Correlation between parental perception and actual childhood patterns of bicycle helmet use and riding practices: implications for designing injury prevention strategies

BACKGROUND/PURPOSE: Bicycle injuries account for 10% of all pediatric traumatic deaths. Bicycle helmets have proven to decrease morbidity and mortality, yet trauma data show low helmet use among injured children. However, owning a bicycle helmet does not universally result in a child wearing a helmet. Furthermore, we hypothesize that parental perception of their children's use of the bicycle helmet may not reflect accurately true utilization by their child. To investigate this hypothesis the authors examined both parents' and their children's reports of bicycle ownership, supervision, riding patterns, and helmet use. METHODS: A random sample of grade 5 and 6 students (ages 8 to 12) and their parents were surveyed about bicycle ownership, riding patterns, supervision, and helmet use. The children and their guardians responded independently to the questionnaire. Statistical analysis was performed using the chi(2) test when indicated. RESULTS: Eighty-eight of 102 children (86%) responded. This represented 56% girls and 44% boys aged 8 to 12 years. Sixty-nine of 90 (77%) of the parents returned the survey. Ninety-six percent of the children owned a bicycle. A total of 87.5% of children owned a bicycle helmet. Eighty percent of the time children ride their bicycles on the road or sidewalk, with less then 20% on marked trails or parks. Parents reported that their children wear a helmet 90% of the time. In contrast, children report no helmet use in up to 61% of riding instances (P <.05). Parents themselves do not wear a helmet in greater then 60% when riding, which is correlated by their children. Seventy-one percent of the children report that they ride unsupervised the majority of the time. CONCLUSIONS: Bicycle and bicycle helmet ownership is high among this study group. There is a significant possibility that children will ride unsupervised, in at-risk situations, without wearing a helmet. Parental perceptions about bicycle helmet use by their children may not accurately reflect true utilization. In this study group parents appear as poor role models for their children. Injury prevention strategies need to focus on children and adults to improve effectiveness.     

Cycling related traumatic brain injury requiring intensive care: association with non-helmet wearing in young people

Introduction

Traumatic injury is the leading cause of death in children after infancy. Almost 25% of all cyclists killed in the UK are children, and two thirds of these will die because of their head injuries. We compared the population of young people wearing helmets whilst cycling, to those admitted with serious post cycling head injuries to our paediatric critical care unit.

3D assessment of damaged bicycle helmets and corresponding craniomaxillo-mandibular skull injuries: A feasibility study

ObjectivesIn the Netherlands, cyclists continue to outnumber other road users in injuries and deaths. The wearing of bicycle helmets is not mandatory in the Netherlands even though research has shown that wearing bicycle helmets can reduce head and brain injuries by up to 88%. Therefore, the aim of this study was to assess the feasibility of using 3D technology to evaluate bicycle-related head injuries and helmet protection.MethodsThree patients who had been involved in a bicycle accident while wearing a helmet were subjected to multi-detector row computed tomography (MDCT) imaging after trauma. The helmets were separately scanned using the same MDCT scanner with tube voltages ranging from 80 kVp to 140 kVp and tube currents ranging from 10 mAs to 300 mAs in order to determine the best image acquisition parameters for helmets. The acquired helmet images were converted into virtual 3D surface hence Standard Tessellation Language (STL) models and merged with MDCT-derived STL models of the patients’ skulls. Finally, all skull fractures and corresponding helmet damage were visualized and related.ResultsImaging bicycle helmets on an MDCT scanner proved to be feasible using a tube voltage of 120 kVp and a tube current of 120 mAs. Merging the resulting STL models of the patients’ skull and helmet allowed the overall damage sustained by both skull and helmet to be related.ConclusionOur proposed 3D method of assessing bicycle helmet damage and corresponding head injuries could offer valuable information for the development and design of safer bicycle helmets.     

PAEDIATRIC BICYCLE INJURIES

Bicycle injuries are an important cause of trauma. Approximately 75% of such accidents occur in children and involve difficult decisions in the areas of education, engineering and legislation. A prospective 3-year study was undertaken to understand the range of injuries and in particular to concentrate on severe injuries. In all. 251 children were admitted to westmead hospital after receiving bicycle injuries. Most injuries were minor but there were 37 serious injuries and six deaths. Head injuries predominated, especially in the seriously injured. The rate of wearing helmets was low, with less than 10% of all admissions wearing a helmet. None of the seriously or fatally injured wore a helmet. Helmet-wearing remains the single most important preventative measure to be instituted if the serious morbidity and mortality rates associated with bicycle injuries are to decrease.     

