1.94; 95% CI 1.33-2.82) and were more than twice as likely to have brain injuries (OR 2.50; 95% CI 1.47-4.25).
Of the three helmet types, half-coverage helmets provided motorcyclists the least protection from head injuries. Furthermore, wearing a loosely fastened helmet may compromise any potential protection.
... Head injuries are more severe in those who wear non-standard helmets than in those who wear standardized helmets [10,11]. Evidence shows that using standardized and full-face helmets reduces traumatic brain injuries and impacts during road accidents [12][13][14][15]. Full-face helmets provide face protection and head protection [9]. ...
... Full-face helmets provide face protection and head protection [9]. In addition, the risk of head and brain injury was higher among motorcyclists with loosely-tied helmets than those with tightly-tightened helmets [15]. Therefore, effective helmet use, which entails wearing a standard, full-face, and correctly fastened helmet, is the key to significantly decreasing injuries and fatalities in motorcycle accidents. ...
... Furthermore, wearing a helmet while riding a motorcycle has proven to prevent death and disability from a road accident [3,12,14,15,18]. However, there are still many motorcyclists who do not wear helmets. ...
Information about wearing standardized and fastened helmets has yet to be explicitly conveyed at the national level to workers in Indonesia. This study aims to determine related factors to standardized helmet usage (use of helmets that meet national standards and fastened clasp) among workers in Indonesia in 2018. The analysis used secondary data from the Indonesian Basic Health Research in 2018. The research design was cross-sectional, with the number of samples that met the inclusion criteria being 278,404 workers of productive age (18-64 years) from 34 provinces in Indonesia. The variables used consist of socio-demographic data, socioeconomic status, and knowing how to use helmets for workers in Indonesia. The data analysis used multivariate logistic regression statistical methods to determine the relationship between the type of work and other factors in standardized helmet use. Most respondents are workers in the informal sector (77.0%), whereby 40.6% used standardized helmets. The multivariate logistic regression model showed that the factors associated with standardized helmet use include education, place of residence (urban), occupation, and social status. The higher the level of education and social status of the worker, the higher their awareness of standardized helmet usage when driving. Therefore, it is necessary to increase awareness of standardized helmet usage, especially for workers in the informal sector with low education and socioeconomic status. Standardized helmet usage by workers provides greater protection against head injuries and reduces the severity of injuries among motorcyclists.
... The World Health Organization (WHO) adopted the Haddon matrix model to explore the risk factors of motorcycle injuries in three domains (human, vehicle, and environment) [10]. Previous studies also identified risk factors in three basic categories, namely, sociodemographic factors (e.g, age, male, education, riding experience), crash characteristics (e.g, mechanism of injury, helmet use, alcohol and drug use, riding speed, risk-taking behavior), and environmental or road condition (e.g, poor visibility, time of day, wet or slippery roads) [5,9,11]. Evidence of specific risk factors for head injuries in motorcycle crashes in the Ghanaian context is limited. ...
... This study found males, alcohol use within 24 hours, being a student, and non-use of a helmet as the significant independent risk factors. The difference in sociodemographic characteristics such as gender, religion, education, and occupation between the cases and controls in this study is consistent with some, but not all, of the findings from previous studies [5,9,11]. For instance, these studies found that younger drivers have higher crash risks than older drivers, with research indicating that the youngest group of drivers has the highest risk [5,9]. ...
... The current study showed that the effect of alcohol consumption on the odds of head injury is modified by the type of motorcyclist, but an unexpectedly lower risk of head injury with reported use of alcohol was observed in patients with no head injury. This goes against the large body of evidence documenting an increased risk of road traffic crashes with alcohol consumption [5,9,11]. This discordant finding may be due to the fact that the current study used selfreport to assess alcohol use. ...
Introduction:
the increasing use of motorcycles in northern Ghana is associated with a high incidence of motorcycle crashes and resultant head injuries. This study sought to determine factors associated with head injuries among survivors of motorcycle crashes in northern Ghana.
Methods:
a prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). A total of 326 cases (victims who suffered a head injury with or without other injuries) and 294 controls (persons who suffered various injuries except for head injury) from motorcycle crashes were consecutively sampled at TTH from December 15, 2019, to May 15, 2020. A semi-structured questionnaire was used to interview patients in addition to medical records review. Factors associated with head injury were examined using multivariable logistic regression at p<0.05 and a 95% confidence interval.
Results:
the prevalence of head injury was 53.03% among of 660 survivors of motorcycle crashes. The majority of the patients were young males aged 15-44 years. The rate of helmet use was lower in cases (12.88%) than in controls (57.82%) (p<0.001). Factors associated with head injury were not wearing helmet (AOR= 9.80, 95% CI: 6.22, 15.43), male (AOR=1.75, 95% CI: 1.07, 2.85), student (AOR=0.38, 95% CI: 0.16, 0.91), and alcohol use within 24 hours (AOR=0.17, 95% CI: 0.04, 0.70).
Conclusion:
non-use of helmet and male gender significantly increased the risk of head injury risk in this study. Alcohol use and being a student were associated with lower odds of head injuries. Motorcycle safety efforts in the study area should emphasize helmet promotion.
... Motorcyclists generally use three types of helmets (see Fig. 1): full-face, open-face, and half-face, although their efficiency in preventing injuries varies, and some types may even provide insufficient protection (Yu et al., 2011). In terms of safety, wearing a full-face helmet is preferable (Sivagnam et al., 2021). ...
... In this study, it was clearly demonstrated that respondents wearing full-face helmets were less affected by the various physiological and psychological health effects caused by traffic noise than respondents wearing half-face helmets or no helmet. Yu et al. (2011) reported that, a full-face helmet provides twice the protection against head and brain injuries during an accident (Yu et al., 2011). So, wearing full-face helmet provides protection from the health effects due to traffic noise exposure. ...
... In this study, it was clearly demonstrated that respondents wearing full-face helmets were less affected by the various physiological and psychological health effects caused by traffic noise than respondents wearing half-face helmets or no helmet. Yu et al. (2011) reported that, a full-face helmet provides twice the protection against head and brain injuries during an accident (Yu et al., 2011). So, wearing full-face helmet provides protection from the health effects due to traffic noise exposure. ...
Introduction: Transportation noise is a major source of concern in urban areas. Motorcycle riders,on the other hand, are the most exposed to traffic noise while riding. This study was carried out on 363 respondents (no-helmet: 121 respondents, half-face helmet: 121 respondents, and full-face helmet: 121 respondents) who were exposed to traffic noise while riding their motorcycles on the same noisy route, having the same exposure hours. The purpose of this study was to determine whether wearing a helmet protects against various traffic noise-induced psychophysiological health issues. It also tried to determine whether the riders were more affected than the pillion riders as a result of traffic noise exposure.
Method: The psychophysiological factors of the respondents, such as annoyance, tiredness, depression, headache, and sleeping problem, were obtained using a standard questionnaire in accordance with ISO 15666, Beck et al. (1961), and Eriksen et al. (1999), respectively. The effect of wearing a helmet on traffic noise-induced psychophysiological reactions was investigated using structural equation modelling.
Results: SEM route analysis revealed these significant relationships: (i) helmet use and gender (p- value: 0.017), (ii)) helmet use and marital status (p-value: 0.043), (iii) riders/pillion-riders and annoyance (p-value: < 0.001), (iv) riders/pillion-riders and gender (p-value: < 0.001). It was also observed that motorcyclists suffer from higher traffic noise-related health issues than pillion riders. SEM analysis further revealed that use of helmet can negatively affect the traffic noise induced annoyance, tiredness, depression, headache, and sleeping problem. Paired test data shows that there are significant differences in traffic noise induced annoyance level, tiredness, headache, depression, sleeping problems, and equivalent noise level.
Conclusion: The use of a full-face helmet protects motorcyclists against a variety of traffic noise-related health problems.
Practical implications: This study presents a thorough overview of the benefits of wearing a helmet against traffic noise pollution.
... [12] In a study of 270,525 patients, multiple logistic regression analyses showed that wearing a helmet was an independent factor that protected motorcyclists from death. [9] Motorcyclists who did not wear helmets were four times more likely to have head injuries and had a ten times higher risk of experiencing traumatic brain injuries [13] than those who did. In addition, helmet use significantly decreased the risk of severe head injuries by almost 50%. ...
... [27] However, this study was conducted in 1990, before the implementation of helmet laws. Furthermore, in 2011, Yu et al. [13] determined that motorcyclists wearing half-helmets had twice the risk of sustaining head and traumatic brain injuries than those who wore full-face helmets. [13] However, this study did not assess the actual injury severity. ...
... Furthermore, in 2011, Yu et al. [13] determined that motorcyclists wearing half-helmets had twice the risk of sustaining head and traumatic brain injuries than those who wore full-face helmets. [13] However, this study did not assess the actual injury severity. Instead, crash severity was determined by the expense involved in repairing the damaged motorcycle, the object that the motorcyclist collided with, and the type of collision. ...
Background: The use of helmets has been promoted worldwide to protect motorcyclists from head-and-neck injuries and to reduce motorcycle accident-related mortality. However, the results of previous studies regarding the effectiveness of different types of helmets are controversial. This study aims to investigate the effectiveness of three types of helmets: half-helmets, open-face helmets, and full-face helmets, in protecting motorcyclists during traffic accidents.
Materials and Methods: A total of 6991 motorcyclists, who were hospitalized between January 1, 2015, and December 31, 2019, were enrolled in this study. They were divided into two groups: those who did not wear helmets (n = 506) and those who wore helmets (n = 6,485). The latter group was subdivided according to the type of helmet used: half-helmet (n = 3,027), open-face helmet (n = 2,528), and full-face helmet (n = 930). The primary outcome was inhospital mortality. The length of hospital stay and associated head-and-neck injuries were secondary outcomes.
Results: Half-helmets offered significantly less protection than full-face helmets, considering that patients using half-helmets had a significantly higher rate of the Abbreviated Injury Scale ≥ 2 injuries to the head region and significantly higher odds of sustaining subdural hematoma, subarachnoid hemorrhage (SAH), and intracerebral hematoma than patients using full-face helmets. However, higher odds of sustaining SAH were noted in patients using open-face helmets. There were no significant differences in the Glasgow Coma Scale score after injury or in the mortality rate in patients using either half-helmets or open-face helmets compared to those using full-face helmets.
Conclusion: This study revealed that half-helmets, but not open-face helmets, offered significantly less protection from head injuries than full-face helmets. However, the mortality rate and length of hospital stay after the injury did not differ among patients using the three types of helmets.
... It is well established that head injuries are accounted for 70% of road accident deaths and most associated with non-helmet wearing motorcycle riders (World Health Organization, 2018;Lin and Kraus, 2009). However, helmeted riders involved in road accidents also suffer from severe facial injuries (Saunders et al, 2020;Kim et al, 2018;Ramli et al, 2014), which are related to improper use of helmet and helmet ejection especially in the case that the rider is thrown from the vehicle (Ramli and Oxley, 2016;Thai, McIntosh, and Pang, 2015;Yu et al., 2011). Improper use of helmet is described by loose helmet fixation and/or retention fastening status that highly increases the riders' risk of suffering a traumatic brain injury or even death (Freitas et al, 2018;Jung, Xiao and Yoon, 2013). ...
... Out of these three types, a full-face helmet is considered as the safest one, since it provides coverage to the entire head, including the chin area. However, a great many of riders in urban traffic tend to wear an open-face helmet or a half-face one, since the absence of chin protection and face coverage increasesamong others-the riders' convenience in terms of ease of helmet removal and placement (Ramli and Oxley, 2016;Yu et al, 2011;Tsai, Wang and Huang, 1995). In addition, other authors note that a number of full-face helmeted riders in urban traffic tend to improperly secure the retention system possibly because of feeling the helmet more stable on their head (Freitas et al, 2018). ...
... However, this particular shell form has an adverse effect in terms of ease of use, since it contributes to the complexity of helmet placement/removal as well as to an increased helmet weight which is an important factor of riders' discomfort during riding. In contrast, an open-face helmet does not protect the chin area, but it is still considered almost as safe as a full-face helmet since it protects a very large area of the head (Sung et al, 2016;Yu et al, 2011). Due to the above compromise, this exact shell form makes it easier for the helmet to be placed /removed and also increases the likelihood to be properly fastened than a full-face helmet. ...
This paper presents the re-design approach of an urban motorcycle helmet to prevent users bypassing the strap fastening system. Related studies show that although a full-face helmet provides the maximum protection to a rider, in practice, full-face helmeted riders in urban traffic tend to improperly fasten it. On that notion, the design goal was to conceive a helmet that combines the advantages of different helmet types while responding to urban driving needs. During design ideation possible solutions were examined focusing on different ways of accessing and fixating the helmet on a rider’s head, without using a strap fastening system. Preliminary concept development produced three design concepts, that were evaluated using two sets of prototypes: (a) the 3D printing method under a 1:2 scale was used to detect any design faults, while the 3D modeled concepts were evaluated in four different crash impacts regarding total deformation and von-Mises stress, and (b) 1:1 models of the three concepts were used by experienced riders to assess possible usability issues during helmet placement/removal. Results of the two-phase evaluation of the three concepts and design issues for further development of them are discussed.
... Rice et al. [23] concluded that novelty helmet or nonstandard helmet use was associated with an increased risk of fatal injuries compared with full-face helmet use after adjustment for speed and other risk factors. By using emergency room admission data in Taiwan, Yu et al. [24] determined that halfcoverage helmets provided poor protection from head injuries. By using Taiwan's National Head Trauma Registry data, Lam et al. [25] reported that full-coverage helmets provided the best protection from neck injuries. ...
