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December 4, 1991, Vol 266, No. 21 >
ARTICLE | December 4, 1991

Bicycle-Associated Head Injuries and Deaths in the United States From 1984 Through 1988: Title and subTitle BreakHow Many Are Preventable? FREE

Jeffrey J. Sacks, MD, MPH; Patricia Holmgreen, MS; Suzanne M. Smith, MD; Daniel M. Sosin, MD
[+] Author Affiliations

Reprint requests to Division of Injury Control (F-36), Centers for Disease Control, 1600 Clifton Rd NE, Atlanta, GA 30333 (Dr Sacks).


JAMA. 1991;266(21):3016-3018. doi:10.1001/jama.1991.03470210084038
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References

Objective.  —To estimate the potential benefits from more widespread bicycle safety helmet use.

Design.  —Review of death certificates and emergency department injury data for 1984 through 1988. Categorization of deaths and injuries as related to bicycling and head injury. Using relative risks of 3.85 and 6.67 derived from a case-control study and varying helmet usage from 10% to 100%, population attributable risk was calculated to estimate preventable deaths and injuries.

Setting.  —Entire United States.

Main Outcome Measures.  —Numbers of US residents coded as dying from bicycle-related head injuries, numbers of persons presenting to emergency departments for bicycle-related head injuries, and numbers of attributable bicycle-related deaths and head injuries.

Main Results.  —From 1984 through 1988, bicycling accounted for 2985 head injury deaths (62% of all bicycling deaths) and 905 752 head injuries (32% of persons with bicycling injuries treated at an emergency department). Forty-one percent of head injury deaths and 76% of head injuries occurred among children less than 15 years of age. Universal use of helmets by all bicyclists could have prevented as many as 2500 deaths and 757 000 head injuries, ie, one death every day and one head injury every 4 minutes.

Conclusions.  —Effective community-based education programs and legislated approaches for increasing bicycle safety helmet usage have been developed and await only the resources and commitment to reduce these unnecessary deaths and injuries.(JAMA. 1991;266:3016-3018)

