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Helmets for preventing injury in motorcycle riders
Abstract
Background:
Motorcycle crash victims form a high proportion of those killed or injured in road traffic crashes. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.
Objectives:
To assess the effects of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.
Search strategy:
We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2007), MEDLINE (up to April 2007), EMBASE (up to April week 16, 2007), CINAHL (January 1982 to February 2003), TRANSPORT (up to issue 12, 2006) (TRANSPORT combines the following databases: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Websites of traffic and road safety research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.
Selection criteria:
We considered studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. We included any studies that compared an intervention and control group. Therefore the following study designs were included: randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.
Data collection and analysis:
Two authors independently screened reference lists for eligible articles. Two authors independently assessed articles for inclusion criteria. Data were abstracted by two independent authors using a standard abstraction form.
Main results:
Sixty-one observational studies were selected of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for death and head injury outcomes. Motorcycle helmets were found to reduce the risk of death and head injury in motorcyclists who crashed. From four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.
Authors' conclusions:
Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.
... difference in mortality reflects the difference in the prevalence of severe head injuries between the groups. Multiple studies have shown better outcome on severe head trauma and mortality for patients involved in motorcycle crashes when wearing a helmet [21,22,30,[32][33][34]. ...
... After adjustment for multiple covariates on regression analysis, helmet use was associated with a 15 % decrease in mortality risk. In line with prior research, our findings reveal that a decreased GCS upon admission emerged as the most powerful indicator of mortality [19,21,30,32,[35][36][37]. ...
... The protective role of helmet in reducing traumatic brain injury and mortality after a motorcycle collision has been consistently demonstrated in the literature [21,22,30,[32][33][34]. In line with these findings, the Eastern Association for the Surgery of Trauma has recently published guidelines supporting the use of full-face as opposed to partial-face helmets as the former have been shown to significantly reduce traumatic brain injury, injury severity to the head and neck as well as injuries and fractures to the face [42,43]. ...
... Wearing a helmet has been shown to reduce the risk of head injuries by 69% and the likelihood of death by nearly 42%. [5][6][7] According to studies, it can significantly minimize injury severity and fatality after an RTA. [5][6][7] However, in a country like India, adherence to basic safety gear such as helmets falls far short of expectations. ...
... [5][6][7] According to studies, it can significantly minimize injury severity and fatality after an RTA. [5][6][7] However, in a country like India, adherence to basic safety gear such as helmets falls far short of expectations. [4,6] Many times, ignorance and purposeful disobedience of current traffic rules are to blame for the ever-increasing number of RTAs. ...
Background
Road traffic accidents (RTAs) remain a prominent cause of mortality and morbidity worldwide. Wearing a helmet while riding a motorbike can significantly minimize injury severity and fatality. This study aimed to identify the factors associated with the use and nonuse of helmets among motorized two-wheelers.
Methods
This observational study was conducted on victims of RTAs who presented to the emergency department of a hospital in Eastern India. Data were collected through a semi-structured questionnaire from March 2021 to December 2021. The data on sociodemographic details of the victims and various extrinsic and intrinsic factors associated with the nonuse of helmets were collected and analyzed.
Results
A total of 346 patients were included. The prevalence of helmet use was 35.7%, and most young adults were helmet nonusers (32.31 ± 12.3 vs. 37.1 ± 12.3, P = 0.15). The pillion riders, alcohol abuse, lower educational levels, and riding on municipal/panchayat roads were associated with statistically significant ( P < 0.05) nonuse of helmets. The injury severity score was significantly higher in helmet nonusers (13.20 ± 6.44 vs. 11.23 ± 6.01, P = 0.004). Among the extrinsic factors, fewer traffic checkpoints ( P < 0.001), visibility issues ( P = 0.02), and use of ear pods ( P = 0.01) were significant factors for the nonuse of helmets. In the intrinsic factors, traveling short distances ( P < 0.001) and forgetfulness ( P < 0.01) were significant factors for the nonuse of helmets.
Conclusions
Traveling short distances, forgetfulness, and fewer traffic check posts are significantly associated with the nonuse of helmets among motorcyclists. Traveling on village or municipality roads and alcohol abuse is significantly associated with helmet nonuse.
... Previous methodological reviews of road safety evaluations have investigated the methods used to evaluate driver behavior interventions (Du et al., 2023) and the study types used to evaluate broader road safety interventions (Wentz et al., 2001). Systematic reviews of the effects of specific interventions such as traffic calming, road type, or speed cameras demonstrate that the most commonly used outcomes measures are the number of crashes, and number of fatal and serious injuries (Beyer & Ker, 2009;Bunn, 2003;Bunn et al., 2003;Desapriya et al., 2014;Elvik & Greibe, 2005;Kwan & Mapstone, 2006;Liu et al., 2008;Wilson et al., 2010). As a result, we lack an up-to-date overview of the current methods used to assess changes HRQOL and disability from road safety interventions aimed at the prevention of road traffic injuries and how often they are used in road safety evaluation studies. ...
... Road safety interventions aim to reduce the number of road traffic crashes and the number of fatalities and severe injuries from those crashes, hence these are the typical outcome measures used in evaluations of these interventions (Beyer & Ker, 2009;Bunn, 2003;Desapriya et al., 2014;Kwan & Mapstone, 2006;Liu et al., 2008;Mulvaney et al., 2015;Wilson et al., 2010). However, nonfatal injuries have long-term impacts on individuals that are not accounted for in these studies. ...
... than in non-admitted patients (25, 10.0%, p < 0.001). Analysis of injury locations showed significant differences for head injuries, which were more common among admitted patients (24,37.5%) compared to non-admitted patients (40,16.1%, ...
... The CDC has highlighted universal helmet laws as the most effective strategy to reduce motorcyclist deaths and associated costs [35,36]. Wearing helmets can reduce the risk of fatality and head injuries by approximately 42% and 69%, respectively [37]. Despite the availability of helmets, compliance remains low, particularly in East Asia, where helmet usage rates can be as low as 3% [38][39][40]. ...
Background
Motorcycles, favored for commercial commuting, offer the dual benefits of optimizing road system utilization and reducing environmental impact. However, the surge in home delivery services in Bahrain has led to an increase in motorcycle-related injuries. This study aimed to explore the effects of motorcycle accidents on delivery personnel, focusing on injury patterns, severity, and contributing factors.
Methods
This retrospective observational study analyzed 313 cases of delivery personnel involved in motorcycle accidents during their working hours at King Hamad University Hospital, Bahrain, from January 2016 to December 2019. Participants included delivery personnel aged 18-60 years with acute injuries from motorbike accidents who presented within 72 hours. Eligibility required complete medical records and employment verification. Cases involving incomplete data, fatalities before arrival, or accidents with other vehicles were excluded. Data sources included emergency department logs, hospital admission records, operative documents, and standardized forms. Variables included demographics, ambulance use, injury type and location, and interventions such as the need for CT scans, endotracheal intubation, blood transfusion, and trauma code activation. Group comparisons utilized chi-square test, Fisher’s exact test, and Mann-Whitney U tests with significance set at p < 0.05. Subgroup analyses explored associations by age, injury type, and trauma code activation.
Results
The mean age of the patients was 30.1 ± 8.26 years, with more than half (N = 167, 53.4%) aged 30 years old or younger. Of all patients, 25 (8%) had trauma code activation, and 175 (55.9%) utilized an ambulance. The most common location of injury was the lower limb (N = 205, 65.5%), followed by the upper limb (N = 164, 52.4%) and the head (N = 64, 20.4%). The median (range) of hospital stay days was 1 (1-32) days. Abrasions were the major type of injury sustained by the patients (N = 233, 74.4%), followed by lacerations (N = 45, 14.4%). Ambulance use was significantly higher in patients with trauma code activation (p = 0.001), head injury (p = 0.042), and pelvic injury (p = 0.047). Blood transfusion was significantly higher among those with abdominal injury (p = 0.002). There were no fatalities recorded during the study period.
Conclusions
This study highlights the risks faced by young delivery personnel in Bahrain, with lower limb injuries and head trauma being prevalent. Despite the effectiveness of current trauma care protocols in managing injuries, gaps remain in preventing severe injuries. The research emphasizes the need for region-specific measures, such as mandatory helmet laws, the use of protective gear, and the establishment of safer routes for delivery personnel. Furthermore, local awareness campaigns about safe riding practices and enhanced training programs for delivery staff can play a crucial role in reducing injury risks. By providing unique data on injury patterns and trauma care in the Gulf region, the study contributes to improving road safety and trauma management while supporting further research and policy development tailored to the specific needs of delivery personnel in Bahrain.
... Data from the Violence and Accident Surveillance Survey in 23 state capitals and the federal district of Brazil showed that helmet use reduced occurrences of head trauma by 76% and occurrences of referral to another hospital, hospitalization or death by 28% (9) . Other studies have estimated that helmet use reduces the risk of fatal accidents by 42% and the risk of head injuries by 69% (10)(11) . ...
... Despite the prohibition of driving a motorcycle without a helmet, more than 20% of the motorcyclists in the present survey were violating this traffic rule at the time of their accident, and thus were accepting the risk of head and neck injuries and death. Previous studies have shown that more than 40% of deaths in traffic are due to traumatic brain injuries (17) and that the use of a helmet protects against death and head injuries, with significant odds ratios of 0.58 and 0.31, respectively (10) . ...
Objectives
to describe traffic accidents involving motorcyclists and analyze the association between possession of a motorcycle driver’s license and use of helmets according to the severity of injuries.
Methods
a cross-sectional study was conducted among all patients hospitalized in the traumatology and orthopedics sector of a public reference hospital in northeastern Brazil.
Results
170 patients were surveyed, the majority were male (95.9%). Their ages ranged from 18 to 67 years. Most were black or brown (52.3%), had completed elementary school (58.9%) and had monthly income smaller than two minimum wages (56.5%). An association was found between being licensed to drive a motorcycle and wearing a helmet. Among those who suffered moderate injuries, this association was OR=5.66(1.85-17.23) and among those who suffered severe injuries it was OR=13.57(2.82-65.14).
Conclusions
people who were licensed to drive motorcycles used a helmet as protective equipment more often and, in accidents, suffered fewer injuries.
Descriptors:
Traffic Accidents; Motorcycle; Head Protective Devices; License; Accidental Injuries
... Similarly, a study conducted in 2016 in Brazil found that 10.6 % of injured motorcycle riders in traffic accidents tested positive for alcohol [20]. Wearing a helmet is an important factor in reducing the severity of motorcycle accidents [21][22][23][24]. Helmet use is mandated by the Road Traffic Act, B.E. 2522 (1979) in Thailand; however, over half of Thai riders and passengers do not wear helmets while riding [18]. ...