... To the best of our knowledge, few studies have investigated the effect of the helmet type on motorcyclist injuries in Taiwan, where motorcycle is a primary transportation mode. Some studies [4,5,8,17,24,25] were conducted using regional hospital data, which may not provide a thorough insight into the underlying relationship between helmet types and motorcyclist injuries. In Taiwan, where motorcycles are the most common means of transportation, the number of hospitalised motorcycle-related head injuries decreased by 33% following implementation of a universal helmet law in 1997 [26]. ...
... Studies conducted in Western countries and Taiwan [17,[20][21][22][23][24][25] have reported that full-coverage helmets protect from head injuries. In line with previous results, our results indicated that standard helmets have a highly protective role. ...
Background: Motorcycle full-coverage helmet use may reduce fatalities and head injuries.
Methods: This retrospective cohort study extracted injury data from eight level-I trauma centres in Taiwan and performed a questionnaire survey to investigate injuries sustained by motorcyclists for the period between January 2015 and June 2017.
Results: As many as 725 patients participated in the questionnaire survey and reported their helmet types or phone use during crashes. The results of multivariate logistic models demonstrated that nonstandard helmet (half or open-face helmet) use was associated with an increased risk of head injuries and more severe injuries (injury severity score ≥ 8). Drunk riding and phone use appeared to be two important risk factors for head injuries and increased injury severity. Anaemia was also found to be a determinant of head injuries."
Conclusions: Compared to full-coverage helmets, nonstandard provide less protection against head injuries and increased injury severity among motorcyclists.
... Head injury is more severe among those who wear non-standard helmet than those who wear standard helmet [7]. Evidence indicates that traumatic brain injury and impact during road crash decreases in standard as well as full-face helmet users [3,[8][9][10][11][12]. Full-face helmet provides facial protection in addition to head protection [4]. ...
... Full-face helmet provides facial protection in addition to head protection [4]. Also, risk of head and brain injury is high among motorcyclists with loosely fastened helmets compared to those with firmly fastened helmets [11]. Thus, using standard, full-face, and properly strapped helmet termed as effective helmet use is key to reducing injuries and deaths to greatest extent in motorcycle crash. ...
... Data collectors were trained both in the class room and in the field. Based on the review of published articles and WHO report the helmet usage pattern was defined as follows [4,7,11,22,23]: standard helmet, which is either a full-face or open-face helmet. Non-standard helmet, which refers to helmets that were designed for another purpose (horse riding helmet, construction helmet), half-coverage helmet, which is not open-face or full-face helmet [22,23]. ...
Background:
Helmet use reduces the risk and severity of head injury and death due to road traffic crash among motorcyclists. The protective efficacy of different types of helmets varies. Wearing firmly fastened full-face helmet termed as effective helmet use provides greatest protection. This study estimates the prevalence and factors associated with effective helmet use among motorcyclists in Mysuru, a tier II city in Southern India.
Methods:
Cross-sectional road side observational study of 3499 motorcyclists (2134 motorcycle riders and 1365 pillion riders) at four traffic intersections was done followed by interview of random sample of 129 of the above riders. Effective helmet use proportion and effective helmet use per 100 person-minute of observation was calculated. Multivariate logistic regression analysis was done to identify factors associated with effective helmet use.
Results:
Prevalence of effective helmet use was 28 per 100 riders and 19.5 per 100 person-minute of observation in traffic intersections. Prevalence rates of effective helmet use was higher among riders (34.5% vs pillion riders 18.1%), female riders (51.3% vs male riders 26.8%), and male pillion riders (30.5% vs female pillion riders 13.7%). Riders commuting for work and school and those ever stopped by the police in the past 3 months had significantly higher odds of effective helmet use.
Conclusion:
Despite helmet use being compulsory by law for motorcyclists, the effective helmet use was low in Mysore. Strict enforcement and frequent checks by the police are necessary to increase the effective helmet use.
... Their effectiveness in preventing head injuries may differ. 11 For example, Lam et al 9 found non-standard helmet (such as HCH and ...
... These findings should be placed into the context of other studies. 7 9 11 15 16 In Taiwan, Yu et al 11 found that compared with motorcyclists wearing FFH, those wearing HCH were more than twice as likely to have head injuries, but that there was no difference in risk of head injury between FFH and OFH. Similarly, in Korea, Sung et al 7 showed that patients with both FFH and OFH had a lower head AIS than victims without a helmet and those with HCH. 7 However, other studies have found differences between the protection provided by FFH and OFH. ...
Background
Motorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana.
Methods
A prospective unmatched case–control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury.
Results
After adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35).
Conclusion
Even in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs.
... The multiple types of helmet worn at the time of the trauma have been simplified, reducing the possibilities to two main types: "Full-face" (road or cross type) and "open-face" (modular, jet, or demi-jet) helmets. [7] Since the presence of an incorrectly fastened helmet is known to have a greater negative impact than the type of helmet itself, this condition has been considered as the absence of any helmet, [8][9][10][11] to avoid any influence on the results. ...
... Consequently, contradictory results are reported in literature. [7,8,10,11,[13][14][15][16][17][18][19][20][21][22][23][24] Our study is, therefore, one of the few in which both the impact of different types of helmet and the severity of facial and brain damages are considered using dedicated scores. In this way, we can measure the greater effectiveness of full-face helmets compared to open-face ones in preventing motorcycle-related facial trauma. ...
Introduction:
Motorcycle accidents are one of the most frequent causes of trauma. Safety devices and helmets can influence the severity of injuries. Our retrospective study wants to evaluate the different effectiveness of Open-face and Full-face helmets in the prevention of craniofacial trauma.
Materials and methods:
The sample consists of 440 patients admitted to two Level I Trauma Centres in Northern Italy, between January 2002 and February 2019, because of motorcycle-related craniofacial trauma. For each patient personal data were collected, as well as type and site of fractures, type of helmet, if worn, Comprehensive Facial Injury (CFI) score and Abbreviated Injury Score (AIS-Head) for head injuries. Inferential statistical analysis was then conducted.
Results:
Two hundred and eighty-eight patients wore Open-face helmets (69.7%) and 125 patients wore Full-face ones (30.3%). Mean CFI score (Standard deviation - SD) observed in patients with Open-face helmets was 7.0 (SD: 6.8) and surgery was required in 149 cases (51.7%); while it was 4.9 (SD: 6.0) in patients with Full-face helmets for whom surgery was required in 43 cases (34.4%) (P < 0.0001 and P = 0.002, respectively). Multivariate analysis shows that severity of facial trauma is a significant risk factor for head injury severity with OR 1.90 (95% confidence interval: 1.43 - 2.51) and P < 0.0001.
Discussion:
Full-face helmets are definitely considered to be more protective for facial trauma, which is also a significant risk factor for the severity of head injuries. The type of helmet chosen influences the need of surgical treatment in case of craniofacial trauma.
... [24][25][26][27] Furthermore, although helmet use has been shown to reduce head injury in other settings, such as motorcycle and bicycle crashes, there are limited data on the role of helmets in preventing specific intracranial injuries or the need for emergency neurosurgical interventions for patients injured on ATVs or recreational dirt bikes. [28][29][30] Despite substantial changes in recreational vehicle use and the adoption of legislation regarding ATV use in multiple states, data on ATV crashes and head injuries in the pediatric population have been infrequently updated over the last 2 decades. 25 Head injury represents a particularly high-acuity subset of all pediatric ATV and dirt bike-related injuries, and consistently updated reporting is important to inform public health initiatives. ...
... Regarding helmet fit specifically, we expect that improper fit or size would only contribute to worse outcomes among helmeted patients. 29,30 We also recognize that neurosurgical consultation is an imperfect proxy for injury severity but serves to describe the impact of helmet use on healthcare resource utilization and specifically neurosurgical services. Similarly, we were unable to control for the degree of other (extracranial) injuries. ...
Objective:
All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade.
Methods:
The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables.
Results:
In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140-0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087-0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079-0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI.
Conclusions:
Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.
... 20 There is a substantial difference in the type of craniofacial injury between those victims wearing open-face and full-face helmets. 21 The risk of head and facial trauma associated with open-face helmets was twice that of full-face helmets, as reported by Yu et al 22 and the type of helmet wore reflects on the type of injury. The odds of undergoing an operation for facial fracture in those who wore open-face helmet were increased. ...
... In literature, several studies show that data of riders without helmet and with OFH did not differ much from each other, whereas a significant difference in the type of injury was found between those wearing open-face and full-face helmets. 22,26 CONCLUSIONS This study shows the effects of compulsory helmet law on RTAs in our country in South Italy. Motorcyclist's behavior changed in the last decade with more attention to use crash helmet bringing to a reduction of incidence of maxillofacial fractures. ...
The compulsory use of helmet by motorcyclists has lowered the incidence of facial trauma, but there are few studies evaluating the effects of different helmet types on such injuries. The authors collected retrospective data from the medical records of 287 motorcyclists presenting facial injuries treated at the maxillofacial surgery department of the “University Magna Graecia” of Catanzaro city in South Italy between 1 January 2007 and 1 August 2018. Patients were wearing 2 types of crash helmets at the time of the trauma, full face ones or open-face ones, and were compared using the Facial Injury Severity Scale (FISS). Those wearing open-face helmet were 3 times more than those wearing full-face helmet, with a higher FISS score.
The purpose of this study was to investigate the impact of Italy's compulsory helmet law on the change in helmet use and in particular if protection offered by helmets w4as different according to helmet type. The authors correlated the FISS scores among motorcyclists wearing these 2 tipologies of crash helmet.
... Mesmo com as leis de trânsito que tentam coibir essas atitudes, como por exemplo a Lei nº 11.705 (Lei Seca) promulgada em 2008, o que podemos concluir com esses dados é que há uma falha na fiscalização, e que os condutores negligenciam essas leis corroborando para o aumento dos acidentes. Destaca-se ainda a padronização e regulamentação do uso do capacete como ferramenta eficaz na proteção do segmento cefálico, assim como seu correto ajustamento e afivelamento (YU et al., 2011). Chaves et al. (2015) são muito felizes ao afirmarem que esses dados exigem intervenções que possam inibir estas atitudes de risco. ...
Analisar, através de estudos científicos, a incidência dosacidentes com motocicleta. Revisão integrativa da literatura,cuja busca foi realizada na base de dados da BibliotecaVirtual em Saúde, em outubro de 2016, com descritorescontrolados em saúde, nos idiomas português e espanhol,combinados com operador booleano AND. Foram selecionadosdoze artigos que atenderam aos critérios de inclusão.Ao analisar as pesquisas observamos aumento na incidênciados acidentes envolvendo motociclistas. Os estudosmostraram que as vítimas eram adultos jovens, sexo masculino,movidos pela imprudência e negligenciando as leis.Quanto a distribuição das ocorrências os estudos apontamque o final de semana apresentou a maior incidência deacidentes, divergindo quanto aos horários das ocorrências.Quanto as características dos acidentes evidenciaram queas colisões e as quedas foram os principais responsáveispelas fraturas e escoriações nos membros inferiores, nacabeça, pescoço e face. Os estudos apontam que as despesascom relação as internações foram custeadas pelo seguroDPVAT e pelo SUS. É necessário que se intensifiquem asatividades educativas e de fiscalização buscando diminuiros elevados índices de acidentes com motocicletas, tendo emvista que estes dados evidenciaram o alto risco que estesindivíduos tem de sofrerem lesões graves e de difícil recuperação.
... Amid the COVID-19 pandemic, enforcing the use of full-face helmets for both motorcycle riders and passengers is highly recommended. Properly worn helmets have been proven to signifcantly decrease the risk of fatal injuries, making their mandatory use a vital measure during this period [75,76]. With healthcare systems strained by the surge in COVID-19 cases, reducing preventable injuries from motorcycle crashes is essential to alleviate the burden on medical facilities. ...
Bangladesh has a significant prevalence of motorcycle usage accompanied by a correspondingly high incidence of motorcycle-related fatalities. The COVID-19 crisis has brought additional challenges to road safety in Bangladesh because of containment strategies and restrictions. The impacts of the pandemic on motorcycle-related road traffic crashes, injuries, and fatalities in Bangladesh are investigated in this study using ARIMA time series analysis. Data spanning 86 months (January 2016 to February 2023) were collected from the Accident Research Institute (ARI), which compiles newspaper-based data serving as an alternative source of information on crashes encompassing both pre-COVID (January 2016 to February 2020) and COVID-19 periods (March 2020 to February 2023). Three COVID-19 waves were demonstrated, with the first wave showing a significant decrease in crashes, injuries, and fatalities due to a government-imposed lockdown. During the second wave, crashes and fatalities approached predicted values, while injuries remained lower than anticipated. The third wave witnessed a sudden drop, followed by a sharp rise in all three variables. Box and whisker plot analysis confirmed the disparities between observed and predicted values, with observed data being lower. These results demonstrate the significant impact that COVID-19 containment strategies have had on trends in motorcycle crashes. By understanding these patterns, policymakers and road safety authorities can develop adaptive interventions to mitigate motorcycle-related incidents during pandemics or similar crises. The study provides a data-driven foundation for designing context-specific policies, adjusting law enforcement strategies, and efficiently allocating resources to enhance road safety under varying conditions.
... Actualmente, los motociclistas disponen principalmente de tres tipos de cascos: integral, abierto y de media cobertura, siendo este último el que ofrece una menor protección ante lesiones craneales. Los cascos modernos están diseñados con una carcasa externa rígida, fabricada generalmente en termoplástico o fibra de vidrio, con el objetivo de reducir la energía del impacto inicial [6]. ...
Las lesiones en la cabeza causadas por accidentes de motocicleta son una de las principales causas de mortalidad grave, siendo el traumatismo craneoencefálico, las lesiones cerebrales, la lesión en la médula espinal, las lesiones faciales y en el cuello las más comunes. El casco es un componente esencial para proteger la cabeza durante un accidente. Un casco moderno generalmente cuenta con una carcasa exterior rígida fabricada en termoplástico o fibra de vidrio, diseñada para reducir la energía del impacto inicial. El modelado 3D en CAD permite diseñar la carcasa del casco, generando un discretizado controlado con elementos hexaédricos para 3D y cuadráticos para 2D, para realizar simulaciones numéricas bajo las condiciones de frontera especificadas en la norma PROY-NOM-206-SCFI/SSA2-2016. Cada simulación se ejecuta manteniendo las mismas condiciones de frontera y propiedades mecánicas tanto para el casco de ABS como para el bloque de acero A36, variando únicamente los elementos 2D y 3D en cada pieza (casco y bloque). Las simulaciones, realizadas durante 20 ms, permiten obtener deformaciones unitarias, esfuerzos y energía interna. Los resultados muestran que, al emplear un material rígido, el tiempo de cómputo es similar independientemente del tipo de elementos (2D o 3D). No obstante, al utilizar elementos 2D para materiales deformables, el tiempo de cómputo se reduce en un 88.4% en comparación con los elementos 3D. Las variaciones observadas se reflejan principalmente en la rigidez del material y la energía interna, debido a la mayor cantidad de elementos en el espesor del material cuando se utilizan elementos 3D. Sin embargo, el esfuerzo máximo y la deformación unitaria máxima son iguales, independientemente del tipo de elemento empleado. La interacción entre elementos 2D y 3D no genera variaciones significativas, excepto en el tiempo de iteración, que aumenta en 0.05 ms, debido a que los elementos 2D, al tener menos elementos en el espesor, requieren más tiempo para generar la interacción. Sin embargo, este incremento es insignificante.
... In general, a modern motorcycle helmet comprises a rigid outer shell made of thermoplastic or fiberglass to decrease the initial impact energy caused by the accident (Yu et al., 2011). The main components of the helmet are the foam liner and the shell. ...
Head injuries resulting from motorcycle accidents are a common cause of serious mortality. The most common injuries in motorcycle accidents are: head trauma, brain injuries, spinal cord injuries, facial injuries, neck injuries, and spinal cord injuries. The helmet is a fundamental piece to protect the head during a motorcycle accident. In general, a modern motorcycle helmet is composed of a rigid outer shell made of thermoplastic or fiberglass to decrease the initial impact energy caused by the accident. Using 3D modeling in CAD, the helmet shell is designed, allowing the controlled discretization of the helmet to be generated with hexahedral type elements to be able to carry out the numerical simulation under the boundary conditions established in the PROY-NOM-206-SCFI/SSA2-2016 standard. Each scenario is carried out under the same boundary conditions and maintaining the mechanical properties of the ABS carcass, the only variation parameter is the thickness of the shells (4, 6, 8 and 10 mm). The simulations are carried out for 20 ms, during which the unit and total strains are obtained, efforts and energy. The results show that the unitary deformation is generated in the impact zone of the helmet in all thicknesses, however, the diameter of the unitary deformation decreases as the thickness increases, in addition the shell increases the energy dissipation and decreases the time required to carry out the dissipation. The 8mm shell reduces impact energy by 91.23%, very similar to the 10mm shell, and the maximum deflection does not exceed the thickness of the shell.
... En el caso de los motociclistas, el uso de casco fue elevado, con porcentajes que superan las estimaciones nacionales y de otros municipios de la misma provincia (ANSV, 2019, 2022a), manteniéndose en línea con estudios previos de esa localidad (ICES, 2019). Sin embargo, se observó que el uso correcto del casco fue visiblemente más bajo tanto en conductores como en pasajeros, lo que disminuye su efectividad en caso de siniestro vial (Jung et al., 2013;Yu et al., 2011). ...
Resumen Las conductas de protección vial son clave para reducir las lesiones y muertes en sinies-tros viales. Este estudio analiza la prevalencia del uso de cinturón, casco y sistemas de retención infantil, así como los factores humanos, vehiculares y ambientales asociados. Se llevó a cabo un estudio observacional en 12 puntos distribuidos en distintos barrios de la ciudad de Sunchales, Argentina. Se registró un total de 1077 ocupantes de vehí-culos de cuatro o más ruedas y 1293 ocupantes de motos. El 42,2% de los ocupantes de vehículos usaba cinturón, aunque el uso fue más elevado entre los conductores (52,3%) que entre los pasajeros (25,4%). En menores de 11 años, solo el 8% usaba SRI y el 36% viajaba en el asiento delantero. El uso de cinturón fue más frecuente en conductores particulares y en zonas de la ciudad con mayor índice de calidad de vida. Entre los pasajeros, se observó un mayor uso en adultos mayores de 60 años y en quienes viajaban en el asiento delantero. Por otro lado, el 96% de los conductores y el 74% de los pasajeros de motos usaba casco, aunque el uso correcto fue menor (63,2% y 42,6%, respectivamente). En los conductores, ser mujer, trasladar pasajeros y conducir motos tipo cross y ruta/deportiva se asoció con un mayor uso de casco. También se observó un uso mayor en conductores de motos con patente y en zonas de la ciudad con mayor calidad de vida. Entre los pasajeros, el uso de casco fue más alto en motos que circulaban con patente y en áreas con mayor calidad de vida. Se discuten los resultados, con especial atención a la calidad de vida como factor relevante para comprender las conductas de protección vial en los usuarios. PALABRAS CLAVE: COMPORTAMIENTO OBSERVADO. CASCO. CINTURÓN DE SEGURIDAD. SISTEMAS DE RETENCIÓN INFANTIL. ÍNDICE DE CALIDAD DE VIDA. Este trabajo está bajo una Licencia Creative Commons Atribución 4.0 Internacional
... Helmets also reduce the risk of traumatic brain injury by two-thirds (National Highway Traffic Safety Administration, 2008). Helmets that cover more of the face are generally more effective than those covering only the top of the head (Yu et al., 2011) and helmets that do not meet federal performance standards (specifically, 49 CFR 571.218), also known as "novelty helmets," do not provide effective protection (Rice et al., 2017). While there have been claims that wearing a helmet increases the risk of neck injury, this has been refuted by about a dozen studies (e.g., Crompton et al., 2011;Orsay et al., 1994). ...
If all states had all-rider helmet laws throughout the 1976–2022 study period, 22,058 fewer motorcyclists would have died in crashes. This represents over 10% of all motorcyclist fatalities during these years. Requiring helmets for all motorcyclists is a straightforward rule of the road that has the potential to reduce annual motorcyclist fatalities, which are at record-high levels of over 6,000 per year, by 10%.
... Substantial reductions in brain strain and facial forces were found with the full-face motorcycle helmet and the face airbag, but there were also slight increases in upper neck tensile force with both full-face helmets; Figure 3. Epidemiologic studies found that full-face motorcycle helmets are more protective than open-face and halfcover helmets in reducing facial injuries (Brewer et al., 2013;Cini et al., 2014;Colangeli et al., 2021;Wu et al., 2019), head injuries (Chaichan et al., 2020;Sung et al., 2016;Yu et al., 2011), or both (Lucci et al., 2021;Tabary et al., 2021). The current study provides biomechanical evidence of the benefit of a full-face helmet for reducing the risk of traumatic brain injuries and facial injuries, indicated by reductions in brain strain and facial forces, respectively. ...
Objective:
Two-wheeler riders frequently sustain injuries to the head and face in real-world crashes, including traumatic brain injury, basilar skull fracture, and facial fracture. Different types of helmets exist today, which are recognized as preventing head injuries in general; however, their efficacy and limitations in facial impact protection are underexplored. Biofidelic surrogate test devices and assessment criteria are lacking in current helmet standards. This study addresses these gaps by applying a new, more biofidelic test method to evaluate conventional full-face helmets and a novel airbag-equipped helmet design. Ultimately, this study aims to contribute to better helmet design and testing standards.
Methods:
Facial impact tests at two locations, mid-face and lower face, were conducted with a complete THOR dummy. Forces applied to the face and at the junction of the head and neck were measured. Brain strain was predicted by a finite element head model taking both linear and rotational head kinematics as input. Four helmet types were evaluated: full-face motorcycle and bike helmets, a novel design called a face airbag (an inflatable structure integrated into an open-face motorcycle helmet), and an open-face motorcycle helmet. The unpaired, two-sided student's t-test was performed between the open-face helmet and the others, which featured face-protective designs.
Results:
A substantial reduction in brain strain and facial forces was found with the full-face motorcycle helmet and face airbag. Upper neck tensile forces increased slightly with both full-face motorcycle (14.4%, p >.05) and bike helmets (21.7%, p =.039). The full-face bike helmet reduced the brain strain and facial forces for lower-face impacts, but not for mid-face impacts. The motorcycle helmet reduced mid-face impact forces while slightly increasing forces in the lower face.
Significance of results:
The chin guards of full-face helmets and the face airbag protect by reducing facial load and brain strain for lower face impact; however, the full-face helmets' influence on neck tension and increased risk for basilar skull fracture need further investigation. The motorcycle helmet's visor re-directed mid-face impact forces to the forehead and lower face via the helmet's upper rim and chin guard: a thus-far undescribed protective mechanism. Given the significance of the visor for facial protection, an impact test procedure should be included in helmet standards, and the use of helmet visors promoted. A simplified, yet biofidelic, facial impact test method should be included in future helmet standards to ensure a minimum level of protection performance.
... Integral helmets (full-face), jaw helmets (full-coverage) and open helmets (half coverage) are the most effective types, which offer the best protection. The differences in the efficiency of these types are not precisely defined and require further research [109], [114], [115]. However, there are reports of the superiority of integral helmets over other types [110]. ...
A motorcycle or moped helmet is currently mandatory, and provides basic protection to the user of a motor-powered two-wheeler against the possible consequences of a road accident.
... Literature has highlighted the fact that proper use of a helmet helps to reduce the frequency and severity of craniofacial and brain injuries. [16][17][18] A high influx of domestic and foreign tourists to the coastal state could also possibly contribute to the increased numbers. ...
The incidence of head injury in maxillofacial trauma patients varies widely in the literature. A good understanding of the patterns of association between them would aid in efficient multidisciplinary treatment. The aim of this study was to understand the associations between head injury and facial trauma, by retrospectively analyzing records of patients seen at a tertiary care trauma center. Demographic data of these patients were also described. Records of 4350 facial trauma patients over a 5-year period were reviewed. 3564 (81.9%) patients were victims of motor vehicular accidents (MVA). Male patients predominated, comprising 3711 (85.3%) patients and 36.6% patients were in the third decade of life. Facial fractures were seen in 2120 (48.7%) patients, the most common being zygoma fractures (60%). At the time of trauma, 2383 (57.3%) patients were under alcohol influence and 2821 (87.8%) victims of 2-wheeler MVAs were not using their helmet. 29.75% of all patients sustained traumatic brain injury (TBI). Midface fractures were found to be strongly associated with TBI. Maxillofacial injury may be considered a risk factor for TBI, and as such should immediately be suspected and investigated for all patients. Prompt recognition and management can improve outcomes in these patients.
... Furthermore, wearing a loosely fastened helmet may compromise any potential protection. 18 Liu et al conducted a study on helmets for preventing injury in motorcycle riders. Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. ...
Objectives To assess the awareness and practice of two-wheeler riders regarding the helmet use, and to determine the association of awareness and practices with selected variables.
Setting and Design This article is a descriptive survey, which was completed at All India Institute of Medical Sciences (AIIMS) premises, New Delhi, India.
Materials and Methods The pretested and validated tools developed by researcher consisted of demographic sheet (8 items) along with structured awareness and practice questionnaire.
Results and Conclusions Maximum participants were male (71.06%) with majority riding for 8 years. As much as 48% of the sample population had accidents while driving. Only 2.9% of them reported to have sustained severe injury during these accidents. The mean awareness and practice score related to helmet use were 49.58 ± 6.019.75 ± 5.56. There was weak correlation between awareness and practice. Association of awareness and practices with selected variables could not be observed (p-value—0.4870). Although public awareness is present, but law needs to be more stringent. Accidents are fatal and it can happen anywhere and anytime, irrespective of long or short distance, and wearing of helmet can save a person from major injuries.
... A similar study reported that nonhelmet-wearing riders have a four times higher risk of head injuries in a vehicular accident. [22] Our study showed that there was a steep increase in facial injuries from 2018 (5.2%) to 2019 (17.9%). A 12-year retrospective study in Gujarat found that maxillofacial injuries are the most common in RTAs in developing countries. ...
