ArticleLiterature Review
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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.

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... The majority 46,032 (68.52%) were tested negative, 14,202 (21.14%) tested positive above the legal limit and remaining 10.34% tested with a BAC < 0.08 g/dl ( Fig. 1 ). A total of 29,922 patients satisfied the inclusion criteria There were significant differences in baseline patient characteristics between the alcohol negative and positive groups including: age ( , P < 0.001), and SBP < 90 (2.9% vs. 4.1%, P < 0.001) and ISS (11 [6][7][8][9][10][11][12][13][14][15][16][17][18] vs. 13 [8][9][10][11][12][13][14][15][16][17][18][19][20][21], P < 0.001). ( Table 1 ) ...
... The majority 46,032 (68.52%) were tested negative, 14,202 (21.14%) tested positive above the legal limit and remaining 10.34% tested with a BAC < 0.08 g/dl ( Fig. 1 ). A total of 29,922 patients satisfied the inclusion criteria There were significant differences in baseline patient characteristics between the alcohol negative and positive groups including: age ( , P < 0.001), and SBP < 90 (2.9% vs. 4.1%, P < 0.001) and ISS (11 [6][7][8][9][10][11][12][13][14][15][16][17][18] vs. 13 [8][9][10][11][12][13][14][15][16][17][18][19][20][21], P < 0.001). ( Table 1 ) ...
... Despite a marked improvement within several patient characteristics after matching, there were still some statistically significant differences seen among the variables between the two groups. These significant differences between the alcohol negative versus positive group included: SBP < 90 (2.6% vs. 4.1%, P < 0.001) and ISS (median [IQR]: 10[6-17] vs. 13 [8][9][10][11][12][13][14][15][16][17][18][19][20][21], P < 0.001), P < 0.001). ( Table 2 ) ...
Article
Background: Motorcyclists who drink and drive are at a higher risk of death and disability than other types of drivers. The purpose of this study was to query a national trauma database to evaluate the impact of elevated blood alcohol concentration (BAC) on outcomes in patients who sustained injury following a motorcycle crash. Methods: The National Trauma Data Bank (NTDB) data was accessed from 2012 to 2014. Patients ≥ 18 years of age who sustained a traumatic injury following a motorcycle accident with a confirmed blood alcohol test at the time of arrival to the hospital were included. Other variables examined were: sex, race, injury severity score (ISS), and initial Glasgow Coma Scale motor score (GCSMOT), systolic blood pressure (SBP, mm Hg), SBP <90, and comorbidities. Patients with a blood alcohol concentration (BAC) at or beyond the legal limit (0.08 g/dL) comprised the "alcohol positive" group, while those with a BAC confirmed negative comprised the "alcohol negative" group. The patients who tested BAC < 0.08 g/dl were excluded from the analysis. The primary outcome of the study was in-hospital mortality. Univariate followed by propensity matched analysis was performed. All p-values were 2 sided and p-values < 0.05 were considered statistically significant. Results: Of 113,843 patients involved in motorcycle crash, 67,183 patients underwent BAC testing. The majority (68.52%) tested negative, 21.14% tested positive above the legal limit and remaining 10.34% tested with a BAC <0.08 g/dl . A total of 29,922 patients, satisfied the inclusion criteria for final analysis. After propensity score matching, there was 100% improvement on standardized mean difference on matching variables (age, sex, race).However, differences continued between the groups on, SBP < 90, ISS and GCSMOT. The hospital mortality rates were 3.1% vs 3.9% (P < 0.001) between alcohol negative and the alcohol positive groups, respectively. The odds ratio of mortality in alcohol positive group was 1.27 (95% CI: 1.07, 1.53) and the absolute risk difference in hospital mortality was 0.008 (CI: 0.002, 0.014). Conclusion: Patients who tested with a BAC above the legal limit sustained a higher injury severity score and higher in-hospital mortality compared to patients who tested negative.
... Evidence exists to suggest that the use of helmets can reduce the risk and occurrence of both head injuries and death due to motorcycle accidents, and in turn reduce hospitalization and morbidity. 6 An important means of increasing the wearing of helmets in low-and middle-income countries is legislation; where helmet-wearing rates are low and a large number of people use motorized two-wheelers. In most low-and middle-income countries, especially in Asia, a motorbike is the common vehicle for the family. ...
... The protective effect of motorcycle helmets is well established in the literature. 6,[13][14][15][16][17][18][19][20] Helmet use was found to benefit both riders and society, with improved discharge outcomes, as well as a decreased mortality rates, head injuries, and costs of hospitalization. 6,[13][14][15][16][17][18][19][20] Moreover, Hotz et al. report a marked increased number and severity of brain injuries following the repeal of a motorcycle helmet law. ...
... 6,[13][14][15][16][17][18][19][20] Helmet use was found to benefit both riders and society, with improved discharge outcomes, as well as a decreased mortality rates, head injuries, and costs of hospitalization. 6,[13][14][15][16][17][18][19][20] Moreover, Hotz et al. report a marked increased number and severity of brain injuries following the repeal of a motorcycle helmet law. 16 Out of total 250 patients of polytrauma ( In our study 14(5.6%) ...
... The head-and-the neck region is the most exposed part of the body, making it a point of direct injury in RTAs. [16][17][18][19][20][21][22][23][24][25][26] According to the previous study by Menon et al. (2008) there was a marked male preponderance (84.6%). [27] The most vulnerable age group was found to be between 21 and 30 years. ...
... The results also correlate with the previous studies. [16][17][18][19][20][21][22][23] The pattern of RTAs in Mangalore has a similar trend as compared to the data published since 2002. The age, gender, and pattern of injury were similar to the previous studies [16][17][18][19][20][21][22][23]30] [ Table 4]. ...
... [16][17][18][19][20][21][22][23] The pattern of RTAs in Mangalore has a similar trend as compared to the data published since 2002. The age, gender, and pattern of injury were similar to the previous studies [16][17][18][19][20][21][22][23]30] [ Table 4]. ...
Article
Background: It has been reported that 20%-60% of all people injured in road traffic accidents (RTAs) tend to have some form of maxillofacial injury. Mangalore city, Karnataka State, India, traffic police has enforced the law to wear helmets to tackle the problem. The outcome of the initiative till date was not measured. Therefore, the objective of the study was to assess the prevalence of maxillofacial injuries among the victims of motorized two-wheeler RTAs, following the passing of the helmet law. Materials and methods: The study was conducted at the Accident and Emergency Department of K.S. Hegde Medical College and Hospital and at the Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India. The inclusion criteria were the patients who had two-wheeler accidents during the time period of 2016-2017 was collected. The data related to age, gender, helmet wearing, diagnosis, and type of orthopedic injuries was included. A descriptive statistics was calculated along with 95% confidence interval; correlation coefficient and odds ratio using STATA software. Results: A total of N = 347 individuals were included in the study. The mean age of the individuals was 33.7 (2-85) years, and the median age was 32 years. 81.55% (N = 283) were male and 18.44% (N = 64) were female. Among the individuals, 51.5% (N = 179) were not wearing helmets and 44.38% (N = 154) of them were males. A total of 25.07 (N = 87) individuals had orthopedic injuries and 16.42% (N = 57) individuals had orthopedic injuries who were not wearing helmets. Conclusion: Under the limitations of the study, we conclude that majority of the two-wheelers are not wearing helmets. This study has demonstrated that the impact of wearing helmet on occurrence of craniofacial and orthopedic injuries is less.
... Consequently, the widespread adoption of mandatory helmet laws has been advocated by many international organizations [5,6]. While previous systematic reviews have proven the ability of helmets to prevent death and injury [7,8], little emphasis has been given to their utility in LMICs. The purpose of this study was to conduct a systematic review and meta-analysis of the literature to assess the potential utility of mandatory motorcycle helmet legislation on helmet usage, motorcyclist mortality, and incidence of traumatic brain injury (TBI) and determine if these outcomes differed across country income levels. ...
... Several systematic reviews and meta-analyses have demonstrated the utility of helmets in decreasing motorcycle related deaths. A Cochrane review completed by Liu and colleagues demonstrated that helmet usage decreased the risk of death from 69% to 42% [7]. Other studies looked specifically at the potential benefits of helmet legislations as an intervention [51,52]. ...
Article
Full-text available
Background The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. Methods and findings A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle–Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg’s and Egger’s tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case–control study, and 5 pre–post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p -value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p -value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law ( p -value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. Conclusions In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.
