Helmets for preventing head, brain, and facial injuries in cyclists

E B E M / S Y S T E M A T I C R E V I E W A B S T R A C T M A Y 2 0 0 3 4 1 : 5 A N N A L S O F E M E R G E N C Y M E D I C I N E 7 3 9 (CIs) for the protective effect of helmets on head, brain, and facial injuries were reported. “Head injury” refers to injury to the scalp, skull, or brain, whereas “brain injury” refers to a loss of consciousness or other objective evidence of traumatic brain injury/dysfunction. ORs were adjusted for several confounders related to crash severity, such as being hit by a car or falling on the street. In addition, brain and head injury results were summarized using meta-analytic techniques. M A I N R E S U L T S Five case-control trials involving 7,253 head-injured patients and 2 case-control trials involving 3,919 face-injured patients were identified. Helmets were associated with a 65% to 88% reduction in the risk of head and brain injury and a 65% reduction in the risk of upper/middle facial lacerations and fractures. For head injuries overall, the summary statistic suggested a substantial reduction of head injuries for cyclists wearing helmets (OR 0.31; 95% CI 0.26 to 0.37). For head injuries among cyclists involved in crashes with motor vehicles, the adjusted statistic showed a similar trend (OR 0.31; 95% CI 0.2 to 0.48). Similar results were obtained for brain injury among cyclists involved in crashes with vehicles, regardless of age. For brain injuries overall, the summary statistic suggested a substantial reduction of brain injuries for cyclists wearing helmets (OR 0.31; 95% CI 0.23 to 0.42). Overall, helmets did not appear to protect cyclists from serious (lacerations and fractures) facial injuries (adjusted OR 0.81; 95% CI 0.45 to 1.5); however, they did appear to protect against serious upper (adjusted OR 0.36; 95% CI 0.26 to 0.49) and middle (adjusted OR 0.35; 95% CI 0.24 to 0.5) facial injuries. are considered highly preventable through the use of helmets,2 makes this review an important one for emergency physicians. The 5 case-control studies examined by the authors of this Cochrane Review contribute significantly to the body of evidence that helmets are causally linked to the prevention of traumatic brain injury. Two additional studies examining facial injuries indicate that helmets effectively prevent facial injuries. Using accepted and systematic methodology, the authors evaluated the evidence from nonrandomized observational (eg, before-after, concurrent controls, ecological studies) research of helmet use to prevent head and facial injuries. Overall, the evidence strongly supports the role of helmets in reducing traumatic head, brain, and facial injuries while riding a bicycle. This evidence is accumulated over the past decade from 3 countries, so the information should be considered generalizable to developed nations. Despite the data presented in these studies (which have been available since 1996), without legislation, helmet use among North Americans remains low (in the 15% to 25% range).5,6 Strategies to increase cyclist helmet use have been the subject of much controversy and debate. In many parts of the world, legislative changes have been required to increase the helmet use in the population above the baselines achieved through education. The public health desire to reduce the burden of injury to the population through legislation contrasts sharply with the belief that individual cyclists have the right to decide whether or not to wear a helmet. Although this Cochrane review cannot resolve this conflict, it lays the foundation on which a rational debate can occur. C O N C L U S I O N S Cyclists wearing helmets appear to be at significantly lower risk of head and brain injuries after a bicycle crash than those not wearing helmets, regardless of age or crash severity. Helmet wearers also have a lower risk of facial injuries, but only for injuries that are serious (lacerations or fractures) and to the upper or middle face. Helmet use among cyclists of all ages is encouraged. Cochrane Systematic Review Author