Wildlife-vehicle collisions: The disproportionate risk of injury faced by motorcyclists

We applied a generalized linear mixed-effects model to determine the factors leading to injuries from wildlife-vehicle collisions (WVCs). We used the Police database representing WVCs which took place on the Czech road network between 2009 and 2022. The majority of WVCs in Czechia are with roe deer, followed by wild boar, i.e., both relatively small ungulates. Less than 2 % of these encounters ends with an injury to the motor vehicle occupants. We found that the probability of sustaining injury was systematically higher for motorcyclists than for car occupants. The odds of sustaining an injury during WVC were roughly 1600 times higher for motorcyclists than for car occupants. When applying an evading manoeuvre, the odds of sustaining an injury were approximately 68 times higher for car occupants while only 2.3 times higher for motorcyclists compared to a direct hit to an animal. The lack of helmets (for motorcyclists) and missing seat belts (for car occupants) were additional factors which made the outcomes worse for WVCs. While the acceptance of a direct hit (preceded by braking) seems to be a reasonable strategy for car drivers, WVC awareness (including maintaining a lower speed during critical times and places) should be raised among motorcyclists as both manoeuvres are almost comparably dangerous for them.

Bicycle-related accidents in Rome: Investigating clinical patterns, demographics, injury contexts, and health outcomes for enhanced public safety

INTRODUCTION

This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents.

METHODS

Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated.

RESULTS

Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients.

CONCLUSIONS

Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages.

Cervical misalignment in motorcyclists in relation to new helmet removal recommendations shown with augmented reality resources: A biomechanical analysis

Objective

The aim of this study is to determine the best technique and position for helmet removal in injured motorcyclists by comparing cervical misalignment produced in the supine position and prone position.

Method

Comparative cross-sectional clinical simulation study to quantify CM using biomechanical analysis with the use of inertial systems. The main variable was determined for the flexion-extension motion. The extraction was tested for both positions (prone position and supine position), which were repeated 3 times for each of the 30 volunteers included, and the movement from the initial neutral position was also determined, resulting in a total of 270 biomechanical studies.

Results

A flexion was observed when moving the patient from the neutral position to the SP, due to the size of the helmet, of 1.29° ± 5.12°. Helmet removal in the supine position resulted in an average flexion-extension range of 17.51° ± 6.49°, while the same extraction in prone position recorded an average range of 10.82° ± 8.05°. For the main variable, statistically significant differences were found when comparing prone position and supine position (p = 0.0087).

Conclusions

The main conclusion of the study is that the helmet removal should be done in the position in which we find the patient, whether in prone position or supine position. Additionally, the new technique described for the prone position causes less movement of the cervical spine than the usual supine position.

The "ZEEP-PEEP test" to evaluate the response to positive end-expiratory pressure delivered by helmet: A prospective physiologic study

Introduction

The improvement in oxygenation after helmet application in hypoxemic patients may be explained by the alveolar recruitment obtained with positive end expiratory pressure (PEEP) or by the administration of a more accurate inspiratory fraction of oxygen (FiO2). We have designed the "ZEEP-PEEP test", capable to distinguish between the FiO2-related or PEEP-related oxygenation improvement. Our primary aim was to describe the use of this test during helmet CPAP to assess the oxygenation improvement attributable to PEEP application.

Material and methods

We performed a prospective physiological study including adult critically ill patients. Respiratory and hemodynamic parameters were recorded before helmet application (PRE step), after helmet application without PEEP (ZEEP step) and after the application of the PEEP valve (PEEP step), while maintaining a constant FiO2. We defined as "PEEP responders" patients showing a PaO2/FiO2 ratio improvement ≥10% after PEEP application.

Results

93 patients were enrolled. Compared to the PRE step, PaO2/FiO2 ratio was significantly improved during helmet CPAP both at ZEEP and PEEP step (189 ± 55, 219 ± 74 and 241 ± 82 mmHg, respectively, p < 0.01). Both PEEP responders (41%) and non-responders showed a significant improvement of PaO2/FiO2 ratio after the application of helmet at ZEEP, PEEP responders also showed a significant improvement of oxygenation after PEEP application (208 ± 70 vs 267 ± 85, p < 0.01).

Conclusions

Helmet CPAP improved oxygenation. This improvement was not only due to the PEEP effect, but also to the increase of the effective inspired FiO2. Performing the ZEEP-PEEP test may help to identify patients who benefit from PEEP.

Riding practices of e-bike riders after the implementation of electric bike management regulations: An observational study in Hangzhou, China

Objective

This study aimed to understand the riding behaviors of electric bike (e-bike) users in Hangzhou after the "Regulations of Zhejiang Province on the Administration of Electric Bicycles".

Methods

The study consisted of two parts, including a questionnaire survey of local e-bike users in Shangcheng District and Jiande County in Hangzhou City, and a cross-sectional observational study of 16 intersections.

Results

A total of 789 e-bike riders participated in the questionnaire survey, and the riding behavior of 99,407 e-bike users was observed. The main purpose of using e-bike was work and daily life, 46.0% of them used e-bikes more than 5 days a week, and 58.5% used e-bikes for less than 30 min each time. A vast majority (81.7%) of e-bike riders believe that the implementation of Zhejiang Regulations has significantly improved the safety level of e-bike riding in the region. The field survey found that the correct rates of helmet wearing by e-bike riders and passengers were 78.83% and 42.27%. The main violations were invalid/non-helmet wearing (21.17%), followed by carrying passengers and running red lights (7.94% and 4.26%). The rates of invalid/non-helmet wearing and running red lights were significantly higher during non-morning rush hour, weekends, and roads without separate non-motorized vehicle lanes than in other conditions (all P < 0.05). Additionally, sunny days and crossroads were risk factors for passenger-carrying and invalid/non-helmet wearing compared to rainy/cloudy days and T-intersections.

Conclusions

The phenomenon that e-bike users' correct practice lags far behind the awareness of various violations has shown some improvement. To further enhance safety measures for e-bike riders, it is necessary to promote education, improve infrastructure, and strengthen law enforcement, in support of the "Zhejiang Regulations" and behavioral interventions.

Endoscopy-Assisted Craniosynostosis Surgery without Postoperative Helmet Molding Therapy

OBJECTIVE

Endoscopy-assisted craniosynostosis surgery (EACS) yields excellent surgical outcomes by minimizing blood loss, operative time, and hospital stays. Postoperative helmet therapy (PHT), commonly employed for head shape correction, involves frequent adjustments, potential complications, and high costs. Given the rising cost of helmet therapy, reduced insurance coverage, and limited availability in low- and middle-income countries, understanding success rates without helmet use is crucial. The present study analyses the anthropometric results of the first EACS series without PHT.

METHODS

A retrospective analysis of a single-center series involving 90 consecutive patients who underwent EACS without PHT from 2012 to 2022 was conducted, with a follow-up exceeding 3 years. The study exclusively included patients with nonsyndromic isolated sagittal synostosis, with 33 meeting the criteria. Craniometric measurements were obtained from preoperative, 1-year postoperative, and the latest computed tomography scans. For isolated sagittal synostosis cases, the cephalic index (CI) was calculated (CI >75 for excellent results, CI 70-75 for good results, and <70 for poor results). Collected data encompassed patient sex, age, and follow-up time.

RESULTS

The mean age was 84.8 ± 45.3 days (2.79 ± 1.49 months) within a range of 3-172 days. The preoperative mean CI was 68 ± 42, increasing to 76 ± 6 1 year postoperatively (mean difference +8 ± 6.3; P = 0.0001). Seventy-one percent of patients achieved excellent results, 23% good (CI = 70-75), and 6% poor. Reintervention was unnecessary.

CONCLUSIONS

EACS without PHT demonstrates favorable anthropometric results, cost reduction, and simplified postoperative management.

Injury patterns and outcomes in motorcycle driver crashes in the United States: The effect of helmet use

BACKGROUND

Motorcycle crashes pose a persistent public health problem with disproportionate rates of severe injuries and mortality. This study aims to analyze injury patterns and outcomes with regard to helmet use. We hypothesized that helmet use is associated with fewer head injuries and does not increase the risk of cervical spine injuries.

METHODS

The National Trauma Data Bank was queried for all motorcycle driver crashes between 2007-2017. Univariable analysis was used to compare demographics, clinical data, injury patterns using abbreviated injury scale, and outcomes between helmeted motorcycle drivers and non-helmeted motorcycle drivers who were injured in traffic crashes. Independent factors associated with mortality were determined by regression analysis after adjustment for potential confounders.

