Epidemiology of bicycle injury, head injury, and helmet use among children in British Columbia: a five year descriptive study

Linn S, Smith D, Sheps S.
Injury Prevention, 1998;4:122-125.

BRIEF NOTES
This is not a complete Commentary but a summary of observations and criticisms that have been made relating to this paper

Summary of paper (based on authors' abstract)

Data on 1,462 injured bicyclists aged 1 - 19, obtained over 5 years from the British Columbia Children's Hospital was analysed with regard to injuries, head injuries and helmet use. Bicycle injuries comprised 4% of all injuries seen during the period. 12.7% of bicyclists were admitted compared with 7.9% for all other injuries. Boys were more injured than girls. More than 70% of injured bicyclists reported no helmet use. Head and face injuries occurred more often among those who did not use helmets. However, there was no excess of minor head injuries among non-users. Of the 62 concussions, 57 had not worn a helmet. Most injuries occurred in the upper or lower extremities. Dental injuries occurred sllightly more often among helmet users but the excess ws not statistically significant.

General observations

Peer criticism

By Towner et al, 2002 :

It is not clear whether cases and controls were well matched, their characteristics were not clear. Similarly is is not clear whether there is inherent bias in the sample.
No exposure data; only injured children were included.
Not enough breakdown of figures.
Difficult to know when unhelmeted children had more severe injuries to other body parts.
Traffic accidents increased with age and more likely to lead to admission.
Partly self-report.
Both helmet use and dental injuries increased over the period.

References

Towner et al, 2002

Towner E, Dowswell T, Burkes M, Dickinson H, Towner J, Hayes M, 2002. Bicycle helmets - a review of their effectiveness: a critical review of the literature. Department for Transport Road Safety Research Report 30.