... Other associated factors with non-helmet use were young females, a lower degree of road safety, barriers to helmet use, and a lack of knowledge of risks from motorbike use. Many previous studies [21][22][23][24] highlighted that motorcycle helmets reduced the risk of death and head injury in crashed motorcyclists. Helmets reduced the incidence of fatal injuries by 37-42 % and head injuries by 56-69 % [23,24]. ...
Background
Motorcycle accidents pose a significant threat to traffic safety in Thailand, particularly in rural areas where the severity of these accidents often results in prolonged medical treatment and a reduction in the quality of life of the affected individual.
Objectives
To investigate the prevalence and the factors associated with motorcycle accidents among motorcycle riders in rural areas in Chiang Mai, Thailand.
Method
A cross-sectional study was conducted from December 2022 to March 2023 via an anonymous survey in Chiang Mai, Thailand. A total of 308 participants engaged with the survey. The data about background information, motorcycle details, personal protective equipment, risky behaviors, attitude toward riding, and history of motorcycle accidents in the prior six months were collected and analyzed by binary logistic regression.
Results
Of 308 participants, the mean age was 56 years old (SD = 14.2), females were 56.8 % (N = 175), 51 % had co-morbidity, and 40.6 % were active alcohol drinkers. The prevalence of individuals who experienced a motorcycle accident within the previous six months was 57.1 %. Notably, the most unsafe riding behavior was not wearing a helmet while riding, which had a prevalence of more than 80 % in both the accident and non-accident groups. The study found significant associated factors for motorcycle accidents in rural communities, including the history of alcohol consumption (aOR 1.71, 95 % CI: 1.05,2.79), changing lanes without using turn signals (aOR 1.93, 95 % CI: 1.07,3.48) and those who strongly disagree with the notion that listening to music while riding is dangerous (aOR 2.80, 95 % CI: 1.06, 7.43).
Conclusion
Over half of motorcycle riders have been in accidents. These findings emphasize the need to enforce drunk-driving and traffic laws. Comprehensive motorcycle rider education and safety training are needed to encourage responsible riding.
... Conducir una motocicleta implica un riesgo considerable de accidentes fatales, especialmente entre conductores inexpertos [2]. Las lesiones en la cabeza resultantes de accidentes de motocicleta son una causa significativa de morbilidad y mortalidad [3], destacándose entre las más comunes el traumatismo craneoencefálico, lesiones cerebrales, daños en la médula espinal, lesiones faciales y cervicales [4]. ...
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.
... Riding a motorcycle carries significant risks of fatal accidents, especially for novice riders (Kardamanidis et al., 2010). Head injuries resulting from motorcycle accidents are a common cause of serious morbidity and mortality (Liu et al., 2008). The most common injuries in motorcycle accidents are head trauma, brain injuries, spinal cord injuries, facial injuries, neck injuries, and spinal cord injuries (Tabary et al., 2021). ...
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.
... Beside identifying groups at risk, the implementation of safety measurement and raising awareness in the general public are key factors. An example for well-established prevention practice are helmets for bicycles and motorcycles, which have proven to reduce TBI and mortality [64,65]. Together with other efforts, like traffic calming, safety belts or regulation of drinking and driving, prevention programs have led to a reduction of TBI [27,28]. ...
Background: Traumatic brain injury (TBI) is referred to as a “silent epidemic” due to its limited awareness in the general public. Nevertheless, it can cause chronic, lifelong physical and cognitive impairments with severe impact on quality of life, resulting in high healthcare costs and loss of employment. To evaluate the outcome after mild and moderate TBI, “return to work (RTW)” is a relevant parameter, reflecting the socio-economic consequences of TBI. Our study aims to summarize RTW-rates to raise awareness on the impact of non-severe TBI. Methods: We performed a systematic literature review screening the databases Medline, Embase and Web of Science for studies reporting RTW in mild to moderate TBI. Studies that reported on RTW after mild or moderate TBI (defined by GCS > 9) in adults, with a minimum follow-up of six months were included. Risk of bias was assessed using the QUIPS tool. Results: We included 13 studies with a total 22,550 patients. The overall RTW rate after at least six months, varies between 37% and 98%. Full RTW is reported in six of the included 13 studies and varies between 12% and 67%. In six studies (46%) the RTW-rate by the end of follow-up was ≤60%, with four studies being from high-income countries. Conclusion: Mild and moderate TBI have a high impact on employment rates with diverging rates for RTW even between high-income countries. Increasing the societal awareness of this silent epidemic is of utmost importance and is one of the missions of the Swiss Brain Health Plan.
... Multiple studies agree on the protective effect of the helmet but differ on the impact of helmet type on maxillofacial fractures. Patel et al. (2023) and Liu et al. (2008) both stated that severity of both hard and soft tissue injuries is greater with open-faced or half-helmets, whereas a meta-analysis by Cavalcante et al. (2021) noted that there was no significant difference in the severity of fractures between open and closed helmets. Arif et al. (2019b) also found greater incidence of both soft tissue and hard tissue maxillofacial injuries in patients using open-face helmets and noted that another factor was whether the helmet was fastened; that is, open-face helmets did not offer protection to the lower half of the face and nonfastened helmets tend to slip off during an accident, resulting in greater incidence of injury. ...
Objective:
The prevalent reliance on 2-wheelers as a preferred mode of private transportation in rural and semi-urban regions and the various associated social and material factors put riders at significant risk for road traffic accidents causing maxillofacial trauma. This epidemiological study aims to investigate these factors and their influence on patterns of maxillofacial injuries among 2-wheeler riders in semi-urban and rural areas of South India.
Methods:
Data from all cases with maxillofacial injuries over 6 years were collected retrospectively, including demographic characteristics, accident specifics, helmet use, injury patterns, and management. Statistical analyses were done using chi-square analysis and logistic regression modeling.
Results:
The cohort of 424 participants was predominantly young males (86.8%) aged 20 to 29 years (45.3%), with low helmet use rates (27.2%). Higher speeds showed a significant correlation with increased hard tissue injuries (P = .003), with all cases over 80 kph invariably resulting in fractures. Collisions were associated with a markedly higher rate of both soft and hard tissue injuries (80.6%) compared to skids (63.7%; P = .005) and a greater prevalence of complex midface fracture patterns. Non-helmet users had significantly elevated rates of lacerations (33.3%), combined abrasion and laceration injuries (33.9%), and severe tissue loss (2.4%). Half-helmet users predominantly suffered mandibular fractures (62.5%). Logistic regression analysis revealed helmet nonuse as a major risk factor, significantly increasing the likelihood of any fracture (Exp(B) = 0.015, P < .001). Higher speeds raised the risk of hard tissue injuries across all speed brackets (P < .001). Collisions were more likely to result in midface fractures (Exp(B) = 818,915.984, P < .001), whereas skidding accidents often led to mandibular fractures. Not wearing a helmet markedly increased the risk of severe fractures across all facial areas, with statistically significant Exp(B) values. Collisions necessitated considerably more surgical interventions (Exp(B) = 0.312, P < .001).
Conclusions:
The findings highlight the vulnerability of young riders and underscore the role of helmet use, speed, and road infrastructure in road traffic accidents causing maxillofacial injuries. They also indicate the need to focus preventive measures and interventions on these factors.
... The undeniable lifesaving role played by motorbike helmets when driving motorbikes and seatbelts when driving two-wheelers should be mentioned here. As reported by Liu et al.(Liu et al., 2008)motorbike helmets save lives. A 2008 study proved the appropriate use of a certified helmet on the road can reduce the risk of mortality by 40% and the risk of head injury by 70%. ...
Purpose: This literature review aims to identify and analyse the most common mechanisms causing injuries in the craniofacial region their diagnosis and possible sequelae. Methods: The study analysed publications from the Medline database made available in PubMed and Google Scholar considering the following keywords "maxillofacial injuries" and/or "maxillofacial trauma" and/or "maxillofacial fractures". Results: Craniofacial injuries in polytrauma patients are often complicated by their heterogeneous nature and coexistence with other injuries. Their incidence and mechanisms vary depending on the country of investigation. Diagnosis includes advanced imaging techniques such as CT scans. Treatment often requires multidisciplinary collaboration. Conclusions: Craniofacial injuries in polytraumatic patients require a complex diagnostic and therapeutic approach. Interdisciplinary collaboration is crucial to achieve the best clinical outcome. The most common causes include road traffic collisions, assaults, falls and sports-related injuries. Despite properly applied treatment protocols, they generate changes in the stomatognathic system, sensory disturbances, blindness and, in extreme cases, can lead to death
... Driver behavior also plays a significant role in road safety. [15,16] Many participants admitted to engaging in avoidable risky behaviors while driving, such as using speaker phones, making calls, and listening to music. [17] A smaller percentage acknowledged watching videos and using Bluetooth headphones. ...
Introduction
In Uttar Pradesh, India, there are many fatal head injuries as a result of road traffic accidents (RTAs). Studying the pattern and distribution of intracranial hemorrhages, a frequent complication of severe head trauma might provide vital information on the efficacy of traffic safety regulations. To improve road safety tactics and lower fatal head injuries in Uttar Pradesh, this study intends to assess the effect of road safety measures on the frequency and distribution of intracranial hemorrhages in fatal head injury patients.
Aim
This study’s objective is to assess the influence of current road safety initiatives on intracranial bleeding distribution and patterns in fatal head injury cases in Uttar Pradesh.
Methodology
The 604 RTA cases with head injuries that were brought to the mortuary of the S.R.N. Hospital in Prayagraj for a medical-legal postmortem assessment over the course of a year, from April 2021 to March 2022, make up the entirety of this prospective study. Following receiving institutional ethical approval and informed consent, structured interviews with attendees utilizing a questionnaire were done to gather the data.
Result
The results show that certain traffic safety measures have reduced the frequency of fatal head injuries in RTAs. A decreased incidence of intracranial hemorrhages was linked to improved traffic infrastructure, including well-planned junctions, pedestrian crossings, and distinct bicycle lanes. Similar results were shown in serious head injuries when traffic restrictions including speed limits, seat belt use, and helmet legislation were strictly enforced.
Conclusion
There are still issues with fatal brain injuries from car accidents, despite some encouraging results. Safety legislation violations, a lack of public knowledge, and inadequate enforcement all contribute to the issue. Disadvantaged groups like walkers and users on two-wheelers continue to be especially susceptible. The results of this investigation offer important new understandings of the efficiency of traffic safety measures and their influence on the distribution and pattern of cerebral hemorrhages in Uttar Pradesh, India. The results point to the necessity of improved public education efforts and traffic safety laws. More research and focused interventions are required to address specific risk factors among various road user groups. This will result in a safer driving environment and a decline in catastrophic brain injuries.