Paediatric bicycle injuries

Bicycle injuries are an important cause of trauma. Approximately 75% of such accidents occur in children and involve difficult decisions in the areas of education, engineering and legislation. A prospective 3-year study was undertaken to understand the range of injuries and in particular to concentrate on severe injuries. In all, 251 children were admitted to Westmead Hospital after receiving bicycle injuries. Most injuries were minor but there were 37 serious injuries and six deaths. Head injuries predominated, especially in the seriously injured. The rate of wearing helmets was low, with less than 10% of all admissions wearing a helmet. None of the seriously or fatally injured wore a helmet. Helmet-wearing remains the single most important preventative measure to be instituted if the serious morbidity and mortality rates associated with bicycle injuries are to decrease.     

Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents

Purpose

While bicycle helmet use reduces bicycle-related head injury, few children wear them regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs.

Methods

A retrospective review of all pediatric patients involved in bicycle-related accidents in LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity.

Results

Of 1248 patients, 11.3% wore helmets, with decreased use among children 12 years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality.

Conclusion

Nearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.     

Neurological injury and death in all-terrain vehicle crashes in West Virginia: a 10-year retrospective review

OBJECTIVE: The purpose of this study was to profile all-terrain vehicle crash victims with neurological injuries who were treated at a Level I trauma center. METHODS: We retrospectively reviewed trauma registry data for 238 patients who were admitted to the Jon Michael Moore Trauma Center at the West Virginia University School of Medicine after all-terrain vehicle crashes, between January 1991 and December 2000. Age, helmet status, alcohol and drug use, head injuries, length of stay, disposition, and hospital costs were studied. Death rates, head injuries, age, helmet use, and safety legislation in all 50 states were compared. RESULTS: Eighty percent of victims were male, with an average age of 27.3 years. Only 22% of all patients were wearing helmets. Alcohol and/or drugs were involved in almost one-half of all incidents. Fifty-five of 238 patients sustained spinal axis injuries; only 5 were wearing helmets. One-third of victims (75 of 238 victims) were in the pediatric population, and only 21% were wearing helmets. Only 15% of victims less than 16 years of age were wearing helmets. There were a total of eight deaths; only one patient was wearing a helmet. CONCLUSION: In the United States, all-terrain vehicles caused an estimated 240 deaths/yr between 1990 and 1994, which increased to 357 deaths/yr between 1995 and 2000. Brain and spine injuries occurred in 80% of fatal crashes. West Virginia has a fatality rate approximately eight times the national rate. Helmets reduce the risk of head injury by 64%, but only 21 states have helmet laws. Juvenile passengers on adult-driven vehicles are infrequently helmeted (<20%) and frequently injured (>65%). We conclude that safety legislation would save lives.     

Analyzing pediatric bicycle injuries using geo-demographic data

PurposeBicycle accidents are potentially preventable, and helmets can mitigate the severity of injuries. The purpose of the study it to investigate geo-demographic areas to establish prevention policies and targeted programs.MethodsFrom October 2013 to March 2020 all bicycle injuries at a Level 1 trauma center were collected for ages ≤18 years. Demographics, injuries, and outcomes were analyzed. Incidents were aggregated to zip codes and the Local Indicators of Spatial Association (LISA) statistic was used to test for spatial clustering of injury rates per 10,000 children.ResultsOver the 8-year time period, 77 cases were identified with an average age of 13±4 years, 83% male and 48% non-Hispanic white. The majority of patients (98%) were not wearing a helmet. Loss of consciousness was reported in 44% and 21% sustained a traumatic brain injury. Twenty-eight percent required ICU care and 36% required operative interventions. There was only 1 mortality in the cohort (<1%).Injuries were more common in lower household income zip codes (Figure 1). Six zip codes encompassing several interstate exits and the connected heavy-traffic roadways comprise a statistically significant cluster of pediatric bicycle accidents (Figure 1).ConclusionLow-income neighborhoods and those near major roadways held the highest risk for pediatric bicycle accidents. Use of helmets was extremely low in the patient population, with high rates of traumatic brain injury. With this information, targeted programs to address high-risk intersections, helmet access, and safety education can be implemented locally.     