Background: Road traffic accidents are not a new phenomenon, rather it’s a disturbing occurrence which shows no sign of abating very soon. Rather, it remains one of those public health issues which even the most educated and civilized populations tend to ignore, primarily for the thrill of it. This study aims to identify the outcome associated with vehicular accidents and its association with socio-demographic factors. Method: This is a retrospective, record-based study of victims of road traffic accidents admitted in a tertiary care hospital in Nashik, Maharashtra. The data would include records from the 2018 to 2019. The variables will include the socio-demographic factors, site of injuries and its severity. A descriptive analysis would be done by SPSS software to find out the prevalence of vehicular accidents, association of site of injury with age and severity of the trauma. Ethical approval would be taken before the initiation of the study. Result: A total of 486 victims of RTAs were included from the medical records of the casualty of a tertiary care hospital, out of which 330 were from the year 2018 and 156
from 2019. A look at the sociodemographic profiles of the RTA victims showed that females comprised only 19.3% (2018) and 18.6% (2019) of the total victims in road traffic accidents, while majority, 80.6% (2018) and 81.4% (2019) were males during the same period. Overall, we can also observe that both in 2018 (38.5%) and 2019 (50.6%) most of the road traffic accidents among the victims were of moderate grade.
Conclusion: The need of the hour is to bring about a change from within through self-reflection of lawmakers, strict implementation of traffic rules and guidelines with hefty fines, lockup, and criminal punishment to habitual wrongdoers.
... Modernization, improvement, and maturity of our trauma system in all its components contributed to the improved clinical outcome in the current study [16]. The increased severity of head injuries in our study may indicate low helmet compliance, low-quality helmets, or improperly fastened helmets [7,43,44]. Collisions became less in high-speed streets/highways and increased in low-speed residential areas, which may explain this finding because riders may be less careful in using their helmets in these areas. Developing an injury prevention strategy to address the concerns regarding the quality of the helmets and collisions in the residential areas is important. ...
Background
There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates.
Methods
This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied.
Results
The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test).
Conclusions
The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.
... Modernization, improvement, and maturity of our trauma system in all its components contributed to the improved clinical outcome in the current study [16,26,[31][32][33]. The increased severity of head injuries in our study may indicate low helmet compliance, low quality helmets, or improperly fastened helmets [7,34,35]. Collisions became less in high-speed streets/highways and increased in low-speed residential areas, which may explain this nding because riders may be less careful in using their helmets in these areas. Developing an injury prevention strategy to address the concerns regarding the quality of the helmets and collisions in the residential areas is important. ...
Background: There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates.
Methods: This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle injured patients who were admitted to Al-Ain Hospital for more than 24 hours or died in the Emergency Department or after hospitalization were studied.
Results: The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's Exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in the prehospital care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's Exact test).
Conclusions: The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention and prehospital care.
... In terms of consistency in riding, around 19% of the riders had a gap between riding (Table 1). Helmet fit is found to be an important factor contributing to the injury outcomes of the riders (Romanow, Hagel, Williamson, & Rowe, 2014;Wali et al., 2018bWali et al., , 2019Yu, Chen, Chiu, & Lin, 2011). Only 52.9% of the riders had acceptable helmet fit (Table 1). ...
Introduction:
Little evidence exists in the literature regarding the discrimination power of better anatomical injury measures in differentiating clinical outcomes in motorcycle crashes. Furthermore, multiple injuries to different body parts of the rider are seldom analyzed. This study focuses on comparing anatomical injury measures such as the injury severity score (ISS) and the new injury severity score (NISS) in capturing injuries of multiple injured riders and examining the discriminatory capabilities of the ISS and NISS in predicting clinical outcomes post motorcycle crash.
Methods:
The study harnessed unique and comprehensive injury data on 322 riders from the US DOT Federal Highway Administration's Motorcycle Crash Causation Study (MCCS). Detailed exploratory analysis is performed and discrete/ordered statistical models are estimated for three clinical outcomes: mortality risk, trauma risk, and trauma status.
Results:
Around 9% of the riders died and 45% of the riders had injuries. Around 36% of the riders were hospitalized, disabled, or institutionalized. While a very strong dependence was found between ISS and NISS, ISS underestimated injuries sustained by riders. Statistical models for mortality risk revealed that a unit increase in the ISS and NISS was correlated with a 1.18 and 1.17 times increase in the odds of mortality, respectively. Moreover, a unit increase in ISS and NISS values was correlated with a higher trauma risk by 1.48 and 1.36 times, respectively. Our analysis reveals that the probability of a rider being hospitalized or disabled/institutionalized increases with an increase in the NISS. Conclusions and practical applications: The NISS exhibits significantly better calibration and discriminatory ability in differentiating survivors and non-survivors and in predicting trauma status - underscoring the importance of accounting for microscopic body-part-level injury data in motorcycle crashes. We consider that compared with the KABCO scale, the ISS and NISS are more nuanced scores that can better measure the overall injury intensity and can lead to more targeted countermeasures.
... A similar finding was that wearing either a not fastened or not properly fastened helmet doubled the probability of sustaining head and brain injuries (Yu et al. 2011) and facial injuries (Ramli et al. 2014). The risk increased up to 7-fold for upper face injuries. ...
Objective
Motorcycle helmets are the most common and effective protective device to reduce head injuries and mortality in crashes among powered two-wheeler riders. Even if they are globally recognized as effective, there are still concerns regarding their correct use, which is necessary to achieve maximum head protection. The goal of this systematic review is to assess which characteristics of helmet design and use showed a positive influence on rider safety, in order to provide insights to improve end-user helmet usage.
Methods
A literature search was carried out combining two sets of keywords, one related with either motorcycle or rider and the other referring to either protective equipment or injuries. After the exclusion of duplicates, 977 papers were screened by reviewers, thus identifying 32 papers that were analyzed in group discussions.
Results
Among the papers included in this study, no strong conflicting conclusions emerged in their results. The studies focusing on the use of different types of helmets highlighted that full-face helmets, compared with other standard helmets, have a positive influence on head injuries and facial injuries. Correct fastening was clearly beneficial for head and facial injuries, induced injuries, and helmet ejection.
Conclusions
This systematic review provides important insights to improve the usage of helmets by end-users. Correct fastening is a crucial factor to avoid helmet roll-off during a crash. Most studies agreed that full-face helmets provide higher protection in comparison with other standard helmets, especially for facial injuries, and no negative influence with respect to neck and spinal injuries.
... In this study, 35% nonhelmeted riders were reported head injury and 5% of the helmeted rider reported head injury. In [11] who observed that people who did not wear helmets were four times more likely to sustain a head injury than helmeted and risk of head injuries associated with open-face helmets was twice that of full-face helmets. [12] The current literature on the topic of the effect of helmet on facial injuries is equivocal. ...
Objective:
The objectives of this study are to evaluate the proportion of helmeted and nonhelmeted patients sustaining mandibular fractures.
Materials and methods:
A retrospective study was conducted on 200 patients reporting to oral and maxillofacial surgery (OMFS) unit, trauma center, and department of OMFS. A predesigned questionnaire was used to collect the necessary data. Patients were evaluated for age, gender, mode of transport (2/4 wheeler), presence of safety measure at the time of accident (helmet/seatbelt), maxillofacial injury in two wheeler (with helmet and without helmet), type of impact, and its association to maxillofacial fractures, particularly site of maxillofacial fractures. The association between mode of injury, presence of safety measures, impact type, and site of maxillofacial injuries was assessed using the Chi-square test. P < 0.5 was considered statistically significant.
Results:
The mean age of patients was 30 years, and approximately 92.5% of accidents patients were male. In this study, 35% nonhelmeted riders were reported head injury and 5% of the helmeted rider reported head injury. 54.5% of the patients suffered frontal impact, 28% collision, and 17.5% lateral slide collision. Head injuries are the main cause of death among the riders of all two wheelers. Lateral sliding collision injuries (17.5%) resulted 60.6% of the fractures mandible, 24.2% midface injury, and associated injury (15.15%).
Conclusion:
The use of helmet is strongly recommended to prevent head injuries and facial injuries. In the nonhelmeted riders in motorcycle accidents, the incidence of mandible fractures increases proportionally.
... A study conducted by Afukaar [51] reported that speeding was highly associated with fatal injuries because the high impact force exceeds human tolerance. Other studies have revealed that drivers involved in head-on crashes are more likely to sustain head, cervical, and chest injuries [52][53][54][55], which generally lead to unfavourable trauma outcomes. ...
Background:
Studies have suggested that trauma centre-related risk factors, such as distance to the nearest trauma hospital, are strong predictors of fatal injuries among motorists. Few studies have used a national dataset to study the effect of trauma centre-related risk factors on fatal injuries among motorists and motorcyclists in a country where traffic is dominated by motorcycles. This study investigated the effect of distance from the nearest trauma hospital on fatal injuries from two-vehicle crashes in Taiwan from 2017 to 2019.
Methods:
A crash dataset and hospital location dataset were combined. The crash dataset was extracted from the National Taiwan Traffic Crash Dataset from 1 January 2017 through 31 December 2019. The primary exposure in this study was distance to the nearest trauma hospital. This study performed a multiple logistic regression to calculate the adjusted odds ratios (AORs) for fatal injuries.
Results:
The multivariate logistic regression models indicated that motorcyclists involved in crashes located ≥5 km from the nearest trauma hospital and in Eastern Taiwan were approximately five times more likely to sustain fatal injuries (AOR = 5.26; 95% CI: 3.69-7.49).
Conclusions:
Distance to, level of, and region of the nearest trauma centre are critical risk factors for fatal injuries among motorcyclists but not motorists. To reduce the mortality rate of trauma cases among motorcyclists, interventions should focus on improving access to trauma hospitals.
... Three helmet types, namely full-face, open-face and half-coverage, are commonly used by motorcyclists, but their effectiveness in preventing injuries might vary and some types may provide even inadequate prevention (Yu et al., 2011a). Further, there is no consensus on the effect of different helmet types on the incidence and severity of head, neck, and facial injuries. ...
Background
Protective helmets may reduce the risk of death and head injury in motorcycle collisions. However, there remains a large gap in knowledge regarding the effectiveness of different types of helmets in preventing injuries.
Objective
To explore and evaluate the effectiveness of different types of motorcycle helmets; that is the association between different helmet types and the incidence and severity of head, neck, and facial injuries among motorcyclists. Also, to explore the effect of different helmet types on riders.
Methods
A systematic search of different scientific databases was conducted from 1965 to April 2019. A scoping review was performed on the included articles. Eligible articles were included regarding defined criteria. Study characteristics, helmet types, fixation status, retention system, the prevention of injury or reduction of its severity were extracted.
Results
A total of 137 studies were included. There was very limited evidence for the better protection of full-face helmets from head and facial injury compared to open-face and half-coverage helmets. There was however scarce evidence for the superiority of a certain helmet type over others in terms of protection from neck injury. The retention system and the fixation status of helmets were two important factors affecting the risk of head and brain injury in motorcyclists. Helmets could also affect and limit the riders in terms of vision, hearing, and ventilation. Multiple solutions have been discussed to mitigate these effects.
Conclusion
Full-face helmets may protect head and face in motorcycle riders more than open-face and half-coverage helmets, but there is not enough evidence for better neck protection among these three helmet types. Helmets can affect the rider’s vision, hearing, and ventilation. When designing a helmet, all of these factors should be taken into account.
... Due to the high impact force that exceeds the human body threshold, speeding is highly correlated with fatal injuries [60]. In addition, drivers involved in a head-on crash were more likely to suffer head, chest and neck injuries [61][62][63][64]. ...
Background:
Research suggests that drivers tend to engage in risk-taking behaviours on public holidays. Studies that examined the association between holidays (or other special days) and fatal injuries are inconsistent. This study used UK STATS19 data to investigate the associations of nine public holidays on road crash casualties.
Methods:
This retrospective study assessed UK STATS19 crash data for 1990-2017. All casualties from two vehicle crashes were initially considered; subsequently, casualties with missing data were excluded. Multiple logistic regression was estimated to explore the associations of potential risk factors with the likelihood of killed or seriously injured (KSI) casualties and to calculate adjusted odds ratios (AORs).
Results:
In total, 3,751,998 casualties from traffic accidents in the United Kingdom during 1990-2017 were included in the final data set; among these, 410,299 (10.9%) were KSI casualties, and 3,341,699 (89.1%) were slight injuries. Crashes on public holidays were 16% (AOR = 1.16; 95% confidence interval [CI] = 1.13-1.19) more likely to involve KSI casualties than were crashes on non-holidays. With other factors controlled for, crashes during the Queen's 2002 Golden Jubilee and on New Year's Day were 48% (AOR = 1.48; 95% CI = 1.06-2.07) and 36% (AOR = 1.36; 1.26-1.48) more likely to lead to KSIs, respectively.
Conclusions:
The proportion of crashes resulting in KSI casualties on public holidays was higher than that on non-holidays. Furthermore, crashes during the Queen's 2002 Golden Jubilee had the highest risk of KSI casualties followed by New Year's Day.
... Research indicates that the use of helmets could decrease the likelihood of these deaths. Compared with helmeted motorcyclists, non-helmeted motorcyclists are more than four times as likely to have head injuries and ten times as likely to have brain injuries (Yu, Chen, Chiu & Lin, 2011). Public awareness regarding the importance of helmet uses is highly needed since the death rate of non-helmeted motorcyclists is found higher in this study. ...