RESULTS

A total of 315,258 patients were included for analysis, 66 % of these patients were helmeted. The sample was 92.5 % male and the median age was 41 years. Non-helmeted motorcycle drivers were more likely to sustain severe head trauma (head abbreviated injury scale ≥ 3: 28.5 % vs. 13.3 %, p < 0.001), had higher intensive care unit-admission (38 % vs. 30.2 %, p<0.001), mechanical ventilation (20.1 % vs. 13 %, p<0.001) and overall mortality rates (6.2 % vs. 3.9 %, p<0.001). Cervical spine injuries occurred in 10.6 % of non-helmeted motorcycle drivers and in 9.5 % of helmeted motorcycle drivers (p<0.001). Helmet use was identified as an independent factor associated with lower mortality [OR 0.849 (0.809-0.891), p<0.001].

CONCLUSION

Helmet use is protective for severe head injuries and associated with decreased mortality. Helmet use was not associated with increased rates of cervical spine injuries. On the contrary, fewer injuries were observed in helmeted motorcycle drivers. Public health initiatives should be aimed at enforcement of universal helmet laws within the United States and across the world.

Gender disparities in observed motorcycle helmet use in Madagascar: female motorcyclists behave safer but have lower overall protection

BACKGROUND

Although motorcycle helmets can save lives in case of a crash, no helmet use data are available for many countries. When data is available, it is often only analysed as a global average, preventing targeted road safety education and legislative action. In this study, we conducted a detailed analysis of motorcycle helmet use in the capital of Madagascar.

METHODS

Using a cross-sectional observational field survey framework, we observed 17 230 individual motorcycles. We systematically recorded motorcycle riders' helmet use, position on the motorcycle, rider numbers and gender.

RESULTS

We found a general helmet use of 76.1%. Observed drivers had a significantly higher helmet use (84.6%) than passengers (47.7%), and subsequently helmet use per motorcycle decreased significantly when the number of riders per motorcycle increased. Female drivers had significantly higher helmet use than male drivers, and female passengers had significantly higher helmet use than male passengers. That is, on the same position of the motorcycle, female riders behaved safer than male riders. However, since female riders were more often passengers than drivers, their average helmet use was lower than that of male riders overall. Contrary to findings from other countries, motorcycle helmet use did not differ significantly throughout the day but was relatively constant.

CONCLUSION

Our results show the potential for injury and fatality prevention in Madagascar through increased passenger helmet use. This increase would also proportionally benefit female riders more than male riders. Findings regarding road safety legislation's applied impact, education, enforcement and future research needs are discussed.

Helmet utilisation and its associated factors among motorcyclists in northern Ghana: an analytical cross-sectional survey

BACKGROUND

Motorcycle crashes are a major source of road traffic deaths in northern Ghana. Helmet use has been low. The last time it was formally assessed (2010), helmet use was 30.0% (34.2% for riders and 1.9% for pillion riders). We sought to determine the current prevalence of helmet use and its associated factors among motorcyclists in northern Ghana.

METHODS

Cross-sectional observations of motorcycle helmet use were conducted among 3853 motorcycle riders and 1097 pillion riders in the Northern Region at 12 different locations near intersections, roundabouts and motorcycle bays. Modified Poisson regression was used to assess the factors associated with helmet use.

RESULTS

The prevalence of helmet use was 22.1% overall: 26.7% among motorcycle riders and 5.7% among pillion riders. On the multivariable regression analysis, the prevalence of helmet use among motorcycle riders was 69% higher during the day compared with the night, 58% higher at weekend compared with weekday, 46% higher among males compared with females, but it was 18% lower on local roads compared with highways, 67% lower among young riders compared with the elderly and 29% lower when riding with pillion rider(s).

CONCLUSION

Despite small increases in motorcycle helmet use among pillion riders, helmet use has declined overall over the past decade. Immediate actions are needed to promote helmet use among motorcyclists in northern Ghana. This calls for a multisectoral approach to address the current low helmet use, targeting young riders, female riders, pillion riders, evening riding and riding on local roads.

High efficiency particulate air filters and heat & moisture exchanger filters increase positive end-expiratory pressure in helmet continuous positive airway pressure: A bench-top study

BACKGROUND

Helmet continuous positive airway pressure (CPAP) has been widely used during the COVID-19 pandemic. Specific filters (i.e. High Efficiency Particulate Air filter: HEPA; Heat & Moisture Exchanger Filter: HMEF) were used to prevent Sars-CoV2 environmental dispersion and were connected to the CPAP helmet. However, HEPA and HMEF filters may act as resistors to expiratory gas flow and increase the levels of pressure within the hood.

METHODS

In a bench-top study, we investigated the levels of airway pressure generated by different HEPA and HMEF filters connected to the CPAP helmet in the absence of a Positive End Expiratory Pressure (PEEP) valve and with two levels of PEEP (5 and 10 cmH2O). All steps were performed using 3 increasing levels of gas flow (60, 80, 100 L/min).

RESULTS

The use of 8 different commercially available filters significantly increased the pressure within the hood of the CPAP helmet with or without the use of PEEP valves. On average, the increase of pressure above the set PEEP ranged from 3 cmH2O to 10 cmH2O across gas flow rates of 60 to 100 L/min. The measure of airway pressure was highly correlated between the laboratory pressure transducer and the Helmet manometer. Bias with 95% Confidence Interval of Bias between the devices was 0.7 (-2.06; 0.66) cmH2O.

CONCLUSIONS

The use of HEPA and HMEF filters placed before the PEEP valve at the expiratory port of the CPAP helmet significantly increase the levels of airway pressure compared to the set level of PEEP. The manometer can detect accurately the airway pressure in the presence of HEPA and HMEF filters in the helmet CPAP and its use should considered.

[Bicycle accidents in the course of time in Münster, Germany : Analysis of changes in bicycle accidents over the past 10 years]

BACKGROUND

Bicycles have been a popular means of transport for many years. Especially in times of increased climate discussion, the bicycle has moved further into focus as an environmentally friendly and cost-effective means of transport. Bike lanes and roads are becoming more crowded and new means of transport such as pedelecs or e‑scooters are emerging.

METHODS

A total of four studies by Münster University Hospital on bicycle accidents and the official accident statistics of the Münster police were compared. In the period from 2009 to 2019, three studies were conducted that considered all bicycle accidents and one study that only considered pedelec riders separately.

RESULTS

The age distribution as well as main causes of accidents remained almost the same over the years. The number of pedelec accidents has increased. Pedelec riders have a higher average age and a higher proportion of intensive care stays; however, this cohort also has a high rate of helmet wearers. Overall, the willingness to wear a helmet seems to have increased.

CONCLUSION

It should be considered that with increasing bicycle traffic, safety measures must be increased accordingly. In this respect, accident prevention should focus on three major areas, engineering, education and enforcement.

Respiratory support effect on pharyngeal area in patients with amyotrophic lateral sclerosis: A fluoroscopic comparison of NIV, helmet/CPAP, and high-flow nasal cannula

The global use of noninvasive respiratory support provided by different supportive ventilation delivery methods (SVDMs) has increased, but the impact of these devices on the upper airway structures of patients with amyotrophic lateral sclerosis (ALS) is not known. We aimed to compare the pharyngeal cross-sectional area during spontaneous breathing with four different SVDMs: intranasal masks, oronasal masks, high-flow nasal cannula (HFNC), and helmet in patients with ALS. We compared measures of the pharyngeal area during spontaneous breathing and SVDM use. The greatest increase was observed with intranasal mask use, followed by HFNC, oronasal mask, and helmet respectively. In conclusion, upper airway opening in patients with ALS is enhanced by positive pressure with intranasal masks and HFNC, showing promise for increasing pharyngeal patency. Future studies should explore its applicability and effectiveness in maintaining long-term pharyngeal patency, especially in this population with bulbar weakness.

Injury patterns and outcomes in motorcycle passengers

INTRODUCTION

Contemporary trauma literature on injuries to motorcycle passengers is scarce. The aim of this study was to examine the injury patterns and outcomes of motorcycle passengers with regard to helmet use. We hypothesized that helmet utilization affects both injury type and outcomes.

METHODS

The National Trauma Data Bank was queried for all motorcycle passengers who were injured in traffic accidents. Participants were stratified according to helmet utilization into helmeted (HM) and nonhelmeted (NHM) groups. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups.

RESULTS

A total of 22,855 patients were included for analysis, of which 57.1% (13,049) used helmet. The median age was 41 years (IQR 26-51), 81% were female, and 16% of patients required urgent operation. NHM had higher risk of major trauma (ISS > 15: 26.8% vs 31.6%, p < 0.001). The most frequently injured body region in NHM was the head (34.6% vs 56.9%, p < 0.001), whereas in HM patients was the lower extremities (65.3% vs 56.7%, p < 0.001). NHM patients were more likely to require admission to the ICU, mechanical ventilation, and had significantly higher mortality rate (3.0% vs 6.3%, p < 0.001). The strongest predictors of mortality were GCS < 9 on admission, hypotension on admission, and severe head injury. Helmet utilization was associated with decreased odds of death (OR 0.636; 95% CI 0.531-0.762; p < 0.001).

CONCLUSION

Motorcycle collisions can lead to significant injury burden and high mortality in motorcycle passengers. Middle-age females are disproportionally affected. Traumatic brain injury is the leading cause of death. Helmet use is associated with decreased risk of head injury and death.

Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19

BACKGROUND

High generated tidal volumes (Vt) have been correlated with higher risk of self-induced lung injury and worse clinical outcome. This study aimed to evaluate the effectiveness and safety of a new helmet continuous positive airway pressure delivered (h-CPAP) configuration allowing Vt monitoring in patients affected by COVID-19.

METHODS

This prospective observational study was performed in the respiratory intermediate care unit of University Hospital in Turin, Italy, between March 24th, and June 15th, 2020. Included patients were treated with CPAP via a single-limb intentional leak configuration by a turbine-driven ventilator, provided with a dedicated patch. Effectiveness and safety of the configuration and healthcare workers safety were the outcomes of the study.

MAIN FINDINGS

Thirty-five patients were included in this study. Median age was 67 years (IQR 57-76 years), and 30 patients (85.7%) were men. Median value of overall leaks (intentional plus unintentional) was 68 L/min (IQR 63-75). Reliability of Vt measurements was 100%. An out of scale of Vt (above 50% compared to the previous values) was never recorded. Six patients (17.1%) needed more than two helmet replacements, due to leak test >10 l/min. Arm oedema and skin breakdowns were reported in sixteen (45.7%) and seven (20%) patients respectively. Among the 63 healthcare workers involved in the care of COVID-19 patients during the study only one was positive at RT-PCR nasopharyngeal swab testing.

CONCLUSIONS

The use of h-CPAP for treating COVID-19 in this configuration allowed for reliable Vt monitoring. Further studies evaluating this configuration in larger patients' cohorts are needed.

Traumatic Head and Neck Injuries in Elite Australian Cricket Players: Retrospective Analysis from 12 Seasons

Objectives

To describe traumatic head and neck injuries in elite Australian cricket players, for the purposes of understanding risk and the role of protective equipment and regulations.

Design

Retrospective cohort study.

Methods

This study reviewed twelve seasons of clinical data for elite male and female cricket players who sustained a traumatic head or neck injury (excluding isolated concussion) whilst participating in a cricket match or training.

Results

199 events of head and neck injuries were recorded over the 12 seasons, equating to an average incidence of 5.6 per 100 players per season. Since the introduction of helmet regulations in 2016, the average incidence was 7.3. Including concurrent injuries, 232 injuries revealed contusions were the most common type of injury (41%, 35-48%), and the face was the most common location (63%, 57-69%). Injuries resulted in the player being unavailable for cricket for one or more days in 15% (11-22%) of events. Since the introduction of cricket helmet regulations, the proportion of injuries sustained while batting decreased from 54% (43-65%) to 38% (30-47%) (p = 0.026), and the proportion of injuries sustained while wicket keeping decreased from 19% (11-29%) to 6% (3-11%) (p=0.004).

Conclusion

Traumatic head and neck injuries occur at an incidence of approximately 7.3 per 100 players per season in elite Australian male and female cricket players. Whilst most injuries cause a low burden with respect to days unavailable, the risk of potentially serious or catastrophic consequences warrants further risk reduction strategies including tightening of the existing industry standard for helmets and governing body regulations.

Graphical Abstract

Human Head and Helmet Interface Friction Coefficients with Biological Sex and Hair Property Comparisons

Dummy headforms used for impact testing have changed little over the years, and frictional characteristics are thought not to represent the human head accurately. The frictional interface between the helmet and head is an essential factor affecting impact response. However, few studies have evaluated the coefficient of friction (COF) between the human head and helmet surface. This study's objectives were to quantify the human head's static and dynamic COF and evaluate the effect of biological sex and hair properties. Seventy-four participants slid their heads along a piece of helmet foam backed by a fixed load cell at varying normal force levels. As normal force increased, static and dynamic human head COF decreased following power-law curves. At 80 N, the static COF is 0.32 (95% CI 0.30-0.34), and the dynamic friction coefficient is 0.27 (95% CI 0.26-0.28). Biological sex and hair properties were determined not to affect human head COF. The COFs between the head and helmet surface should be used to develop more biofidelic head impact testing methods, define boundary conditions for computer simulations, and aid decision-making for helmet designs.