Attitudes of winter sport participants toward ski helmet mandatory

The aim of this study was to examine attitudes of winter sport participants toward a ski helmet mandatory. In total, 959 persons who had to estimate statements regarding ski helmet and helmet mandatory with the aid of a five level Likert scale were interviewed. About 85?% of interviewed persons totally agreed that a ski helmet reduces head injury risk although only 64?% are wearing a ski helmet. Significant more helmet wearers and females compared to non-wearers and males totally agreed that all winter sport participants should wear ski helmets on slopes as well as that all children on slopes should wear a ski helmet. Also, significant more helmet wearers and females compared to non-wearers and males totally agreed that a ski helmet mandatory for all people has to be recommended as well as that a ski helmet mandatory for children under 16 years has to be recommended. However, the acceptance for a helmet mandatory for all people as well as for children was significantly lower compared to recommendations for helmet use irrespective of helmet use or gender. Therefore, we conclude that preventive helmet campaigns possibly attain a higher acceptance leading to a higher helmet use compared to a helmet mandatory.     

All-terrain vehicle and bicycle crashes in children: epidemiology and comparison of injury severity

Background/Purpose: Despite statements by the American Academy of Pediatrics (AAP) and the US Consumer Product Safety Commission (CPSC) against the use of all-terrain vehicles (ATVs) by children under the age of 16 years, nearly half of ATV-related injuries and over 35% of all ATV-related deaths continue to occur in this age group. Because ATV and bicycle crashes have been associated with serious injury in children, the authors compared the demographics, mechanism of injury, injury severity, and outcome of children with ATV- and bicycle-related injuries. Further, the authors sought to identify whether ATV-related injuries elicited changes in risk-taking behavior. Methods: A retrospective, comparative analysis of 109 children admitted for ATV-related injuries and 994 children admitted for bicycle-related injuries to a level 1 pediatric trauma center between January 1991 and June 2000 was performed. A phone survey was conducted to determine self-reported changes in safety behaviors or use patterns after ATV injury. Results: Mean age was 11.1 [plusmn] 3.5 years (range, 2 to 18 years) for ATV crashes versus 9.4 [plusmn] 3.3 years (range, 1 to 17 years) for bicycle crashes (P [lt ] .05). Ninety-three percent of ATV crashes occurred in children less than 16 years of age; 31% in children [le ]10 years of age; and 7% in children [le ]5 years of age. Male-to-female ratio was about 3:1 for both groups. White race accounted for 97% of ATV injuries compared with 79% of bicycle injuries (P [lt ] .05). Falls from ATVs or bicycles were the most common mechanism of injury (41% v 59%, respectively). Collisions with motor vehicles were more common for bicyclists (32% v 10%), whereas collisions with stationary objects were more common among ATV riders (27% v 9%). Sixteen percent of ATV crashes were caused by a roll-over mechanism. Mean injury severity score (ISS) were significantly higher for victims of ATV crashes (8.3 ATV v 6.7 bicycle; P [lt ] .05). ATV-related trauma was associated with multiple injuries, more operative interventions, and longer hospital stays. Location and distribution of injuries were similar for both groups. Helmet use was low in both groups but higher for ATV riders (23% v 8%; P [lt ] .5). Mortality rate was similar for both groups (0.9% for ATV riders v 0.7% for bicyclists). There was a 39% response for the phone survey post-ATV injury. Twenty-three of 43 (53%) respondents owned the ATV, and 70% of these received safety information at the time of purchase. However, only 14% of injured riders received any formal training before riding ATVs. Postinjury, 60% of children continued to ride, although 42% reported decreased riding time. Fifty-four percent of children reportedly wore helmets preinjury, and there were no changes in helmet usage postinjury. There were no differences in pre- and postinjury parental supervision (61% v 65%). Conclusions: Both ATV and bicycle-related injuries occur predominantly in boys, but ATV victims are older and almost all are white. Almost all ATV injuries occurred in children under the age of 16 years. Although both ATV and bicycle crashes cause severe injuries in children, injury severity is higher for ATV crashes in terms of multiple injuries, need for operative intervention, and longer length of stay. Despite severe injuries, the majority of children injured by ATVs continue to ride, albeit fewer hours per day, and safety behaviors are unaltered. These data reinforce the current AAP stance that legislation prohibiting the use of ATVs in children under the age of 16 years without a valid driver's license should be pursued and enforced aggressively.     