Like the other Asian countries, the increase in motorcycle crashes and consequent fatalities in Bangladesh is a growing problem resulting from the massive increase of motorcycles. Of over 2.9 million of registered motor vehicles, motorcycles represent almost 65% in the country. This high percentage is the direct result of cheap and availability of the motorcycle and local road characteristics in the country. Crash and fatality data of this huge percentage of motorcycles showed a significant increase over the last decades. This study focuses on the safety situation of this mode in Bangladesh. The study used police reported crash database preserved at the Accident Research Institute (ARI) of Bangladesh University of Engineering and Technology (BUET). The analyses revealed that the highest number of motorcycle fatalities occurred in rural locations (74%). Among the road classes national highways contributed to the highest (45%) fatality rate. The majority of the victims were 26 to 30 years old (22%). Of those involved in fatal crashes, 88% of the motorcyclists did not wear helmets. The highest number of fatalities by type of collision was head on (49%) followed by rear end (29%) and sideswipe (12%). The study compared crash data of five national dailies to quantify the underreporting of police reported data. This comparison exposed significant underreporting in the country. In addition, structured self-administered questionnaire survey was conducted at five hospitals in Dhaka city in order to identify motorcyclists’ driving behavior along with the predominant injury patterns due to the crashes. The survey results demonstrated that predominant injury patterns were fracture in the right leg (22%) and fracture in the left leg (15%). The survey results also exposed root causes of crashes, daily riding time and operating speed during crashes. Finally, the study recommends few effective strategies and countermeasures in this situation.
... The type of helmet, the patient was wearing at the time of accident also inuences the mortality [19]. The study shows that, full helmet decreases the mortality because of head injury and also protects the facial bones. ...
The injury to the face is second most common in cases with road traffic accidents in patients on two wheelers. This adds to physical, social, emotional, economical burden and also psychological problems to the patient. It is a retrospective case record study of patients who had come to casualty with Road traffic accidents and were riding a two wheeler. 89 patients were selected with facial bone fractures and analyzed. Out of 89 patients 19% patients had single bone fracture and 67% had multiple bone fractures. Most common fractures were maxilla and nasoethmoid fractures. Conclusion- wearing full helmets can decrease the severity of these injuries. Awareness about wearing full helmets should increase.
This research investigated the effect of proper motorcycle helmet buckling on head injury through experimentation. The study used an Instron Dynatup 9250HV monorail impact machine, with a single open-face helmet attached to a Hybrid III dummy and a Shimmer 200 g IMU sensor installed in the dummy's skull. The helmet used in the research was a certified helmet from SIRIM Berhad. It was impacted at the frontal location in two different scenarios. Firstly, as a loosely buckled helmet with the impact occurring on the face shield, and secondly, as a firmly buckled helmet with the impact correctly absorbed by the frontal helmet shell. The protective performance of the helmet was evaluated using peak linear acceleration (PLA), peak rotational acceleration (PRA), head injury criterion (HIC) and brain injury criterion (BrIC). The results showed that the loosely buckled helmet had higher values for PLA, PRA, HIC and BrIC, indicating a higher head and brain injury risk. It is worth noting that the impact on the face shield was at a slightly lower speed than the impact on the helmet shell, but the acceleration profile for the improperly buckled helmet still showed a higher PLA value. The comparison of both scenarios is at the impact speed of 6.0 m/s. This research provides scientific evidence supporting the importance of proper helmet buckling to reduce the risk of injury and potentially save lives.
This research evaluates the protective performance of full-face, open-face, and half-coverage motorcycle helmets by taking the head injury criterion (HIC) and brain injury criterion (BrIC) as performance indicators. A pendulum test rig was developed to produce a 5.58 ± 0.29 m/s impact speed. The researchers gave a head impact with or without a helmet to an anthropomorphic test device (ATD) head and neck called Hybrid III at its frontal, rear, and side areas. The Hybrid III had an installed Shimmer 200 g IMU sensor in its skull. The raw data output was linear and rotational velocities recorded using ConsensysPro software version 1.6.0. The linear velocity data are then processed by MATLAB® 2016b software because its raw data are uncalibrated. Calibrated linear and rotational velocities were then used to calculate HIC and BrIC. The research can determine no definite best helmet type through the crash impact experiment; as a result it shows the inconsistency of HIC score among three different types of helmets at each impact location. Furthermore, the research found that the helmet type did not provide significant protection towards rotational impact. It is worth mentioning that side impact may cause the highest injury severity due to rotational motion.
Motorcyclists are the largest contributor to road fatalities in Indonesia, with the main causal factors found to be speeding and not wearing a helmet. One of the most efficient ways to reduce road deaths in Indonesia would be to reduce speeding behaviour and increase helmet wearing by strengthening speed and helmet wearing enforcement combined with education. Stronger enforcement combined with education have been shown to be highly effective in reducing fatalities in other countries. This study assesses the benefits of stronger enforcement on speed limit and helmet wearing. It also explores what are the most effective strategies to strengthen enforcement using fixed and mobile speed cameras, point to point speed cameras and AI technology that can be used to enforce helmet wearing rates. The paper concludes with an estimation of the potential benefits if such stronger enforcement were implemented in Indonesia.
Background Motorcycle crashes are a major source of road traffic deaths in northern Ghana. Helmet use has been low. The last time it was formally assessed (2010), helmet use was 30.0% (34.2% for riders and 1.9%
for pillion riders). We sought to determine the current prevalence of helmet use and its associated factors among motorcyclists in northern Ghana.
Methods Cross-sectional observations of motorcycle helmet use were conducted among 3853 motorcycle riders and 1097 pillion riders in the Northern Region at 12 different locations near intersections, roundabouts and motorcycle bays. Modified Poisson regression was used to assess the factors associated with helmet use. Results The prevalence of helmet use was 22.1% overall: 26.7% among motorcycle riders and 5.7% among pillion riders. On the multivariable regression analysis, the prevalence of helmet use among motorcycle riders was 69% higher during the day compared with the night, 58% higher at weekend compared with weekday, 46% higher among males compared with females, but it was 18% lower on local roads compared with highways, 67% lower among young riders compared with the elderly and 29% lower when riding with pillion rider(s). Conclusion Despite small increases in motorcycle helmet use among pillion riders, helmet use has declined overall over the past decade. Immediate actions are needed to promote helmet use among motorcyclists in northern Ghana. This calls for a multisectoral approach to address the current low helmet use, targeting young riders, female riders, pillion riders, evening riding and riding on local roads.
Background
Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low‐ and middle‐income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high‐income countries have successfully reduced RTI by using a public health approach and implementing evidence‐based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high‐income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.
Objectives
The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.
Search Methods
The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.
Selection Criteria
The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post‐crash pre‐hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non‐fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.
Data Collection and Analysis
The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case‐control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.
Main Results
The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post‐crash pre‐hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non‐fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety‐six percent of the studies were reported from high‐income countries (HIC), 4.5% from upper‐middle‐income countries, and only 1.4% from lower‐middle and low‐income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.
Authors' Conclusions
The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence‐synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
According to Section 129 of the Motor Vehicles Act, 1998, "Every person, above four years of age, driving or riding a motorcycle of any class or description, shall, while in a public place, wear protective headgear conforming to the Bureau of Indian Standards. The Two-wheeler automobile market of India is one of the most competitive markets in the world and also has emerged as one of the largest automobile markets in the world. In the current paper, an attempt has been made to examine various factors that affect the buying behaviour of consumers while selecting a helmet. Primary data was collected from people of different ages, occupations, gender and etc. of the Saurashtra region through a structured questionnaire and further data were analysed using various statistical tools to derive a meaningful conclusion. So this study of consumer purchasing behavior will help everybody as all are consumers and so it is essential for a marketer to understand which factors affect the most for the consumer while they purchase the helmet. And this will help the marketer to formulate different marketing strategies.
Background:
Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture etiology, pattern, management, and treatment outcomes in pediatric mandibular fracture patients.
Methods:
A retrospective review was performed of patients under 18 years of age who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, etiology, medical history, associated facial fractures, other associated injuries, treatments, and outcomes.
Results:
A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy (PT) and rest (n=253, 47.7%). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared to patients with a single facial fracture (p<0.0001). Older age (p<0.001), gender (p=0.042), mechanism (p=0.008) and cause of injury (p=0.002), as well as specific fractures (e.g., isolated angle (p=0.001)) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with CREF or ORIF compared to conservative management (OR=1.8; 95% Cl 1.0-3.2 and OR=2.1; 95% Cl 1.2-3.5, respectively).
Conclusion:
Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large scale studies characterizing these injuries are critical for guiding physicians in the management of these patients.
Vulnerable Road Users (VRUs), like Motorised two-wheelers (MTWs), are the most affected class of road users. Road safety project evaluation requires analysis of social cost of road crashes. Researchers attempted to understand Willingness to Pay (WTP) for different classes of road users. In this study, WTP for reduction in the chance of fatality is estimated and influence of individual's perception of safety, their socio-demographic characteristics and whether they can make independent financial decisions on WTP is analysed. WTP was observed to vary with the amount of safety improvement the expense will offer. Payment card method was adopted for estimating WTP for various levels of risk reduction and to understand the variation of WTP with variation in the chance of fatality reduction for Indian MTWs. The WTP-CV Payment Card Questionnaire was designed. The questionnaire includes socio-demographic data, risk exposure, financial independence rated on a scale of 1 to 7 and lastly, the valuation questions for various levels of fatality risk reduction. A total of 541 data were collected through face-to-face interviews, online and telephonic interviews. It could be observed that the MTWs with higher degrees of education, higher monthly incomes and more crash history are prepared to pay more. The WTP and probability of risk reduction could be observed as not a linear function. Also, an individual's attitude towards safety influences the WTP greatly.
Background
Morbidity and mortality from road traffic crashes are steadily increasing globally and they remain a major public health challenge. This burden is disproportionately borne by low-and middle-income countries, especially Sub-Saharan Africa where motorcycle helmet use is low and where there are challenges of affordability and availability of standard helmets. We sought to assess the availability and cost of helmets in retail outlets in northern Ghana.
Methods
A market survey of 408 randomly sampled automobile-related retail outlets in Tamale, northern Ghana was conducted. Multivariable logistic regression was used to identify factors associated with helmet availability and gamma regression was used to identify factors associated with their cost.
Results
Helmets were available in 233 (57.1%) of surveyed retail outlets. On multivariable logistic regression, street vendors were 48% less likely and motorcycle repair shops 86% less likely to sell helmets than automobile/motorcycle shops. Outlets outside the Central Business District were 46% less likely to sell helmets than outlets inside that district. Nigerian retailers were five times more likely to sell helmets than Ghanaian retailers. Median helmet cost was 8.50 USD. Helmet cost decreased by 16% at street vendors, 21% at motorcycle repair shops, and 25% at outlets run by the owner. The cost increased by older age of retailer (1% per year of age), education level of retailer (12% higher for secondary education, 56% higher for tertiary education, compared to basic education), and sex (14% higher for male retailer).
Conclusion
Motorcycle helmets were available in some retail outlets in northern Ghana. Efforts to improve helmet availability should address outlets in which they are less commonly sold, including street vendors, motorcycle repair shops, outlets run by Ghanaians, and outlets outside the Central Business District.
Purpose: The purpose of this study was to investigate (1) the association among helmet wearing, incidence rate of traumatic brain injury (TBI), and in-hospital mortality; TBI was diagnosed when the head Abbreviated Injury Scale (AIS) was ≥1, and as severe TBI when head AIS was ≥3; and (2) the association between helmet type and incidence rate of TBI, severe TBI, and in-hospital mortality of motorcycle accidents based on the newly revised Emergency Department-based Injury In-depth Surveillance (EDIIS) data.Methods: Data collected from EDIIS between January 1, 2020 and December 31, 2020 were analyzed. The final study population comprised 1,910 patients, who were divided into two groups: helmet wearing group and unhelmeted group. In addition, the correlation between helmet type and motorcycle accident was determined in 596 patients who knew the exact type of helmet they wore. A total of 710 patients who wore helmet but did not know the type were excluded from this analysis. Multivariate logistic regression was performed in both the groups to investigate the factors affecting the primary (occurrence of TBIs) and secondary outcomes (severe TBI and in-hospital mortality).Results: The prevalence of Injury Severity Scores, TBIs, and severe TBIs as well as in-hospitalmortality were the highest in the unhelmeted group. Additionally, the results from the group that wore and knew the type of helmet worn indicated that wearing a full-face helmet decreased the incidence of TBIs in comparison to a half-face helmet.Conclusions: The wearing of a helmet in motorcycle accidents is very important as it plays a role in reducing the occurrence of TBIs and severe TBIs and in-hospital mortality. The use of a full-face helmet lowered the incidence of TBIs.
Background
While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death.
Methods
We searched for studies without exclusion based on: age, language, date, or randomization. Case reports, professional riders, and studies without original data were excluded. Pooled results were reported as OR (95% CI). Risk of bias and certainty was assessed. (PROSPERO #CRD42021226929).
Results
Of 4431 studies identified, 3074 were duplicates, leaving 1357 that were screened. Eighty-one full texts were assessed for eligibility, with 37 studies (n = 37,233) eventually included. Full-face helmets reduced traumatic brain injury (OR 0.40 [0.23–0.70]); injury severity for the head and neck (Abbreviated Injury Scale [AIS] mean difference −0.64 [-1.10 - -0.18]) and face (AIS mean difference −0.49 [-0.71 - -0.27]); and facial fracture (OR 0.26 [0.15–0.46]).
Conclusion
Full-face motorcycle helmets are conditionally recommended to reduce traumatic brain injury, facial fractures, and injury severity.