... Unlike helmets, compulsory in France for almost 40 years, jackets, trousers and boots are not compulsory; gloves have been mandatory since 2016 (ONISR 2017). Helmets have long been reported to be effective (Gabella et al. 1995;Houston and Richardson 2008;Khor et al. 2017;Liu et al. 2008;Moskal et al. 2008), but studies of motorcycle clothing, back protectors or airbags are much scarcer. Aldman et al. found that clothing reduced soft-tissue injuries, but not fractures (Aldman et al. 1981), whereas Feldkamp and Junghanns reported a much lower rate of open fracture in users wearing protective clothing (Feldkamp and Junghanns 1976). ...
Article
Objective: This study assesses the effectiveness of protective clothing (motorcycle jacket, trousers, gloves, knee-high or ankle boots, back protection) for motorized 2-wheeler (MTW) riders. Methods: This retrospective observational study used injury data from the Rhône Registry of Road Accident Victims, plus a postal survey conducted in 2016. Seven thousand one hundred forty-eight MTW riders involved in accidents between 2010 and 2014 were identified from the Registry and were invited to complete a questionnaire. Nine hundred seventy-nine individuals returned the questionnaire with relevant information; 951 with complete injury descriptions and clothing information were included in the study. The impact of protective clothing on injury risk was estimated using Poisson regression, with weighting for nonrespondents. Results: Sixty-seven percent of MTW riders sustained upper limb injuries and 47% sustained lower limb injuries. Gloves were the most frequent gear worn (76%), followed by jackets (59%) and knee-high or ankle boots (37%). Only 23% had back protection and 0.3% had an airbag. Wearing protective clothing was associated with a lower risk of soft tissue injury to upper and lower limbs: For upper limbs, the risk was lower when one of 2 items (a motorcycle jacket or gloves) was worn (relative risk [RR] = 0.36; 95% confidence interval [CI], 0.18-0.75) and was lowest when both were worn (RR = 0.28; 95% CI, 0.12-0.69); for lower limbs, risk was reduced by wearing both motorcycle trousers and boots (RR = 0.60; 95% CI, 0.40-0.91) but was not significantly reduced when only one of these items was worn (RR = 0.90; 95% CI, 0.67-1.21). This protective effect was mainly due to a reduction in abrasions/lacerations rather than contusions. However, protective clothing did not reduce the risk of fracture, dislocation, or sprain, except for knee-high or ankle boots, which were associated with lower risk of ankle or foot fracture (RR = 0.43; 95% CI, 0.24-0.75). No effect of back protectors was shown. Conclusions: This study confirms the potential for motorcycle clothing to protect users from injury, in particular abrasions and lacerations. However, it did not show any significant protective effect against more serious injuries, such as fracture, dislocation, or sprain, except for knee-high or ankle boots, which reduced foot and ankle fracture risk. Our results argue for more widespread use of protective clothing by MTW users.
... 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]. ...
Article
Full-text available
Keywords: Facial Injury; Helmet; Trauma in Saudi; Severe Facial Injury
... Suatu tinjauan Cochrane yang dilakukan oleh Liu et al. 26 mengenai efektivitas helm dalam mencegah cedera kepala dan juga cedera wajah menyimpulkan bahwa penelitian selama ini kualitasnya rendah ditinjau dari segi metodologi karena umumnya menggunakan desain potong lintang dan juga terdapat banyak bias dalam penelitian yang diakibatkan oleh masalah etis yang akan muncul bila penelitian dibuat dalam randomized trial. ...
Article
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Helmet can reduce head trauma as well as maxillofacial trauma due to motorcycle accident. This study was aimed to prove the effect of helmet and its type in reducing craniofacial injury. Any intracranial abnormalities were evaluated with the CT Marshall scoring system and maxillofacial abnormalities were evaluated with FISS. This was an analytical comparative study with a cross sectional design. The results showed that there were 72 patients with craniofacial trauma; 59 patients with intracranial abnormalities and 24 patients with maxillofacial abnormalities. There were 43.1% patients that wore helmet; 31.9% of them wore open-face helmet. Data were analyzed by using the unpaired t-tests. Based on FISS, the effect of helmet on maxillofacial injury obtained a t-value of 0.787 (P = 0.217) which indicated that there was no difference in FISS scores between patients wearing helmet and not. Based on the CT Marshall scoring system, the effect of helmet on the intracranial injury obtained a t-value of 1.822 (P = 0.036) which indicated that there was a difference in scores between patients wearing helmet and not. This meant that wearing helmets had some influence on the occurence of head injuries. Based on FISS, the impacts of full-face helmet and open-face helmet on maxillofacial injuries obtained a t-value of 1.890 (P = 0.034) which indicated that there was a difference in FISS between the two types of helmets. Based on the CT Marshall scoring system, the impacts of full-face helmet and open-face helmet on intracranial injuries obtained a t-value of 1.714 (P = 0.049) which indicated that there was a difference in CT Marshall scores between the two types of helmets. Conclusion: Helmet and its type, full-face and open-face, had some influence on the occurence of either maxillofacial or intracranial injuries.Keywords: craniofacial injury, motorcycle, helmetAbstrak: Penggunaan helm dapat mengurangi kejadian trauma kepala dan trauma maksiofasial akibat kecelakaan sepeda motor. Penelitian ini bertujuan untuk membuktikan bahwa pemakaian helm dan tipe helm berperan dalam menurunkan cedera kraniofasial. Abnormalitas intrakranial dievaluasi dengan skoring CT Marshall dan abnormalitas maksilofasial dievaluasi dengan FISS. Jenis penelitian ialah analitik komparatif dengan desain potong lintang. Hasil penelitian mendapatkan 72 pasien dengan trauma kraniofasial; 59 pasien dengan abnormalitas intrakranial dan 24 pasien dengan abnormalitas maksilofasial. Terdapat 43,1% pasien yang menggunakan helm; 31,9% menggunakan helm open-face. Data dianalisis menggyunakan uji t tidak berpasangan. Berdasarkan FISS, efek helm terhadap cedera maksilofasial mendapatkan t = 0,787 (P = 0,217) yag menunjukkan tidak terdapat perbedaan skor antara pasien yang menggunakan dan tidak menggunakan helm. Berdasarkan skoring CT Marshall, efek helm terhadap cedera intrakranial mendapatkan t = 1,822 (P = 0,036) yang menunjukkan terdapat perbedaan skor antara pasien yang menggunakan dan tidak menggunakan helm. Hal ini memperlihatkan bahwa penggunaan helm berpengaruh terhadap kejadian cedera kepala. Berdasarkan FISS, dampak jenis helm full-face dan open-face terhadap cedera maksilofasial mendapatkan t = 1,890 (P = 0,034) yang menyatakan terdapat perbedaan skor FISS antara pengggunaan kedua jenis helm. Berdasarkan skoring CT Marshall, dampak helm full-face dan open-face terhadap cedera intrakranial mendapatkan t = 1,714 (P = 0,049) yang menunjukkan terdapat perbedaan skor CT Marshall antara penggunaan kedua jenis helm. Simpulan: Penggunaan helm dan jenis helm (full-face dan open-face) memengaruhi terjadinya cedera maksilofasial dan intrakranial.Kata kunci: cedera kraniofasial, sepeda motor, helm
... For instance, one review (Bunn et al., 2013) suggested that area-wide traffic calming measures may be a promising intervention for reducing the number of road traffic injuries and deaths. In another review (Liu et al., 2008), researchers found that the motorcycle helmet reduced the risks of death and head injury in motorcyclists who crashed. ...