Perceptions, barriers, and strategies regarding helmet use by female pillion riders in Pakistan: A qualitative study

INTRODUCTION

Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders.

METHODS

Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach.

RESULTS

Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though "safety" was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers.

CONCLUSION

Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan.

Changes in pediatric injuries sustained while engaged in activities where helmet usage is recommended during the COVID-19 pandemic

BACKGROUND

Unintentional injuries, including traumatic brain injuries (TBI), are the leading cause of pediatric morbidity and mortality in the USA. Helmet usage can reduce TBI incidence and severity; however, the epidemiology of pediatric TBI and helmet use is ever evolving. With lifestyle changes potentially accelerated by the pandemic, we predicted a decrease in helmet utilization with an associated increase in TBI during the pandemic compared to the pre-pandemic period.

RESULTS

There were 1093 patients that presented with AWHUR injuries from 2018 to 2020 with an annual increase from 263 patients in 2018 up to 492 in 2020. The most frequently implicated mechanisms included bicycles (35.9%), ATVs (20.3%), skateboards (11.6%), scooters (8.3%), and dirt bikes (7.4%). Unhelmeted patients increased from 111 (58.7%) in 2018 to 258 (64.8%) in 2020. There was not a significant difference in the proportion of injuries that were unhelmeted from 38.9% in 2018-2019 to 35.2% in 2020 (p = 0.30), as well as the proportion of head injuries from 2018 to 2019 (24.3%) to 2020 (29.3%) (p = 0.07). A significant increase was seen in neurosurgical consultation from 17 (6.5%) in 2018 to 87 (17.7%) in 2020 (p = 0.02). Notably, there was an increase in the percentage of publicly insured patients presenting with injuries from AWHUR during 2020 (p < 0.001); this group also had suboptimal helmet usage.

CONCLUSION

This study found an increase in patients presenting with injuries sustained while engaged in AWHUR in relation to the COVID-19 pandemic. Concerningly, there was a trend toward decreased helmet utilization and increased injury severity markers. Further analysis is needed into the communities impacted the most by AWHUR injuries.

Assessment of child safety on bicycles in baby carriers - The importance of evaluating both head and neck injuries

INTRODUCTION

The paper addresses an important accident type that involves children in bicycle seats - the bicycle fall over. It is a significant and common accident type and many parents have been reported to experience this type of "close call." The fall over occurs at low velocities and even while a bicycle is standing still, and may result from a split-second lack of attention on behalf of the accompanying adult (e.g. while loading groceries, i.e. while not being exposed to traffic per se). Moreover, irrespective of the low velocities involved, the trauma that may result to the head of the child is considerable and may be life-threatening, as shown in the study.

METHOD

The paper presents two methods to address this accident scenario in a quantitative way: in-situ accelerometer-based measurement and numerical modeling approaches. It is shown that the methods produce consistent results under the prerequisites of the study. They are therefore promising methods to be used in the study of this type of accident.

RESULTS

The importanance of the protective role of a child helmet is without discussion in everyday traffic.However, this study draws attention to one particular effect observed in this accident type: that the geometry of the helmet may at times expose the child's head to considerably larger forces, by having contact with the ground. The study also highlights the importance of neck bending injuries during bicycle fall over, which are often neglected in the safety assessment - not only for children in bicycle seats. The study concludes that considering only head acceleration may lead to biased conclusions about using helmets as protective devices.

Performance of helmet CPAP using different configurations: Turbine-driven ventilators vs Venturi devices

BACKGROUND

Traditionally, Venturi-based flow generators have been preferred over mechanical ventilators to provide continuous positive airway pressure (CPAP) through the helmet (h-CPAP). Recently, modern turbine-driven ventilators (TDVs) showed to be safe and effective in delivering h-CPAP. We aimed to compare the pressure stability during h-CPAP delivered by Venturi devices and TDVs and assess the impact of High Efficiency Particulate Air (HEPA) filters on their performance.

METHODS

We performed a bench study using an artificial lung simulator set in a restrictive respiratory condition, simulating two different levels of patient effort (high and low) with and without the interposition of the HEPA filter. We calculated the average of minimal (Pmin), maximal (Pmax) and mean (Pmean) airway pressure and the time product measured on the airway pressure curve (PTPinsp). We defined the pressure swing (Pswing) as Pmax - Pmin and pressure drop (Pdrop) as End Expiratory Pressure - Pmin.