REFERENCES

1 +
 Centers for Disease Control. Bicycle-related injuries: data from the National Electronic Injury Surveillance System. MMWR . 1987;;36:269-271.
2 +
Friede AM, Azzara CV, Gallagher SS, Guyer B.  The epidemiology of injuries to bicycle riders. Pediatr Clin North Am . 1985;;32:141-151.
3 +
Buntain WL.  Bicycle injuries in children: an economic insight and literature review.  In: Proceedings of the 29th annual meeting of the American Association for Automotive Medicine ; Washington, DC. October 7-9, 1985;:307-321.
4 +
Fife D, Davis J, Tate L, Wells JK, Mohan D, Williams A.  Fatal injuries to bicyclists: the experience in Dade County, Florida. J Trauma . 1983;;23:745-755.
5 +
McDermott FT, Klug GL.  Injury profile of pedal and motor cyclist casualties in Victoria. Aust N Z J Surg . 1985;;55:477-483.
6 +
Lundar T, Nestvold K.  Pediatric head injuries caused by traffic accidents: a prospective study with 5-year follow-up. Child Nerv Syst . 1985;;1: 24-28.
7 +
Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA.  Disability caused by minor head injury. Neurosurgery . 1981;;9:221-228.
8 +
Rimel RW, Giordani B, Barth JT, Jane JA.  Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery . 1982;;11:344-351.
9 +
Weiss BD.  Childhood bicycle injuries: what can we do? AJDC . 1987;;141:135-136.
10 +
Thompson RS, Rivara FP, Thompson DC.  A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med . 1989;;320:1361-1367.
11 +
Weiss BD.  Bicycle helmet use by children. Pediatrics . 1986;;77:677-679.
12 +
 Bike helmets: unused lifesavers. Consumer Rep . (May) 1990;:348-353.
13 +
Flora JD, Abbott RD.  National trends in bicycle accidents. J Safety Res . 1979;;11:20-27.
14 +
National Center for Health Statistics. Vital Statistics Mortality Data, Multiple Cause-of-Death Detail, 1984-1988 . Hyattsville, Md: US Department of Health and Human Services, Public Health Service, Centers for Disease Control. Machine-readable public-use data tapes.
15 +
World Health Organization. Manual of the International Classification of Diseases, Injuries, and Causes of Death, Ninth Revision . Geneva, Switzerland: World Health Organization; 1977;.
16 +
Sosin DM, Sacks JJ, Smith SM.  Head injury-associated deaths in the United States from 1979 to 1986. JAMA . 1989;;262:2251-2255.
17 +
Bureau of the Census. Intercensal Population Estimates by Race, Sex, and Age, 1984-1988 . Washington, DC: US Department of Commerce, Bureau of the Census. Machine-readable data files.
18 +
Rothman K. Modern Epidemiology . Boston, Mass: Little Brown & Co; 1986;:38-39.
19 +
DiGuiseppi CG, Rivara FP, Koepsell TD, Polissar L.  Bicycle helmet use by children: evaluation of a community-wide helmet campaign. JAMA . 1989;;262:2256-2261.
20 +
Dorsch MM, Woodward AJ, Somers RL.  Do bicycle safety helmets reduce severity of head injury in real crashes? Accid Anal Prev . 1987;;19:183-190.
21 +
Wasserman RC, Waller JA, Monty MJ, Emery AB, Robinson DR.  Bicyclists, helmets, and head injuries: a rider-based study of helmet use and effectiveness. Am J Public Health . 1988;;78:1220-1221.
22 +
Wasserman RC, Buccini RV.  Helmet protection from head injuries among recreational bicyclists. Am J Sports Med . 1990;;18:96-97.
23 +
Buccini RV. Would widespread helmet use decrease bicyclist mortality? Presented at the American Public Health Association annual meeting. October 18-22,1987; New Orleans, La. Abstract.
24 +
Hodgson VR. Impact, Skid, and Retention Tests on a Representative Group of Bicycle Helmets to Determine Their Head-Neck Protective Characteristics . Detroit, Mich: Wayne State University, Department of Neurosurgery; 1990;.
25 +
Thompson DC, Thompson RS, Rivara FP, Wolf ME.  A case-control study of the effectiveness of bicycle safety helmets in preventing facial injury. Am J Public Health . 1990;;80:1471-1474.
26 +
Williams M.  The protective performance of bicyclists' helmets in accidents. Accid Anal Prev . 1991;;23:119-131.
27 +
Bishop PJ, Briard BD.  Impact performance of bicycle helmets. Can J Sport Sci . 1984;;9:94-101.
28 +
Weiss BD, Duncan B.  Bicycle helmet use by children: knowledge and behavior of physicians. Am J Public Health . 1986;;76:1022-1023.
29 +
Wood T, Milne P.  Head injuries to pedal cyclists and the promotion of helmet use in Victoria, Australia. Accid Anal Prev . 1988;;20:177-185.