Prevalence and determinants of non-standard motorcycle safety helmets amongst food delivery workers in Selangor and Kuala Lumpur

BackgroundAlmost half of the global traffic crashes involve vulnerable groups such as pedestrian, cyclists and two-wheeler users. The main objective of this study was to determine the factors that influence standard of the safety helmets used amongst food delivery workers by presence of Standard and Industrial Research Institute of Malaysia (SIRIM) certification label.MethodsA cross sectional study was conducted amongst 150 food delivery workers from fast food outlets in the vicinity of Selangor and Kuala Lumpur. During observation, safety helmets were classified as standard safety helmet in the presence of SIRIM label and non-standard in the absence of the label. They were approached for questionnaire participation once consent was obtained and were requested to exchange their safety helmet voluntarily with a new one after the interview. Data analysis was carried out using SPSS. Chi square and logistic regression analysis was applied to determine the significance and odds ratio of the variables studied, respectively (penetration test, age, education level, knowledge, crash history, types of safety helmet, marital status and years of riding experience) against the presence of SIRIM label.ResultsThe response rate for this study was 85.2%. The prevalence of non-standard helmets use amongst fast food delivery workers was 55.3%. Safety helmets that failed the penetration test had higher odds of being non-standard helmets compared with safety helmets passing the test. Types of safety helmet indicated half-shell safety helmets had higher odds to be non-standard safety helmets compared to full-shell safety helmets. Riders with more years of riding experience were in high odds of wearing non-standard safety helmets compared to riders with less riding experience.ConclusionNon-standard (non-SIRIM approved) helmets were more likely to be half-shell helmets, were more likely to fail the standards penetration test, and were more likely to be worn by older, more experienced riders. The implications of these findings are discussed.     

Bicyclist head injury prevention by helmets and mandatory wearing legislation in Victoria, Australia.

After a decade of promotion and education, legislation for mandatory helmet wearing by bicyclists in Victoria was introduced on 1 July 1990. The legislation was a world first. Comparison of 1710 bicyclist casualties wearing and not wearing helmets has demonstrated that wearing helmets certified to the Australian Standard reduces the head injury risk by at least 39% and lessens head injury severity. Simulated impact testing of helmets has shown that they provide protection in most impacts including collisions involving a motor vehicle. Legislation for mandatory helmet wearing in Victoria has led to increased wearing rates and marked reductions in bicyclist fatalities and head injuries. The Victorian experience gives substantial support to the introduction of legislation for mandatory helmet wearing by bicyclists.     

Open reduction and internal fixation in flexion-distraction injuries to the lower spine in children and adolescents involved in traffic accidents as car occupants

Flexion-distraction injuries of the spine are reported after traffic accidents in individuals wearing only lap seatbelts. We examine here this type of injury in one child and two adolescents who all were seated in the rear seat of cars involved in traffic accidents. All of the children were wearing regular three-point safety belts not adjusted to children. They were all treated surgically. Two of the patients had no neurological impairment, while one patient suffered persistent complete paraplegia. In two patients intra-abdominal lesions required surgery. Flexion-distraction injuries in individuals with an immature skeleton, wearing standard three-point safety belts, have not been reported in the literature. The pathomechanism of the lesion in the lower spine may well involve damage to the intestines, particularly at the junction between the mobile intra-abdominal and the fixed retroperitoneal part of the gut. Reduction and stable fixation preserve the anatomy of the lower spine, while unstable fixation methods do not secure reduction sufficiently to allow early mobilisation.     

A local bicycle helmet 'law' in a Swedish municipality - the effects on helmet use

The municipality of Motala in Sweden introduced a local bicycle helmet 'law' on May 1, 1996. This is not a legally enacted ordinance, but instead a legislated recommendation backed up by information and education. Formally, the law applies to children (aged 6-12 years), although the intention is to increase helmet use by all cyclists. The objective of the present study was to quantitatively evaluate the impact of the Motala helmet law on observed use of helmets by children and adults. Bicycle helmet use was monitored in Motala (n = 2,458/year) and in control towns (n = 17,818/year) both before and after adoption of the helmet law (1995-1998). Chi-square tests showed that helmet wearing 1995-1998 increased in Motala among all bicyclists (from 6.1% to 10.5%) and adults biking on cycle paths (from 1.8% to 7.6%). Helmet use by school children aged 6-12 increased during the first 6 months after introduction of the law (from 65.0% to 75.7%) but then progressively decreased to the pre-law level. Considering children cycling on cycle paths and for recreation in housing areas, there was a tendency towards increased helmet use during the first post-law year, but this was followed by a reduction to a lower level in 1998 than in 1995. Logistic regression analysis taking into account data from the control towns indicated that the helmet law had a positive effect on children cycling to schools during the first 6 months, and a weak delayed but more long-term positive effect on adult cyclists on cycle paths. There were no positive effects on children in housing areas and on cycle paths. The Motala helmet law probably would have had greater and more lasting effects on helmet use by bicyclists, if certain problems had been avoided during the initiation phase. Moreover, although it did have a positive influence on both school children and adults, it is not legally binding, and hence no penalties can be imposed. Presumably, compulsory legislation would have a more substantial impact on helmet wearing than a non-mandatory helmet 'law' such as that introduced in Motala.     

