title: Head injury mechanisms in helmet-protected motorcyclists: prospective multicenter study.
abstract: BACKGROUND
  In a prospective study, three research groups at Hannover (H) and Munich (M) in Germany and Glasgow (G) in the United Kingdom collected data from motorcycle crashes between July 1996 and July 1998 to investigate head injury mechanisms in helmet-protected motorcyclists.
  
  
  METHODS
  The head lesions of motorcyclists with Abbreviated Injury Score-Head (AISHead) 2+ injuries and/or helmet impact were classified into direct force effect (DFE) and indirect force effect (IFE) lesions. The effecting forces and the force consequences were analyzed in detail.
  
  
  RESULTS
  Two-hundred twenty-six motorcyclists (H, n = 115; M, n = 56; and G, n = 55) were included. Collision opponents were cars (57.8%), trucks (8.0%), pedestrians (2.3%), bicycles (1.4%), two-wheel motor vehicles (0.8%), and others (4.2%). In 25.4% no other moving object was involved. The mean impact speed was 55 km/h (range, 0-120 km/h) and correlated with AISHead. Seventy-six (33%) motorcyclists had no head injury, 21% (n = 48) AISHead 1, and 46% (n = 103) AISHead 2+. Four hundred nine head lesions were further classified: 36.9% DFE and 63.1% IFE. Lesions included 20.5% bone, 51.3% brain, and 28.1% skin. The most frequent brain lesions were subdural hematomas (22.4%, n = 47) and subarachnoid hematomas (25.2%, n = 53). Lesions of skin or bone were mainly DFE lesions, whereas brain lesions were mostly IFE lesions.
  
  
  CONCLUSIONS
  A modification of the design of the helmet shell may have a preventative effect on DFE lesions, which are caused by a high amount of direct force transfer. Acceleration or deceleration forces induce IFE lesions, particularly rotation, which is an important and underestimated factor. The reduction of the effecting forces and the kinetic consequences should be a goal for future motorcycle helmet generations.
authors.affiliation: Trauma Department, Hannover, Germany. richter.martinus@mh-hannover.de
authors.forename: M
authors.initials: M
authors.lastname: Richter
authors.forename: D
authors.initials: D
authors.lastname: Otte
authors.forename: U
authors.initials: U
authors.lastname: Lehmann
authors.forename: B
authors.initials: B
authors.lastname: Chinn
authors.forename: E
authors.initials: E
authors.lastname: Schuller
authors.forename: D
authors.initials: D
authors.lastname: Doyle
authors.forename: K
authors.initials: K
authors.lastname: Sturrock
authors.forename: C
authors.initials: C
authors.lastname: Krettek
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D005858:Germany / Q000453:epidemiology; D006260:Head Protective Devices / Q000592:standards*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology