title: Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma center.
abstract: OBJECTIVE
  The regional pediatric trauma center in Buffalo, NY, has been active in pediatric injury prevention programs, including community education and distribution of bicycle helmets, since 1990. Since June 1, 1994, the use of bicycle safety helmets for children under 14 years of age has been mandated by a state law in New York. The authors undertook this study to assess the impact of this legislation on the frequency of helmet use in children involved in bicycle crashes presenting to the regional pediatric trauma center, and to assess the impact of helmet use on the number and severity of head injuries.
  
  
  METHODS
  Bicycle crash victims (n = 208) admitted to a regional pediatric trauma center from 1993 to 1995 were studied retrospectively. Head injuries were classified as concussion alone, skull fractures, intracranial hemorrhages (ie, epidural, subdural, and subarachnoid), cerebral contusions, or diffuse cerebral edema alone (without any other intracranial injury). Helmeted children (HC) were compared with nonhelmeted children (NHC) using chi2 and Fisher's Exact test. P value less than .05 was considered significant.
  
  
  RESULTS
  Only 31 children (15%) wore helmets at the time of the crash. Helmet use increased from 2%, during the period of education alone, to 26% after the legislation went into effect (P < .00001). The proportion of children suffering head injuries was similar in both groups (HC, 68%; NHC, 61%; P = NS). However, the type of head injury was different. HC were more likely to sustain concussion alone (HC, 65%; NHC, 44%; P < .03). HC were less likely to have skull fractures (HC, 0%; NHC, 13%; P < .02), and exhibited a trend toward less intracranial hemorrhages (HC, 0%; NHC, 9%; P = NS), cerebral contusions (HC, 3%; NHC, 5%; P = NS), and cerebral edema (HC, 0%; NHC, 0.6%; P = NS). Excluding the isolated concussions, head injuries were noted in only one HC, compared with 30 NHC (P < .04). None of the three children who died wore helmets at the time of the crash, and all died of multiple head injuries.
  
  
  CONCLUSIONS
  The bicycle helmet safety law resulted in a 13-fold increase in the use of bicycle helmets among the children admitted to a regional pediatric trauma center after bicycle crashes, but the helmet use remains inadequate. Helmet use reduced the severity of head injuries, and might have prevented deaths caused by head injuries.
authors.affiliation: Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Shafi
authors.forename: J C
authors.initials: JC
authors.lastname: Gilbert
authors.forename: F
authors.initials: F
authors.lastname: Loghmanee
authors.forename: J E
authors.initials: JE
authors.lastname: Allen
authors.forename: M G
authors.initials: MG
authors.lastname: Caty
authors.forename: P L
authors.initials: PL
authors.lastname: Glick
authors.forename: S
authors.initials: S
authors.lastname: Carden
authors.forename: R G
authors.initials: RG
authors.lastname: Azizkhan
mesh_terms: D001642:Bicycling / Q000293:injuries* / Q000331:legislation & jurisprudence*; D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices