title: Effectiveness of bicycle helmets in preventing head injury in children: case-control study.
abstract: OBJECTIVE
  To examine the risk of injury to the head and the effect of wearing helmets in bicycle accidents among children.
  
  
  METHODS
  Case-control study by questionnaire completed by the children and their carers.
  
  
  METHODS
  Two large children's hospitals in Brisbane, Australia.
  
  
  METHODS
  445 children presenting with bicycle related injuries during 15 April 1991 to 30 June 1992. The cases comprised 102 children who had sustained injury to the upper head including the skull, forehead and scalp or loss of consciousness. The controls were 278 cyclists presenting with injuries other than to the head or face. A further 65 children with injuries to the face were considered as an extra comparison group.
  
  
  METHODS
  Cause and type of injury, wearing of helmet.
  
  
  RESULTS
  Most children (230) were injured after losing control and falling from their bicycle. Only 31 had contact with another moving vehicle. Children with head injury were significantly more likely to have made contact with a moving vehicle than control children (19 (19%) v 12 (4%), P < 0.001). Head injuries were more likely to occur on paved surfaces than on grass, gravel, or dirt. Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%).
  
  
  CONCLUSIONS
  The risk of head injury in bicycle accidents is reduced among children wearing a helmet. Current helmet design maximises protection in the type of accident most commonly occurring in this study. Legislation enforcing helmet use among children should be considered.
authors.affiliation: Epidemiology Unit, Queensland Institute of Medical Research, Herston, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Acton
authors.forename: J
authors.initials: J
authors.lastname: Nixon
authors.forename: D
authors.initials: D
authors.lastname: Battistutta
authors.forename: W R
authors.initials: WR
authors.lastname: Pitt
authors.forename: R
authors.initials: R
authors.lastname: Clark
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D001642:Bicycling / Q000293:injuries*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000517:prevention & control*; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D012737:Sex Factors