Profiling Cycling Trauma Throughout the Body with and Without Helmet Usage in a Large United States Health-care Network

Overview

Journal J Emerg Trauma Shock

Specialty Emergency Medicine

Date 2020 May 13

PMID 32395055

Authors

Shanna Elizabeth Williams

Laura Cook

Tyler Goff

Reema Kashif

Rachel Nelson

Melissa Janse

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to characterize bodily injury patterns associated with helmet usage by comparing trauma sustained by helmeted and helmetless cyclists admitted to a large US health-care system.

Materials And Methods: A prospective trauma registry associated with a large regional United States health-care network was queried for bicycle injuries resulting in hospital admission over a 5-year period. Data pertaining to helmet usage, demographics, injury description (s), Abbreviated Injury Scale score, Injury Severity Score, and hospital length of stay were collected from 140 patients treated for bicycle-related injuries. Mann-Whitney tests were performed.

Results: Fifty-six of the injured cyclists were helmeted (40%) and 84 were not helmeted (60%). A significantly greater proportion of helmeted cyclists exhibited abrasions and a higher incidence of injury across all injury types ( = <0.001 and 0.003). The number and severity of injury to the external body ( = <0.001 and 0.001) and overall injury severity ( = 0.004) for patients with multiple injuries were also significantly greater among helmeted cyclists. Helmeted cyclists did demonstrate significantly shorter hospital stays ( = 0.021).

Conclusion: While the helmeted and helmetless riders admitted to the emergency department exhibit few differences in injury patterns, when significant injury differences were detected, they were more prevalent in helmeted riders. These differences were represented by minor-to-moderate injuries relative to morbidity and mortality, suggesting that the trauma profile of the helmeted and helmetless riders is relatively comparable. Yet, helmetless wearers did have significantly longer hospital stays, which may indicate underlying health disparities and/or behavioral differences.

References

Seicean A, Seicean S, Neuhauser D, Benzel E, Weil R . The Influence of Race on Short-term Outcomes After Laminectomy and/or Fusion Spine Surgery. Spine (Phila Pa 1976). 2016; 42(1):34-41. DOI: 10.1097/BRS.0000000000001657. View

Phillips R, Fyhri A, Sagberg F . Risk compensation and bicycle helmets. Risk Anal. 2011; 31(8):1187-95. DOI: 10.1111/j.1539-6924.2011.01589.x. View

Sethi M, Heidenberg J, Wall S, Ayoung-Chee P, Slaughter D, Levine D . Bicycle helmets are highly protective against traumatic brain injury within a dense urban setting. Injury. 2015; 46(12):2483-90. DOI: 10.1016/j.injury.2015.07.030. View

Reis R, Hino A, Parra D, Hallal P, Brownson R . Bicycling and walking for transportation in three Brazilian cities. Am J Prev Med. 2013; 44(2):e9-17. PMC: 4763277. DOI: 10.1016/j.amepre.2012.10.014. View

Davis A, Vinci L, Okwuosa T, Chase A, Huang E . Cardiovascular health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007; 64(5 Suppl):29S-100S. PMC: 2367222. DOI: 10.1177/1077558707305416. View

Lad S, Bagley J, Kenney K, Ugiliweneza B, Kong M, Bagley C . Racial disparities in outcomes of spinal surgery for lumbar stenosis. Spine (Phila Pa 1976). 2012; 38(11):927-35. DOI: 10.1097/BRS.0b013e31828165f9. View

Castle S, Burke R, Arbogast H, Upperman J . Bicycle helmet legislation and injury patterns in trauma patients under age 18. J Surg Res. 2010; 173(2):327-31. DOI: 10.1016/j.jss.2010.10.031. View

Schneider E, Calkins K, Weiss M, Herman J, Wolfgang C, Makary M . Race-based differences in length of stay among patients undergoing pancreatoduodenectomy. Surgery. 2014; 156(3):528-37. DOI: 10.1016/j.surg.2014.04.004. View

Gamble T, Walker I . Wearing a Bicycle Helmet Can Increase Risk Taking and Sensation Seeking in Adults. Psychol Sci. 2016; 27(2):289-94. PMC: 4767144. DOI: 10.1177/0956797615620784. View

10.

Messiah A, Constant A, Contrand B, Felonneau M, Lagarde E . Risk compensation: a male phenomenon? Results from a controlled intervention trial promoting helmet use among cyclists. Am J Public Health. 2012; 102 Suppl 2:S204-6. PMC: 3477913. DOI: 10.2105/AJPH.2012.300711. View

11.

Zibung E, Riddez L, Nordenvall C . Helmet use in bicycle trauma patients: a population-based study. Eur J Trauma Emerg Surg. 2015; 41(5):517-21. DOI: 10.1007/s00068-014-0471-y. View

12.

Rooks R, Simonsick E, Klesges L, Newman A, Ayonayon H, Harris T . Racial disparities in health care access and cardiovascular disease indicators in Black and White older adults in the Health ABC Study. J Aging Health. 2008; 20(6):599-614. PMC: 2733332. DOI: 10.1177/0898264308321023. View

13.

Hedlund J . Risky business: safety regulations, risks compensation, and individual behavior. Inj Prev. 2000; 6(2):82-90. PMC: 1730605. DOI: 10.1136/ip.6.2.82. View

14.

Thai K, McIntosh A, Pang T . Bicycle helmet size, adjustment, and stability. Traffic Inj Prev. 2014; 16:268-75. DOI: 10.1080/15389588.2014.931948. View

15.

Brown J, Gestring M, Leeper C, Sperry J, Peitzman A, Billiar T . The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?. J Trauma Acute Care Surg. 2017; 82(6):995-1001. PMC: 5464600. DOI: 10.1097/TA.0000000000001440. View

16.

Copes W, Champion H, Sacco W, Lawnick M, Keast S, Bain L . The Injury Severity Score revisited. J Trauma. 1988; 28(1):69-77. DOI: 10.1097/00005373-198801000-00010. View

17.

McWilliams J, Meara E, Zaslavsky A, Ayanian J . Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage. Ann Intern Med. 2009; 150(8):505-15. DOI: 10.7326/0003-4819-150-8-200904210-00005. View

18.

Bambach M, Mitchell R, Grzebieta R, Olivier J . The effectiveness of helmets in bicycle collisions with motor vehicles: a case-control study. Accid Anal Prev. 2013; 53:78-88. DOI: 10.1016/j.aap.2013.01.005. View

19.

Bolorunduro O, Villegas C, Oyetunji T, Haut E, STEVENS K, Chang D . Validating the Injury Severity Score (ISS) in different populations: ISS predicts mortality better among Hispanics and females. J Surg Res. 2010; 166(1):40-4. DOI: 10.1016/j.jss.2010.04.012. View

20.

Amoros E, Chiron M, Martin J, Thelot B, Laumon B . Bicycle helmet wearing and the risk of head, face, and neck injury: a French case--control study based on a road trauma registry. Inj Prev. 2011; 18(1):27-32. DOI: 10.1136/ip.2011.031815. View