Article
Full-text available
Low- and middle-income countries have the highest proportions of road accident fatalities among vulnerable road users. This review established the effectiveness of road engineering and the enforcement of traffic laws, and regulation interventions to prevent injury (fatal and non-fatal) to vulnerable road users from low- and middle-income countries. We searched the following databases up to Jan 04, 2018: PubMed; OvidSP Medline, OvidSP Embase, OvidSP Transport, Cochrane Injuries Group Specialized Register, Cochrane Central Register of Controlled Trials, and Proquest ERIC database. In addition, road safety organizations' databases and conference proceedings were hand searched to Jan 2018. Twenty-eight studies were matched to the study inclusion criteria of which we did not analyze six studies assessed as C grade for risk-of-bias. We estimated the effect-size of 18 studies. Four of the studies presented a unique outcome or a study design; it was not possible to calculate a standardized effect-size. The risk-of-bias rating of the studies included for effect-size analysis ranged between A and B grade. There was no evidence that road engineering interventions were effective for road traffic death counts, the number of injuries, and road accident casualty outcomes. While the enforcement of mandatory helmet law was ineffective in reducing road traffic death counts, intervention efforts proved effective in decreasing injuries. Enforcement of mandatory helmet law, automated-enforcement-system (camera), and pedestrian signal interventions were effective in increasing road users' compliance with road safety laws. Daytime running-headlight intervention reduced the number of road accident casualties. The quality of evidence for outcomes was ranked very low. Further research is needed to examine the effects of road engineering interventions on injury severity outcomes. Even though the evidence was of very low quality, traffic laws, and regulation interventions when combined with enforcement initiatives or with, other approaches proved effective in changing drivers' behaviors. Research on road engineering interventions combined with automated-enforcement-systems must be explored in an Low- and Middle-Income Country (LMIC) setting. The review found evidence gaps on the effects of segregation of vulnerable road users from motorized vehicles, changes in intersections, and bicycle infrastructure interventions.
... On the road, craniocerebral injury is the leading cause of serious injury to cyclists in road traffic (World Health Organization, 2006). However, wearing a helmet reduces the risk of head injury of motorcycle riders by 69% (Liu et al., 2008), and wearing a helmet reduces the risk of head injury for cyclists by 63%-88% (Thompson, Rivara & Thompson, 1999). ...
Article
Full-text available
Recently, object detection methods have developed rapidly and have been widely used in many areas. In many scenarios, helmet wearing detection is very useful, because people are required to wear helmets to protect their safety when they work in construction sites or cycle in the streets. However, for the problem of helmet wearing detection in complex scenes such as construction sites and workshops, the detection accuracy of current approaches still needs to be improved. In this work, we analyze the mechanism and performance of several detection algorithms and identify two feasible base algorithms that have complementary advantages. We use one base algorithm to detect relatively large heads and helmets. Also, we use the other base algorithm to detect relatively small heads, and we add another convolutional neural network to detect whether there is a helmet above each head. Then, we integrate these two base algorithms with an ensemble method. In this method, we first propose an approach to merge information of heads and helmets from the base algorithms, and then propose a linear function to estimate the confidence score of the identified heads and helmets. Experiments on a benchmark data set show that, our approach increases the precision and recall for base algorithms, and the mean Average Precision of our approach is 0.93, which is better than many other approaches. With GPU acceleration, our approach can achieve real-time processing on contemporary computers, which is useful in practice.
... 4 Motorcycle users-either drivers or passengers-are at a high risk of serious head and neck injuries. 12 Since using a certified helmet on roads can reduce the risk of mortality by 40% and that of serious injury by 70%, [12][13][14] it is recommended or mandated by law in 44 countries (both for drivers and passengers) around the world, including Thailand. However, the level of enforcing legislation of helmet use varies by country. ...
Article
Background. Road traffic accidents are the fourth leading cause of death in the entire population, and the first among the youth (ages 15-19 years) in Thailand. The situation in Thailand is worse than in neighboring low- to middle-income countries in the Southeast Asia region. Seventy-three percent of the deaths in the country are motorcycle drivers or passengers. Although motorcyclists (both drivers and passengers) have been obligated to wear helmets by law, the prevalence of helmet use nationwide is not high (43.7% in 2010). Methods. We performed a systematic review to examine potential social determinants of helmet use behavior (observational studies) and to summarize previous intervention studies to promote helmet use (interventional studies) in the country. Studies were identified in PubMed and Web of Science, and by additional review of Thai-written literature. Results. We identified 16 relevant studies for social determinants of helmet use and 5 relevant studies for promoting helmet use in Thailand. Our review shows that several factors such as teens and children (age), women (gender), rural areas (geography), and alcohol drinking (interaction with another behavior) are associated with non-helmet use. We also identified 4 interventional studies implemented in Thailand: 1 law enforcement program and 4 community-based educational programs. Although all the studies improved the prevalence of helmet use after the interventions, only 2 studies exceeded 50%. Conclusion. There is consistent evidence that being younger, being a woman, living in non-Bangkok areas, and drinking alcohol are associated with non-helmet use among motorcycle users in Thailand. We also observed that the effect of past intervention programs is limited.
... Head injuries account for 88% of death among motorcyclists in low-and middle-income countries [4]. Wearing a helmet reduces the risk of head injuries by 69% and possibilities of death by 42% [6]. However, a large proportion of motorcyclists suffer head injuries in road crash in spite of wearing helmets. ...
Article
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Background: Helmet use reduces the risk and severity of head injury and death due to road traffic crash among motorcyclists. The protective efficacy of different types of helmets varies. Wearing firmly fastened full-face helmet termed as effective helmet use provides greatest protection. This study estimates the prevalence and factors associated with effective helmet use among motorcyclists in Mysuru, a tier II city in Southern India. Methods: Cross-sectional road side observational study of 3499 motorcyclists (2134 motorcycle riders and 1365 pillion riders) at four traffic intersections was done followed by interview of random sample of 129 of the above riders. Effective helmet use proportion and effective helmet use per 100 person-minute of observation was calculated. Multivariate logistic regression analysis was done to identify factors associated with effective helmet use. Results: Prevalence of effective helmet use was 28 per 100 riders and 19.5 per 100 person-minute of observation in traffic intersections. Prevalence rates of effective helmet use was higher among riders (34.5% vs pillion riders 18.1%), female riders (51.3% vs male riders 26.8%), and male pillion riders (30.5% vs female pillion riders 13.7%). Riders commuting for work and school and those ever stopped by the police in the past 3 months had significantly higher odds of effective helmet use. Conclusion: Despite helmet use being compulsory by law for motorcyclists, the effective helmet use was low in Mysore. Strict enforcement and frequent checks by the police are necessary to increase the effective helmet use.
... Moreover, it is shown to be more common up to age of 14 years old. To prevent such injury, use of bicycle helmet can prevent TDI and facial injuries by 65% (Liu et al., 2008). One study suggested extension of the area of helmet coverage can reduce the risk of facial trauma (Acton et al., 1996). ...
Conference Paper
Aim The aim of this study was to assess whether or not increasing levels of antibacterial polylysine (PLS) and monocalcium phosphate (MCPM) within dental composites can reduce Streptococcus mutans biofilm formation on surfaces. Methods Five experimental composites were prepared with PLS (4,6,8 wt. %) and MCPM (8,12, 16 wt.%). Control samples were commercial materials Z250 (3M), Activa , Fuji II and the same experimental samples with no PLS or MCPM. Set discs (10mm diameter and 1mm depth) were immersed in 1 ml BHI broth with 1% (w/v) sucrose and 5*106 S. mutans then incubated in air with 5% CO2 for 24 hours. In each experiment, 3 discs with the same formula were tested 3 times (n=3x3). Biofilm thickness and mass on material surfaces were determined using confocal microscopy and crystal violet (CV) staining. Results CV optical density decreased when MCPM and PLS concentrations were increased. Composite formula with MCPM 16 and PLS 8 showed the lowest level of bacterial reduction. Biofilm thickness was between 120 and 150 microns for all the commercial materials and the experimental control. With 4% and 8% PLS, biofilm thickness declined to 70 and 40 microns whilst 8% and 16% MCPM gave an average thickness of 60 and 50 micron, respectively. Biofilm mass decreased by 55% when PLS was increased from 4% to 8%, however, increasing MCPM from 8% to 16% did not affect the results. Conclusion Doubling PLS content in composites caused a greater reduction in biofilm growth on dental composites than doubling MCPM.
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Introduction: Road traffic injuries (RTIs) are an important contributor to the morbidity and mortality of developing countries. In Uganda, motorcycle taxis, known as boda bodas, are responsible for a growing proportion of RTIs. This study seeks to evaluate and comment on traffic safety trends from the past decade. Methods: Traffic reports from the Ugandan police force (2009 to 2017) were analyzed for RTI characteristics. Furthermore, one month of casualty ward data in 2015 and 2018 was collected from the Mulago National Referral Hospital and reviewed for casualty demographics and trauma type. Results: RTI motorcycle contribution rose steadily from 2009 to 2017 (24.5% to 33.9%). While the total number of crashes dropped from 22,461 to 13,244 between 2010 and 2017, the proportion of fatal RTIs increased from 14.7% to 22.2%. In the casualty ward, RTIs accounted for a greater proportion of patients and traumas in 2018 compared to 2015 (10%/41% and 36%/64%, respectively). Conclusions: Although RTIs have seen a gross reduction in Uganda, they have become more deadly, with greater motorcycle involvement. Hospital data demonstrate a rising need for trauma and neurosurgical care to manage greater RTI patient burden. Combining RTI prevention and care pathway improvements may mitigate current RTI trends.
