Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset

Abstract

ObjectivesIn the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.SettingThe NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).Participants11 192 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.Outcome measuresTARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.ResultsData on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p<0.001). Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%–20.4%) versus 47.6% (1211, 45.6%–49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%–20.8%) versus 27.1% (691, 25.4%–28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%–3.1%) versus 8.5% (217, 7.5%–9.7%) (p<0.001). There was a statistically significant increase in chest, spinal, upper and lower limb injury in the helmeted group in comparison to the un-helmeted group (all p<0.001), though in a subsequent analysis of these anatomical injury patterns, those cyclists wearing helmets were still found to have lower rates of TBI. In reviewing TARN injury codes for specific TBI and facial injuries, there was a highly significant decrease in rates of impact injury between cyclists wearing helmets and those not.ConclusionsThis study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.

Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by Abbreviated Injury Score in the Netherlands

“…In addition, the e-bike is gaining popularity amongst the elderly in the Netherlands and injuries from e-bike accidents are more severe than for regular bicycles and less than 1% wears a helmet 26 . Helmets could prevent TBI or at least lower the chances of severe TBI and need for neurosurgical intervention for cyclists 27 . Furthermore, fall prevention in the elderly population, could also lead to a decrease in the incidence of moderate and severe TBI.…”

Epidemiology of paediatric moderate and severe traumatic brain injury in the Netherlands

“…As incidence rates were highest in the oldest age group, investigation regarding adherence to helmet laws amongst moped drivers could be helpful. Helmet use could potentially prevent TBI or at least lower the chances of severe TBI and seems to protect against skull fractures (20)(21)(22). In another study from Nottingham, none J o u r n a l P r e -p r o o f of the 22 children who were admitted with primarily head injuries to a paediatric ICU wore a helmet (23).…”

“…RTAs were the most common trauma mechanism, falls accounted for 30% (n=98). Median AIShead was 3 (SD: 3-4), median ISS 13 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) and 40% of children had an ISS higher than 16 (n=141). Most children had a GCS of 15 if they had an AIShead of 3 (65%), this dropped to 50% if the AIShead was 5 (Table 1).…”

Incidence report of traumatic brain injury in Mimika Public Hospital Papua

“…In recent studies in the pedal cycling community, the use of helmets was associated with a reduction in severe TBI and a lower rate of TBI cases. 13 This study had several limitations. First, this study of TBI in Mimika, Papua, Indonesia, which was one of many high dense populations in Indonesia with limited health resources, was unable to be described as a full condition of TBI in Indonesia.…”