... Promoting helmet use could significantly reduce TBIs and mortality rates. 23 South Korea has implemented various policies to reduce RTIs, such as mandatory bicycle helmet law and seat belt use for all car occupants (both enacted in 2018), infrastructure improvements, including the instalment of speed cameras and traffic lights in school zones and the development of bicycle lanes and educational programmes. 24 These efforts have decreased serious injuries and deaths on the road, 25 however, the burden of RTIs still remains high. ...
Introduction
Road traffic injuries (RTIs) are the leading cause of mortality among children and adolescents. This study aimed to compare clinical characteristics and identify factors associated with severe RTIs based on types of road users among children and adolescents with RTIs.
Methods
A retrospective multicentre observational study was conducted using the Emergency Department-based Injury In-depth Surveillance registry in South Korea. A total of 78 021 participants younger than 19 years who presented with RTIs to the participating emergency departments from 2011 to 2021 were classified into four groups: passengers, pedestrians, motorcyclists and bicyclists. Demographic and injury-related factors were analysed using a multivariate logistic regression model to determine associations with severe RTIs, as indicated by the Excess Mortality Ratio-based Injury Severity Score of ≥16. The prevalence of traumatic brain injury (TBI), hospitalisations, intensive care unit (ICU) admissions and severe RTIs among road users was compared.
Results
Head injuries were most prevalent in passengers (55.3%), motorcyclists (46.7%) and bicyclists (50.1%). Motorcyclists exhibited the highest proportion of TBI (8.3%), total admissions (28.8%), ICU admissions (8.2%), severe RTIs (41.0%) and mortality (2.0%). Safety devices significantly reduced severe RTIs in passengers and motorcyclists (adjusted OR (95% CI) 0.77 (0.70 to 0.85) and 0.69 (0.62 to 0.76), respectively.
Conclusion
The distinct clinical characteristics and factors associated with severe RTIs among different road user types in children and adolescents highlight the need for targeted interventions. Tailoring strategies to the specific requirements of each group is essential for effectively mitigating the occurrence of severe RTIs in this vulnerable demographic.
... As indicated in the most recent report by the World Health Organization [4], approximately 1.3 million individuals lose their lives annually due to road traffic accidents, with another 20 to 50 million suffering non-fatal injuries, over fifty percent of which involve vulnerable road users. Helmet wearing can significantly reduce the risk of traffic accidents [5], but the wearing rate is generally low, especially in developing countries. ...
Craniocerebral injuries represent the primary cause of fatalities among riders involved in two-wheeler accidents; nevertheless, the prevalence of helmet usage among these riders remains alarmingly low. Consequently, the accurate identification of riders who are wearing safety helmets is of paramount importance. Current detection algorithms exhibit several limitations, including inadequate accuracy, substantial model size, and suboptimal performance in complex environments with small targets. To address these challenges, we propose a novel lightweight detection algorithm, termed GL-YOLOv5, which is an enhancement of the You Only Look Once version 5 (YOLOv5) framework. This model incorporates a Global DualPooling NoReduction Blend Attention (GDPB) module, which optimizes the MobileNetV3 architecture by reducing the number of channels by half and implementing a parallelized channel and spatial attention mechanism without dimensionality reduction. Additionally, it replaces the conventional convolutional layer with a channel shuffle approach to overcome the constraints associated with the Squeeze-and-Excitation (SE) attention module, thereby significantly improving both the efficiency and accuracy of feature extraction and decreasing computational complexity. Furthermore, we have optimized the Variable Normalization and Attention Channel Spatial Partitioning (VNACSP) within the C3 module of YOLOv5, which enhances sensitivity to small targets through the application of a lightweight channel attention mechanism, substituting it for the standard convolution in the necking network. The Parameter-Free Spatial Adaptive Feature Fusion (PSAFF) module is designed to adaptively modify the weights of each spatial position through spatial pooling and activation functions, thereby effectively enhancing the model’s ability to perceive contextual information over distances. Ultimately, GL-YOLOv5 performs remarkably in the custom dataset, achieving a model parameter count of 922,895 M, a computational load of 2.9 GFLOPS, and a mean average precision (mAP) of 92.1%. These advancements significantly improve the model’s detection capabilities and underscore its potential for practical applications.
... Notably, many older adults were involved in crashes while driving motorcycles, which may be related to age-related physical decline. Unlike car drivers, motorcyclists need to stay [8][9][10] and it has been mandatory in Thailand for drivers since 1996 and for passengers since 2007. 11 Some studies suggest that protective clothing can exert such effects, [12][13][14] but it may not be practical in tropical countries. ...
Background
Road safety for older adults should receive more attention in low-income and middle-income countries with rapidly ageing populations.
Methods
Using injury surveillance data from Khon Kaen Regional Hospital in northeastern Thailand, we calculated the proportion of older adults in the total number of patients who were fatally and non-fatally injured in road traffic crashes in each year from 2001 to 2020 and the proportion of road user type in the fatal and non-fatal patients by age groups for the entire study period to examine the extent to which older adults were involved in the crashes and with what mode of transportation.
Results
During the 20-year period, there were 5046 fatal and 180 353 non-fatal patients of whom 509 (10%) and 6087 (3%) were aged 65 years or older, respectively. From 2001 to 2020, this proportion increased from 3% to 20% among the fatal patients and from 1% to 6% among the non-fatal patients. Of the fatal and non-fatal patients aged 65 years or older, 50% and 54% were involved in road traffic crashes while driving motorcycles and 28% and 22% while riding bicycles or walking, respectively. Compared with patients aged 65–74 years, those aged 75 years or older tended to be bicyclists or pedestrians in the crashes, though as high as 40% of them were motorcycle drivers.
Conclusion
Older adults are increasingly injured in road traffic crashes as vulnerable road users in Thailand. Therefore, road safety efforts should consider their presence on the road.
... Two-wheeler accidents are a significant cause of ocular trauma. They are more prevalent in developing than developed countries [1]. ...
BACKGROUND: The objective of this study was to evaluate the role of helmets in providing protection against ocular trauma during road traffic accidents. MATERIAL AND METHODS: We conducted a retrospective comparative observational study on ocular trauma due to road traffic accidents. We collected data from 100 patients. Patients in Group A had 50 cases of road traffic accidents while using helmets, and patients in Group B had 50 cases of road traffic accidents without helmets. The demographics, ocular parameters, type of injury, and severity of injury were compared between the two groups. RESULTS: Among the 100 patients evaluated, 30% had subconjunctival haemorrhage (SCH), among which 90% were not using helmets. Similarly, 21% presented with ecchymosis; among them, 95% were riding without a helmet. 18% presented with a cut lacerated wound, all of whom were not using a helmet. There were 13% of patients with lid tears, and all did not use a helmet. 23% had abrasions: in this subgroup, 82.6% didn’t use helmets (p = 0.000). 2% of patients suffered globe rupture, and neither wore a helmet. CONCLUSION: Road traffic accidents, especially while riding a two-wheeler, are a significant and growing cause of blindness. Helmets and visors are paramount to avoid substantial visual loss in road traffic accidents.
... [20] Helmets have been reported to reduce the risk of head injury by 69% and the risk of death by 42%. [21]In some states in the U.S. that do not have universal helmet laws, 57% of motorcyclists killed in 2019 were not wearing helmets, as compared to 9% in the states with universal helmet laws. [19] Offner et al, [22] Brandt et al, [23] and Keng et al [24] reported that the use of motorcycle helmets has decreased the overall death rate of motorcycle crashes when compared with non-helmeted riders. ...
Background: Road traffic accidents in Nigeria remain the leading cause of head injuries. The use of helmets, seat belts, and car seats for young children has been advocated to reduce the severity of traumatic head injury (TBI) but the implementation of these gadgets is yet to come into full effect. Objectives: We aim to determine the association between the use of safety devices with the Glasgow coma scale (GCS) and Rotterdam CT score in patients with TBI. Materials and Methods: A total of 170 participants with a traumatic brain injury (TBI) were recruited. A quick GCS examination, and a brain computed tomography (CT) scan was done. Results: A total of 137(80.6%) participants had abnormal CT findings while 33(19.4%) had normal CT findings. 58 participants did not use safety helmets and 14 had a Rotterdam score of 1. All 14 participants who used safety helmets had a Rotterdam score of 1. Rotterdam score of 2-3 was seen in 16(27.6%) participants who did not use safety helmets. The Rotterdam score of 4-6 was recorded in 30(31.7%) participants in patients without safety gear. There was a statistically significant correlation between the use of safety devices and the severity of head injury (assessed by GCS and Rotterdam score) in MCRTA and MVRTA (p < 0.001). A greater proportion without safety devices had severe head injuries. Conclusion: With the use of safety devices, the severity of traumatic head injuries was less.
... 25 The effectiveness of wearing a helmet in preventing traumatic brain injury and reducing the severity and mortality of motorcycle injuries is well known. 28 However, in the context of motorcycle traffic collisions, there is currently limited emphasis on equipment or technological advancements aimed at preventing injuries beyond head trauma. On the other hand, in order to prevent injuries in car occupants involved in traffic collisions, the utilization of seat belts and airbags is highly recommended, and it is advised to use age and weight-appropriate restraint systems for infant and small children. ...
Objective
Motorcyclists face a higher risk of severe morbidity and mortality compared to automobile passengers. This study aimed to determine the injury characteristics of motorcyclists according to their body mass index (BMI).
Methods
A retrospective observational cross‐sectional study was conducted using data from the Emergency Department‐based Injury In‐depth Surveillance (EDIIS) registry. Motorcycle riders aged 18 or older who were injured and admitted to study hospitals between 2019 and 2020 were included. Patients were divided into three groups based on BMI cutoffs of 18.5 and 25 kg/m²: the low, optimal, and high BMI groups. The primary outcome was anatomical injury location according to the abbreviated injury scale. The secondary outcomes were the surgery and intensive care unit admission rate, and the 48‐h and 30‐day in‐hospital mortality. Multivariable logistic regression analysis was performed to assess the impact of BMI on outcomes.
Results
Among 1280 patients, the low and high BMI groups had higher risk of abdominal injuries (AIS ≥ 2) than the optimal BMI group, with adjusted odds ratios of 2.82 (95% CI 1.41–5.63) and 1.61 (95% CI 1.17–2.21), respectively. Only the low BMI group had a significant association with severe abdominal injury (AIS ≥ 3), with an adjusted odds ratio of 3.11 (95% CI 1.31–7.39). No significant association was found between BMI and surgery, ICU admission, or mortality.
Conclusion
The low BMI group was more likely to have an abdominal injury (AIS score ≥2 or AIS score ≥3) during motorcycle injuries. BMI was not associated with surgery, ICU admission, or mortality.
