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December 25, 1996, Vol 276, No. 24 >
ARTICLE | December 25, 1996

Effectiveness of Bicycle Safety Helmets in Preventing Head Injuries: Title and subTitle BreakA Case-Control Study FREE

Robert S. Thompson, MD; Frederick P. Rivara, MD, MPH; Diane C. Thompson, MS
[+] Author Affiliations

Corresponding author: Diane C. Thompson, MS, Harborview Injury Prevention and Research Center, 325 Ninth Ave, Box 359960, Seattle, WA 98104-2499 (e-mail: dct@u.washington.edu).


JAMA. 1996;276(24):1968-1973. doi:10.1001/jama.1996.03540240046029
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References

Objectives.  —To examine the protective effectiveness of bicycle helmets in 4 different age groups of bicyclists, in crashes involving motor vehicles, and by helmet type and certification standards.

Research Design.  —Prospective case-control study

Setting.  —Emergency departments (EDs) in 7 Seattle, Wash, area hospitals between March 1, 1992, and August 31, 1994.

Participants.  —Case subjects were all bicyclists treated in EDs for head injuries, all who were hospitalized, and all who died at the scene. Control subjects were bicyclists treated for nonhead injuries.

Main Results.  —There were 3390 injured bicyclists in the study; 29% of cases and 56% of controls were helmeted. Risk of head injury in helmeted vs unhelmeted cyclists adjusted for age and motor vehicle involvement indicate a protective effect of 69% to 74% for helmets for 3 different categories of head injury: any head injury (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.26-0.37), brain injury (OR, 0.35; 95% CI, 0.25-0.48), or severe brain injury (OR, 0.26; 95% CI, 0.14-0,48). Adjusted ORs for each of 4 age groups (<6 y, 6-12 y, 13-19 y, and ≥20 years) indicate similar levels of helmet protection by age (OR range, 0.27-0.40). Helmets were equally effective in crashes involving motor vehicles (OR, 0. 95% CI, 0.20-0.48) and those not involving motor vehicles (OR, 0.32; 95% CI, 0.20-0.39). There was no effect modification by age or motor vehicle involvement (P=.7 and P=.3). No significant differences were found for the protective effect of hard-shell, thin-shell, or no-shell helmets (P=.5).

Conclusions.  —Bicycle helmets, regardless of type, provide substantial protection against head injuries for cyclists of all ages involved in crashes, including crashes involving motor vehicles.