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Motorcycles are the most common type of vehicle involved in traffic deaths in developing countries. Although helmets can provide protection against injury, there is limited evidence available regarding which type of helmet best protects against head and neck injuries in this setting. This review was conducted based on articles in the PubMed, Scopus, and Web of Science databases. We compared full-face helmets with other types of helmet with regard to head and neck injury prevention in road accidents involving motorcyclists. Of 702 studies, six were eligible with a total of 6,529 participants. When compared with partial and open helmets, the odds ratio of full-face helmets was 0.356 (95% CI of 0.280, 0.453) and 0.636 (95% CI of 0.453, 0.894), respectively, for reduction of head and neck injuries. In conclusion, full-face helmets reduced head and neck injuries in motorcycle accidents to a greater extent than other types of helmet. Policy makers should recommend that motorcyclists use full-face helmets.
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It is a narrative review of all papers published on trauma from Nigeria till 2010
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Introduction: Hugh Cairns, a neurosurgeon practising in Oxford, noted in a 1941 report the high number of deaths in motorcycle accidents, and advocated the use of helmets. Objective: to review road traffic accident fatality data to assess how the risk of death in a motorcycle accident has changed, or not changed, since the publication of Cairns’ findings.Material and Methods: analyses of road traffic accident data for Great Britain (1950–2017).Results and Discussion: in modern times, the risk of fatality for a motorcycle rider is around fifty times greater than that for a car driver, per mile travelled. Although the wearing of a helmet became mandatory in Great Britain in 1973, motorcyclist fatalities increased in the following years, against a background of falling all-road-user fatalities. Fatalities, however, declined markedly after restrictions were placed on novice riders in the early 1980s.Conclusions: a motorcyclist remains essentially as vulnerable as one was in the 1940s, aside from the reduced risk of head injury, and death from head injury, afforded by use of a helmet. On most modern motorcycles, in contrast to modern motor cars, there is no restraint system, nor impact energy-absorbing vehicular structure. The implementation of restrictions on novice rider led to a greater fatality rate reduction than had the enactment of the requirement to wear a helmet a decade earlier.
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Purpose: Facial trauma caused by motorcycle accidents has become a major issue because of its high prevalence and morbidity, causing death and esthetic and functional sequelae in many individuals. This work evaluated helmet and alcohol use and severity of facial fractures in motorcyclists treated at public hospitals in Pernambuco, Brazil. Patients and methods: This prospective study was conducted from December 2016 to December 2018 and submitted to statistical and descriptive analysis. Variables such as gender, age, helmet use and type, previous accidents, and duration of hospitalization were collected. The Facial Injury Severity Scale was used to classify the facial fractures. The Alcohol Use Disorders Identification Test was used to verify alcohol dependence. Results: The sample was composed of 455 patients. Most were male patients (90.8%) and were aged 18 to 29 years (54.5%). Of the patients, 36.5% reported no helmet use and 31.6% reported wearing an open helmet. Alcohol use was reported in 38.7% of the group. In 79.8% of the sample, alcohol use was classified as low risk. There was a greater likelihood of having severe facial trauma if patients were aged between 30 and 39 years and had harmful or at-risk alcohol use. These patients also tended to remain hospitalized for more than 10 days. No statistically significant relationship was found with the type of helmet. Conclusions: The individuals most affected by facial trauma were young male patients (aged 18 to 29 years). Patients aged 30 to 39 years with high-risk use and dependence on alcohol were more likely to have more complex facial trauma. The type of helmet used was not effective in reducing the severity of facial fractures.
Road fatalities are largely preventable problem with large socioeconomic impact. Due to the rapidly increasing population, transport systems and road infrastructure have not met the demand. The use of motorized two-wheeler vehicles has increased, as informal transport. However, evidence on their safety is scarce. The aim of this article is to examine the safety and social equity issues in MTW in the informal transport sector. Factors can be used to explain traffic collisions in MTW in the formal/informal transport sectors: design, rider behavior, road design, enforcement, and regulation of the informal transport sector. Evidence suggests that MTWs could be a common related to pedestrian fatalities. Informal transport drivers are typically poor, uneducated, young men who due to lack of other employment options move into the informal sector. Their vehicles are old, unmaintained and have a lack of protective equipment for themselves and their passengers. Young, male drivers speed, take risks and not use protective equipment. Users of informal transport live in the poorer peripheries of cities, which, have limited, inefficient or unaffordable public transport. The provision of transport has therefore become an often unrecognized, important social equity issue and studies are urgently needed on MTW in the informal transport sector.
Despite strong advocacy, the UN Decade of Action for Road Safety (2011–2020) is ending with most low- and middle-income countries (LMICs) no closer to the Sustainable Development Goals target of reducing traffic mortality by half. In contrast, most high-income countries (HICs) have seen large benefits in recent decades from large-scale safety interventions. We aimed to assess how much LMICs would benefit from interventions that address six key risk factors related to helmet use, seatbelt use, speed control, drink driving, and vehicle design for safety of occupants and pedestrians. We use a comparative risk assessment framework to estimate mortality and health loss (disability adjusted life years lost, DALYs) that would be averted if these risks were reduced through intervention. We estimate effects for six countries that span all developing regions: China, Colombia, Ethiopia, India, Iran, and Russia. We find relatively large benefits (27% reductions in road traffic deaths and DALYs) from speed control in all countries, and about 5%-20% reductions due to other interventions depending on who is at risk in each country. To achieve larger gains, LMICs would need to move beyond simply learning from HICs and undertake new research to address risk factors particularly relevant to their context.
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Background: Road traffic injuries (RTIs) are an important public health problem around the world, with the majority of RTIs occurring in low- and middle-income countries. This study aimed to determine disability-adjusted life years (DALY) of RTIs in the northeast of Iran. Methods: In this cross-sectional study, we used the death registration system to calculate years of life lost (YLL) due to RTIs. To determine the years lost due to disability (YLD), hospital records of all people injured in road accidents were used. To estimate DALY, we used YLD and YLL to calculate DALY according to the Global Burden of Disease (GBD) 2003 guideline and the age/sex composition of the population was taken from the Statistical Centre of Iran (SCI) in 2016. All collected data entered into Excel software and performed calculations. Results: Our findings showed that a total of 3403 RTIs and 132 deaths were recorded in 2016. The DALY was 38 per 1,000 of which 26.9 per 1,000 were related to YLL and 11.1 per 1,000 were related to YLD. The highest YLL rate in both sexes was in the 15-29 and 30-44 age groups with 49.8 per 1,000 and 46.0 per 1,000, respectively. This reflects a sex ratio of DALY in males (57.7 per 1,000) to females (8.6 per 1,000) was 6.7. Conclusions: It seems to be necessary, appropriate effective intervention programs and periodic evaluations are required regarding prevention and reducing traffic accidents mostly in middle-aged men.
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Objective: We conducted a triple phase project for motorcycle helmets advocacy in Darab, a city in southwest Iran. The aim of this study was to evaluate the effect of the project on decreasing the hazards of motorcycle accidents. Methods: Using a questionnaire, data for ICU admission rates, hospital costs for patients who required ICU admission, rate of helmet usage, mortality and the duration of ICU care for patients admitted to Darab hospital due to motorcycle accidents in Winter 2015 (before conducting the project) and Winter 2016 (after conducting the project) were gathered and compared. This feature was also separately done for patients younger than 17 years. Results: The rate of wearing helmets increased significantly in winter 2016 (from 3.4 % to 33%). Also ICU admission rate due to head trauma was significantly decreased after the project was done (from 14.5 % to 4%). However, hospital costs for patients required ICU admission were increased in winter 2016. This increase, though not significant, seems to be due to an increase in health service expenses in the year 2016 as compared with the year 2015. The mortality rate was not significantly changed between the two mentioned years results. For patients younger than 17 years, no ICU admissions were needed in winter 2016. Conclusion: Even a short period of intervention can have positive effects on increasing the safety of motorcycle drivers.