... The use of safety helmets is the most effective means to reduce head injuries and other fatal injuries of motorcycle and non-motor vehicle riders [12]. Studies have shown that motorcycle riders who use safety helmets have 69% lower risk of head injury and 42% lower risk of death [13,14]. It is suggested that improving the wearing proportion of helmets of e-bike riders is one of the important intervention measures to prevent and reduce e-bike traffic injuries. ...
Objective
This study aimed to understand the riding behaviors of electric bike (e-bike) users in Hangzhou after the “Regulations of Zhejiang Province on the Administration of Electric Bicycles”.
Methods
The study consisted of two parts, including a questionnaire survey of local e-bike users in Shangcheng District and Jiande County in Hangzhou City, and a cross-sectional observational study of 16 intersections.
Results
A total of 789 e-bike riders participated in the questionnaire survey, and the riding behavior of 99,407 e-bike users was observed. The main purpose of using e-bike was work and daily life, 46.0% of them used e-bikes more than 5 days a week, and 58.5% used e-bikes for less than 30 min each time. A vast majority (81.7%) of e-bike riders believe that the implementation of Zhejiang Regulations has significantly improved the safety level of e-bike riding in the region. The field survey found that the correct rates of helmet wearing by e-bike riders and passengers were 78.83% and 42.27%. The main violations were invalid/non-helmet wearing (21.17%), followed by carrying passengers and running red lights (7.94% and 4.26%). The rates of invalid/non-helmet wearing and running red lights were significantly higher during non-morning rush hour, weekends, and roads without separate non-motorized vehicle lanes than in other conditions (all P < 0.05). Additionally, sunny days and crossroads were risk factors for passenger-carrying and invalid/non-helmet wearing compared to rainy/cloudy days and T-intersections.
Conclusions
The phenomenon that e-bike users' correct practice lags far behind the awareness of various violations has shown some improvement. To further enhance safety measures for e-bike riders, it is necessary to promote education, improve infrastructure, and strengthen law enforcement, in support of the “Zhejiang Regulations” and behavioral interventions.
... Studies found that it can minimise the risk of death to 42-69%. 40 However, 88.3% of our participants reported overtaking frequently, although most of them knew it was dangerous. In comparison, only 44.4% of participants in an Iranian study performed overtaking practice. ...
Introduction
Road traffic injuries (RTIs), particularly motorbike injuries, are one of the leading causes of death worldwide and have been a serious concern in low- and middle-income countries like Bangladesh. Therefore, this study aimed to assess the level of knowledge and practices on road safety measures among motorbikers in Dhaka, Bangladesh.
Methods
This cross-sectional study was conducted from January 2022 to December 2022 among 350 motorbikers of Dhaka city via a series of face-to-face interviews. Motorbikers who regularly ride a motorcycle were interviewed about their road safety knowledge and practices through a two-stage cluster sampling technique. Frequency distribution, independent sample t-test and one-way analysis of variance (ANOVA) were performed in data analysis.
Results
Out of the 350 motorbikers, only 54.6% had good knowledge and 16.9% had poor knowledge on the signs and safety regulations of roads. Moreover, only 50.6% of respondents followed good practices while 23.4% followed poor practices of road safety measures. One-way ANOVA analysis demonstrates that the average knowledge score was significantly (p<0.05) higher among higher-educated, unmarried and non-smokers. Additionally, higher education level, non-smoking status and being Muslim were significantly (p<0.05) associated with good road safety practices.
Conclusions
The overall good knowledge level and practices of road safety measures among the motorbikers was not satisfactory although the majority of them knew individual signs and regulations. Therefore, this study suggests that education and strict enforcement of traffic rules may increase their knowledge and practice behaviour regarding road safety which in turn would minimise traffic injuries and fatalities.
... Numerous studies have shown that using helmet decreases the risk of head injury and death [9,10]. The United States National Highway Traffic Safety Administration has suggested a decline in severe brain injury by 67% [11]. ...
Keywords: Facial Injury; Helmet; Trauma in Saudi; Severe Facial Injury
... Helmets are recommended to prevent severe injuries and wearing helmets for motorbikers is a law in most countries. Studies found that it can minimize the risk of death to 42%-69% [48]. However, 88.3% of our participants reported overtaking frequently, albeit most of them knew it is dangerous. ...
Introduction
Road traffic accidents (RTAs) including motorbike accidents are the leading cause of death for teenagers between 15 and 29 and have been a serious concern in low- and middle-income countries like Bangladesh. Therefore, this study aims to assess the level of knowledge and practice on road safety measures among motorbikers in Bangladesh.
Methods
This cross-sectional study was conducted from January 2022 to December 2022 among 350 motor-bikers of Dhaka, the capital of Bangladesh via a series of face-to-face interviews. Motor bikers who regularly ride a motorcycle were interviewed about their road safety knowledge and practices through two-stage cluster sampling technique. Frequency distribution, independent sample t-test, and One-way ANOVA were performed.
Results
Out of the 350 motorbikers, only 54.6% had good knowledge and 16.9% had poor knowledge on the signs and safety regulations of roads. Moreover, only 50.6% of respondents followed good practices while 23.4% followed poor practices of road safety measures. One way ANOVA analysis demonstrates that the average knowledge score was significantly (p<0.05) higher among higher-educated, unmarried and non-smokers. Additionally, higher education level, non-smoking status and being Muslim were significantly (P<0.05) associated with good road safety practices.
Conclusions
The overall good knowledge level and practices of road safety measures among the motorbikers were not satisfactory albeit the majority of them knew individual signs and regulations. Therefore, this study suggests that education and strict enforcement of traffic rules may increase their knowledge and practice behavior regarding road safety which in turn would minimize traffic injuries and fatalities.
The protective efficacy of helmets may be misconstrued due to shortcomings in crash data collection systems. This paper aims to decipher the reasons behind the “helmet protection paradox,” using Bengaluru, India, as a case study. Official reports indicated that three-fourths of fatal two-wheeler crashes in Bengaluru city involved riders who were wearing helmets, leading to a paradoxical interpretation of the protective efficacy of helmets. Understanding helmet use patterns in the source population and crash data systems is key to resolving this paradox. Our findings suggest that the paradox arises from a combination of a high prevalence of non-standard helmet use in Bengaluru and shortcomings in recording the “type of helmet use” in data systems. It is recommended that existing crash and fatality data systems capture information regarding the “type of helmet use” to prevent erroneous interpretations of the protective efficacy of helmets.
Objectives:
Motorcycle helmets save lives and reduce serious injury after motorcycle collisions (MCC). In 2022, 18 states had laws requiring helmet use by motorcyclists aged ≥21 years. Our objective was to compare helmet use and head trauma in emergency medical services (EMS) patients involved in MCC in states with and without helmet use laws.
Methods:
We conducted an analysis of the 2022 ImageTrend Collaborate national EMS dataset. We included 9-1-1 responses where the patient was a motorcyclist in a transport accident (ICD-10 V20-V29) and aged ≥21 years. Patient demographics, incident urbanicity, helmet use, presence of state helmet use law, patient disposition, Glasgow Coma Scale (GCS) score, and trauma team activations were examined. Our primary outcome of interest was EMS documentation of helmet use (yes/no). Our secondary outcome was the presence of a head injury. We examined EMS-documented head injury, defined using clinician impressions and chief complaint anatomical location. Chi-square tests were used to assess differences in proportions, and a multivariable logistic regression model was used to estimate odds of moderate/severe head injury adjusted for covariates of interest.
Results:
A total of 15,891 patient encounters were included, 10,738 (67.6%) occurred in states without helmet use laws. States without helmet use laws had higher proportions of unhelmeted patients (56.8% vs 24.2%, p < 0.001), encounters in non-metro/rural areas (19.7% vs 13.3%, p < 0.001), and GCS-defined moderate/severe head injuries (4.6% vs 2.3%, p < 0.001). In a multivariable model that included 10-yr age groups, sex, race, urbanicity, and documented helmet use, the adjusted odds of moderate/severe head injury were lower for females (0.47, 95%CI, 0.35-0.65) and Black patients (0.47, 95%CI 0.32-0.70), and were higher for incidents in nonmetro/rural areas (1.58, 95%CI 1.28-1.95) and when EMS had not documented helmet use (3.17, 95%CI 2.56-3.92).
Conclusions:
In this retrospective cross-sectional study, a higher proportion of patients involved in MCCs in states without helmet laws were not wearing helmets at the time of injury, and unhelemted patients had increased likelihood of sustaining a head injury. Emergency medical services agencies in states without helmet laws should prepare their systems and clinicians for an increased incidence of head injuries after MCCs.
Bu çalışmanın amacı 2018-2022 yılları arasında motosiklet, bisiklet ve scooter kazaları sonrası acil servise başvuran ve ekstremite yaralanması saptanan hastaların klinik özelliklerinin değerlendirilmesidir. 01.10.2018 - 31.10.2022 tarihleri arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Acil Servisine motosiklet, bisiklet ve scooter kazası nedeniyle başvuran olguların kayıtları retrospektif olarak incelenmiştir. Acil servise başvuran 1204 motosiklet, 573 bisiklet ve 123 scooter olmak üzere toplam 1900 trafik kazası olgusu çalışmaya alındı. Olguların %87,7’si erkekti ve yaş ortalaması 27,9±11,4 yıldı. Kazaların en sık (%40,7) yaz aylarında ve mesai sonrası saatler olan 17:00–00:00 arasında (%40,8) meydana geldiği görüldü. Olguların %13,5’inde üst ekstremite, %10,6’sında alt ekstremite fraktürü saptandı. Üst ekstremitede en sık fraktür saptanan kemikler sırasıyla; radius (%4,2), humerus (%2,1) ve klavikula (%2,1) iken, en sık alt ekstremite fraktürü saptanan kemikler tibia (%4,1), fibula (%2,7) ve metatarsal kemikler (%1,9) idi. Olguların %81,4’ü taburcu olurken, %3,2’si yoğun bakım ünitesi (YBÜ)’ne yatırıldı ve %0,4’ü ise eksitus oldu. Çok değişkenli lojistik regresyon analizi sonuçlarına göre; herhangi bir alt ekstremite kemiğinde fraktür varlığı (OR: 2,250 [%95 GA: 1,211 - 4,180], p= 0,012) ve konsültasyon istenmesi (OR: 2,004 [%95 GA: 1,180 - 3,404], p= 0,011) diğer değişkenlerden bağımsız olarak YBÜ’ne yatış/eksitus ile ilişki saptandı.Alt ekstremite kemiklerinde fraktür saptanan ve herhangi bir nedenle konsültasyon istenen olgular arasında yoğun bakım ünitesine yatış/ eksitus riski daha yüksekti. Bu risk faktörlerine sahip olgularda, daha hızlı planlama ve uygun müdahelenin erken dönemde yapılması ile morbidite ve mortalite oranları azaltmada yardımcı olabilir.
