OBJECTIVES: This study analyzed the reduction in risk of head injuries associated with use of bicycle helmets among persons ages 3 to 70 and the cost-effectiveness of helmet use based on this estimated risk reduction. METHODS: To derive our cost-effectiveness estimates, we combined injury incidence data gathered through a detailed and comprehensive injury registration system in Norway, acute medical treatment cost information for the Norwegian health service, and information reported in the scientific literature regarding the health protective effects of helmet use. The analysis included all cases of head injuries reported through the registration system from 1990 through 1996. We performed an age-stratified analysis to determine the incidence of bicycle-related head injuries, the 5-year reduction in absolute risk of injury, the number needed to treat, and the cost-effectiveness of helmet use. To test the robustness of the findings to parameter assumptions, we performed sensitivity analysis. RESULTS: The risk of head injury was highest among children aged 5 to 16. The greatest reduction in absolute risk of head injury, 1.0 to 1.4% over 5 years estimated helmet lifetime, occurred among children who started using a helmet between the ages of 3 and 13. Estimates indicate that it would cost approximately U.S. $2,200 in bicycle helmet expenses to prevent any one upper head injury in children ages 3-13. In contrast, it would cost U.S. $10,000-25,000 to avoid a single injury among adults. CONCLUSIONS: Bicycle safety helmets appear to be several times more cost-effective for children than adults, primarily because of the higher risk of head injury among children. Programs aiming to increase helmet use should consider the differences in injury risk and cost-effectiveness among different age groups and target their efforts accordingly.
Denmark is one of the leading cycling nations, where cycling trips constitute a large share of the total trips, and cycling safety assumes a top priority position in the agenda of policy makers. The current study sheds light on the aggravating and mitigating factors associated with cyclist injury severity on Danish roads by examining a comprehensive set of accidents involving a cyclist and a collision partner between 2007 and 2011.
This study estimates a generalized ordered logit model of the severity of cyclist injuries because of its ability to accommodate the ordered-response nature of severity while relaxing the proportional odds assumption.
Model estimates show that cyclist fragility (children under 10 years old and elderly cyclists over 60 years of age) and cyclist intoxication are aggravating individual factors, while helmet use is a mitigating factor. Speed limits above 70-80 km/h, slippery road surface, and location of the crash on road sections are aggravating infrastructure factors, while the availability of cycling paths and dense urban development are mitigating factors. Heavy vehicle involvement and conflicts between cyclists going straight or turning left and other vehicles going straight are aggravating vehicle involvement factors. Practical applications: The results are discussed in the context of applied policies, engineering, and traffic management solutions for bicycle safety in Denmark.
To describe all terrain vehicle (ATV) ownership, access, use, and safety behaviours in rural Manitoba children.
Questionnaire administered to a convenience sample of grade 6 students attending an agricultural fair.
162 grade 6 children participated. The mean age was 11.4 years, and 46% were male. 125 students (77%) reported having access to ATVs, including 69 four wheeled, 24 three wheeled, and four both three and four wheeled ATVs. ATV experience was reported in 95 students, significantly more often in males and among those with a family owned ATV, with no difference between children living on a farm and in a town. Use of helmets and protective clothing was inadequate (10-40%), and dangerous riding habits common, with males and children living on a farm reporting significantly fewer desirable behaviours.
ATVs are commonly used by children in rural Manitoba, with inadequate protective gear and dangerous riding habits. Mandatory rider training, consumer and dealer education, and legislation enforcement could improve ATV safety in this population.
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To review head injury in football through historical, anatomic, and physiological analysis.
We obtained data from a thorough review of the literature.
The reported incidence of concussion among high school football players dropped from 19% in 1983 to 4% in 1999. During the 1997 Canadian Football League season, players with a previous loss of consciousness in football were 6.15 times more likely to experience a concussion than players without a previous loss of consciousness (P
The impact attenuating characteristics of a sample of 81 football helmets used in competitive high school programs were determined using a Hodgson-Wayne State University (WSU) headform and a modified National Operating Committee on Standards for Athletic Equipment (NOCSAE) test protocol. The helmets, classified by liner type as suspension (37), padded-suspension (22), and padded (22) had been in use for 6 to 8 years. Each was subjected to two consecutive right rear boss impacts from a drop height of 1.5 m, onto a rigid anvil covered with a 45 durometer hardness rubber pad. Analogue signals from a triaxial accelerometer located at the center of gravity of the headform were analogue to digital (A/D) converted at 6060.6 Hz and processed on a Hewlett Packard 9845B minicomputer to yield a resultant acceleration-time curve from which peak acceleration (gpeak) and the Gadd Severity Index (GSI) were determined. The mean gpeak was 205 g for helmets with suspension liners, 165 g for helmets with padded-suspension liners, and 156 g for helmets with padded liners. Twenty-four suspension helmets and five padded or padded-suspension helmets had GSI values greater than 1200. Using a criterion of GSI1500, the failure rate for suspension helmets was 19% compared to 2% for padded and padded-suspension helmets combined. If the criterion chosen was GSI1200, the failure rate for suspension helmets was 65% as opposed to 11% for the padded and padded-suspension helmets combined. Suspension helmets are decidedly inferior under impact conditions to the padded and padded-suspension helmets.
BACKGROUND: Bicycle helmets prevent head injury in bicycle riders. Still, only a portion of bicycle riders in Norway use bicycle helmets. The aim of this study was to estimate the number of head injuries among bicycle riders that might be prevented by increased helmet use in Norway. MATERIAL AND METHODS: We used data from the Norwegian National Injury Register for the years 1995 and 1996 to estimate the number of bicycle injuries in Norway. In order to estimate the number of bicycle users and helmet users in different age groups, we used data from earlier surveys of bicycle use. Data on the effectiveness of helmet promotion interventions have been obtained from a systematic review of the literature. RESULTS: The overall annual incidence rate was 92 injuries per 100,000 bicycle users. The incidence varied with age and was highest among children. If every rider used a helmet, about 1,600 head injuries would be avoided every year, of these, 800 among children aged 0-14. Currently available helmet promotion interventions may improve the use among children by about 40%, thus preventing about 1,500 head injuries over a period of three years. Successful helmet promotion interventions use a combination of health education and helmet distribution strategies. INTERPRETATIONS: There is a significant health improvement potential in promoting bicycle helmets in Norway by implementation of evaluated modes of intervention.
Comment In: Tidsskr Nor Laegeforen. 2000 Aug 20;120(19):233110997099
Observation of 992 motor vehicles and their drivers revealed that most drivers do not have their head restraints effectively positioned. Improper positioning was more common with adjustable restraints, in commercial vehicles, and among male drivers. Some head restraints could not be adjusted properly. Improvements in headrest adjustment might help decrease morbidity in motor vehicle accidents.
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Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment.
To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment.
University sports medicine clinic.
A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players.
Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained.
The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale.
All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players.
Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited.