Head injury is the most common cause of death and serious disability in bicycle- related crashes (1). Head injury accounts for 62% of bicycle-related deaths (4). In addition, approximately 33% of all bicycle-related emergency department visits and 67% of all bicycle-related hospital admissions (5,8) involve head injuries (1,4,5).
Head injury accounts for approximately 44% of all deaths resulting from injury in the United States (9), and approximately 7% of brain injuries are bicycle-related (2). Among survivors of nonfatal head injuries, the effects of the injury can be profound, disabling, and longlasting (9). Even after minor head injuries, persons may experience persistent neurologic symptoms (e.g., headache, dizziness, reduced memory, increased irritability, fatigue, inability to concentrate, and emotional instability). These symptoms are sometimes referred to as the "postconcussional syndrome" (10).
From 1984 through 1988, greater than 40% of all deaths from bicycle-related head injury were among persons less than 15 years of age (4). In all age groups, death rates were higher among males. Death rates from bicycle-related head injury were highest among males 10-14 years of age. During the same years, greater than 75% of persons treated in emergency departments for bicycle-related head injury were less than 15 years of age. Rates for bicycle-related head injury were also higher for males than females in all age groups; the rates were highest among males 5-15 years of age (4).
Nearly 90% of deaths from bicycle-related head injury result from collisions with motor vehicles (4). However, motor vehicle collisions cause less than 25% of the nonfatal bicycle-related head injuries that are treated in emergency departments (1,11). Excluding collisions with motor vehicles, common causes of nonfatal bicycle-related head injuries include falls, striking fixed objects, and collisions with other bicycles (1,11).
BICYCLE HELMETS AND THE PREVENTION OF HEAD INJURY
The implementation of effective bicycle helmet programs could have a substantial impact on rates for fatal and nonfatal bicycle-related head injury (4). For example, from 1984 through 1988, if a presumed helmet-use rate of 10% had been increased to 100% (i.e., universal helmet use), an average of 500 fatal and 151,400 nonfatal bicycle-related head injuries could have been prevented each year (4).
Several researchers (2,5,8,12) have recommended that bicyclists use helmets to prevent head injuries. However, controlled studies evaluating the effectiveness of bicycle helmets in bicycle crashes have not been available until recently. In particular, the results of a case-control study in Seattle in 1989 indicated that the use of bicycle helmets reduced the risk for bicycle-related head injury by 74%-85% (1). The findings of other studies that have compared the proportions of helmeted and unhelmeted riders who sustained head injury in bicycle crashes (13-15) detected higher risks for head injury among unhelmeted riders (crude odds ratio=4.2 {13}, 19.6 {14}, and 4.5 {15}). Although other strategies may be useful in preventing bicycle-related injuries (i.e., proper road design and maintenance; improvement in bicycle design, manufacturing, and repair; and bicycle safety training {5,16,17}), the use of these strategies does not eliminate the need for bicycle helmets.
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