Road transportation has become increasingly lethal, highlighting a need for swift implementation and road safety measures and enhanced study to develop more effective safety strategies. All factors related to the road environment, including road design, human behaviour, and vehicle characteristics, should be thoroughly inspected to more accurately and precisely understand their involvement in road accidents. Currently, the state of road-related legislation, databases, and technologies in Nepal is poor compared to other countries. The road safety bill has been pending since 2017, leaving the National Road Safety Council (NRSC) without clear ownership and resources. Developing countries like Nepal tend to prioritize infrastructure development over the management of resources for road safety audits. Prioritizing the introduction of effective road safety policies is critical, as further delays will result in preventable loss of human life and significant monetary costs. Nepal’s challenging terrain and low-income status make it difficult to design, construct, operate and maintain roads to the highest standards. However, with the availability of more affordable hardware and advanced software, there should be a clear focus on utilizing these tools to improve road safety and address these challenges. The development of the Kathmandu-Terai Fast Track brings with it a significant responsibility to maintain road safety.
Non-inflatable chest protector is a passive safety device to protect powered two-wheeler (PTW) riders from thorax injuries. Before being put on the market, the protectors should be qualified for the European standard tests EN1621-3:2018 which remains uncertain regarding the impact energy level, force evaluation thresholds, and impact configurations. This study aims to ascertain whether the standard EN1621-3:2018 ensures adequate chest protection for PTW riders. Thus, three generic protectors were created to qualify for standard tests and then evaluated against rider chest impact scenarios by finite element modelling. Bar-to-rider and rider-to-bar virtual impacts were simulated with a range of impact energy 50 ∼ 1563 J. In virtual standard tests, protector 1 had the lowest impact force, followed by protectors 2 and 3. In chest impact analysis, the rider with or without protector was rarely found injured under the testing standard energy level (50 J). The chest impact force was below the standard force threshold of 24 kN under all impact energy levels. Protector 3 had a generally better protection performance in terms of chest deflection than protectors 1 and 2, which were not consistent with the standard testing results. The rider chest responses in bar-to-rider impacts differed significantly from the responses in bar-to-rider impacts. Therefore, future testing standard might introduce more appropriate impact energy, force thresholds and accident-relevant impact configurations to ensure the device’s effectiveness in providing protection during PTW crashes. This study furnishes valuable insights into enhancing the design and evaluation methodologies of protective gear, thus directly contributing to the advancement of PTW rider safety.
Background and Objective. Motorbikes are a popular mode of transportation in developing nations, especially in places where public transportation is not easily accessible. This research aims to investigate the prevalence of road traffic crashes (RTCs) among motorcyclists in Noakhali, Bangladesh, and to identify the factors that play a role in these crashes. Methods. A cross-sectional survey was conducted using a structured questionnaire involving 402 motorcyclists from four major southeastern towns, comprising 350 (86.07%) males and 52 (12.93%) females. The chi-square test was applied in bivariate analysis, and binary multivariable logistic regression was performed to determine the risk factors of road traffic crashes. Results. This study’s findings revealed that the overall reported prevalence of road traffic crashes involving motorcycle drivers over one year was 68.66%. Multivariable logistic regression analysis revealed several factors that significantly impacted road traffic crashes. These factors included driving without a valid driving license, the young age (<20) of motorcyclists, driving in rainy weather, exceeding the speed limit, per-week working hours, smoking status, motorcycle ownership, the brand of motorcycle, and not wearing a helmet while driving. Conclusion. The study findings highlight the need for improving motorcycle safety by implementing measures such as imposing per-week work hour limits for riders, enforcing traffic regulations, and promoting helmet use among motorcycle drivers. The results of this study draw attention to the Bangladesh Road Transport Authority (BRTA) and motorcycle drivers in the country to decrease motorcycle crashes and the severity of injuries by implementing efficient guidelines and strategies for driving motorcycles. The findings of this study can assist policymakers and concerned authorities in taking the essential steps to lessen road traffic crashes among motorcyclists in Bangladesh.
Bu çalışma kapsamında Dünya Sağlık Örgütü tarafından belirlenmiş olan beş farklı yol kullanıcı davranışına (hız yapma davranışı, alkollü araç kullanımı, emniyet kemeri kullanımı, çocuk koruma sistemleri kullanımı ve motosiklet kaskı kullanımı) yönelik trafik kurallarının caydırıcı etkileri Skinner’ın (1953) Edimsel Koşullanma Kuramı bağlamında incelenmiştir. Edimsel Koşullanmanın pekiştirme ve ceza bileşenlerini içeren caydırıcı kuralların, sürücüler tarafından nasıl algılandığını anlamak için nitel araştırma yapılmıştır. Araştırmada, ehliyet sahibi ve aktif araç kullanan 31 katılımcıdan yarı yapılandırılmış görüşmelerle veri toplanmıştır. Ardından edimsel koşullanma bileşenlerinin her biri için hazırlanan çoktan seçmeli sorularla en sık tercih edilen yöntem incelenmiştir. Bununla birlikte, yarı yapılandırılmış görüşmelerin pekiştirme ve ceza bileşenleri kapsamında temel başlıklarını belirlemek amacıyla içerik analizi uygulanmıştır. Sürücülerin en sık rapor ettiği ehliyet kaybetme düşüncesi, edimsel koşullanma bağlamında olumsuz cezanın en caydırıcı yöntem olduğu sonucunu vermiştir. İçerik analizi sonuçlarına göre “caydırıcı yaptırım uygulamaları” ve “sistem uygulamaları” adlı iki ana grup oluşmuştur. Araştırmada katılımcılara genel olarak trafik kurallarına neden uyulmadığına dair sorular yöneltilip cevaplar beklenmiştir. Elde edilen sonuçlar kapsamında caydırıcılığı en yüksek olan yaptırımın “ehliyete el konulması” olduğu ve bu yaptırımın sürücülerin günlük hayatını etkileyeceği yönünde bulgulara ulaşılmıştır. Dolayısıyla, ehliyet kaybetme algısının sürücülere daha fazla benimsetilmesi amacıyla denetimlerin sıklığının ve niteliklerinin arttırılmasının caydırıcılığı da arttıracağı ön görülmektedir.
OBJECTIVES
One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED).
METHODS
This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1.
RESULTS
A total of 180 patient’s data were included for final analysis. The median (interquartile range) age of the patients was 32 (24–45) years. The majority were males ( n = 147 [81.6%]) with a male–female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury ( n = 122 [67.7%]). Unilateral eye involvement was the most common ( n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva ( n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases ( n = 125 [69.4%]) with a visual acuity of > 6/18. The majority ( n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 ( n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions.
CONCLUSION
OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.
Introduction
The majority of trauma-related deaths occur in low- and middle-income countries; however, limited data exists in these settings related to injury types and severity. The prevalence of trauma similar to our setting was less estimated. This study aimed to find the prevalence of traumatic injury among patients presented to the department of emergency medicine of a tertiary care centre.
Methods
This is a descriptive cross-sectional study conducted among patients presented to the Department of Emergency Medicine from 15 September 2021 to 14 September 2022. Ethical approval was taken from the Institutional Review Committee. World Health Organization trauma minimum data set, injury mechanism, types and patient disposition data were collected and injury severity scores were calculated. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.
Results
Among 47,825 patients, 1,524 (3.19%) (3.03-3.34, 95% Confidence Interval) patients presented with a traumatic injury. A total of 967 (63.45%) were males and had a median age of 30 years (Interquartile range: 25). Most injuries were caused by falls 650 (42.65%), followed by road traffic accidents 411 (26.97%). A majority had minor Injury Severity Scores 1280 (83.99%).
Conclusions
The prevalence of traumatic injury among patients presenting to emergency was found to be lower than other studies done in similar settings.
El libro 58 de “Gestión del Conocimiento. Perspectiva Multidisciplinaria” de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones.
The human head is most vulnerable to injury during activities such as road traffic and sports. To mitigate the risk of traumatic brain injury (TBI), helmets serve as an important protective device. This study proposes a hedgehog biomimetic helmet with auxetic lattice liners in the shape of a hemisphere. The helmeted head impact configuration is built based on a high bio-fidelity head-neck finite element model incorporated into our novel helmet model. Biomechanical responses including acceleration, intracranial pressure, and von Mises strain of head are extracted from the simulation model to assess TBI risks. The results indicate that the helmet featuring auxetic lattice liners outperforms those without liners or with other liner designs, offering superior protection. Compared to the threshold, the novel helmet design was found to reduce the head injury criterion value by 72.65%. Additionally, parametric studies of lattice’s bar radius for uniform and graded auxetic lattice liners are discussed. Finally, this study also carries out the optimization design of lattice strut radius and height, resulting in a lightweight auxetic lattice liner with superior protective performance. The outcomes of this study extend the application of auxetic materials and provide guidance for designing helmet liners that better mitigate TBI.
Introduction:
Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders.
Methods:
Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach.
Results:
Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though "safety" was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers.
Conclusion:
Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan.
Introduction:
motorcycle injuries comprise considerable morbidity, disability and mortality of road traffic casualties. The study aimed to assess the pattern and characteristics of motorcycle crash injuries that sought care at the Emergency Departments in Tier III hospitals in Kisumu City during a six-month period from May to November 2019.
Methods:
this was a cross-sectional study of all motorcycle injury patients presenting to three tier III public and private hospitals in Kisumu City. Using a structured questionnaire, data were collected on human and injury characteristics. Multiple logistic regression model was used to determine the predictors of fatality. Statistical significance was set at p<0.05.
Results:
a total of 1073 of motorcycle crash injury patients sought and obtained care at the hospitals. The majority (73.6%) were males. Seventy-three cases resulted in death (case-fatality rate of 6.80%. The age range was 2-84 years, with a mean of 29.6 years (± SD 12.19). Majority, (43.3%) were aged 21-30 years. Most of the crashes occurred during the daytime (79.1%). Of all motorcycle riders and pillion passengers 30.6% wore helmets at the time of the crash. Head injuries (43.6%) were the most common. Injury seventy scores (ISS) ranged from 1 to 51. Glasgow comma scale <3, un-helmeted patients and major trauma (ISS > 16), significantly influenced mortality (P< 0.001).
Conclusion:
these findings confirmed and strengthened the documented substantial morbidity, mortality that motorcycle crashes place on individuals and society, contribute to the body of literature on motorcycle injuries and potentially assist in policy decisions on motorcycle transport safety.
To determine the effects of motorcycle helmet use on the outcome of patients admitted to a Level I trauma center, we studied patient outcomes and demographic and epidemiologic variables of 474 patients injured in motorcycle collisions and treated at such a center over a 45-month period. Of those involved in a motorcycle collision, 50% were not wearing a helmet, 23% were wearing a helmet, and in 27% helmet use was unknown. Those who were wearing a helmet had fewer and less severe head and facial injuries, required fewer days on a ventilator, and sustained no serious neck injuries; fewer patients who wore helmets were discharged with disability, and hospital charges were lower. These data support the need for both increased public education regarding helmet use and mandatory helmet use legislation.