Goalkeeping is specialized position in hockey especially from the standpoint of injury risks involved because of the nature of the game including the mass of the ball used. Generally, the helmets available are designed taking into consideration, the adult body especially the cephalic dimensions. But receiving training for developing into a well-trained player involves initiating the training process much before attaining the adulthood in tune with the philosophy catch them young. In this backdrop an attempt is being made to develop a design of a helmet meant for the Bengalee adolescents, who should ideally receive more protection from injuries for lack of skill and experience to protect them. The relevant anthropometric parameters especially the cephalic dimensions like head breadth and length were measured using spreading caliper from 48 consenting individuals. A personalized design of the helmet meant for the goalkeeper from the Bengalee adolescent population was proposed subsequent to mathematical modeling.
Skull fracture and brain injury are frequent head injuries in electric two-wheeler (ETW) accidents, and the type of helmet and impact conditions affect the effectiveness of the helmet in protecting the rider's head. The purpose of this study was to conduct in-depth reconstructions of rider's head-to-ground impacts in ten ETW accidents by using a multi-body system combined with a finite element approach and to evaluate the effect of two typical full-face helmets (FFH) and one half-coverage helmet (HCH) through head accelerations and intracranial biomechanics injury metrics in ground impacts. The results showed that all three helmets reduced the risk of skull fracture in most cases, however, FFH performed better due to its wider protection area. In addition, three helmets showed varying degrees of overall reduction in measuring all indicators of brain injury. Although the effectiveness of the helmets on angular acceleration was largely influenced by the angle and location of impact, it was certain that wearing an FFH was more likely to reduce rotational head movements than an HCH, and that the FFH also offered the better advantage in reducing diffuse axonal injury (DAI) risk due to its better resistance to ejection in a crash.
According to WHO data, the Global status report on road safety 2018, Indonesia in 2018, with a population of 261,115,456 people reported 31,282 deaths due to traffic accidents, with an estimated mortality rate of 12.2 per 100,000 people. From the number of deaths, 73.6% were two-wheeled-vehicle riders. It is also stated in this report that even though Indonesia has implemented regulations regarding the need to wear head protection while riding, it is estimated that only 71% wear helmets. This study was aimed to obtain the description of injuries that occurred among two-wheeled-vehicle riders who had traffic accidents with and without wearing helmets. The results showed that the wound description of two-wheeled riders who did not wear helmets was not much different from the riders who wore helmets when they had traffic accidents, however, it could be differed from the severity of the injuries. In conclusion, there was a difference in wound description of traffic accidents between two-wheeled drivers with and without wearing helmets. Keywords: wound, traffic accident, two-wheeled riders, helmet Abstrak: Menurut data WHO “Global status report on road safety 2018”, pada tahun 2018, Indonesia dengan populasi 261.115.456 penduduk dilaporkan mengalami 31.282 jumlah kematian akibat kecelakaan lalu lintas, dengan estimasi angka kematian 12,2 per 100.000 orang. Dari jumlah kejadian kematian tersebut, 73,6% ialah pengendara kendaraan roda dua. Dikatakan juga bahwa dari semua pengendara tersebut, walaupun Indonesia telah menerapkan peraturan akan keperluan memakai alat pelindung kepala selagi berlalu lintas, terestimasi hanya 71% yang memakai helm. Penelitian ini bertujuan untuk mendapatkan gambaran luka pada kecelakaan lalu lintas khususnya pengendara kendaraan roda dua yang tidak memakai helm. Jenis penelitian ialah literature review, menggunakan data yang diperoleh dari database Pubmed, Clinical Key, dan Google Scholar. Hasil penelitian mendapatkan 10 literatur yang memenuhi kriteria inklusi dan eksklusi serta lolos tahap seleksi dari 1.321 literatur. Gambaran luka yang didapat pada pengendara roda dua yang tidak dan yang memakai helm saat mengalami kecelakaan lalu lintas dapat dibedakan dengan melihat tingkat keparahan dari luka dan cedera yang dialami oleh pengendara tersebut. Simpulan penelitian ini ialah terdapat perbedaan gambaran luka akibat kecelakaan pada pengendara roda dua yang memakai helm dan yang tidak memakai helm.Kata kunci: luka, kecelakaan lalu lintas, pengendara roda dua, helm
This study proposes a random parameter bivariate probit model to analyze risk factors on the crash injury severity of both motorcycle riders and passengers in a single modeling framework. The proposed model can not only account for the underlying correlation of common factors affecting the rider and its pillion passenger simultaneously, but also can capture the unobserved heterogeneity across crash samples. The case analysis is based on 3665 motorcycle-carrying-passenger crashes in Hunan province of China. Model comparisons show that the proposed random parameter bivariate probit model outperforms two conventional models in the goodness-of-fit. The results of parameter estimations show that, age and gender differences in passengers pose significant effects on injury severity of the rider in crashes. Specifically, when carrying a vulnerable passenger including women, children and elders, the rider is less likely to sustain severe injuries. But for injury severity of the passenger, these vulnerable passengers are more likely to suffer from severe injuries. Apart form age and gender attributes, factors including collision objects, helmet use, drunk riding, night without lights, peak periods, high-speed roads have significant effects on rider injury and/or passenger injury. Relevant suggestions to alleviate the injury severity for motorcycle-carrying-passengers crashes are recommended.
In India, every year, more than 4 lakhs people lose their lives in different accidents as per Government of India data that translates to more than one person getting killed every minute in the country. Out of this, Road Traffic Injury (RTI) is the most serious preventable but large and growing public health burden especially for low and middle income countries including India. 141,526 persons were killed and 477,731 injured in road traffic accidents in India in 2014 (NCRB 2015); obviously, it includes a large number of two-wheeler riders. Motorcyclists are a group of vulnerable road users, representing 23% of the global RTI burden. It has been observed that among motorcyclists, injury to the head and neck is often the main cause of death and disability. Though use of helmets can reduce substantially the number and severity of injuries and deaths, there is common tendency to not to wear it, and the non-use or improper wearing during use of helmets is associated with injuries and disabilities in case of accidents taking place leads to higher treatment costs in the event of a crash. Studies have identified poor/ improper design of helmets as one of the reason of non-usage; therefore, addressing the underlying cause is the need of the hour. In this backdrop, a study has been undertaken to ‘personalize’ or tailor make helmets on the basis of anthropometric data for developing regression models to predict the appropriate helmet for the user in order to facilitate reduction of non-usage of helmets due to improper fit. Data from North and Eastern India of young adults of age range 20–30 years have been used to develop the model, and the latter has been validated subsequently. Further studies with similar focus are required to design standard ‘personalized’ helmets that may have the potential to reduce at least some proportion of the RTI.
Keywords: RTI, User centricity, Accident prevention, Nutritional Anthropometry, Mathematical model, Design intervention
Ergonomics is one of the emerging fields of interest for the researchers of the twenty-first century but is being incorporated into unusual traits of human life from the period of prehistoric Greek civilization. On the former, it has been tried to present how Greeks have used ergonomics in the manufacture of various products. Later on, during the twentieth century, there have been many changes in the application of ergonomics in different aspects of the product design. In this paper, an attempt has been made to represent how ergonomics in product design has changed its face from the prehistoric Greek civilization to the present age and what are the future trends of ergonomic developments in product design.
Purpose
This article consists of a systematic review of the literature, which verified whether the use and types of helmets reduce the occurrence and severity of facial fractures in hospitalized motorcyclists after traffic accidents.
Methods
Prevalence studies and cohort studies, published in Latin American languages with no restrictions on publication dates, were considered. Two authors independently screened reference lists for eligible articles, assessed them for inclusion criteria, and extracted the data using a specific form. Twenty-six articles were selected, all prevalence studies.
Results
The patients who used a helmet had a lower prevalence and severity of facial fractures, compared to patients who did not wear a helmet. There were no differences in the occurrence of lower third fractures between patients who used or did not wear a helmet at the time of the trauma; as well as in meta-analyzes of occurrence and severity of facial trauma between helmet types (open or closed).
Conclusion
It can be concluded that the use of helmet leads to a lower number of fractures and severity of trauma when compared to non-use. Regarding the type of helmet, there was no difference in the occurrence and severity of facial fracture in individuals who used closed or opened helmet.
Motorcycle helmet wearing rates remain low in smaller cities in developing countries. We therefore examined the knowledge, attitudes, and behavior of motorcyclists towards helmet use in two mid-sized cities in China. The methods included roadside observation and interview. Observational sites were randomly selected from main roads and secondary streets; all motorcycles passing by were observed. Riders near the sites were opportunistically approached and asked about knowledge of and perceptions about helmet use. Altogether, 75,949 drivers and 17,230 passengers were observed. A large proportion of both drivers and passengers (34% and 71%, respectively) did not wear a helmet, or did not have their helmet fastened (34% and 14%). Proper helmet usage rates were lower among male drivers, younger people, on secondary streets, and during the evenings and weekends. The majority of the 2325 drivers interviewed (90%) acknowledged the benefits of helmet wearing, but 72% reported that helmets are not always comfortable, and only 20% said they would wear a helmet for preventive purposes. Furthermore, many felt that police enforcement was not strict (62%). These results suggest that educational programs about helmet use in provincial China should emphasize the risks of improper use. Strict enforcement, especially on secondary roads and during non-peak hours, could also improve helmet usage.
This study evaluated the effect of the motorcycle helmet law implemented in Taiwan on June 1, 1997.
Collecting data on 8795 cases of motorcycle-related head injuries from 56 major Taiwanese hospitals, we compared the situation 1 year before and after implementation of the helmet law.
After implementation of the law, the number of motorcycle-related head injuries decreased by 33%, from 5260 to 3535. Decreases in length of hospital stay and in severity of injury and better outcome were also seen. The likelihood ratio chi 2 test showed that severity decreased after the law's implementation (P < .001). Full helmets were found to be safer than half-shell helmets.
The helmet law effectively decreased the mortality and morbidity from motorcycle-related head injuries.
The association of helmet use with death in a motorcycle crash can be estimated using matched-pair cohort methods. By estimating effects among naturally matched pairs on the same motorcycle, one can account for potential confounding by motorcycle characteristics, crash characteristics, and other factors that may influence the outcome. The authors used Fatality Analysis Reporting System data, from 1980 through 1998, for motorcycles that crashed with two riders and either the driver or the passenger, or both, died. For their main analysis, the authors estimated the relative risk of death using conditional Poisson regression. The relative risk of death, accounting for the matching on motorcycle and adjusted for age, sex, and seat position, for a helmeted rider compared with an unhelmeted rider was 0.61 (95% confidence interval: 0.54, 0.70). The authors suggest that conditional Poisson regression is useful for the analysis of traffic crash data, where occupants are naturally matched in a vehicle and where crash-related confounders may be difficult or impossible to measure.
To evaluate the impact of a revised Italian motorcycle-moped-scooter helmet law on crash brain injuries.
A pre-post law evaluation of helmet use and traumatic brain injury (TBI) occurrence from 1999 to 2001.
Romagna region, northeastern Italy, with a 2000 resident population of 983 534 persons.
Motorcycle-moped rider survey for helmet use compliance and all residents in the region admitted to the Division of Neurosurgery of the Maurizio Bufalini Hospital in Cesena, Italy for TBI.
Helmet use compliance and change in TBI admissions and type(s) of brain lesions.
Helmet use increased from an average of less than 20% to over 96%. A comparison of TBI incidence in the Romagna region shows that there was no significant variation before and after introduction of the revised helmet law, except for TBI admissions for motorcycle-moped crashes where a 66% decrease was observed. In the same area TBI admissions by age group showed that motorcycle mopeds riders aged 14-60 years sustained significantly fewer TBIs. The rate of TBI admissions to neurosurgery decreased by over 31% and epidural hematomas almost completely disappeared in crash injured moped riders.
The revised Italian mandatory helmet law, with police enforcement, is an effective measure for TBI prevention at all ages.
To compare the effectiveness of motorcycle helmets seen in prospective on-the-street motorcycle accident investigations. The data are drawn from two detailed, in-depth studies of motorcycle accidents, in which trained investigators collected extensive accident evidence on-scene immediately after the crash. This article compares helmeted and unhelmeted motorcycle riders on a per-accident basis for fatality rates, the rate of serious (AIS > 2) brain injuries among survivors, or an outcome that involved either of the two.
Nine hundred motorcycle crashes in Los Angeles and 969 crashes in Thailand were investigated in detail at the accident scenes, including photos of vehicles, skids, damage, and sometimes the rider. Helmets were collected and injury information was obtained from riders and care providers. This evidence was then used to reconstruct collision events to identify speeds, precrash motions, collision contacts, injury causation, and helmet performance.
In both studies, approximately 6% of riders were killed and 20-25% were hospitalized. Overall, unhelmeted riders were two to three times as likely to be killed, and three times as likely to suffer either death or survival with AIS > 2 brain injury. Unhelmeted survivors had three to four times as many AIS > 2 brain injuries as helmeted riders on a per-crash basis. Nearly 100% of riders with AIS > 4 somatic injuries died. Such injuries were 30% of Thailand fatalities and 57% of L.A. fatalities, but only about 2-3% of the overall accident population. Among the 97-98% of riders with AIS < 5 somatic injuries, helmet use could prevent about three-fourths of fatalities and brain injuries.
Helmets were extremely effective in preventing brain injury and death in 97% of the accident population in less-than-extreme crashes. Helmet use cannot prevent all fatalities because many of those killed succumb to below-the-neck injuries that a helmet cannot prevent.
