Bicycle Helmet Use Trends and Related Risk of Mortality and Traumatic Brain Injury among Pediatric Trauma

Introduction: An estimated 33 million children ride bicycles annually in the United States, resulting in ~450,000 emergency department visits and 384 deaths--most resulting from traumatic brain injury (TBI). Bicycle helmet use among children is low despite educational and injury prevention efforts. The study aims to evaluate helmet use trends and determine risk of in-hospital mortality and TBI among the national pediatric trauma population. Materials and methods: We analyzed a nationally-representative sample of patients from the National Trauma Data Bank National Sample Program for 2003-2004 and 2007-2010. Patients ≤ 17 years of age admitted to a Level I or II trauma center with blunt injury due to pedal cycle and data for helmet use were included. Patients wearing a helmet at the time of injury were compared to those without a helmet. Adjusted logistic regression models determined the odds of helmet use, TBI, and in-hospital mortality. Results: Overall, only 21% of children wore helmets at the time of injury. Helmet use decreased significantly from 28% in 2003-2004 to 19% in 2009-2010. Patients aged 10-17 years, females, Hispanics, African Americans, and those lacking private insurance had higher odds of not wearing a helmet. Helmet use and Hispanic and African American race/ethnicity were protective against TBI. Patients aged 13-17 years and African Americans were at greater risk of in-hospital mortality. Patients who wore a helmet, were male, or were Hispanic had lower odds of death. Conclusions: Bicycle helmet use among the national pediatric trauma population is low and has not improved. While helmet use is protective against TBI and lowers risk of death following bicycle-related injury, certain age and racial/ethnic groups are at increased risk of mortality and have higher odds of suffering a TBI following bicycle-related injury. Knowledge dissemination of helmet use trends and related risks of injury and mortality from non-compliance could improve prevention efforts aimed at increasing helmet compliance among pediatric bicycle riders.