The effect of bicycling helmets in preventing significant bicycle-related injuries in children

Objective: To identify bicycle-related injuries in children and the effect of helmet use on injury patterns and prevention. Design: A prospective cohort of injured children with case-control design looking at serious head injuries and helmet use. Setting: A tertiary care childrens' hospital emergency room. Patients: All patients presenting between April 1, 1991 and September 30, 1993, between the ages of 3 and 16 years, with bicycle-related injuries were included. Intervention: The Childrens' Hospital Injury Research and Prevention Program (CHIRPP) Database was used. Standardized information collected on each child included age and sex of the child; nature, location, and time of accident/injury; whether any safety devices were being used at the time of the accident; and the attending physician's determination of the injury(s) and treatment rendered. Main outcome measures: Injuries were categorized as major or minor, based upon a consensus of the authors, in a retrospective fashion. Results: Separate bicycle accidents (n = 699) were recorded resulting in 856 injuries. Only 13.7% of the children were wearing helmets at the time of their accidents. Seventy-six serious head injuries were recorded. The risk of serious head injury was significantly greater when a helmet was not worn (chi(2) 0.01 < p < 0.05). This represents an odds ratio of 3,12 [confidence interval (CI) = 95% 1.13-8.75]. There was no significant difference in terms of serious injuries overall comparing helmeted and nonhelmeted children (odds ratio = 1.11, 95% CI = 0.721.72). Conclusions: Helmets afford a protective effect with respect to serious head injuries.