This paper presents a revised approach to estimating the approach energy E\dA absorbed in an accident. The paper details the revised method for energy estimation for front and rear impacts (side impacts will be discussed in a later publication). The new algorithm originates from the fact that CRASH3 requires an estimate of approach energy absorbed (E\dA) and not force or stiffness. Therefore, the simplest approach is to model the behavior of E\dA with residual crush. Data from more than 1000 tests in the National Highway Traffic Safety Administration’s (NHTSA's) data-base are tabulated and presented. Finally, the paper validates the new algorithm by analyzing data from a number of staged collisions. The work reported in this paper was executed under contract to the National Highway Traffic Safety Administration (NHTSA) as a part of their research
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than two thousand persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life-threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.
Mandatory motorcycle helmet-use legislation is supported by the high morbidity of motorcycle trauma and its cost to society. Opponents argue, however, that the majority of motorcycle trauma morbidity and costs are the result of injuries to body regions other than the head. Previous data do not address this argument because they fail to control for differences in non-head injury severity (i.e., kinetic impact) between helmeted and unhelmeted patients. This study investigates the impact of helmet use on the morbidity and cost of motorcycle trauma, after controlling for non-head injuries. A retrospective review of all patients admitted to Harborview Medical Center with motorcycle trauma from 1/1/85 to 1/1/90 was performed. Non-head injury severity was determined by calculating an ISS that did not include head injury. This non-head ISS was used to control for injury severity below the neck. Four hundred twenty-five patients were identified. Stratified analysis showed that helmet use decreased the need for and duration of mechanical ventilation, the length of ICU stay, the need for rehabilitation, and prevented head injury. Costs of acute care were significantly less in helmeted patients. Regression analysis, controlling for age, gender, and blood alcohol level (as well as non-head injury severity), confirmed that acute costs were 40% less with helmet use.
Objective.
—To rebut criticism of a previous study of motorcycle helmet—use laws through reanalysis with improved measures of exposure, stratification for regional differences in crash risk, and addressing of total motorcycle-related mortality and the grounds for targeting motorcyclists for helmet-use laws.Design.
—Death certificate—based correlational study of motorcycle-related deaths and motorcycle helmet—use laws.Population Studied.
—United States resident deaths from 1979 through 1986.Results.
—Regardless of the denominator used (resident population, motorcycle registrations, or motorcycle crashes), states with full helmet-use laws had consistently lower head injury—associated death rates than states without such laws, even when stratified by region. Total motorcycle-related mortality, however, was similar between law groups. On a registration or crash basis, motorcyclists who died in crashes had a fivefold to sixfold higher risk of head injury than those who died using any other type of motor vehicle.Conclusion.
—Full helmet-use laws were consistently associated with lower rates of head injury—associated death. While disagreement remains on the acceptability of the legislative approach, the scientific basis for motorcycle helmet— use laws as a head injury prevention tool appears sound.(JAMA. 1992;267:1649-1651)
Acknowledgments The authors,thank Richard Sattin for his insightful comments,and Mario Schootman,for preparing,a preliminary version of the report. The authors also offer sincere thanks to Patricia Holmgreen, Dionne White, Lee Annest, and other members of the Office of Statistics and Programming, National Center for Injury Prevention and Control, for their statistical assistance; and Margy Warner, Lois Fingerhut, and other staff of the National Center for Health Statistics for their guidance and consultation.
Objectives:
This study examined the prevalence of non-standard helmet use among motorcycle riders following introduction of a mandatory helmet use law and the prevalence of head injuries among a sample of non-standard helmet users involved in motorcycle crashes.
Methods:
Motorcycle rider observations were conducted at 29 statewide locations in the 2 years following the introduction of the mandatory helmet use law in January, 1992. Medical records of motorcyclists who were injured in 1992 for whom a crash report was available and for whom medical care was administered in one of 28 hospitals were reviewed. Chi-squares and analysis of variance were used to describe differences between groups.
Results:
Prevalence of non-standard helmet use averaged 10.2%, with a range across observation sites from 0 to 48.0%. Non-standard helmet use varied by type of roadway, day of week, and time of day. Injuries to the head were more frequent and of greater severity among those wearing non-standard helmets than both those wearing no helmet and those wearing standard helmets.
Conclusions:
Non-standard helmets appear to offer little head protection during a crash. Future study is needed to understand the dynamics leading to head injury when different types of helmets are worn.
Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.
Motorcycle riders are over 30 times more likely than car occupants to die in a traffic crash. While this fact is well known, specific issues of methodology in epidemiological motorcycle-injury research have been rarely researched. To facilitate more-valid research on motorcycle injuries, this article evaluates the current state of our knowledge on how we measure the population at risk of injury, completeness of case finding and identification, validity of crash/injury data sources, and completeness of information on important exposures such as alcohol consumption, helmet status, crash severity, and crash speeds, as well as problems of existing injury severity scales and statistical analyses for correlated injury data.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
To rebut criticism of a previous study of motorcycle helmet-use laws through reanalysis with improved measures of exposure, stratification for regional differences in crash risk, and addressing of total motorcycle-related mortality and the grounds for targeting motorcyclists for helmet-use laws.
Death certificate-based correlational study of motorcycle-related deaths and motorcycle helmet-use laws.
United States resident deaths from 1979 through 1986.
Regardless of the denominator used (resident population, motorcycle registrations, or motorcycle crashes), states with full helmet-use laws had consistently lower head injury-associated death rates than states without such laws, even when stratified by region. Total motorcycle-related mortality, however, was similar between law groups. On a registration or crash basis, motorcyclists who died in crashes had a fivefold to sixfold higher risk of head injury than those who died using any other type of motor vehicle.
Full helmet-use laws were consistently associated with lower rates of head injury-associated death. While disagreement remains on the acceptability of the legislative approach, the scientific basis for motorcycle helmet-use laws as a head injury prevention tool appears sound.
Mandatory motorcycle helmet-use legislation is supported by the high morbidity of motorcycle trauma and its cost to society. Opponents argue, however, that the majority of motorcycle trauma morbidity and costs are the result of injuries to body regions other than the head. Previous data do not address this argument because they fail to control for differences in non-head injury severity (i.e., kinetic impact) between helmeted and unhelmeted patients. This study investigates the impact of helmet use on the morbidity and cost of motorcycle trauma, after controlling for non-head injuries. A retrospective review of all patients admitted to Harborview Medical Center with motorcycle trauma from 1/1/85 to 1/1/90 was performed. Non-head injury severity was determined by calculating an ISS that did not include head injury. This non-head ISS was used to control for injury severity below the neck. Four hundred twenty-five patients were identified. Stratified analysis showed that helmet use decreased the need for and duration of mechanical ventilation, the length of ICU stay, the need for rehabilitation, and prevented head injury. Costs of acute care were significantly less in helmeted patients. Regression analysis, controlling for age, gender, and blood alcohol level (as well as non-head injury severity), confirmed that acute costs were 40% less with helmet use.
The TRISS system is an important, widely used method for predicting survival in trauma patients. One significant shortcoming of TRISS is its inability to include intubated patients in survival analysis because a respiratory rate and a verbal response are not obtainable. This report describes one approach to this problem. Data from 994 patients with blunt trauma were examined. Like TRISS, survival probability was calculated using a logistic regression model that included age and Injury Severity Score (ISS); however, the best motor response and systolic blood pressure were used in place of the Revised Trauma Score (RTS). With this model, the sensitivity, specificity, and misclassification rate were 57%, 98.9%, and 3.6%, respectively. For TRISS, the sensitivity, specificity, and misclassification rate are 58.8%, 99.3%, and 3.0%, respectively. Thus, our model has predictive performance comparable with TRISS. More importantly, it is applicable to intubated patients who are not pharmacologically paralyzed. Further investigation with larger data bases is necessary.
Certain features of head-injured patients admitted to the Chang Gung Memorial Hospital in Taiwan during the period 1977 to 1987 were reviewed. The most common causes of injury were motorcycle accidents (56.3%) and street accidents with pedestrian injury (29.47%). The age groups with the greatest incidence of injury were aged 16-20 years, 21-25 years, and 25-30 years. The pedestrian group involving the highest incidence of injury was less than 10 years of age. Overall mortality was 17.26%. The injured pedestrian group had the highest mortality (19.1%). Initial clinical assessment was recorded using the Glasgow Coma Scale. Head-injured patients with a GCS less than 8 had a mortality in the injured pedestrian group of 46%, whereas the mortality rate in the motorcycle accident group was 41%. Additional features studied were time of occurrence of injury and pattern of injury. Information gathered from this study would suggest the need to establish a Head Injury Prevention Program in Taiwan. This of course implies major cooperation among the providers of health care delivery, the medical profession, legislators, and the government at all levels.
Mickey, R. M. (Dept of Mathematics and Statistics, U. of Vermont, Burlington, VT 05405) and S. Greenland. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–37.
Much controversy exists regarding proper methods for the selection of variables in confounder control. Many authors condemn any use of significance testing, some encourage such testing, and others propose a mixed approach. This paper presents the results of a Monte Carlo simulation of several confounder selection criteria, including change-in-estimate and collapsibility test criteria. The methods are compared with respect to their Impact on Inferences regarding the study factor's effect, as measured by test size and power, bias, mean-squared error, and confidence Interval coverage rates. In situations in which the best decision (of whether or not to adjust) is not always obvious, the change-in-estimate criterion tends to be superior, though significance testing methods can perform acceptably If their significance levels are set much higher than conventional levels (to values of 0.20 or more).
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than 2,000 persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma. The score is easily derived, and is based on a widely used injury classification system, the Abbreviated Injury Scale. Use of the Injury Severity Score facilitates comparison of the mortality experience of varied groups of trauma patients, thereby improving ability to evaluate care of the injured.
Four cases reports are described: Case 1-An 18 year old girl pillion on a motor cycle was thrown from the machine after a collision with an oncoming vehicle. Her helmet was seen to fly off before impact and was found later with intact strap and fixing bolts. She was unconscious from impact and suffered diffuse brain injury. She died five days later. Case 2-A 21 year old racing motorcyclist crashed, and during the course of the accident I witnessed his helmet become detached from his head; fortunately he was injured. The helmet was found with the strap correctly fastened and the fittings intact. Later examination of the rider with the helmet on showed that an apparently well fitting helmet could be easily lifted over the back of his head. Case 3 and 4-Two racing motor cyclists, aged 23 and 29, collided and were thrown from their machines. A film of the accident showed both helmets clearly coming off over the backs of the riders' heads. Both riders suffered fatal diffuse brain injuries. Many motor cyclists may possibly be at risk of losing their helmets in accidents. Modification of the helmet by moving the strap mounting bolts further back and higher up the helmet would alter the pivot point, making it harder for the helmet to come off. Alternatively, the customer and dealer selling helmets should be aware of the problem. A simple test of somebody pushing the helmet upwards from behind while it is on the customer's head should be performed. If the helmet can reach the vertex or beyond the customer should refuse to buy it and the dealer to sell it.
In 1992 a new Traffic Rules Code was enacted in Spain. This Code included a helmet law that came into force on 1 September 1992. Since then, helmet use is compulsory for motorcycles in urban areas. Previously, helmet use had been obligatory only for motorcycle in highways. To evaluate driver and passenger compliance with the helmet law, an observational prevalence survey of helmet use in Pamplona (a city of 183,539 inhabitants in the north of Spain) was performed. The utilization of helmet by motorcycle drivers and their passengers was recorded three months before and three after the helmet law took effect. Helmet use increased from 19.7% in the first period to 94.8% in the second period. After the law took effect helmet use was higher among drivers 97.5% than among passengers 77.5%. Passengers used helmet more frequently when the driver was also using helmet. The prevalence ratio of helmet use, in those passengers whose driver used helmet versus those who didn't, was 9.91 (95% CI = 1.52, 64.83). Health education and law enforcement efforts should be targeted to drivers to prevent them from giving a ride to passengers without helmet.
Helmets have been shown to be effective in preventing head injuries in motorcyclists, but some studies have suggested that helmets may cause injury to parts of the head or neck because they add mass to the head.
This study examined patterns of fatal injuries in helmeted and unhelmeted motorcyclists.
Coroner reports, hospital records, and police reports for motorcyclists fatally injured in crashes from July 1, 1988 through October 31, 1989 were examined. All injury diagnoses were abstracted and coded to the 1990 version of The Abbreviated Injury Scale and the International Classification of Diseases, 9th revision.
Cerebral injury, intracranial hemorrhage, face, skull vault, and cervical spine injuries were more likely to be found in fatally injured unhelmeted motorcyclists than in helmeted motorcyclists.
These results expand earlier reports showing that helmets provide protection for all types and locations of head injuries, and show that they are not associated with increased neck injury occurrence.
To determine the effects of the California motorcycle helmet use law on statewide fatalities and a large sample of nonfatal injuries before and after law implementation.
Police reports and death certificates were collected for motorcycle crash fatalities in California for 1991 (prelaw) and 1992 (postlaw). Official counts of registered motorcycles provided a statewide basis for exposure to a motorcycle crash. Autopsy results were collected for fatalities in 11 counties. Hospital records were reviewed for nonfatal injuries in 28 hospitals in 10 of the 11 counties. Police reports were linked to injury data for the riders. SUBJECTS AND PATIENTS: A total of 850 fatalities and injury data for 547 fatally injured riders and 3252 nonfatally injured patients.
