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Helmets Protect Pediatric Bicyclists From Head Injury And Do Not Increase Risk Of Cervical Spine Injury: Time For A Universal Helmet Law
Areg Grigorian1, Bima Hasjim1, Sebastian D Schubl1, Michael Lekawa1, Dennis Kim2, Nicole Bernal1, Jeffry Nahmias1
1University of California, Irvine, Anaheim, CA;2University of California, Los Angeles - Harbor, Torrance, CA

Background (issue): There are 21 states requiring pediatric bicyclists to wear a helmet. The risk of cervical spine fracture and cord injury with and without helmets has been debated. We sought to determine the incidence of helmeted-riders among pediatric bicyclists involved in a collision and hypothesized the risk of a serious head and cervical spine fracture or cord injury to be higher in non-helmeted bicyclists (NHB), compared to helmeted-bicyclists (HB).
Methods: The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for pediatric (age<16-years-old) bicyclists involved in a collision. HB were compared to NHB. A serious head injury was defined by abbreviated injury scale grade >2 for the head. A logistic regression analysis was performed.
Findings: From 3,693 bicyclists, 3,039 (82.3%) were NHB. Compared to HB, NHB were more often black (21.6% vs. 3.8%, p<0.001), without insurance (4.6% vs. 2.4%,p=0.012) and had a higher rate of a serious head injury (24.6% vs. 9.3%,p<0.001). Both groups had similar rates of complications and mortality (p>0.05). The risk of a serious head injury was higher in NHB (OR 3.17, 2.41-4.18,p<0.001) while the risk of cervical spine fracture or cord injury was similar (p>0.05).
Conclusions (implications for practice): Pediatric bicyclists involved in a collision infrequently wear helmets. The risk of a serious head injury is higher in NHB, but the risk of cervical spine fracture or cord injury is similar. A universal helmet law may help decrease the risk of traumatic brain injury. Community outreach programs to increase helmet wearing among high-risk groups is needed.


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