RESULTS

Pswing across CPAP levels varied widely among all the tested devices. During "low effort", no difference in Pswing and Pdrop was found between Venturi devices and TDVs; during high effort, Pswing (p<0.001) and Pdrop (p<0.001) were significantly higher in TDVs compared to Venturi devices, but the PTPinsp was lower (1.50 SD 0.54 vs 1.67 SD 0.55, p<0.001). HEPA filter addition almost doubled Pswing and PTPinsp (p<0.001) but left unaltered the differences among Venturi and TDVs systems in favor of the latter (p<0.001).

CONCLUSIONS

TDVs performed better than Venturi systems in delivering a stable positive pressure level during h-CPAP in a bench setting.

Helmet Use and Jaw and Tooth Injuries in Motorcyclists Admitted to a Referral Hospital

Background and Aim

The use of helmets has been reported to reduce the incidence and severity of head injuries in motorcyclists. However, there remains a significant gap in knowledge regarding the effectiveness of helmets, especially in preventing jaw and tooth injuries.

Patients and Methods

In this retrospective analytical study record, all traffic accidents that occurred continuously from 2017 to 2019 in which the motorcyclists were on at least one side of the collision based on inclusion criteria. Data from injury variables in medical records were merged with data related to helmet use in the trauma registration system in Excel software. Then, the final analysis was performed with STATA software version 14 at a significance level of < 0.05.

Results

In total, 1807 people participated in the study, and 160 (9.37) people used helmets. The incidence rate of jaw and tooth injuries was 86 (5.04%). Logistic regression implied that the odds ratio for helmet use was 0.7, which considering the p value of 0.419, shows no significant relationship between wearing helmets and jaw and tooth injuries.

Conclusion

Helmets alone cannot prevent jaw and tooth injuries, and designers should design helmets that protect the head and the jaw and tooth. In prevention programs and campaigns for motorcyclists, every age, gender, job, grade group and marital status are target groups.

high-flow nasal oxygen: a randomized trial

BACKGROUND

Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure.

METHODS

In this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6 months after the enrollment.

RESULTS

Among 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47-77] of predicted vs. 80% [71-88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53-70] vs. 80 [70-83], p = 0.01).

CONCLUSIONS

In patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6 months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients. Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020.

[E-scooter, e-bike and bicycle injuries in the same period-A prospective analysis of a level 1 trauma center]

BACKGROUND

The actual number of accidents in e‑scooter drivers in Germany seems to be significantly higher than the current figures from the Statistisches Bundesamt suggest. This epidemiological study examines e‑scooter injuries and compares them with e‑bike and bicycle injuries.

OBJECTIVE

In order to create a comparable database on the dangers of e‑scooters, e‑bikes and bicycles, the typical injury patterns were analyzed and prevention options derived from them.

MATERIAL AND METHODS

All accidents involving e‑scooters, e‑bikes and bicycles that were presented via the university emergency room of a level 1 trauma center between 15 June 2019 and 31 October 2020 were prospectively investigated.

RESULTS

In our study, 68 accidents in e‑scooter drivers were included, of which only 11.8% (n = 8) were recorded by the police. Significantly more of them were male than female (p = 0.032) with a mean age of 31.1 (±13) years. At the same time, we registered 34 accidents in e‑bike riders and 356 in cyclists. In all three groups, most injuries occurred to the head, followed by injuries to the upper extremities. Significantly more e‑scooter drivers had an ISS ≥ 16 than in the group of injured cyclists (p = 0.016). E‑scooter riders who had an accident had a significantly longer length of stay in hospital, than e‑bike riders (p = 0.003) and cyclists (p = 0.001), 52.9% (n = 18) of e‑bike riders and 53.3% (n = 113) cyclists wore a helmet, compared to only 1.5% (n = 1) of e‑scooter riders. The most common cause of accidents among e‑bike riders (17.7%; n = 6) and cyclists (10.4%; n = 37) was slipping away on tram rails, while for e‑scooter riders it was colliding with a curb (7.4%; n = 5).

CONCLUSION

The three patient collectives examined showed different causes and profiles of injuries. The reasons for an increased proportion of seriously injured people compared to cyclists are electromobility, driving under the influence of alcohol and inadequate wearing of a helmet on e‑scooters when head injuries dominate. 73.5% (n = 50) of the e‑scooter accidents recorded by us were not registered by the police and therefore do not appear in the current statistics of the statistisches Bundesamt. As a result, a much higher number of e‑scooter accidents can be assumed. Preventive measures could include the introduction of compulsory helmets, a higher number of traffic controls and the expansion of bike tracks.

