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J Trauma Nurs. 2007 Apr-Jun;14(2):84-7.

The effect of bicycle helmet legislation on pediatric injury.

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Akron Children's Hospital, Ohio 44308-1062, USA.



Research supports the use of a correctly fitted bicycle helmet to reduce the risk of bicycle-related head injury. Although parents believe bicycle helmets work, a large percentage of children do not wear helmets while riding.


The purpose of this study was to track pediatric bicycle-related injuries presenting to a pediatric trauma center 1 year before and 5 years after 2001 bicycle helmet legislation aimed to protect children 0 to 16 years.


Prospective data collection of pedal cycle injury e-code 826.1 from hospital discharge data set from January 1, 2000, through December 31, 2005. Bicycle-related injuries among children 0 to 16 years were grouped by injury type (head, extremity, and other), age, and gender.


For years reviewed (2000-2005), bicycle-related injuries were highest in the period May through August. Bicycle-related injury rates per 100,000 for this population were 1,452 a year before legislation. The injury rate decreased 27% (1,054/100,000) one year later. Overall, bicycle-related injury per 100,000 continues to be down by 24%. Data show that extremity injury is greater than head and other injury categories in both male (24% greater) and female (27% greater) children 0 to 16 years one year before legislation. Data show extremity injury rates per 100,000 is greater than head and other injury categories in both male (24% greater) and female (38% greater) categories 5 years later. Bicycle-related injury rates per 100,000 in boys were greater than girls for all years reported. Male extremity injury was 45% higher for 10- to 16-year-old boys than for 5- to 9-year-old boys a year before legislation and continued to rise to 58% in 2005. Male head injury rates per 100,000 were higher in 5- to 9-year-old boys (598/100,000) than in 10- to 16- year-old boys (354/100,000) one year before legislation. In 2005, the bicycle-related head injury rates per 100,000 dropped to 485 for 5- to 9-year-old vs 223 for the 10- to 16-year-old boys. Female extremity injury rate per 100,000 for 5- to 9-year-old girls in 2000 was 367, exceeding the 10- to 16-year category rate of 213 per 100,000. In 2005, female extremity injury per 100,000 was 299 for the 5- to 9-year-old girls and rose 16% to 250 for 10- to 16-year-old girls. Head injury rates per 100,000 for 5- to 9-year-old girls in 2000 were 325, ending with a rate of 254 per 100,000 in 2005. Head injury rates per 100,000 for 10- to 16-year-old girls in 2000 were 93, ending in 2005 with a rate of 91 per 100,000.


The greatest reduction in injury occurred 1 year after legislation, suggesting that promoting bicycle helmet use in the community is effective in reducing injury. The overall rate of bicycle-related injury in the population studied continues to be down 24%, suggesting bicycle helmet legislation for children is an effective adjunct in reducing injury. Extremity injury rates were greater than head injury in both male and female populations, suggesting that future bicycle safety initiatives address extremity injury. Female head injury rates in the 10- to 16-year-old population changed very little from baseline and would benefit from further investigation of female riding habits and perceived barriers to bicycle helmet use.

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