A total of 1,351 victims of motorcycle accidents, brought to one of 15 hospitals responsible for emergency care in Taipei, Taiwan, between August 1 and October 15, 1990, were enrolled in a case-control study to investigate the effectiveness of different types of helmets for the prevention of head injuries. A total of 562 of those with head injuries were assigned to the case group, while the remaining 789 victims without head injuries were considered as emergency room controls. The case group was subdivided into daytime and evening cases, according to the time of accident. For each daytime case, we took four pictures of passing motorcycles at the same time and place during the week after each accident. Of the 254 daytime cases, we successfully took pictures for 224 (88%) and identified 1,094 motorcycle riders in the pictures as street controls. Logistic regression analyses were used to determine the roles of the following variables in predicting risk of head injury: age, sex, riding position, weather, place of accident, helmet type, and motorcycle type, and status of helmet wearing. The relative risk of head injury among motorcycle riders was significantly reduced by wearing a full-face helmet, but not by wearing a full- or a partial-coverage helmet.
This article evaluates the effectiveness of motorcycle helmets in accident situations. A latent variable model is developed and estimated. It is concluded that (1) motorcycle helmets have no statistically significant effect on the probability of fatality; (2) helmets reduce the severity of head injuries; and (3) past a critical impact speed, helmets increase the severity of neck injuries. Further analysis establishes the qualitative and quantitative nature of the head-neck injury trade-off.
Motorcycle accidents are still a dominant public health problem. Victims of motorcycle accidents often suffer from head injury. Secondary injury protection with motorcycle helmets coupled with helmet use law enforcement will mitigate the severity of head injury. A prospective study was done on patients with motorcycle accidents in the Hadyai Municipality who attended at the emergency rooms of Songklanagarind Hospital and Hadyai General Hospital. General demographic data, whether the patients were wearing a helmet or not at the time of the crash, and the incidence and severity of the head injury were collected. Five hundred and eight-five patients with motorcycle accidents were studied. 75% of cases were between 20 and 40 years of age. The incidence of helmet use was 38.6%. Head injury occurred in 6.2% of cases with most being in the nonhelmet group. Helmet use could have prevented head and neck injury significantly (OR 0.39, 95% CI: 0.16-0.88) It is concluded that in Thailand, helmet use has not increased to a satisfactory level. The beneficial effects of motorcycle helmets can be demonstrated in this study.
In 1976, the helmet was made mandatory in Belgium for motorcycle riders with machines under 50cc. This case study is based on 284 road casualties with such vehicles: 97 were wearing a protective helmet and 187 were riding without helmet. Our method of categorizing and classifying injuries is drawn from the Abbreviated Injury Scale of J.D. States and D.F. Huelke. There were fewer minor and moderate injuries in cases where the helmet was worn. When riders of light motorcycles were not wearing a helmet, 17% had serious injuries, but they survived with either moderate or even total work incapacity. The serious injuries and sequelae in the case of three drivers wearing a helmet (3.9%) were due to cervical cord lesions. Eighteen patients not wearing a helmet (9.6%) were killed following very serious injuries to the central nervous system; 17.8% survived with moderate sequelae or complete work incapacity. By contrast with these data, we note that riders wearing a helmet suffered serious injuries to the central nervous system in only 3.9% of the cases, and we have to note only 1% of fatalities in this group.
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.
BACKGROUND: This paper describes a study on the epidemiology of accidents among users of two-wheeled motor vehicles in two Italian cities, Rome and Naples. METHODS: A surveillance study was conducted, recruiting the victims of accidents among users of two-wheeled motor vehicles, visiting the emergency departments of two Italian hospitals. The registration form includes personal data of the involved person, circumstances of the accident, means of arrival at the hospital, type of vehicles involved, helmet use, and eventually third parties involved, and data on the specific injury diagnosis. RESULTS: 736 injured drivers of two-wheeled motor vehicles were investigated for the study (65.1% males, 34.9% females). The mean age of the victims was 22.92 years; 42.9% of the injuries were the result of a single accident. In 35.5% of the injuries cars were involved and in 8.6% of the cases there was a passenger included. Only 12% of the injured people were wearing a helmet. Most of the lesions concerns the knee or lower leg (27.5%), followed by the head (17.5%), elbow and forearm (8.8%), wrist and hand (8.6%), shoulder and upper arm (8.4%) and ankle and foot (6.9%). Helmet use has a protective effect (OR = 0.23), whereas accidents in Naples and during dark hours are associated with an increased risk of head injury (respectively OR = 1.93, and OR = 1.46). CONCLUSION: In this study the lower injury risk due to the use of the helmet on the frequency and severity of head trauma was confirmed. Moreover, the results confirm that Emergency Departments can provide essential epidemiological information, and they have already provided clear arguments in favour of extending the compulsory use of helmets to people above 18 years in Italy.
Information on injuries, rider, crash and vehicle characteristics were obtained for 174 fatally injured and 379 nonfatally injured motorcyclists in Los Angeles County, California in 1988-1989. Helmet use was 25 percent among fatally injured riders and 32 percent in the nonfatally injured group. In both samples, not using helmets was associated with greater likelihood and greater severity of head injury, youthful age, Hispanic ethnicity, alcohol use, not owning the motorcycle or having vehicle liability insurance, and not being licensed to operate a motorcycle. This profile suggests that those not using helmets when helmet use is voluntary are a higher risk group than helmet users, and thus more in need of the protection helmets provide. Helmet use laws, which characteristically increase use rates to close to 100 percent, are an effective way to reduce their injuries.
The motorcycle helmet effectiveness study conducted by J. P. Goldstein (1986) suggests that there exists a possible "trade-off" between head and neck injuries for a potential helmet user. Some groups have cited this study and have suggested that the current status of the mandatory helmet usage law in Alberta be reviewed. In this article, methodology and results of Goldstein's study are presented and evaluated, and evidence from other studies is presented. Due to methodological weaknesses in Goldstein's study, its results cannot be relied upon for policy formulation, particularly the repeal ofmandatory helmet legislation. Evidence from other studies provides no conclusive evidence of the trade-off between head and neck injuries for a motorcyclist wearing a helmet. The review of other studies indicates that helmets protect motorcycle riders from both head and neck injuries and that the risk of being killed is much higher jor helmetless riders. Perhaps, through helmet restraining collars or use of lighter helmets, both head and neck injuries can be further minimized.
A group of 220 motorcycle accidents from Utah are categorized according to head injury severity and stepwise discriminant analysis is applied to the resulting groups. It is concluded from this analysis that speed is the most important factor related to head injury severity in motorcycle crashes. Of the total of 9 variables which are needed to differentiate among the groups, 4 are direct or indirect measures of speed, 2 are not explained, 2 are measures of impact severity, and 1 is a measure of impact surface.
Helmets are effective in decreasing maxillofacial trauma in motorcycle crashes. The impact, however, of motorcycle crashes on the location and patterns of craniofacial injuries among helmeted versus unhelmeted patients has not been examined. In the present study, 331 injured motorcyclists were evaluated to compare the incidence of craniofacial and spinal injury in 77 (23%) helmeted and 254 (77%) nonhelmeted patients. Nonhelmeted motorcyclists were three times more likely to suffer facial fractures (5.2% vs. 16.1%) than those wearing helmets (p < 0.01). Skull fracture occurred in only one helmeted patient (1.2%), compared with 36 (12.3%) of nonhelmeted patients (p less than or equal to 0.01). The incidence of spinal injury was not significantly different between the two groups. Blood alcohol levels demonstrated that 12% of the helmeted group were legally intoxicated (blood alcohol level > 100 mg/dL), in contrast to 37.9% of the nonhelmeted motorcyclists (p less than or equal to 0.01). Failure to wear a helmet resulted in a significantly higher incidence of craniofacial injury among patients involved in motorcycle crashes, but did not. affect spinal injury or mortality. Alcohol usage seemed to correlate with failure to use helmets. Helmet use should be legally mandated on a national level for ah motorcyclists.
A review of US mortality data from 1979 to 1986 identified 15 194 deaths and nearly 600 000 years of potential life lost before age 65 years that were associated with head injuries from motorcycle crashes. White males from 15 to 34 years of age accounted for 69% of the deaths. The rate of motorcycle-related deaths associated with head injury declined modestly between 1979 and 1986 (19% using rates based on resident population and 8% based on motorcycle registrations). Population-based rates adjusted for age, sex, and race in states with partial or no motorcycle helmet—use laws were almost twice those in states with comprehensive helmet-use laws. Two states that weakened their helmet-use laws from comprehensive to partial during the study period had increases in motorcycle-related head injury death rates (184% and 73%), and one state that strengthened its law from partial to comprehensive had a decline in its death rate (44%). Head injury death rates based on motorcycle registrations were also lowest in states with comprehensive helmet-use laws. Since helmets reduce the severity of nonfatal head injuries in addition to lowering the rate of fatal injuries, we urge the adoption and enforcement of comprehensive motorcycle helmet—use legislation.
(JAMA. 1990;264:2395-2399)
In 1976 the U.S. Congress removed the threat of withdrawal of certain highway funds from states that failed to enact motorcycle helmet laws. Since then over half the states have either repealed or weakened these laws. Most researchers in the field agree that this has lead to a significant increase in injuries and fatalities among motorcyclists involved in accidents. Potential limitations of many of the studies on which these conclusions are based include the facts that fatalities can result from injuries to parts of the body not protected by helmets and that other factors, such as speed and alcohol use, are not taken into account, usually due to lack of data. The former will result in a loss of power and the latter in the introduction of bias. In this article I model the level of head injury rather than the fatality rate and build a multivariate model that includes the other factors. The basic model is an ordered probit model with heteroscedasticity in the errors. The adequacy of the model is tested by Lagrange multiplier and goodness-of-fit tests. The former include tests for the normality of the errors and the specification of the regressors. Predictions from the model include that helmets lead to a 42% increase in the number of riders with no head injury and a $1,700 per rider decrease in the direct medical cost of treating the riders.
This article evaluates the effectiveness of motorcycle helmets in accident situations. A latent variable model is developed and estimated. It is concluded that (1) motorcycle helmets have no statistically significant effect on the probability of fatality; (2) helmets reduce the severity of head injuries; and (3) past a critical impact speed, helmets increase the severity of neck injuries. Further analysis establishes the qualitative and quantitative nature of the head-neck injury trade-off.