Figures

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Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 Centers for Disease Control. Bicycle-related injuries: data from the National Electronic Injury Surveillance System. MMWR . 1987;;36:269-271.
2 +
Friede AM, Azzara CV, Gallagher SS, Guyer B.  The epidemiology of injuries to bicycle riders. Pediatr Clin North Am . 1985;;32:141-151.
3 +
Buntain WL.  Bicycle injuries in children: an economic insight and literature review.  In: Proceedings of the 29th annual meeting of the American Association for Automotive Medicine ; Washington, DC. October 7-9, 1985;:307-321.
4 +
Fife D, Davis J, Tate L, Wells JK, Mohan D, Williams A.  Fatal injuries to bicyclists: the experience in Dade County, Florida. J Trauma . 1983;;23:745-755.
5 +
McDermott FT, Klug GL.  Injury profile of pedal and motor cyclist casualties in Victoria. Aust N Z J Surg . 1985;;55:477-483.
6 +
Lundar T, Nestvold K.  Pediatric head injuries caused by traffic accidents: a prospective study with 5-year follow-up. Child Nerv Syst . 1985;;1: 24-28.
7 +
Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA.  Disability caused by minor head injury. Neurosurgery . 1981;;9:221-228.
8 +
Rimel RW, Giordani B, Barth JT, Jane JA.  Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery . 1982;;11:344-351.
9 +
Weiss BD.  Childhood bicycle injuries: what can we do? AJDC . 1987;;141:135-136.
10 +
Thompson RS, Rivara FP, Thompson DC.  A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med . 1989;;320:1361-1367.
11 +
Weiss BD.  Bicycle helmet use by children. Pediatrics . 1986;;77:677-679.
12 +
 Bike helmets: unused lifesavers. Consumer Rep . (May) 1990;:348-353.
13 +
Flora JD, Abbott RD.  National trends in bicycle accidents. J Safety Res . 1979;;11:20-27.
14 +
National Center for Health Statistics. Vital Statistics Mortality Data, Multiple Cause-of-Death Detail, 1984-1988 . Hyattsville, Md: US Department of Health and Human Services, Public Health Service, Centers for Disease Control. Machine-readable public-use data tapes.
15 +
World Health Organization. Manual of the International Classification of Diseases, Injuries, and Causes of Death, Ninth Revision . Geneva, Switzerland: World Health Organization; 1977;.
16 +
Sosin DM, Sacks JJ, Smith SM.  Head injury-associated deaths in the United States from 1979 to 1986. JAMA . 1989;;262:2251-2255.
17 +
Bureau of the Census. Intercensal Population Estimates by Race, Sex, and Age, 1984-1988 . Washington, DC: US Department of Commerce, Bureau of the Census. Machine-readable data files.
18 +
Rothman K. Modern Epidemiology . Boston, Mass: Little Brown & Co; 1986;:38-39.
19 +
DiGuiseppi CG, Rivara FP, Koepsell TD, Polissar L.  Bicycle helmet use by children: evaluation of a community-wide helmet campaign. JAMA . 1989;;262:2256-2261.
20 +
Dorsch MM, Woodward AJ, Somers RL.  Do bicycle safety helmets reduce severity of head injury in real crashes? Accid Anal Prev . 1987;;19:183-190.
21 +
Wasserman RC, Waller JA, Monty MJ, Emery AB, Robinson DR.  Bicyclists, helmets, and head injuries: a rider-based study of helmet use and effectiveness. Am J Public Health . 1988;;78:1220-1221.
22 +
Wasserman RC, Buccini RV.  Helmet protection from head injuries among recreational bicyclists. Am J Sports Med . 1990;;18:96-97.
23 +
Buccini RV. Would widespread helmet use decrease bicyclist mortality? Presented at the American Public Health Association annual meeting. October 18-22,1987; New Orleans, La. Abstract.
24 +
Hodgson VR. Impact, Skid, and Retention Tests on a Representative Group of Bicycle Helmets to Determine Their Head-Neck Protective Characteristics . Detroit, Mich: Wayne State University, Department of Neurosurgery; 1990;.
25 +
Thompson DC, Thompson RS, Rivara FP, Wolf ME.  A case-control study of the effectiveness of bicycle safety helmets in preventing facial injury. Am J Public Health . 1990;;80:1471-1474.
26 +
Williams M.  The protective performance of bicyclists' helmets in accidents. Accid Anal Prev . 1991;;23:119-131.
27 +
Bishop PJ, Briard BD.  Impact performance of bicycle helmets. Can J Sport Sci . 1984;;9:94-101.
28 +
Weiss BD, Duncan B.  Bicycle helmet use by children: knowledge and behavior of physicians. Am J Public Health . 1986;;76:1022-1023.
29 +
Wood T, Milne P.  Head injuries to pedal cyclists and the promotion of helmet use in Victoria, Australia. Accid Anal Prev . 1988;;20:177-185.

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