title: Bicycle helmet wearing and the risk of head, face, and neck injury: a French case--control study based on a road trauma registry.
abstract: BACKGROUND
  Previous case-control studies on bicycle helmet efficacy are mostly Anglo-Saxon, and based on data from the early 1990s when hard-shell helmets were common.
  
  
  METHODS
  In France, the Rhône county (1.6 million inhabitants) is covered by a road trauma registry that includes emergency department visits, hospital admissions, and fatalities. Over the 1998-2008 period, 13,797 cyclist casualties were identified. The injuries sustained were coded using the Abbreviated Injury Scale (AIS) for injuries to the head (AIS1+ and AIS3+), face (AIS1+), or neck (AIS1+). The study uses a case-control design where the control group includes cyclists injured below the neck-that is, not injured in the region associated with the helmet. We first adjusted for age, gender, and type of crash, as in a previously published Cochrane review. Then we adjusted for injury severity based on non-head, face, or neck injury, and when relevant, for crash location: type of road, urban/rural area.
  
  
  RESULTS
  The fully adjusted ORs of helmeted versus unhelmeted cyclists are: for AIS1+ head injuries, 0.69 (95% CI 0.59 to 0.81); for AIS3+ head injuries sustained in urban areas, 0.34 (95% CI 0.15 to 0.65), those sustained in rural areas, 0.07 (95% CI 0.02 to 0.23); for AIS1+ facial injuries, 0.72 (95% CI 0.62 to 0.83); and for AIS1+ neck injuries, 1.18 (95% CI 0.94 to 1.47).
  
  
  CONCLUSIONS
  This study confirms the protective effect for head and facial injuries, even though soft-shell helmets have now become more common. The reduction of risk is greater for serious head injuries. The study is inconclusive about the risk for neck injuries.
authors: Transport, Occupational and Environmental Epidemiology Research and Surveillance Unit (UMRESTTE), French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), Lyon-Bron, France. emmanuelle.amoros@ifsttar.fr
authors: Emmanuelle
authors: E
authors: Amoros
authors: Mireille
authors: M
authors: Chiron
authors: Jean-Louis
authors: JL
authors: Martin
authors: Bertrand
authors: B
authors: Thélot
authors: Bernard
authors: B
authors: Laumon