In 1979, Yeo (1979a,b) reported a lower likelihood of damage to the cord of the cervical spine (cervical spinal cord injury, or cervical SCI) for wearers of full-face helmets compared with open-face helmets among motorcyclists that had sustained a head impact. However, it appears that the study suffered from factors biasing the results away from the null hypothesis. The present study suggests that there may be no added benefit or harm of the full-face helmet relative to the open-face helmet on cervical SCI.
Motorcycle injuries are a major cause of morbidity and mortality, particularly among adolescents and young adults. The authors linked data from two different sources, the Fatal Accident Reporting System and the Multiple Cause of Death (death certificate) file, describing all motorcyclist fatalities in California in 1987 and 1988. The utility of this linkage was compromised by inadequate reporting of helmet use and by the high proportion (40%) of death certificates that listed no specific injury types. Nonetheless, these data confirmed that helmet use protects against head injury. Several personal and environmental characteristics, including seating position and speed limit, were associated with the probability of helmet use.
(C) Williams & Wilkins 1991. All Rights Reserved.
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.
It has been established that seat belt use by car occupants and helmet use by motorcycle riders substantially reduces the risk of serious and fatal injuries following accidents. No study, however, has evaluated the motor vehicle deaths that could be prevented in Greece by general use of these devices, even though this country has the highest mortality from motor vehicle accidents in the European Union. We have estimated the odds ratios (OR) for death rather than injury in a motor vehicle accident by seat belt use among occupants of passenger cars or helmet use among motorcycle riders, using a nationwide database in which persons killed or injured in road traffic accidents in 1985 and 1994 were recorded. The study base included 910 dead and 19511 injured persons for 1985 and 1203 dead and 22186 injured persons for 1994. The OR and 95% confidence intervals (CI) for death rather than injury was 0.69 (CI: 0.58 to 0.81, p < 10−1) for seat belt users versus non-users and 0.64 (CI: 0.51 to 0.81; p < 10−3) for helmet users versus non-users. There was evidence that the protective effect of these passive safety devices increased from 1985 to 1994 probably reflecting technological improvements. The proportion of all deaths that could have been avoided if all car occupants used seat belts was estimated to 27%, whereas 38% of motorcycle deaths could have been avoided if all motorcycle riders used helmets. These proportions translate to about 500 deaths per year, mostly deaths among young men.
Thesis (Ph. D.)--University of California, Los Angeles, 1996. Typescript (photocopy). Vita. Includes bibliographical references.
Mopeds were legalized for use in New York State on December 1, 1976. A significant increase in cycle accidents is expected because moped users will represent a new group of inexperienced cycle users. The RAI (research accident investigation) team of the Department of Orthopedics at the University of Rochester School of Medicine and Dentistry, under contract from the State of New York Department of Motor Vehicles, is investigating cycle accidents beginning in 1976. The area covered by the investigation is Monroe (Rochester), Wayne, and Ontario counties; three contiguous Upstate counties which statistically are microcosmic of New York State excluding New York City. Injury data is obtained from area hospitals and is combined with police accident reports and in-depth studies by RAI investigators. Data from 1976 and the first part of 1977 indicate that mopeds are becoming involved in cycle injury accidents. Injury patterns reveal that head and lower extremity injuries are the most common serious injury. Helmets are protective of the head but do not affect the incidence or severity of neck injuries. Motorcycle, minibike, and moped accidents are far more injury-producing than closed vehicle accidents. Cycle accidents are the most common causes of serious lower extremity injuries in some hospitals. Mopeds have become extremely popular vehicles in their usage, and accident involvement is expected to increase rapidly in the next few years.
The risk of fatal or non fatal injury is a 110% higher for riders of motorcycles generally than for car drivers. Especially for the larger motorcycles the risk of death is 6 times and the risk of injury is 5 times higher than for cars, while to ride a moped or motorized bicycle is less dangerous. The number of killed or injured 16-25 yr old adolescents in the FRG is running up to alarming 61%. From 1968-1974, 467 motorcycles riders were treated as in patients. The 16-25 yr olds represented 64% of all motorcycle patients with increasing tendency. The most important injuries were head injuries in 50% and fractures of the extremities in 59%. The relation of arm to leg injury is 1:2. The dangerous lesions increased from 39% in 1968 to 46% in 1974. 8% of our patients died. All of them had head injuries that could be accused as the cause of death in 82%. A prospective study of 124 patients tried to give an insight into several special questions concerning: type of motorcycle, circumstances of trauma, driving experience and the amount of personal protection including helmets and clothing. The larger the motorcycle the more frequently it is used for hobby. 46% of the accidents happened in urban areas. 82% of the drivers had their licence or owned their motorcycle less than 6 mth. Researching the amount and effectiveness of protective measures used by drivers the following most interesting facts were seen. From 124 drivers, 73=59% had no helmets and 68.5% had no protective clothes. The severity of injury is independent of the speed at the time of accident. Severe injuries and head injuries happen most frequently in patients with motorized bicycles. Protective measures are used most by drivers of large motorcycles and never by riders of motorized bicycles. The users of helmets substain head injuries in 45% and the unprotected in 60%. The use of helmets diminishes the severe head injury from 41% to 21.8%. Severe injuries are diminished by the use of protective clothes from 52.9 to 28.1%. This investigation shows the necessity of protective helmets and clothes for all motorized two wheeled vehicles that should be legally instituted.
The design of motor cycle helmets has been changing over the years and at the present time there are two basic types in popular use: "full-face" and "jet" helmets. Both helmet types give good protection to the brain, but, one would think, different degrees of facial protection. A special study of traffic crashes has indicated that full-face helmets provide significantly greater protection against facial injury than do jet helmets. The study also indicated that the wearers of full-face helmets have no greater risk of involvement in road traffic crashes than do the wearers of jet helemts. It is suggested that the use of full-face helmets should be encouraged and consideration given to the revision of helmet standards to require the provision of facial protection.
Male drivers sustained relatively more serious motorcycle collision injuries than did male passengers, female drivers, or female passengers. For male drivers, severity of injury was related to age. The relative frequency of serious head injury was highest for drivers not wearing helmets who were involved in collisions at low or high speeds. Severity of injury was related to speed at the time of collision but not in all types of collisions. Factors associated with the incidence of collisions were not identical to those related to the severity of the injury sustained.
To provide a population-based injury and cost profile for motorcycle injury in Connecticut.
Population-based retrospective epidemiologic review of Connecticut death certificates, hospital discharge data, and police accident reports.
Connecticut death certificates identified 112 deaths from motorcycle injuries for an annual death rate of 1.2 per 100,000 persons. Death rates were highest among 20- to 24-year-old men. Nonhelmeted motorcyclists were 3.4-fold more likely to die than were helmeted riders (P less than .05). An estimated 2,361 motorcycle-related hospital discharges resulted in an annual hospitalization rate of 24.7 per 100,000 persons. Head, neck, and spinal injuries accounted for 22% of all injuries. Total costs exceeded 5.1 million. These data are crucial in advocating re-enactment of motorcycle helmet laws.
A comprehensive study was conducted of all motorcycle traffic crashes occurring in Maryland during a one-year period. All available medical and cost data were linked with police crash reports. During the study period, 1,900 motorcycle drivers were involved in crashes. The data indicated that (i) helmet usage was 35% overall, 30% among fatally injured drivers, and only 16% among drivers with a history of drug/alcohol conviction, (ii) unhelmeted drivers seen at an emergency department were almost twice as likely to have sustained head injury (40%) as were helmeted drivers (21%) (the corresponding percentages for hospitalized drivers were 55% and 38%), and (iii) acute care cost for unhelmeted drivers was three times ($30,365) that of helmeted drivers.
To determine the effect of the use of a motorcycle helmet on reducing the mortality, morbidity, and health care costs resulting from motorcycle crashes.
A prospective, multicenter study of all eligible motorcycle crash victims.
The emergency departments of eight medical centers across the state of Illinois, including representatives from urban, rural, teaching, and community facilities.
All motorcycle crash victims presenting less than 24 hours after injury for whom helmet information was known. Data were collected from April 1 through October 31, 1988.
Fifty-eight of 398 patients (14.6%) were helmeted, and 340 (85.4%) were not. The nonhelmeted patients had higher Injury Severity Scores (11.9 vs 7.02), sustained head/neck injuries more frequently (41.7 vs 24.1%), and had lower Glasgow Coma Scores (13.73 vs 14.51). Twenty-five of the 26 fatalities were nonhelmeted patients. By logistic regression, the lack of helmet use was found to be a major risk factor for increased severity of injury. A 23% increase in health care costs was demonstrated for nonhelmeted patients (average charges 5,852).
Helmet use may reduce the overall severity of injury and the incidence of head injuries resulting from motorcycle crashes. A trend toward higher health care costs was demonstrated in the nonhelmeted patients.
Since 1975, 26 states have repealed or modified their motorcycle (M/C) helmet laws. Louisiana (LA) reinstated the M/C helmet law in 1982. The medical and financial impact of repeal in Kansas (KS), reinstatement in LA (accident, fatality, and critical injury rates) have been studied through 1987. Current FARS data and studies from KS, LA, 10 states and 5 countries are compared and reported. Without M/C helmet legislation, the user rate drops from 99% to 50%. With reinstatement, the user rate rises to >95%. Average hospital stay (days) for helmeted (H) riders is 5.8, non-helmeted (NH), 11.8. Fatality rate/1, 000 M/C registrations is 6.2 NH, 1.6 H. Changes effected through M/C helmet legislation: fatality rate was 1.17 (1981), falling to 0.44 (1987) with legislation (62% decrease) (LA); 66% change Colorado, 42% Oklahoma; fatality rate/1, 000 accidents changed 28% from 42.68 NH to 30.81 H; injury accidents 84% to 73%, critical injury reduction 44% (1981 to 1987). Risk of head injury: NH 2.07>H. Risk of a fatal accident: NH 1.44>H. Accident rate is less with M/C helmet legislation than without (19% KS, 48% LA). The medical costs (LA 1981 to 1987) decreased 48.8%. Length of stay decreased 37%. The major impact hospital stay >20 days: 80% decline. Cost of long-term disability >30 days: 81.2% decrease (LA). Average disability was 26.7 vs. 51.1 days (KS); 25.5 H required hospitalization per 100 accidents vs. 41.6 NH. Medical costs: NH 306%>H (KS). Based on 1989 dollars, 4.9 billion was absorbed by the public in the form of increased taxation, higher insurance costs, and lost taxes. M/C helmet legislation decreases medical costs. In this era of spiraling health care costs, legislation mandating the use of protective helmets should be considered as a viable alternative to raising taxes.
