Journal of Pediatric Surgery
Volume 33, Issue 2 , Pages 317-321, February 1998

Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma center☆

  • Shahid Shafi

      Affiliations

    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.
    • ,
  • James C Gilbert

      Affiliations

    • Corresponding Author InformationAddress reprint requests to James C. Gilbert, MD, Department of Pediatric Surgery, The Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222.
    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.
    • ,
  • Fazlollah Loghmanee

      Affiliations

    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.
    • ,
  • James E Allen

      Affiliations

    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.
    • ,
  • Michael G Caty

      Affiliations

    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.
    • ,
  • Philip L Glick

      Affiliations

    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.
    • ,
  • Susan Carden

      Affiliations

    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.
    • ,
  • Richard G Azizkhan

      Affiliations

    • Division of Pediatric Surgery, Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pathology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York Buffalo, New York, USA
    • the Department of Pediatric Surgery, Kiwanis Pediatric Trauma Center, the Children's Hospital of Buffalo USA
    • the Office of the Medical Examiner, Erie County, NY, USA.

Abstract 

Purpose: The regional pediatric trauma center in Buffalo, NY, has been active in pediatric injury prevention programs, including community education 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 undertook this study to assess the impact of this legislation on the frequency of helmet use in children involved in bicycle crashes presenting to the regional pediatric trauma center, and to assess the impact of helmet use on the number and severity of head injuries.

Methods: Bicycle crash victims (n = 208) admitted to a regional pediatric trauma center from 1993 to 1995 were studied retrospectively. Head injuries were classified as concussion alone, skull fractures, intracranial hemorrhages (ie, 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 χ2 and Fisher's Exact test. P value less than .05 was considered 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 < .00001). 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 fractures (HC, 0%; NHC, 13%; P < .02), and exhibited a trend toward less intracranial hemorrhages (HC, 0%; NHC, 9%; P = NS), cerebral contusions (HC, 3%; NHC, 5%; P = NS), and cerebral edema (HC, 0%; NHC, 0.6%; P = NS). Excluding the isolated concussions, head injuries were noted in only 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 multiple 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 severity of head injuries, and might have prevented deaths caused by head injuries.

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☆ Presented at the 28th Annual Meeting of the American Pediatric Surgical Association, Naples, Florida, May 18–21, 1997.

PII: S0022-3468(98)90454-7

Journal of Pediatric Surgery
Volume 33, Issue 2 , Pages 317-321, February 1998

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