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Background The Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China’s progress toward these targets is critical to improving population health for its 1.4 billion people. Methods and findings We used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0–100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators. We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods. Conclusion The study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to perform better than the central and western provinces, and women are predicted to be more likely than men to achieve these targets by 2030. In order to make good progress, China must take a series of concerted actions, including more investments in public goods and services for health and redressing the intracountry inequities.
Article
770 million motorcycles are estimated on the roads. Motorcyclists represent more than 380,000 annual deaths worldwide. 28% of the global fatalities in the roads in 2016. With the increase of the accident rate, studies have been developed within the scientific literature. Bibliometric analysis is applied in the field of motorcycle safety in order to identify relevant publications on risk factors of road crashes and their implications. The information in this research was extracted from Web of Science and Scopus databases between 1947 and May 31, 2018. The study identified the key bibliometric indicators such as publications, authors, journals, countries, institutions, citation and co-citation analysis, subject categories, and co-occurrence of terms. EndNote, Microsoft Excel, Statgraphics Centurion and VOS-viewer software were used for the analysis. In total, 1813 articles were considered. The publications from 2000 to 2017 exhibits an average growth of 9%. The journal “Accident Analysis and Prevention” was the key issue in the publication and citation. The top institutions were the University of California, Universiti Putra Malaysia, and Monash University. The average citation of the top 10 articles was 134. A network visualization map showed that ‘vehicle’, ‘model’, ‘system’, ‘road’, ‘safety’, and ‘behavior’ were the most commons key terms. Bibliometric analysis demonstrates a high collaboration between authors and institutions. Two growing trends were identified. First, studies on the protection of the motorcyclist and the safe design considering the performance. Second, studies in analysis, characterization, and prevention of accidents. These studies are more related to the generation of strategies for the protection of road safety for motorcyclists.
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Background: A prospective study was conducted to investigate the effects of helmet nonuse and seating position on patterns and severity of motorcycle injuries among child passengers in Taiwan. Methods: In total, 305 child passengers aged ≤14 years who visited the emergency departments of three teaching hospitals following a motorcycle crash were recruited. Children's injury data were collected from medical records, and their riding behaviors along with operators' demographics were sourced from telephone interviews. Parental responses over the telephone about children's riding behaviors were checked by roadside observations. Results: Results of the multivariable logistic regression analysis revealed that compared to child passengers aged ≥7 years, those aged ≤3 (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.37~6.06) and 4~6 years (OR, 2.93; 95% CI, 1.50~5.70) were significantly more likely to have sustained a head/face injury, while those aged 4~6 years (OR, 2.76; 95% CI, 1.01~7.55) were significantly more likely to have sustained a severe injury. Compared to child passengers who were wearing a full-coverage helmet, those who were not wearing a helmet were significantly more likely to have sustained a head/face injury (OR, 3.12; 95% CI, 1.02~9.52) and a severe injury (OR, 3.02; 95% CI, 1.19~7.62). Children seated in front of the operator were significantly more likely to have experienced a head/face injury (OR, 2.22; 95% CI, 1.25~3.94) than those seated behind the operator. For each increment in the riding speed of 1 km/h, the odds of a severe injury to child passengers increased by 5% (OR, 1.05; 95% CI, 1.01~1.09). Conclusions: For the safety of child motorcycle passengers, laws on a minimum age restriction, helmet use, an adequate seating position, and riding speed need to be enacted and comprehensively enforced.
Article
Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere. Methods: We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient. Results: Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate–severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA. Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; P < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; P < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model. Conclusions: The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.
Article
Purpose: Deaths and serious injuries from road accidents remain a serious issue in developing countries, including for young people, for whom they are the largest cause of death. This article provides an assessment of interventions to reduce these deaths and injuries for adolescents in 75 developing countries. Methods: We draw on new data on deaths and injuries by age, gender, and accident type for the 75 countries and on the road safety experience of developed and, more recently, developing countries. Critical tasks are to identify key interventions in road safety and estimate their impact and cost. We incorporate these impact and cost estimates in a modeling framework to calculate the reduction in deaths and serious injuries achieved out to 2030, relative to the base case. Finally, established methods are used to value the economic and social benefits arising from these reductions, and hence to calculate benefit-cost ratios. Results: For the unchanged policy case, we estimate that there will be about 3 million deaths and 7.4 million serious injuries from road accidents for persons aged 10-24 years in the 75 countries to 2030. The preferred interventions avert one million of these deaths and 3 million serious injuries, at a cost of $6.5 billion per annum over 2016-2030, or $1.2 per capita across the total population of these countries. After valuing the benefits of the deaths and serious injuries averted, we find a benefit-cost ratio of 7.6 for 2016-2030, but of 9.9 if the interventions continue to 2050. Conclusions: Proven methods, suitably adjusted to local conditions, are available to reduce the tragic toll of road accidents in developing countries. These initiatives are likely to have strong economic and social returns, and should be given high priority.
Article
Introduction Colombia is the fourth largest country in South America. It is an upper middle-income country with an estimated population of 49.2 million people, and road traffic collisions (RTCs) are the second most common cause of traumatic death. The United Nations (UN) proclaimed 2011 to 2020 as the “Decade of Action for Road Safety.” In this context, the government of Colombia established the National Road Safety Plan (PNSV) for the period 2011-2021, aiming to reduce RTC-related deaths by 26%. Some road safety laws (RSLs) were implemented before the PNSV, but their impact on deaths and injuries is still not known. Study Objective The aim of this study was to evaluate whether these RSLs have had a long-term effect on road safety in the country. Methods Data on RTC casualties, deaths, and injuries from January 1, 2001 through December 31, 2017 were collated from official Colombian governmental publications. Three different periods were considered for analysis: 2001-2010 to evaluate the Transit Code; 2011-2017 to evaluate the PNSV; and 2001-2017 to evaluate a composite of the full study period. Analyses of trends in deaths and injuries were related to dates of new RSLs. Results A total of 102,723 deaths (12.7%) and 707,778 injuries (87.3%) were reported from 2001 through 2017. The Transit Code period (2001-2010) showed a 10.1% decline in deaths, 16.6% decline in injuries, and rates per 100,000 inhabitants and per 10,000 registered vehicles also declined. During the period of the PNSV (2011-2017), there was an increase in the number of deaths by 16.6%, injuries decreased by 1.7%, and death rates per 100,000 inhabitants also increased. During the total study period, a 12.4% reduction in the total number of casualties was achieved, and death and injury rates per 100,000 inhabitants decreased by 12.4% and 27.5%, respectively. Discussion Despite the introduction of the PNSV, RTCs remain the second most common cause of preventable death in Colombia. Overall, while the absolute number of RTCs and deaths has been increasing, the rate of RTCs per 10,000 registered vehicles has been decreasing. This suggests that although the goals of the PNSV may not be realized, some of the laws emanating from it may be having a beneficial effect. Further study is required over a protracted period to determine the longer-term impact of these initiatives.
Article
Introduction Despite the ubiquity of motorized vehicular transport, non-motorized transportation continues to be common in sub-Saharan Africa. Methods We performed a retrospective analysis of trauma patients presenting to Kamuzu Central Hospital in Malawi from February 2008 to May 2018. Demographic and clinical variables including injury characteristics and outcomes were collected. We performed bivariate and multivariate logistic regression to determine predictors of mortality following non-motorized vehicular trauma. Results This study included 36,412 patients involved in vehicular road injuries. Patients in the non-motorized group had a preponderance of men (84% versus 73%, p<0.01). The proportion of patients with Glasgow Coma Scale > 8 was slightly higher in the non-motorized group (99% versus 98%, p<0.01), though injury severity did not differ significantly between the two groups. A higher proportion in the motorized group had the most severe injury of contusions and abrasions (56% versus 50%, p<0.01). In contrast, the non-motorized group had a higher proportion of orthopedic injuries (24% versus 16%, p<0.01). The crude mortality rate was 4.51% and 2.15% in the motorized and non-motorized groups, respectively. After controlling for demographic factors and injury severity, the incidence rate ratio of mortality did not differ significantly between motorized and non-motorized trauma groups (IRR 0.91, p=0.35). Conclusions Non-motorized vehicular trauma remains a significant proportion of morbidity and mortality resulting from road traffic injuries. The injury severity and incidence rate ratio of mortality did not differ between motorized and non-motorized trauma groups. Health care providers should not underestimate the severity of injuries from non-motorized trauma.
