Clinical Surgery| Volume 213, ISSUE 2, P413-417, February 2017

Bicycle helmets work when it matters the most


      • The aim of this study was to assess the association of helmets with severity of traumatic brain injury and facial fractures after bicycle-related accidents.
      • Results of our study strongly support our hypothesis that helmet use in bicycle riders with intracranial bleed is independently associated with reduction in overall facial fractures and severity of TBI.
      • Injury prevention programs should advocate the use of helmets in bicycle riders especially in the teenage group where least compliance with bicycle helmet use was observed.



      Helmets are known to reduce the incidence of traumatic brain injury (TBI) after bicycle-related accidents. The aim of this study was to assess the association of helmets with severity of TBI and facial fractures after bicycle-related accidents.


      We performed an analysis of the 2012 National Trauma Data Bank abstracted information of all patients with an intracranial hemorrhage after bicycle-related accidents. Regression analysis was also performed.


      A total of 6,267 patients were included. About 25.1% (n = 1,573) of bicycle riders were helmeted. Overall, 52.4% (n = 3,284) of the patients had severe TBI, and the mortality rate was 2.8% (n = 176). Helmeted bicycle riders had 51% reduced odds of severe TBI (odds ratio [OR] .49, 95% confidence interval [CI] .43 to .55, P < .001) and 44% reduced odds of mortality (OR .56, 95% CI .34 to .78, P = .010). Helmet use also reduced the odds of facial fractures by 31% (OR .69, 95% CI .58 to .81, P < .001).


      Bicycle helmet use provides protection against severe TBI, reduces facial fractures, and saves lives even after sustaining an intracranial hemorrhage.


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        • Joseph B.
        • Pandit V.
        • Zangbar B.
        • et al.
        Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries.
        Eur J Trauma Emerg Surg. 2014; 40: 729-732
        • Rivara F.P.
        • Thompson D.C.
        • Patterson M.Q.
        • et al.
        Prevention of bicycle-related injuries: helmets, education, and legislation.
        Annu Rev Public Health. 1998; 19: 293-318
      1. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. [cited 2015 September 1]; Available at: Accessed August 3, 2013.

        • Coronado V.G.
        • Xu L.
        • Basavaraju S.V.
        • et al.
        Surveillance for traumatic brain injury-related deaths—United States, 1997–2007.
        MMWR Surveill Summ. 2011; 60: 1-32
        • Schulman J.
        • Sacks J.
        • Provenzano G.
        State level estimates of the incidence and economic burden of head injuries stemming from non-universal use of bicycle helmets.
        Inj Prev. 2002; 8: 47-52
        • Maimaris C.
        • Summers C.L.
        • Browning C.
        • et al.
        Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers.
        BMJ. 1994; 308: 1537-1540
        • McDermott F.T.
        Bicyclist head injury prevention by helmets and mandatory wearing legislation in Victoria, Australia.
        Ann R Coll Surg Engl. 1995; 77: 38-44
        • Thomas S.
        • Acton C.
        • Nixon J.
        • et al.
        Effectiveness of bicycle helmets in preventing head injury in children: case-control study.
        BMJ. 1994; 308: 173-176
        • Thompson D.C.
        • Rivara F.P.
        • Thompson R.S.
        Effectiveness of bicycle safety helmets in preventing head injuries: a case-control study.
        JAMA. 1996; 276: 1968-1973
        • Thompson R.S.
        • Rivara F.P.
        • Thompson D.C.
        A case-control study of the effectiveness of bicycle safety helmets.
        N Engl J Med. 1989; 320: 1361-1367
        • Thompson D.C.
        • Rivara F.P.
        • Thompson R.
        Helmets for preventing head and facial injuries in bicyclists.
        Cochrane Database Syst Rev. 1999; : CD001855
        • Crompton J.G.
        • Oyetunji T.A.
        • Pollack K.M.
        • et al.
        Association between helmets and facial injury after a motorcycle collision: an analysis of more than 40,000 patients from the National Trauma Data Bank.
        Arch Surg. 2012; 147: 674-676
        • Moore L.
        • Hanley J.A.
        • Turgeon A.F.
        • et al.
        A multiple imputation model for imputing missing physiologic data in the National Trauma Data Bank.
        J Am Coll Surg. 2009; 209: 572-579
        • Dorsch M.M.
        • Woodward A.J.
        • Somers R.L.
        Do bicycle safety helmets reduce severity of head injury in real crashes?.
        Accid Anal Prev. 1987; 19: 183-190
        • Spaite D.W.
        • Murphy M.
        • Criss E.A.
        • et al.
        A prospective analysis of injury severity among helmeted and nonhelmeted bicyclists involved in collisions with motor vehicles.
        J Trauma. 1991; 31: 1510-1516
        • McDermott F.T.
        • Lane J.C.
        • Brazenor G.
        • et al.
        The effectiveness of bicyclist helmets: a study of 1710 casualties.
        J Trauma Acute Care Surg. 1993; 34: 834-845
        • Thompson D.C.
        • Thompson R.S.
        • Rivara F.P.
        • et al.
        A case-control study of the effectiveness of bicycle safety helmets in preventing facial injury.
        Am J Public Health. 1990; 80: 1471-1474
        • Hemmila M.R.
        • Jakubus J.L.
        • Wahl W.L.
        • et al.
        Detecting the blind spot: complications in the trauma registry and trauma quality improvement.
        Surgery. 2007; 142: 439-449