Question:
How large a problem are bicycle-related head injuries in the United States? Approximately two-thirds of these cyclists were children oradolescents.An estimated 140,000 children are treated each year in emergency departments for head injuries sustained while bicyclingIn 1991, societal costs associated with bicycle-related head injury or death were estimated to exceed $3 billion.5 What can be done?

Riders should wear bicycle helmets every time they ride. In the event of a crash, wearing a bicycle helmet reduces the risk of serious head injury by as much as 85% and the risk for brain injury by as much as 88%.6 Helmets have also been shown to reduce the risk of injury to the upper and mid-face by 65%.7 In fact, if each rider wore a helmet, an estimated 500 bicycle-related fatalities and 151,000 nonfatal head injuries would be prevented each year—that’s one death per day and one injury every four minutes.8 Unfortunately, estimates on helmet usage suggest that only 25% of children ages 5-14 years wear a helmet when riding.9 The percentage is close to zero when looking at teen riders. Children and adolescents’ most common complaints are that helmets are not fashionable, or "cool", their friends don=t wear them, and/or they are uncomfortable (usually too hot). Riders also convey that they do not think about the importance of bike helmets, nor about the need to protect themselves from injury, particularly if they are not riding in traffic. Accordingly, the national health goal for 2010 is for 50% of teenage bicyclists in 9th-12th grade to wear wear helmets.10 What strategies are available to get bicyclists to wear helmets?

Answer: Once someone sent me an email reporting that they had performed a medical investigation of all of the bicycle fatalities in their state (17 of them) and had enough information in 14 of the reports to verify that all but one would have died regardless of whether or not they had a head injury.

Twelve months before the wearing of a cycle helmet was to become mandatory in New Zealand [in 1993], a substantial proportion of cyclists on public roads had 'voluntarily' adopted wearing a helmet. Helmet wearing rates had increased up to 84%, 62%, and 39% [from virtually zero in 1980] for primary school children, secondary school children, and adults respectively by the end of the period of interest. The purpose of this study was to examine the serious injury trends for three age groups of cyclists: primary school age (5-12 years), secondary school age (13-18 years), and adults (over 18 years) admitted to selected public hospitals between 1980 and 1992; Twelve months before the introduction of helmet legislation. Serious injury was defined as "admitted to hospital" then disaggregated by type of crash and length of stay. Statistical models were constructed that included the proportion of people admitted to hospital with head injury, then analyzed using Poisson regression. Results revealed that the increased helmet wearing percentages has had little association with serious head injuries to cyclists as a percentage of all serious injuries to cyclists for all three groups, with no apparent difference between bicycle only and all bicycle crashes. Discussion of the results includes possible explanation for the absence of a decline in the percentage of serious head injury among cyclists as cycle helmet wearing has increased.