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We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations. We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls. In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.
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Major growth in economy over the last few years, alongside the increasing trend of ride sharing applications resulted in a significant increase of motorized vehicles in Bangladesh. With the increase of motorized vehicles in national and regional highways, there has been a spike in the number of road fatalities. Being one of the fastest growing economies, Bangladesh is still lagging behind in terms of ensuring road safety and awareness due to its poor law enforcement and improper management from the authorities. Safety restraints, particularly helmet and seatbelt, have been proven to be highly effective in reducing road fatality and accidents. But unfortunately, the number of applications of such safety restraints is not up to the mark compared to the number of motorized vehicles plying in the highways in this region. Previous research on road accidents and application of safety restraints in Bangladesh mostly comprised of volumetric studies and statistical analysis of road fatalities and trends of road accidents in the region. There is a gap in research regarding the socio demographic factors that influenced one’s perception of helmet or seat belt usage and the dependence of the factors among themselves, especially for the case developing nations such as Bangladesh. The following study seeks to establish a causal relationship among the factors that influence the rider or driver’s usage of helmet and seatbelt respectively, in order to identify the variables that has the most impact on safety restraints application and their impact on other influencing factors. In this study, a causal relationship was established among variables that represent both demographic and safety perception to identify the factors that influenced helmet and seat belt use on national and regional highways in Bangladesh. The network was established based on previous research findings and expert knowledge using Bayesian Belief Network. The Bayesian network was formed using PC algorithm that was based on conditional independence. Data were collected from 32 intersections from national and regional highways. The study was conducted on secondary data provided by Roads and Highways Department (RHD). The Bayesian network was used to find the posterior probability for all variables for the presence of helmet and seat belt respectively using the expectation-maximization algorithm and sensitivity analysis. xii Results showed that effectiveness of helmet as safety restraint, motorbike ownership, and helmet avoidance are the major influential factors for helmet use, whereas education level, license type, perception of accident reduction, and perception of injury for not wearing helmet are the main factors behind seat belt usage. In both cases, police intervention did not have any significant effect on helmet and seat belt usage, indicating poor law enforcement in the region. Results from this study can be a useful resource for policy makers and law enforcement authorities to take necessary actions to encourage use of safety restraints among riders and drivers. Keywords: Safety Restraint, Bayesian Network, Helmet and Seat belt, Safety Perception, Developing Country.
Article
Introduction: The popularity of motorcycle riding in Iran is increasing. However, there is a lack of information about the safety of different motorcycle types. This study aimed to compare the severity of injury and trauma pattern between scooter (vespa) and street (standard) motorcycle riders. Method: In a prospective cohort study, a comparison of demographics, injury severity, trauma pattern, and clinical characteristics between 324 riders (162 Vespa and 162 standard motorcycles) admitted to emergency departments was undertaken. The risk factors associated with severe injuries in the two groups were also determined. An emergency medicine specialist determined the severity of trauma based on the abbreviated injury scale (AIS). Results: The Odds Ratio (OR) of severe injuries was significantly higher in the standard motorcycle riders' group (OR: 3.09; 95% CI: 1.9-4.21; p: 0.013). The frequency of lower extremity fractures was significantly lower in the Vespa group (OR: 4.11; 95% CI: 2.01-6.25; p = 0.012). The frequency of admission to the intensive care unit was significantly higher in the standard motorbike riders' group (OR: 1.64; 95% CI: 1.11-2.51; p = 0.033). The multivariate analysis indicated that motorcycle type, the speed at the time of the accident, use of helmet, and age of riders are the most important predictors of trauma severity in riders (p<0.05). Conclusion: The pattern of injury varies between standard and Vespa motorcycles. The standard motorcycle riders were prone to a higher risk of adverse outcomes such as severe injuries. Due to the particular structure of scooters, the rate of lower limb injuries was significantly lower than standard motorcycles.
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Background Although head injury (HI) from low- and middle-income countries (LMIC) heavily contributes to the global disease burden, studies are disproportionately less from this part of the world. Knowing the different epidemiological characteristics from high-income nations can target appropriate prevention strategies. This study aims to provide a comprehensive overview of the clinico-epidemiological data of HI patients, focusing on the existing challenges with possible solutions from a developing nation’s perspective.Methods This is a prospective, registry-based, observational study of HI in an Indian tertiary trauma-care center over 4 years. Various clinico-epidemiological parameters, risk factors, and imaging spectrum were analyzed in a multivariate model to identify the challenges faced by LMIC and discuss pragmatic solutions.ResultsThe study included a large-volume cohort of 14,888 patients. Notably, half of these patients belonged to mild HI, despite most were referred (90.3%) cases. Only one-third (30.8%) had severe HI. Less than a third reached us within 6 h of injury. Road traffic accidents (RTA) accounted for most injuries (61.1%), especially in the young (70.9%). Higher age, males, RTA, helmet non-usage, drunken driving, systemic injuries, and specific imaging features had an independent association with injury severity.Conclusions The study represents the much-needed, large-volume, epidemiological profile of HI from an LMIC, highlighting the suboptimal utilization of peripheral healthcare systems. Strengthening and integrating these facilities with the tertiary centers in a hub and enhanced spoke model, task sharing design, and efficient back-referrals promise effective neurotrauma care while avoiding overburden in the tertiary centers. Better implementation of road safety laws also has the potential to reduce the burden of HI.
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Background Road Traffic Accidents (RTA) are one of the most common causes of morbidity and mortality in Saudi Arabia despite preventive measures and programs. The major factors for the increase in the incidence of mortality and morbidity are due to human factors, such as over speeding, not obeying traffic laws, fatigue, and driving before the legal age. In this study, we aim to report the pattern of orthopaedic injuries (OIs) from RTA in the south-western region of Saudi Arabia and to explore the healthcare outcomes of OIs. Method ology: This is a retrospective, record-based, case series study including RTA patients who were admitted to the Emergency Department (ED) at a tertiary hospital in the south-western region of Saudi Arabia. The data was collected for 531 admitted RTA patients with OIs over for five years from May 2011 to May 2016. Patients who were 15 years of age or above were included in this study. The data were analyzed using the statistical package for social science (SPSS) version 21. Results A total of 531 patients were included with an age range between 15 to 90 years with an average age of 29 ± 2 years. Most of the population was male constituting 91.3% of the sample while 91.9% of the sample were Saudis. About 75% of the OIs had simple fractures and complex fractures were recorded among 10.2% of the cases. About half of the cases (52%) had lower limb fractures and 32% had upper limb fractures. Conclusions RTA and the resultant OIs, death, and permanent disabilities cause a tremendous burden on economic resources and should be of concern for local authorities. More attention and regularities should be paid to avoid life-threatening driving behaviors.
Article
Like many low- and middle-income countries, Nepal is experiencing a massive motorization, predominantly from increased use of motorcycles which is driving a surge in road-related injuries and fatalities. Motorcycles and their riders have been identified as a focal point for road traffic injury prevention measures. While helmet use is mandatory for both motorcycle drivers and passengers, fines for helmet non-use are only levied on drivers, not on passengers, and it is unclear how this unequal enforcement translates to helmet use rates in Nepal. Hence, a video-based observation on motorcyclists’ helmet use was conducted alongside a questionnaire survey on fatalism, perceived police enforcement, risk-taking personality, and perceived usefulness of helmets. For the observation and questionnaire survey, seven rural and urban sites were selected from all seven provinces of Nepal, representing varied populations, road environments, and elevations. The observation of the helmet use behavior of 2548 motorcycle riders revealed an alarming picture of helmet use in Nepal. While more than 98% of observed motorcycle drivers in Nepal used a motorcycle helmet, less than 1% of observed passengers did so. Interviews of 220 riders show that the absence of a fine for helmet non-use by passengers is accompanied by an unawareness of the traffic law, where only 11.8% of respondents knew about the mandatory helmet use law for passengers. Unhelmeted riders had a significantly higher attribution of road related crashes to fate, compared with riders that used a helmet. Results of this study can serve as an evidence base for revisions of Nepal’s Vehicle and Transportation Management Act in regard to traffic rule enforcement and fines. They further show the global importance of comprehensive regulation on safety related behaviors of road users. The feasibility of more comprehensive enforcement is discussed against the background of helmet availability for passengers.