Pediatric Heelys injuries

BACKGROUND: To determine the incidence and severity of injuries caused by Heelys. METHODS: A retrospective review of all fractures presenting to an orthopaedic emergency room at a metropolitan children's hospital during a 90-day period. The type of fracture, mechanism of injury, and management were recorded for each patient. For those injuries related to the use of Heelys, further data were collected including total number of visits, cast changes, and cost. Each Heelys patient/family was contacted and answered a questionnaire detailing their use of Heelys and the events surrounding the injury. RESULTS: A total of 953 patients with fractures were evaluated for 90 days. Sixteen patients with 17 fractures (1.68%) were identified as being related to the use of Heelys. This compares to the incidence of fractures in our sample from basketball (6.19%), bicycle (4.41%), football (4.09%), monkeybars (3.78%), skateboarding (3.25%), soccer (2.62%), baseball (2.52%), and trampoline (2.31%). The average age of each Heelys patient was 8.9 years, and 13 patients were girls. There were 16 upper extremity and 1 lower extremity fracture. No patient needed operative treatment or admission. Average number of follow-up visits was 1.6, with an average of 1.4 casts per patient. Average cost per patient was $1368. Ninety-two percent of the Heelys injuries occurred outdoors. Fifty-four percent of children were being supervised when they fell, but only 31% were wearing any safety equipment. Sixty-two percent of parents were not aware that safety equipment was recommended. All 13 parents indicated that they would not purchase another pair of Heelys, and only 23% of the children wanted to keep using Heelys after the injury. CONCLUSIONS: The incidence of Heelys injuries (1.68%) was relatively low compared with other common childhood play activities. The fractures were mostly in the upper extremity, and no fracture required surgical intervention or admission to the hospital. Sixty-two percent of the parents were not aware that safety equipment was recommended, and only 31% of the children were wearing safety equipment.     

The current injury situation of bicyclists--a medical and technical crash analysis

BACKGROUND: The purpose of the study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. METHODS: Technical and medical data were prospectively collected shortly after the crash at the crash scenes. RESULTS: Included were 4,264 injured bicyclists from 1985 to 2003. Fifty-five percent of the bicyclists were male and 45% were women. The mean age of bicyclists was 52.0 years. The crashes took place in urban areas in 95.2% of the cases, and in rural areas in 4.8% of the cases. Collision opponents were cars in 65.8%, trucks in 7.2%, bicyclists in 7.4%, standing objects in 8.8%, multiple opponents or objects in 4.3%, and others in 6.5%. The mean collision speed was 21.3 km/h. The helmet use rate was 1.7%. Fifty-five percent of bicyclists used bicycle traffic lanes before the crash. The mean Maximum Abbreviated Injury Scale/Injury Severity Score (ISS) was 1.45 of 3.9. The incidence of multiple injuries (ISS>16)/death was 2.0%/1.5%. The ISS/Maximum Abbreviated Injury Scale score was higher in bicyclists without a helmet than in bicyclists with a helmet, and in bicyclists who had not used bicycle traffic lanes than in bicyclists who had used bicycle traffic lanes (t test, p<0.05). CONCLUSION: In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two-thirds of the head injuries could have been prevented by helmets. More consequent helmet use and an extension of bicycle traffic lanes for a better separation of bicyclists and motorized vehicles would be simple but very effective preventive measures.     

Performance of horse-riding helmets in frontal and side impacts

Cases of head injury are reviewed in which riders wearing jockey skull caps have suffered impacts to the front, back or side of their helmets. The design and constructional materials of such helmets are assessed. Impact tests that simulate the accidents confirm the low energy absorption potential of some helmets for lateral impacts. Most pedal or motorcycle helmet designs afford better lateral impact protection.     