Changes in number and rates among statewide fatalities were estimated. The number and pattern of head injuries in fatally and nonfatally injured motorcycle riders were evaluated.
After implementation of the helmet use law, statewide motorcycle crash fatalities decreased by 37.5%, from 523 fatalities in 1991 to 327 in 1992, more than 37%, and an estimated 92 to 122 fatalities were prevented. Motorcycle fatality rates were reduced by 26.5%, from 70.1 per 100,000 registered motorcycles in 1991 to 51.5 per 100,000 in 1992. Head injuries decreased significantly among both fatally and nonfatally injured motorcyclists.
Enactment of an unrestricted helmet law significantly reduces the incidence of motorcycle crash fatalities and the number and severity of head injuries.
Many studies have reported that helmet use by motorcycle riders significantly decreases their risk of head injury, death, and disability in the event of a crash. However, these studies have not controlled for crash severity and thus do not conclusively show the value of helmet use by motorcycle riders. Using data from a statewide trauma registry, the present study examines the association of helmet use with various outcomes of motorcycle crashes, controlling for overall crash severity as measured by a modified Injury Severity Score. The results show that in crashes where the overall degree of injury was comparable, the risk of head injury in hospitalized motorcyclists was nearly twice as high for unhelmeted riders as it was for helmeted riders, thus confirming the protective effects of helmet use. However, there were no significant differences in various measurements of resource utilization, including days in hospital, hospital charges, and need for post-hospital rehabilitation. A higher incidence of extremity injuries among the helmeted riders may account for their failure to demonstrate consistently lower resource utilization, despite lower rates of head injury.
The incidence, type, severity, and costs of crash-related injuries requiring hospitalization or resulting in death were compared for helmeted and unhelmeted motorcyclists.
This was a retrospective cohort study of injured motorcyclists in Washington State in 1989. Motorcycle crash data were linked to statewide hospitalization and death data.
The 2090 crashes included in this study resulted in 409 hospitalizations (20%) and 59 fatalities (28%). Although unhelmeted motorcyclists were only slightly more likely to be hospitalized overall, they were more severely injured, nearly three times more likely to have been head injured, and nearly four times more likely to have been severely or critically head injured than helmeted riders. Unhelmeted riders were also more likely to be readmitted to a hospital for follow-up treatment and to die from their injuries. The average hospital stay for unhelmeted motorcyclists was longer, and cost more per case; the cost of hospitalization for unhelmeted motorcyclists was 60% more overall (2.2 million).
Helmet use is strongly associated with reduced probability and severity of injury, reduced economic impact, and a reduction in motorcyclist deaths.
This paper examines motorcycle helmet use and injuries in a developing country with a helmet law. Data were collected by systematic street observations and interviews with motorcyclists and supplemented with motorcycle injury data from a 1 month study of all patients coming to emergency departments in Yogyakarta, Indonesia. Observations show that 89% of motorcycle drivers (N = 9242) wore helmets; only 20% of the passengers (N = 3541) did. However, only 55% of the drivers wore helmets correctly (e.g. with chin strap buckled). Differences in time and place were noted in interviews when motorcyclists reported wearing helmets least at night and when no police were around; various reasons for not wearing helmets included physical discomfort and absence of police surveillance. Data from emergency departments found that motorcycles were involved in 64% of all traffic accident injuries, comprising 33% of total trauma patients presenting to emergency departments. Injury Severity Scores were calculated for the 26% of motorcycle injuries which were admitted to the hospital, with 60% having scores of 1-8, 27% 9-15, and 9% > 15. We conclude that although motorcycle drivers appear to comply with the motorcycle helmet law, it is a "token compliance." Less than 50% of riders were maximally protected by helmets and very little safety consciousness was found among drivers. Suggestions for improving helmet use that take cultural definitions of wearing helmets into account are presented for future research.
In Spain, a federal road safety law went into effect in the fall of 1992 extending to urban areas the unrestricted use of safety helmets by all two wheel motor vehicle occupants.
To assess the effect of the law in reducing fatal motorcycle crash injuries; to estimate the number of lives saved; and to determine changes in the distribution of severity and anatomical location of injuries.
Pre-test/post-test design of all deaths of two wheel motor vehicle occupants from 1990-92 (pre-law period) and from 1993-95 (post-law period) detected by the Barcelona Forensic Institute and the city police department. Injuries were coded using the 1990 version of the abbreviated injury scale. Poisson regression methods were used to model trends in mortality ratios and to provide estimates of the number of lives saved.
Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants were spared, representing a decrease of 25% in the observed motorcycle crash mortality in the post-law period when compared with what would be expected if no such law had gone into effect. The proportion of deaths with severe head injuries was also reduced from 76% to 67% in the post-law period.
This study offers the first evaluation of a helmet law using combined forensic and police data in a large south European urban area where there is widespread use of motorcycles. Our results confirm the effectiveness of the helmet law, as measured by the reduction in the number of deaths and mortality ratios after the law implementation. The findings reinforce the public health benefits of mandatory non-restricted motorcycle and moped helmet use, even in urban areas with lower traffic speeds.
This study examined crash severity and injury patterns between helmeted and unhelmeted adolescent motorcycle riders.
Among an initial population of 4,721 junior college students, 1,284 students were involved in 1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was measured by both the type of collision object and the repair cost of motorcycle damage.
The incidence rates of crash, injury, hospitalization, and deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3, respectively. Compared with helmeted riders, unhelmeted riders had more noncollisions and fewer collisions with a moving car but there was no significant difference in repair cost of motorcycle damage between these groups. More injuries to the external skin, face, and head and more severe injuries occurred in unhelmeted than in helmeted riders. Among crashes resulting in hospitalization/death, more injuries to the face and head occurred in unhelmeted riders than in helmeted riders.
Crashes involving unhelmeted riders were not more severe but more frequently involved face and head injuries than crashes involving helmeted riders.
In a prospective study, three research groups at Hannover (H) and Munich (M) in Germany and Glasgow (G) in the United Kingdom collected data from motorcycle crashes between July 1996 and July 1998 to investigate head injury mechanisms in helmet-protected motorcyclists.
The head lesions of motorcyclists with Abbreviated Injury Score-Head (AISHead) 2+ injuries and/or helmet impact were classified into direct force effect (DFE) and indirect force effect (IFE) lesions. The effecting forces and the force consequences were analyzed in detail.
Two-hundred twenty-six motorcyclists (H, n = 115; M, n = 56; and G, n = 55) were included. Collision opponents were cars (57.8%), trucks (8.0%), pedestrians (2.3%), bicycles (1.4%), two-wheel motor vehicles (0.8%), and others (4.2%). In 25.4% no other moving object was involved. The mean impact speed was 55 km/h (range, 0-120 km/h) and correlated with AISHead. Seventy-six (33%) motorcyclists had no head injury, 21% (n = 48) AISHead 1, and 46% (n = 103) AISHead 2+. Four hundred nine head lesions were further classified: 36.9% DFE and 63.1% IFE. Lesions included 20.5% bone, 51.3% brain, and 28.1% skin. The most frequent brain lesions were subdural hematomas (22.4%, n = 47) and subarachnoid hematomas (25.2%, n = 53). Lesions of skin or bone were mainly DFE lesions, whereas brain lesions were mostly IFE lesions.
A modification of the design of the helmet shell may have a preventative effect on DFE lesions, which are caused by a high amount of direct force transfer. Acceleration or deceleration forces induce IFE lesions, particularly rotation, which is an important and underestimated factor. The reduction of the effecting forces and the kinetic consequences should be a goal for future motorcycle helmet generations.
All patients involved in motorcycle crashes admitted to various hospitals in the Yorkshire region of UK between January 1993 and December 1999 were retrospectively reviewed to identify the factors that are likely to predict a reduced survival. Of the 1239 patients requiring hospital admission, 74 died. The probability of reduced survival was estimated by a logistic regression model using independent variables such as head injury, thoracic trauma, abdominal injury, spinal injury and pelvic fracture and a compound variable of pelvic fracture combined with a long bone fracture. The odds ratio for head injury was 0.349, chest injury 0.39, abdominal injury 0.42, and the compound variable (pelvis plus a long bone fracture) 0.576. The mean injury severity score (ISS) in the fatal group was 35.96 compared to 12.2 in the group that survived (P<0.01). There was a significant difference in the Glasgow coma scale (GCS) between patients wearing a helmet and those that did not wear any protective headgear (P=0.0007). Head injury followed by chest and abdominal trauma were found to predict a reduced survival rate. Use of helmets should continue to be compulsory. Chest and abdominal injuries should be diagnosed and treated early to reduce mortality.
Helmets shown to reduce motorcyclist head injury and death Motorcyclists are at high risk in traffic crashes, particularly for head injury. A review of trials concluded that helmets reduce the risk of head injury by around 72%. The risk of death is also reduced, although it is not possible to estimate a percentage figure for this reduction from the available evidence. It is likely that the protective effect of the helmet may depend on other factors, such as speed. There is, so far, insufficient evidence to compare the effectiveness of different types of helmet. Some studies have suggested that helmets may protect against facial injury and that they have no effect on neck injury, but more research is required for a conclusive answer. The review supports the view that helmet use should be actively encouraged worldwide for rider safety.
Evidence suggests that the present and projected global burden of road-traffic injuries is disproportionately borne by countries that can least afford to meet the health service, economic, and societal challenges posed. Although the evidence base on which these estimates are made remains somewhat precarious in view of the limited data systems in most low-income and middle-income countries (as per the classification on the World Bank website), these projections highlight the essential need to address road-traffic injuries as a public-health priority. Most well-evaluated effective interventions do not directly focus on efforts to protect vulnerable road users, such as motorcyclists and pedestrians. Yet, these groups comprise the majority of road-traffic victims in low-income and middle-income countries, and consequently, the majority of the road-traffic victims globally. Appropriately responding to these disparities in available evidence and prevention efforts is necessary if we are to comprehensively address this global-health dilemma.
This paper presents the approach taken by the Malaysian Government to contain motorcycle casualties in Malaysia. It involves the exposure control, crash prevention, behaviour modification and injury control related to humans, vehicles and the environment based on pre-crash, crash and post-crash scenarios of motorcycle accidents. These initiatives emanated mainly from the research and development carried out by the Road Safety Research Centre at Universiti Putra Malaysia. Recent outcomes from these initiatives are presented and their impact is highlighted.
This study investigated motorcycle helmet ownership, quality, purchase price, and affordability in Vietnam.
A random sample of motorcyclists was interviewed to investigate aspects of helmet ownership, the purchase price, and affordability of a motorcycle helmet. Multivariate modeling conducted to determine factors associated with the purchase price and affordability of motorcycle helmets. Helmet quality was assessed based on current legal requirements in Vietnam.
The prevalence of helmet use in Vietnam remains low (23.3%) despite a high level of helmet ownership (94%), indicating that this is an important area for public health intervention. Overall the quality of helmets appeared to be good; however, few helmets displayed legally required information. Motorcyclists with a high income purchase more helmets for their household rather than more expensive helmets.
To ensure that helmets are accessible to the community, policy-makers need to consider pricing motorcycle helmets at a price indicated by the results of this study. Prior to universal motorcycle helmet legislation, the government will also need to ensure that standard helmets are available and that enforcement is at a level to ensure that motorcycle helmets are actually used.
Modern Epidemiology. 3 rd edn The measurement of observer agree-ment for categorical data
- Rothman Kj S Greenland
- Lash Tl 34 Landis Jr
- Koch
Rothman KJ, Greenland S, Lash TL (eds). Modern Epidemiology. 3 rd edn. Philadelphia, PA: Lippincott Williams and Wilkins, 2008. 34 Landis JR, Koch GG. The measurement of observer agree-ment for categorical data. Biometrics 1977;33:159–74.
Knowledge on Protection and Use of Motorcycle Helmets in College Students. The 15th Meeting of the Ergonomics Society of Taiwan A review of risk factors and patterns of motorcycle injuries
- Rc Liang
- Lin
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27 Liang RC, Lin YH. Knowledge on Protection and Use of Motorcycle Helmets in College Students. The 15th Meeting of the Ergonomics Society of Taiwan; 2008 March 15. Taipei, Taiwan, R.O.C. 28 Lin MR, Kraus JF. A review of risk factors and patterns of motorcycle injuries. Accident Anal Prev 2009;41:710–22.
CRASH3 Damage Algorithm Reformulation for Front and Rear Collisions Society for Automotive Engineering Crash severity, injury pat-terns, and helmet use in adolescent motorcycle riders
- Prasad
- Lin Mr Ak
- Hwang Hf
- Kuo
38 Prasad AK. CRASH3 Damage Algorithm Reformulation for Front and Rear Collisions. Warrendale, PA: Society for Automotive Engineering, 1990. 39 Lin MR, Hwang HF, Kuo NW. Crash severity, injury pat-terns, and helmet use in adolescent motorcycle riders. J Trauma 2001;50:24–30.
Knowledge on Protection and Use of Motorcycle Helmets in College Students. The 15th Meeting of the Ergonomics Society of Taiwan
- R C Liang
- Y H Lin
Liang RC, Lin YH. Knowledge on Protection and Use of
Motorcycle Helmets in College Students. The 15th Meeting
of the Ergonomics Society of Taiwan; 2008 March 15. Taipei,
Taiwan, R.O.C.
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- K J Rothman
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Epidemiology. 3 rd edn. Philadelphia, PA: Lippincott
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- Rowland
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