A review of US mortality data from 1979 to 1986 identified 15,194 deaths and nearly 600,000 years of potential life lost before age 65 years that were associated with head injuries from motorcycle crashes. White males from 15 to 34 years of age accounted for 69% of the deaths. The rate of motorcycle-related deaths associated with head injury declined modestly between 1979 and 1986 (19% using rates based on resident population and 8% based on motorcycle registrations). Population-based rates adjusted for age, sex, and race in states with partial or no motorcycle helmet-use laws were almost twice those in states with comprehensive helmet-use laws. Two states that weakened their helmet-use laws from comprehensive to partial during the study period had increases in motorcycle-related head injury death rates (184% and 73%), and one state that strengthened its law from partial to comprehensive had a decline in its death rate (44%). Head injury death rates based on motorcycle registrations were also lowest in states with comprehensive helmet-use laws. Since helmets reduce the severity of nonfatal head injuries in addition to lowering the rate of fatal injuries, we urge the adoption and enforcement of comprehensive motorcycle helmet-use legislation.
Helmet effectiveness in preventing fatalities to motorcycle drivers and passengers was determined by applying the double pair comparison method to the Fatal Accident Reporting System (FARS) data for 1975 through 1986. Motorcycles with a driver and a passenger, at least one of whom was killed, were used. In order to reduce as much as possible potentially confounding effects due to the dependence of survivability on sex and age, the analysis is confined to male drivers (there were insufficient female driver data), and to cases in which the driver and passenger age do not differ by more than three years. Motorcycle helmet effectiveness estimates are found to be relatively unaffected by performing the analyses in a number of ways different from that indicated above. It was found that helmets are (28 +/- 8)% effective in preventing fatalities to motorcycle riders (the error is one standard error), the effectiveness being similar for male and female passengers, and similar for drivers and passengers. An additional result found was that the fatality risk in the driver seat exceeds that in the passenger seat by (26 +/- 2)%. The 28% effectiveness found generates calculated fatality increases from repeal of mandatory helmet-wearing laws that are compatible with observed increases.
Two-wheeler trauma in developing countries differs in some respects when compared to that in developed countries. A total of 302 cases involved in motorcycle, scooter, and moped accidents were analyzed. There were 201 drivers and 101 passengers. Injury severity scores (ISS), overall number of wounds, and number of fractures were studied. Motorcycle riders had a significantly higher ISS than did scooter riders. Persons involved in collisions with other powered vehicles had 36% more fractures and higher ISS than those involved in accidents where no collision occurred with a powered vehicle. Female passengers, sitting sideways, and involved in collisions, sustained fewer injuries than did a comparable group of male passengers who sat astride; the ISS of female passengers was also lower. Helmet users had a much lower incidence and severity of head injury than riders who did not use helmets. Turbans appeared to offer partial protection from head injury.
In the present study, the incidence of severe brain injury was 600 percent higher for patients riding without a helmet and the incidence of all brain injuries was nearly twice as high in the nonhelmeted riders. All surviving patients with severe brain injury sustained residual long-term disability. The incidence of injury and death was much higher for motorcyclists than for occupants of automobiles involved in accidents. Riding a motorcycle is dangerous and riding without a helmet is fool-hardy. Helmets also protect the face, as facial fractures were twice as common in the nonhelmeted riders. There were no significant differences between nonhelmeted and helmeted motorcyclists in terms of overall injury as measured by an injury severity score of 16 or greater. Orthopedic injuries, in this study, were so common that orthopedic surgeons performed more major operations than all other surgical specialists combined. Depth of orthopedic coverage is essential to treat significant numbers of injured motorcyclists. Neurosurgeons are key members of a trauma care team. Helmet laws would help us utilize our limited neurosurgical capacity more effectively by reducing the incidence of brain injury. Medical professionals must educate the public regarding the societal and personal cost of unhelmeted motorcycle riding. Legislation mandating helmet usage for motorcycle riders must be sought.
In a consecutive series of 132 motorcycle and moped riders killed in 1977-1983 in southern Sweden and examined post mortem, almost half of the fatal injuries of the head and neck occurred remote from the point of impact, namely certain intracranial injuries without fractures, ring fractures of the base of the skull, disruption of the junction of the head and neck and injuries of the cervical spine. Ring fractures of the base of the skull were noticeably more frequent in motorcyclists than in car occupants who died. Injuries occurring remote from the point of impact were often the result of impacts against the anterior part of the head, especially against the face. All 5 riders suffering disruption of the junction of the head and neck were helmeted, which suggests that the helmet may promote such injuries. In some of these cases, no sign of impact against the head could be detected. The inertia of the head, enhanced by the helmet, is supposed to contribute to some of these injuries, which calls into question the protection provided by the helmet. Fatal head injuries at the point of impact were mostly found on the lateral-posterior part of the head. These injuries were often irrespective of whether or not a helmet was used. The points of impact were found mainly rung around the head. Protective helmets should be improved in order to give better protection against injuries at the site of impact, especially in the above-mentioned area, to give better protection of the face and to increase energy-absorbing capacity.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirty-five states repealed or altered mandatory motorcycle helmet legislation since May 1976. In-depth evaluation of the impact of the change has been reported from four states. The results reveal significant decreases in helmet usage and significant increases in head injury and deaths. In one state (Kansas) there was also an increase in the accident rate. Evaluation of the financial impact reveals up to 200% increase in medical costs and a significant increase in days of disability. Repeal of mandatory helmet legislation is extremely costly in any parameter measured.
In the United Kingdom there appears to be little available information concerning the prevalence and the patterns of head and of facial injuries sustained in road traffic accidents by motorcyclists wearing protective helmets. The present preliminary survey was of 56 accidents in urban traffic. 50 per cent of surviving motor-cyclists incurred head injuries. Soft tissue facial wounds were sustained by 38 per cent and fractures of facial bone and teeth by 11 per cent of the injured. The majority of the accidents occurred at speeds of 30 m.p.h. or less to riders of machines of small cubic capacity. Motor-cyclists wearing open-face style helmets had more facial damage after accidents than those wearing full-face style helmets. The results of the survey suggest the need for research into the degree of protection against head and facial injuries offered by the various helmet styles and their constituent materials.
A descriptive epidemiologic study utilizing a multi-disciplinary reporting format was undertaken to assess the impact of helmet usage on motorcycle trauma in North Dakota from 1977 through 1980. This approach yielded an 82.6% reporting increase compared to previous data collection techniques. More than 60% of the 2,934 crashes involved unhelmeted cyclists. Two-thirds of all crashes resulted in injury, with head, neck, and face (HNF) trauma accounting for 21.4% of all lesions. Compared to their helmeted counterparts, helmetless riders suffered HNF trauma 2.30 times as often, and were 3.19 times as susceptible to fatal injuries. the number of injuries and the severity of trauma were significantly higher (P = .01) for those individuals not wearing helmets. A substantial decline in usage occurred in those under 18 years of age, despite the legal requirement that this group wear protective headgear.
Motorcycle use in Minnesota has been increasing steadily over the past decade as have injuries and deaths resulting from motorcycle collisions. Three-hundred ninety-seven motorcycle injury cases were identified at seven Minneapolis-St. Paul area hospitals. Information on the nature and severity of injury and the circumstances surrounding the accident was obtained. Extremity injuries occurred most commonly. Head injuries were present in 40 percent of the cases. A case-control approach was used to describe the association between helmet use and head trauma.
The cases of 311 motorcycle accident victims who were seen at a major trauma center over 17 months were reviewed. The types and severity of injuries were standardized according to the Injury Severity Score (ISS) for motor vehicle accidents. Victims were categorized into groups: helmet or no helmet and major, minor or no head injury. Major injury was defined as a 3 on the Abbreviated Injury Scale for "head" (loss of consciousness for at least 15 minutes with or without skull fracture and with or without neurological deficit). THE FOLLOWING CONCLUSIONS ARE DRAWN: (1) The death rate for those with and without helmets was not significantly different, (2) the victims of fatal accidents had identical total ISS scores regardless of the presence of helmets, (3) the chance of sustaining a severe head injury was significantly higher in the no helmet group and (4) the incidence of long-term neurological defect was three times greater in the no helmet group.
To assess the current morbidity and mortality of motorcycle trauma in the state of Illinois and, specifically, to assess the incidence and cost of head injury to motorcycle crash patients according to their helmet use.
Retrospective, cross-sectional examination of the Illinois Department of Public Health Trauma Registry, for which data are available from July 1, 1991, through December 31, 1992. Data are collected from all hospitals designated as Level I or Level II trauma centers in Illinois.
All patients involved in motorcycle crashes and subsequently taken to a Level I or Level II trauma center in Illinois and entered into the trauma registry during the period studied.
Head injury, spinal injury, helmet use, demographic data, hospital charges, days in ICU, and source of payment were selected as outcome measures. During the 18-month study period, 1,231 motorcycle trauma patients were entered into the trauma registry. Eighteen percent were helmeted and 56.0% were nonhelmeted. In 26.0% the helmet status at the time of the crash was unknown. Thirty percent of the helmeted patients sustained head injury and 4% sustained spinal or vertebral injury, compared with 51% and 8%, respectively, for nonhelmeted patients. Nonhelmeted patients were significantly more likely to sustain severe (Abbreviated Injury Score [AIS], 3 or more) or critical (AIS, 5 or more) head injury. Patients with these serious head injuries incurred almost three times the hospital charges and used a disproportionately larger share of ICU days than those with mild or no head injuries. There was a trend toward greater use of public funds or self-pay status (no insurance) for payment of hospital charges in nonhelmeted patients.
Motorcycle helmet nonuse was associated with an increased incidence of serious head injury. Motorcycle trauma patients with severe or critical head injuries used a significantly greater proportion of ICU days and hospital charges than those with mild or no head injuries.
Helmets are effective in decreasing maxillofacial trauma in motorcycle crashes. The impact, however, of motorcycle crashes on the location and patterns of craniofacial injuries among helmeted versus unhelmeted patients has not been examined. In the present study, 331 injured motorcyclists were evaluated to compare the incidence of craniofacial and spinal injury in 77 (23%) helmeted and 254 (77%) nonhelmeted patients. Nonhelmeted motorcyclists were three times more likely to suffer facial fractures (5.2% vs. 16.1%) than those wearing helmets (p < 0.01). Skull fracture occurred in only one helmeted patient (1.2%), compared with 36 (12.3%) of nonhelmeted patients (p < or = 0.01). The incidence of spinal injury was not significantly different between the two groups. Blood alcohol levels demonstrated that 12% of the helmeted group were legally intoxicated (blood alcohol level > 100 mg/dL), in contrast to 37.9% of the nonhelmeted motorcyclists (p < or = 0.01). Failure to wear a helmet resulted in a significantly higher incidence of craniofacial injury among patients involved in motorcycle crashes, but did not affect spinal injury or mortality. Alcohol usage seemed to correlate with failure to use helmets. Helmet use should be legally mandated on a national level for all motorcyclists.