REFERENCES

1 +
Thompson DC, Dannenberg AL, Thompson RS, Rivara FP.  Bicycling . In: Caine C, Caine D, Lindner K, eds. Epidemiology of Sports Injuries . Champaign, Ill: Human Kinetics Publishers; 1996;:98-112.
2 +
Henderson M. The effectiveness of bicycle helmets: a review . Sydney, Australia: The Motor Accidents Authority of New South Wales; 1996;.
3 +
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.
4 +
Thomas S, Acton C, Nixon J, Battisutta D, Pitt WR, Clark R.  Effectiveness of bicycle helmets in preventing head injury in children: case control study . BMJ . 1994;;308:173-176.
5 +
McDermott FT, Lane JC, Brazenor GA, Debney EA.  The effectiveness of bicyclist helmets: a study of 1710 casualties . J Trauma . 1993;;34:834-845.
6 +
Maimaris C, Summers CL, Browning C, Palmer CR.  Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers . BMJ . 1994;;308:1537-1540.
7 +
Cameron MH, Vulcan PA, Finch CF, Newstad SV.  Bicycle helmet use following a decade of helmet promotion in Victoria, Australia: an evaluation . Accid Anal Prev . 1994;;26:325-337.
8 +
Rivara FP, Thompson DC, Thompson RS, et al.  The Seattle children's bicycle helmet campaign . Pediatrics . 1994;;93:567-569.
9 +
Pitt WR, Thomas S, Nixon J, Clark R, Battisutta D, Acton C.  Trends in head injuries among child bicyclists . BMJ . 1994;;308:177.
10 +
McCarthy M.  Do cycle helmets prevent serious head injury? BMJ . 1992;;305:881-882.
11 +
Hillman M. Cycle Helmets: The Case for and Against . London, England: Policy Studies Institute; 1993;.
12 +
Teasdale B, Jennett B.  Assessment of coma and impaired consciousness . Lancet . 1974;;2:81-84.
13 +
Tri-Analyics Inc. TRI-CODE 5.0 (Personal Computer Injury Coding Software) . Bel Air, Md: Tri-Analytics Inc; 1989;.
14 +
National Center for Health Statistics. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) . Washington, DC: US Dept of Health and Human Services; 1991;. DHHS publication PHS 91-1260.
15 +
Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale, 1990 Revision . Des Plaines, Ill: Association for the Advancement of Automotive Medicine; 1990;.
16 +
SAS Institute Inc. SAS Language and Procedures: Usage, Version 6, First Edition . Cary, NC: SAS Institute Inc; 1989;.
17 +
Cornfield JA.  Statistical problem arising from retrospective studies . In: Neyman J, ed. Proceedings of the Third Berkeley Symposium, Vol 4 . Berkeley: University of California Press; 1956;:135-148.
18 +
Breslow NE, Day NE.  Statistical methods in cancer research . In: Breslow NE, Day NE, eds. The Analysis of Case-Control Studies, Volume 1 . Lyon, France: International Agency for Research on Cancer; 1980;:190-246. International Agency for Research on Cancer publication 32.
19 +
Thompson DC.  Effectiveness of bicycle helmets . J Trauma . 1994;;36:463.
20 +
Vulcan PA, Cameron MH, Watson WL.  Mandatory bicycle helmet use: experience in Victoria, Australia . World J Surg . 1992;;16:389-397.
21 +
McDermott F.  Protection afforded by cycle helmets . BMJ . 1994;;309:877.
22 +
Thompson DC, Thompson RS, Rivara MP, Wolf ME.  Case-control study of the effectiveness of bicycle safety helmets in preventing facial injury . Am J Public Health . 1990;;80:1471-1474.
23 +
Thompson DC, Nunn ME, Thompson RS, Rivara FP.  Effectiveness of bicycle safety helmets in preventing serious facial injury . JAMA . 1996;;276:1974-1975.
24 +
Thompson DC, Rebolledo V, Thompson RS, Kaufman A, Rivara FP. Bike speed measurements in a recreational population. Inj Prev. In press.
25 +
Spaite DW, Murphy M, Criss EA, Valenzuela TD, Meislin HW.  A prospective analysis of injury severity among helmeted and nonhelmeted bicyclists involved in collisions with motor vehicles . J Trauma . 1991;;31:1510-1516.
26 +
Cote TR, Sacks JJ, Lambert-Huber DA, Dannenberg AL, Kresnow M, Lipitz A.  Bicycle helmet use among Maryland children: effect of legislation and education . Pediatrics . 1992;;89:1216-1220.
27 +
Wachtel A, Lewiston D.  Risk factors for bicyclemotor vehicle collisions at intersections . Inst Transportation Eng J . 1994;;64:30-32.