Injury profile of pedal and motor cyclist casualties in Victoria

The injury profiles of 512 pedal and 667 motor cyclist casualties managed during 1977-80 at four Melbourne teaching hospitals have been analysed using the Abbreviated Injury Scale (1980 revision). Additional comparison has been made between cyclist casualties involved in collisions with another vehicle, in single vehicle accidents and between casualties aged 17 years or more. Pedal cyclist casualties sustained significantly more frequent and severe head injury although the maximum level of injury to any part of the body (maximum abbreviated injury score) was, with the exception of casualties involved in single vehicle accidents, significantly greater in motor cyclist casualties. Head injury occurred in 59% of pedal and 26% of motor cyclist casualties (P less than 0.001); severe head injuries occurred in 9% and 4%, correspondingly. These differences may be explained, at least in part, by the fact that virtually all motor cyclists were protected by safety helmets whereas few pedal cyclists were similarly protected. The following countermeasures are recommended: effective promotion of approved safety helmet wearing in all schools; bulk purchase of helmets through the Ministry of Education for low cost distribution; a Government subsidy to reduce the costs of helmet purchase; legislation for compulsory wearing of approved safety helmets by pedal cyclists.     

Seat belt use before and after motor vehicle trauma

BACKGROUND: Motor vehicle crashes cause significant morbidity and mortality annually. Seat belt use has partially been associated with a decreased risk of morbidity and mortality among those involved in motor vehicle crashes. Persons injured in motor vehicle crashes and not wearing seat belts have an increased risk of admission to trauma centers for motor vehicle crash-related injury. The purpose of this study was to measure changes in seat belt use after discharge among patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes. METHODS: Patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes during 1998 were eligible for participation. A telephone interview was conducted with a random sample of 136 eligible patients regarding patterns of seat belt use before and after their collision. Demographic data and clinical characteristics were also collected. The frequency of seat belt use before and after crash involvement was compared for all patients and stratified by age, gender, race, and Injury Severity Score (ISS). RESULTS: Slightly over half (54%) of patients reported "always" wearing a seat belt before their collision compared with 85% afterward. Younger age groups, male subjects, and whites had the largest increases in the frequency of seat belt use after collision (45%, 37%, and 44% increases, respectively). With respect to injury severity, the largest increase in the frequency of seat belt use was among those with ISS of 15 to 25 (82% increase). Significant concordance between patient- and emergency medical service-reported use of seat belts was observed. Among subjects reported by emergency medical service personnel to have been restrained, nearly 90% reported belt use at the time of the telephone interview. The most frequently cited occasion for failure to use seat belts (30%) was when taking short trips. Other reported reasons were forgetting to fasten belts (29%), discomfort (10%), being in a rush (8%), riding in the back seat (4%), and that seat belts were unnecessary when riding with a good driver (3%). CONCLUSION: Involvement in a motor vehicle crash results in increased seat belt use. Prevention efforts should be directed toward those patients who report infrequent use. Patient "converts" to seat belt use after collisions may be useful in public awareness and prevention campaigns.     

Characteristics of helmet or knit cap use in head injury of snowboarders

The rate of head injury is 1.86-6 times higher for snowboarding than for skiing. Detailed data about the usefulness of a helmet or knit cap for protecting against serious head injuries have not been reported. The present study evaluated the use of a helmet or knit cap for preventing head injuries. Questionnaire data were collected from 1,190 consecutive patients in a hospital during the 1999/2000-2002/2003 winter seasons at Uonuma ski resort, Niigata, Japan. Patients were divided into the helmet, knit cap, and no cap groups. Upper technical level was highest and jumping as the cause of injury was most frequent in the helmet group. After adjustment for other confounders, there was a significant negative association between the occurrence of serious head injury during snowboarding and female sex (adjusted odds ratio 0.55, 95% confidence interval 0.421-0.718, p < 0.0001) and a significant positive association between serious head injury and jumping (adjusted odds ratio 2.25, 95% confidence interval 1.48-3.43, p = 0.0001). Among snowboarding maneuvers, only jumping showed a significant negative association between wearing of a helmet or knit cap and the occurrence of serious head injury (p = 0.036). Snowboarders who wear helmets might attempt dangerous maneuvers causing injuries. Wearing of a helmet or knit cap protected against serious head injuries on jumping. Every snowboarder should wear a helmet or knit cap on jumping to prevent head injury.