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Motorcycle- and moped crashes are prevalent in motorised societies and carry a significant risk of serious injury. Whereas helmet use has reduced the frequency and severity of head injuries, the association between helmet use and neck injury risk is less clear. In the present retrospective study, we examined the relationship between helmet use and various types of head and neck injuries resulting from fatal motorcycle and moped crashes during a 20-year period. Eighty-three cases were included of whom 56 were analysed in detail based on their confirmed use/non-use of helmet. Intracranial haemorrhage was the most common finding, followed by CNS disruption and skull fracture. There was a significantly lower prevalence of skull vault fractures and epidural haemorrhage in the helmeted cases. Injuries to the brainstem and cervical spine fracture/dislocation were more common in the helmeted cases, although this was likely a function of higher speeds among motorcycle riders rather than an effect of helmet use per se. Further investigation of these findings require additional detailed information regarding the nature and severity of the crash, as well as helmet use and type, in order to assess non-confounded associations with the anatomical distribution, type and severity of observed head and neck injuries.
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Pancreatic cancer presents a unique challenge for the development of effective oncotherapies. The tumor microenvironment (TME) of this type of tumor typically contains a dense desmoplastic barrier composed of aberrant extracellular matrix proteins, as well as an acidic hypoxic and necrotic core. Additionally, the immune system surrounding this type of tumor has often been suppressed by the TME. Hence, choosing the correct model of the tumor microenvironment within which to test a potential anti-cancer therapy is a critical experimental design decision. While the typical solid tumor contains a complex microenvironment including both phenotypic and genotypic heterogeneity, the methods used to model this disease state often do not reflect this complexity. This simplistic approach may have contributed to stagnant five-year survival rates experienced over the past four decades. Oncolytic bacteria, a class of bacteria with the innate ability to seek and destroy solid tumors has been revived from historical anecdotes in an attempt to overcome these challenges. Regardless of the promise of oncolytic bacteria, accurate assessment of their potential requires choosing the proper tumor model. This study explores the impact of cancer cell lines co-cultures with Wild-Type C. novyi to establish the efficacy of this oncolytic bacteria in a monolayer culture.
Article
Introduction: Cell phones are an integral part of daily life but are distractors that can contribute to injury. The present study uses a large national emergency department (ED) database to evaluate the frequency, anatomic location, and type of injuries associated with cell phone use. We hypothesize that orthopaedic injuries related to cell phone use have increased over time and affect certain body parts and age groups more than others. Methods: The 1999 to 2018 Nation Electronic Injury Surveillance System was queried for cell phone-related injuries leading to ED visits (injuries to the head or face or involving a landline were excluded). Demographics, type of orthopaedic injury, and body part injured were tabulated, and injuries were then classified over time as direct mechanical or cell phone use-associated, as well as related to texting compared with talking. Results: A weighted national total of 44,599 injuries met inclusion criteria. A marked increase was noted in the incidence of cell phone use-associated injuries over the time (2,900%). Injuries occurred in persons with mean ± standard deviation age of 36.6 ± 19.9 years old, predominantly in women (60.6%), at home (32.8%) or on the street (22.4%), and while walking (31.6%) or driving (18.16%). The distribution of orthopaedic injuries was defined and occurred most frequently in the neck, lower torso/hip, and ankle. The most common types of injuries were sprain/strain (56.8%) and fracture (32.6%). The proportion of fracture injury types was significantly greater in adults aged greater than 65 (P < 0.001). The proportion of injuries related to texting on a cell phone was greatest in the 13- to 29-year-old age group and declined as age increased. Discussion: Orthopaedic injures related to cell phone use resulting in ED visits have markedly increased over time. The distribution and characteristics of such injuries can be used in targeted public health education and policy development.
Article
Introduction: Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders. Methods: Retrospective review (2014-2018) of a single level 1 trauma center's registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student's t-test or Pearson's χ2p-value ≤0.05 as significant. State Department of Transportation data registry for state level mortality and collision incidence over the same time period was also obtained. Results: Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS. Conclusions: Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.
Article
Objective: The objectives of this study are to evaluate the proportion of helmeted and nonhelmeted patients sustaining mandibular fractures. Materials and methods: A retrospective study was conducted on 200 patients reporting to oral and maxillofacial surgery (OMFS) unit, trauma center, and department of OMFS. A predesigned questionnaire was used to collect the necessary data. Patients were evaluated for age, gender, mode of transport (2/4 wheeler), presence of safety measure at the time of accident (helmet/seatbelt), maxillofacial injury in two wheeler (with helmet and without helmet), type of impact, and its association to maxillofacial fractures, particularly site of maxillofacial fractures. The association between mode of injury, presence of safety measures, impact type, and site of maxillofacial injuries was assessed using the Chi-square test. P < 0.5 was considered statistically significant. Results: The mean age of patients was 30 years, and approximately 92.5% of accidents patients were male. In this study, 35% nonhelmeted riders were reported head injury and 5% of the helmeted rider reported head injury. 54.5% of the patients suffered frontal impact, 28% collision, and 17.5% lateral slide collision. Head injuries are the main cause of death among the riders of all two wheelers. Lateral sliding collision injuries (17.5%) resulted 60.6% of the fractures mandible, 24.2% midface injury, and associated injury (15.15%). Conclusion: The use of helmet is strongly recommended to prevent head injuries and facial injuries. In the nonhelmeted riders in motorcycle accidents, the incidence of mandible fractures increases proportionally.
Article
Introduction To identify the association between skull fracture (SF) and in-hospital mortality in patients with severe traumatic brain injury (TBI). Materials and methods This multicenter cohort study included a retrospective analysis of data from the Japan Trauma Data Bank (JTDB). JTDB is a nationwide, prospective, observational trauma registry with data from 235 hospitals. Adult patients with severe TBI (Glasgow Coma Scale <9, head Abbreviated Injury Scale (AIS) ≥ 3, and any other AIS < 3) who were registered in the JTDB between January 2004 and December 2017 were included in the study. Patients who (a) were < 16 years old, (b) developed cardiac arrest before or at hospital arrival, and (c) had burns and penetrating injuries were excluded from the study. In-hospital mortality was the primary outcome assessed. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) of SF and their 95% confidence intervals (CIs) for in-hospital mortality. Results A total of 9607 patients were enrolled [median age: 67 (interquartile range: 50–78) years] in the study. Among those patients, 3574 (37.2%) and 6033 (62.8%) were included in the SF and non-SF groups, respectively. The overall in-hospital mortality rate was 44.1% (4238/9607). A multivariate analysis of the association between SF and in-hospital mortality yielded a crude OR of 1.63 (95% CI: 1.47–1.80). A subgroup analysis of the association of skull vault fractures, skull base fractures, and both fractures together with in-hospital mortality yielded adjusted ORs of 1.60 (95% CI: 1.42–1.98), 1.40 (95% CI: 1.16–1.70), and 2.14 (95% CI: 1.74–2.64), respectively, relative to the non-SF group. Conclusions This observational study showed that SF is associated with in-hospital mortality among patients with severe TBI. Furthermore, patients with both skull base and skull vault fractures were associated with higher in-hospital mortality than those with only one of these injuries.
Article
Background Protective helmets may reduce the risk of death and head injury in motorcycle collisions. However, there remains a large gap in knowledge regarding the effectiveness of different types of helmets in preventing injuries. Objective To explore and evaluate the effectiveness of different types of motorcycle helmets; that is the association between different helmet types and the incidence and severity of head, neck, and facial injuries among motorcyclists. Also, to explore the effect of different helmet types on riders. Methods A systematic search of different scientific databases was conducted from 1965 to April 2019. A scoping review was performed on the included articles. Eligible articles were included regarding defined criteria. Study characteristics, helmet types, fixation status, retention system, the prevention of injury or reduction of its severity were extracted. Results A total of 137 studies were included. There was very limited evidence for the better protection of full-face helmets from head and facial injury compared to open-face and half-coverage helmets. There was however scarce evidence for the superiority of a certain helmet type over others in terms of protection from neck injury. The retention system and the fixation status of helmets were two important factors affecting the risk of head and brain injury in motorcyclists. Helmets could also affect and limit the riders in terms of vision, hearing, and ventilation. Multiple solutions have been discussed to mitigate these effects. Conclusion Full-face helmets may protect head and face in motorcycle riders more than open-face and half-coverage helmets, but there is not enough evidence for better neck protection among these three helmet types. Helmets can affect the rider’s vision, hearing, and ventilation. When designing a helmet, all of these factors should be taken into account.
