title: Impact of Helmet Use on Severity of Epidural Hematomas in Cambodia.
abstract: BACKGROUND
  Traumatic brain injury is a major cause of morbidity and mortality worldwide, often necessitating neurosurgical intervention to evacuate intracranial bleeding. Since the early 2000s, Cambodia has been undergoing a rapid increase in motorcycle transit and in road traffic accidents, but the prevalence of helmet usage remains low. Epidural hematomas are severe traumatic brain injuries that can necessitate neurosurgical intervention.
  
  
  METHODS
  This is a retrospective cohort study of patients with epidural hematoma secondary to motorcycle accidents who presented to a major national tertiary care center in Phnom Penh, Cambodia, between November 2013 and March 2016. All patients were diagnosed with computed tomography of the head.
  
  
  RESULTS
  In this cohort, 21.6% of patients in motorcycle accidents presented with epidural hematoma and 89.1% of patients were men, 47.6% were intoxicated, and were 87.8% were not wearing helmets at the moment of impact. Not wearing a helmet was associated with a 6.90-fold increase in odds of presenting with a moderate-to-severe Glasgow coma scale score and a 3.76-fold increase in odds of requiring craniotomy or craniectomy for evacuation of hematoma. Male sex was also associated with increased odds of higher clinical severity at presentation and indication for craniotomy or craniectomy, and alcohol intoxication at the time of accident was not associated with either.
  
  
  CONCLUSIONS
  Helmet usage is protective in reducing the severity of presentation and need for neurosurgical intervention for patients with epidural hematoma secondary to motorcycle accidents.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Saksham
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia.
authors.forename: Vycheth
authors.initials: V
authors.lastname: Iv
authors.affiliation: Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia.
authors.forename: Nang
authors.initials: N
authors.lastname: Sam
authors.affiliation: Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia.
authors.forename: Din
authors.initials: D
authors.lastname: Vuthy
authors.affiliation: Asia Injury Prevention Foundation, Toul Svay Prey Commune, Chamka Mom District, Phnom Penh, Cambodia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Klaric
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
authors.affiliation: Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: keebpark@gmail.com.
authors.forename: Kee B
authors.initials: KB
authors.lastname: Park
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000435:Alcoholic Intoxication / Q000401:mortality*; D002160:Cambodia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006260:Head Protective Devices / Q000592:standards* / Q000706:statistics & numerical data*; D006407:Hematoma, Epidural, Cranial / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009049:Motorcycles / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Cambodia; Epidural hematoma; Helmet usage; Low-income countries; Road traffic accidents; Traumatic brain injury