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1 +
Thompson DC, Dannenberg AL, Thompson RS, Rivara FP.  Bicycling . In: Caine C, Caine D, Lindner K, eds. Epidemiology of Sports Injuries . Champaign, Ill: Human Kinetics Publishers; 1996;:98-112.
2 +
Henderson M. The effectiveness of bicycle helmets: a review . Sydney, Australia: The Motor Accidents Authority of New South Wales; 1996;.
3 +
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.
4 +
Thomas S, Acton C, Nixon J, Battisutta D, Pitt WR, Clark R.  Effectiveness of bicycle helmets in preventing head injury in children: case control study . BMJ . 1994;;308:173-176.
5 +
McDermott FT, Lane JC, Brazenor GA, Debney EA.  The effectiveness of bicyclist helmets: a study of 1710 casualties . J Trauma . 1993;;34:834-845.
6 +
Maimaris C, Summers CL, Browning C, Palmer CR.  Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers . BMJ . 1994;;308:1537-1540.
7 +
Cameron MH, Vulcan PA, Finch CF, Newstad SV.  Bicycle helmet use following a decade of helmet promotion in Victoria, Australia: an evaluation . Accid Anal Prev . 1994;;26:325-337.
8 +
Rivara FP, Thompson DC, Thompson RS, et al.  The Seattle children's bicycle helmet campaign . Pediatrics . 1994;;93:567-569.
9 +
Pitt WR, Thomas S, Nixon J, Clark R, Battisutta D, Acton C.  Trends in head injuries among child bicyclists . BMJ . 1994;;308:177.
10 +
McCarthy M.  Do cycle helmets prevent serious head injury? BMJ . 1992;;305:881-882.
11 +
Hillman M. Cycle Helmets: The Case for and Against . London, England: Policy Studies Institute; 1993;.
12 +
Teasdale B, Jennett B.  Assessment of coma and impaired consciousness . Lancet . 1974;;2:81-84.
13 +
Tri-Analyics Inc. TRI-CODE 5.0 (Personal Computer Injury Coding Software) . Bel Air, Md: Tri-Analytics Inc; 1989;.
14 +
National Center for Health Statistics. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) . Washington, DC: US Dept of Health and Human Services; 1991;. DHHS publication PHS 91-1260.
15 +
Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale, 1990 Revision . Des Plaines, Ill: Association for the Advancement of Automotive Medicine; 1990;.
16 +
SAS Institute Inc. SAS Language and Procedures: Usage, Version 6, First Edition . Cary, NC: SAS Institute Inc; 1989;.
17 +
Cornfield JA.  Statistical problem arising from retrospective studies . In: Neyman J, ed. Proceedings of the Third Berkeley Symposium, Vol 4 . Berkeley: University of California Press; 1956;:135-148.
18 +
Breslow NE, Day NE.  Statistical methods in cancer research . In: Breslow NE, Day NE, eds. The Analysis of Case-Control Studies, Volume 1 . Lyon, France: International Agency for Research on Cancer; 1980;:190-246. International Agency for Research on Cancer publication 32.
19 +
Thompson DC.  Effectiveness of bicycle helmets . J Trauma . 1994;;36:463.
20 +
Vulcan PA, Cameron MH, Watson WL.  Mandatory bicycle helmet use: experience in Victoria, Australia . World J Surg . 1992;;16:389-397.
21 +
McDermott F.  Protection afforded by cycle helmets . BMJ . 1994;;309:877.
22 +
Thompson DC, Thompson RS, Rivara MP, Wolf ME.  Case-control study of the effectiveness of bicycle safety helmets in preventing facial injury . Am J Public Health . 1990;;80:1471-1474.
23 +
Thompson DC, Nunn ME, Thompson RS, Rivara FP.  Effectiveness of bicycle safety helmets in preventing serious facial injury . JAMA . 1996;;276:1974-1975.
24 +
Thompson DC, Rebolledo V, Thompson RS, Kaufman A, Rivara FP. Bike speed measurements in a recreational population. Inj Prev. In press.
25 +
Spaite DW, Murphy M, Criss EA, Valenzuela TD, Meislin HW.  A prospective analysis of injury severity among helmeted and nonhelmeted bicyclists involved in collisions with motor vehicles . J Trauma . 1991;;31:1510-1516.
26 +
Cote TR, Sacks JJ, Lambert-Huber DA, Dannenberg AL, Kresnow M, Lipitz A.  Bicycle helmet use among Maryland children: effect of legislation and education . Pediatrics . 1992;;89:1216-1220.
27 +
Wachtel A, Lewiston D.  Risk factors for bicyclemotor vehicle collisions at intersections . Inst Transportation Eng J . 1994;;64:30-32.

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