Article
Purpose This article consists of a systematic review of the literature, which verified whether the use and types of helmets reduce the occurrence and severity of facial fractures in hospitalized motorcyclists after traffic accidents. Methods Prevalence studies and cohort studies, published in Latin American languages with no restrictions on publication dates, were considered. Two authors independently screened reference lists for eligible articles, assessed them for inclusion criteria, and extracted the data using a specific form. Twenty-six articles were selected, all prevalence studies. Results The patients who used a helmet had a lower prevalence and severity of facial fractures, compared to patients who did not wear a helmet. There were no differences in the occurrence of lower third fractures between patients who used or did not wear a helmet at the time of the trauma; as well as in meta-analyzes of occurrence and severity of facial trauma between helmet types (open or closed). Conclusion It can be concluded that the use of helmet leads to a lower number of fractures and severity of trauma when compared to non-use. Regarding the type of helmet, there was no difference in the occurrence and severity of facial fracture in individuals who used closed or opened helmet.
Article
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In this paper, we use estimates of the effectiveness of existing road safety technologies and interventions to estimate the reduction in road safety deaths in six Indian cities over the next decade, in order to achieve the SDG 3.6 goal of a 50% reduction by 2030. Only the existing interventions are considered and technologies that might be available in the future are not accounted for. The results show that similar policies for all cities will not produce the same results, and that achieving the SDG 3.6 goal does not automatically reduce fatality rates in cities with high fatality rates. The introduction of safer cars with currently available safety technologies, although necessary, will have much less effect than the combined effect of motorcycle safety technologies, speed control and traffic calming. This study suggests that while SDG 3.6 targets may be satisfied by 2030 with great effort in India, the presently available safety interventions may not be adequate to bring about death rates below 2.0 per hundred thousand persons. Since the situation differs significantly between cities, it will be important to evolve city-specific policies for safety intervention priorities and changes in travel behavior. The desired reduction in road traffic injuries in India will not be possible without much greater investment in road safety research and road design for safer travel.
Article
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Background In the large cities of Benin, motorcycle taxi drivers, mainly between the ages of 20 and 40, are particularly exposed to accidents due to their profession. User awareness, along with legislative reforms and enforcement measures, would reduce the incidence of crashes and injuries. This study aims to test the effectiveness of an awareness-raising model regarding helmet use for motorcycle taxi drivers. Methods This is a quasi-experimental study that will take place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities will be implemented in the intervention area, targeting a group of motorcycle taxi drivers. The messages to be developed for awareness-raising will focus on the most frequently influencing factors, as identified by the baseline collection. These key messages will be disseminated through various tools and communication channels (banners, motorcycle stickers and motorcycle taxi uniforms, interactive sessions). Data will be collected prospectively via a self-reported questionnaire and observation, carried out before the intervention, at the end, and 6 months later. The data will relate to knowledge, attitudes and practices regarding helmet use. The analysis will compare the indicators between the groups, as well as between the pre- and post-intervention phase. The KoboCollect software will be used for data entry and processing, and Stata 15 will be used for data analysis. Chi-square or Fisher, Student’s or Kruskal-Wallis tests will be used for the comparisons. The difference-in-difference method will be used to determine the specific effect of the awareness activities. Discussion This study will assess the contribution of awareness messages to changing the behaviour of motorcycle taxi drivers by determining the specific effect of the intervention.
Article
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Introduction: The U.S. experience with motorcycle helmets affords an important insight into the responses of adolescents to age-specific laws. Political contention has led to a number of U.S. state law changes back and forth between universal and age-specific laws. Because both kinds of law require adolescent motorcyclists to wear helmets, relatively few studies have focused on how the law type affects their behavior. Method: Differential behavior is tested by a systematic review of literature, leading to a meta-analysis, in relation to the experience of various states' motorcycle helmet laws. An electronic search was conducted for before-and-after studies in U.S. states that include data on adolescent helmet usage - both with a universally applicable motorcycle helmet law, and with an age-restricted law (usually, under-21 or under-18) - from observational, injury or fatality records for a certain period (e.g., 12 months) pre and post the state law change. Results: The search yielded ten studies, including two that compared a set of age-specific law states with a set of universal law states over the same time period. Heterogeneity analysis of seven single-state studies with raw data revealed an acceptable fit for a random-effects model. Additional noncompliance with age-restricted laws was indicated by an attributable percentage among exposed of over 65% and odds ratio exceeding 4. Conclusions: About two-thirds of adolescent noncompliance with age-restricted motorcycle helmet usage laws disappears with universal applicability. Evidence from numerous international studies of youth reaction to helmet laws suggests that a large part of the greater compliance with universal laws is due to their conveying a more convincing message that helmets afford protection against injury. Practical Applications: The meta-analysis provides fresh, young-rider perspective on the continuing debate over motorcycle-helmet laws. Broader insight into adolescent psychology suggests considering alternatives to age-restricted laws more widely in safety and health policy.
Chapter
Globally, the leading cause of morbidity and mortality among infants, children, and adolescents is trauma. Although pediatric injury is well studied in the developed world, much is unknown regarding childhood injury in low- and middle-income countries (LMICs). Understanding the epidemiology of injury among children may facilitate the development of prevention initiatives and preparation of the health system to care for these patients. In this chapter, we review the classification systems and common mechanisms and risk factors of injury. To reduce the rates of pediatric injury and improve the outcomes of injured children, systematic data collection and review should be a component of clinics, hospitals, and health systems. Additionally, the surgeon can play a role in injury control through championing local or wider surveillance, counseling children and parents in prevention, organizing trauma care, performing research, and advocating for better resources.
Article
Background No states currently require adult bicycle riders to wear helmets. Opponents of a universal helmet law argue that helmets may cause a greater torque on the neck during collisions, potentially increasing the risk of cervical spine fracture (CSF). This assumption has not been supported by data for motorcyclists. Therefore, we sought to evaluate the risk of CSF and cervical spinal cord injury (CSCI) in helmeted bicyclists (HBs) versus nonhelmeted bicyclists (NHBs) involved in collisions. We hypothesize that in adult HBs, there is an increased incidence of CSF and injury but lower rates of severe head injury and mortality than in NHBs. Materials and methods The Trauma Quality Improvement Program (2010-2016) was queried for adult bicyclists involved in collisions, comparing HBs with NHBs. A multivariable logistic regression model was used for analysis. Results Of 25,047 bicyclists, 14,234 (56.8%) were NHBs. NHBs were more often black (13.3% versus 2.3%, P < 0.001) and screened positive for alcohol on admission (25.7% versus 4.6%, P < 0.001). NHBs had lower rates of CSF (17.7% versus 23.7%, P < 0.001) and CSCI (1.1% versus 1.9%, P < 0.001) but higher rates of mortality (4.9% versus 2.2%, P < 0.001) and a higher risk for severe head injury (odds ratio [OR]: 2.26, 2.13-2.40, P < 0.001). After adjusting for covariates, NHBs had a higher risk of mortality (OR: 2.38, 2.00-2.84, P < 0.001) but lower risk of CSF (OR: 0.66 0.62-0.71, P < 0.001) and CSCI (OR: 0.53, 0.42-0.68, P < 0.001). Conclusions HBs involved in collisions have a higher risk of CSF and CSCI; however, NHBs have a higher risk of severe head injury and mortality. Consideration for a universal helmet law among bicyclists and ongoing research regarding helmet development is needed.
Article
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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.
Article
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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.
Article
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.
Article
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.
Article
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.
Conference Paper
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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)
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
Thesis (Ph. D.)--University of California, Los Angeles, 1996. Typescript (photocopy). Vita. Includes bibliographical references.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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 $29 million; 29% of hospitalized patients were uninsured, and 42% of the cost was not reimbursed to the hospitals. Motorcycle injuries contribute significantly to Connecticut's mortality, morbidity, and medical costs. Our study suggests that a uniform helmet law would save an estimated ten lives and prevent more than 90 nonfatal injuries in Connecticut each year at a cost savings to the state of $5.1 million. These data are crucial in advocating re-enactment of motorcycle helmet laws.
Article
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.
Article
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 $7,208 vs $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.
Article
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, $120.8 million of additional medical care and rehabilitation expenses/per year were due directly to non-use of helmets (U.S.); 60—82% of NH riders have no insurance; $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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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)
Article
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.
Article
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.
Article
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.