IMPACT OF BICYCLE HELMET SAFETY LEGISLATION ON CHILDREN ADMITTED TO AREGIONAL PEDIATRIC TRAUMA CENTER

Purpose: The regional pediatric trauma center in Buffalo, NY, has been active in pediatric injury prevention programs, including community e ducation 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 under took this study to assess the impact of this legislation on the freque ncy of helmet use in children involved in bicycle crashes presenting t o the regional pediatric trauma center, and to assess the impact of he lmet use on the number and severity of head injuries. Methods: Bicycle crash victims (n = 208) admitted to a regional pediatric trauma cente r from 1993 to 1995 were studied retrospectively. Head injuries were c lassified as concussion alone, skull fractures, intracranial hemorrhag es tie, 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 chi(2) and Fisher's Exact test. P value less than .05 was consid ered 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 < .0 0001). 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 fractu res (HC, 0%; NHC, 13%; P < .02), and exhibited a trend toward less int racranial hemorrhages (HC, 0%; NHC, 9%; P = NS), cerebral contusions ( HC, 3%; NHC, 5%; P = NS), and cerebral edema (HC, 0%; NHC, 0.6%; P = N S). Excluding the isolated concussions, head injuries were noted in on ly 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 multip le 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 severit y of head injuries, and might have prevented deaths caused by head inj uries. Copyright (C) 1998 by W.B. Saunders Company.