title: Characteristics and clinical outcomes of head-injured cyclists with and without helmets in urban and rural areas of Taiwan: A 15-year study.
abstract: Bicycle riding is increasingly popular in Taiwan, but the number of cyclists injured and cyclists' death rates are both increasing. The aim of this study was to investigate the different characteristics and clinical outcomes of traffic accident-related head injuries among cyclists in urban and rural areas.
  
  
  
  Records of 812 patients (533 urban and 279 rural) admitted to 27 hospitals in Taipei City and Hualien County as the result of a traumatic head injury while bicycling between 1998 and 2013 were retrieved for study. Demographics, details about the accident, protective helmet use, and clinical outcomes were then subjected to analysis.
  
  
  
  Urban victims were more likely to be injured during morning and early evening rush hours and rural victims during the day; most urban victims were between 19 and 34 years of age and injured in the slow lane; rural victims tended to be younger or older and were injured in the fast lane (all P ≤.001). Riders who wore a helmet were less likely to suffer loss of consciousness (odds ratio [OR] = 0.31), amnesia (OR = 0.069), neurological disorders (OR = 0.205), or facial fractures (OR = 0.369). Older age, more severe head injuries, and bicycle-motor vehicle collisions influenced the severity of symptoms on admission and the residual effects at discharge.
  
  
  
  Differences in the characteristics of injuries in urban and rural areas and the utilization of protective helmets may help government authorities adopt appropriate policies to promote safer and more enjoyable cycling.
authors.affiliation: a School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan.|b Secretary Office, Shuang Ho Hospital, Taipei Medical University , Taiwan.
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Kuo
authors.affiliation: a School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
authors.affiliation: c Division of Neurosurgery, Shuang Ho Hospital, Taipei Medical University , Taiwan.|d College of Medicine, Taipei Medical University , Taipei , Taiwan.
authors.forename: Jia-Wei
authors.initials: JW
authors.lastname: Lin
authors.affiliation: a School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan.|d College of Medicine, Taipei Medical University , Taipei , Taiwan.|e Department of Emergency Medicine , Shuang Ho Hospital, Taipei Medical University , Taiwan.
authors.forename: Shin-Han
authors.initials: SH
authors.lastname: Tsai
authors.affiliation: f Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University , Taipei , Taiwan.
authors.forename: Mau-Roung
authors.initials: MR
authors.lastname: Lin
authors.affiliation: g Division of Neurosurgery , Taipei Medical University Hospital , Taipei , Taiwan.
authors.forename: Yung-Hsiao
authors.initials: YH
authors.lastname: Chiang
authors.affiliation: c Division of Neurosurgery, Shuang Ho Hospital, Taipei Medical University , Taiwan.
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Lin
authors.affiliation: a School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan.
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Chu
authors.affiliation: d College of Medicine, Taipei Medical University , Taipei , Taiwan.|f Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University , Taipei , Taiwan.
authors.forename: Tsan-Hon
authors.initials: TH
authors.lastname: Liou
authors.affiliation: a School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan.
authors.forename: Wen-Ta
authors.initials: WT
authors.lastname: Chiu
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001642:Bicycling / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
keywords: Helmet; bicycle; traffic accidents; traumatic head injury; urban–rural