Head-ground impact conditions and helmet performance in E-scooter falls

OBJECTIVE

Head injuries are common injuries in E-scooter accidents which have dramatically increased in recent years. The head impact conditions and helmet performance during E-scooter accidents are barely investigated. This study aims to characterize the head-ground impact biomechanics and evaluate bicycle helmet protection in typical E-scooter falls.

METHOD

The finite element (FE) model of a hybrid III dummy riding an E-scooter was developed and validated. The FE model with and without a bicycle helmet was used to reproduce twenty-seven E-scooter falls caused by the collision with a curb, in which different riding speeds (10, 20, and 30 km/h), curb orientations (30, 60, and 90°), and E-scooter orientations (-15, 0, and 15°) were simulated. Head-ground impact velocities and locations were evaluated for the unhelmeted configurations while the helmet performance was evaluated with the reduction of head injury metrics.

RESULTS

E-scooter falls always resulted in an oblique head-ground impact, with 78 % on the forehead. The mean vertical and tangential head-ground impact velocities were respectively 5.7 ± 1.5 m/s and 3.7 ± 2.0 m/s. The helmet significantly (p < 0.1) reduced the head linear acceleration, angular velocity, HIC_36, and BrIC, but not the angular acceleration. However, even with the helmet, the head injury metrics were mostly above the thresholds of severe head injuries.

CONCLUSION

Typical E-scooter falls might cause severe head injuries. The bicycle helmet was efficient to reduce head injury metrics but not to prevent severe head injuries. Future helmet standard evaluations should involve higher impact energy and the angular acceleration assessment in oblique impacts.

Long-term outcomes of patients with COVID-19 treated with helmet noninvasive ventilation or usual respiratory support: follow-up study of the Helmet-COVID randomized clinical trial

PURPOSE

To evaluate whether helmet noninvasive ventilation compared to usual respiratory support reduces 180-day mortality and improves health-related quality of life (HRQoL) in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia.

METHODS

This is a pre-planned follow-up study of the Helmet-COVID trial. In this multicenter, randomized clinical trial, adults with acute hypoxemic respiratory failure (n = 320) due to coronavirus disease 2019 (COVID-19) were randomized to receive helmet noninvasive ventilation or usual respiratory support. The modified intention-to-treat population consisted of all enrolled patients except three who were lost at follow-up. The study outcomes were 180-day mortality, EuroQoL (EQ)-5D-5L index values, and EQ-visual analog scale (EQ-VAS). In the modified intention-to-treat analysis, non-survivors were assigned a value of 0 for EQ-5D-5L and EQ-VAS.

RESULTS

Within 180 days, 63/159 patients (39.6%) died in the helmet noninvasive ventilation group compared to 65/158 patients (41.1%) in the usual respiratory support group (risk difference - 1.5% (95% confidence interval [CI] - 12.3, 9.3, p = 0.78). In the modified intention-to-treat analysis, patients in the helmet noninvasive ventilation and the usual respiratory support groups did not differ in EQ-5D-5L index values (median 0.68 [IQR 0.00, 1.00], compared to 0.67 [IQR 0.00, 1.00], median difference 0.00 [95% CI - 0.32, 0.32; p = 0.91]) or EQ-VAS scores (median 70 [IQR 0, 93], compared to 70 [IQR 0, 90], median difference 0.00 (95% CI - 31.92, 31.92; p = 0.55).

CONCLUSIONS

Helmet noninvasive ventilation did not reduce 180-day mortality or improve HRQoL compared to usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia.

Helmet CPAP bundle: A narrative review of practical aspects and nursing interventions to improve patient's comfort

BACKGROUND

The application of Continuous Positive Airway Pressure (CPAP) with a helmet is increasing around the world, both inside and outside of the intensive care unit. Current published literature focus's on indications, contraindications and efficiency of Helmet CPAP in differing clinical scenarios. Few reports, summarising the available knowledge concerning technical characteristics and nursing interventions to improve patient's comfort, are available.

AIM

To identify the crucial technical aspects in managing patients undergoing Helmet-CPAP, and what nursing interventions may increase comfort.

METHODS

A narrative literature review of primary research published 2002 onwards. The search strategy comprised an electronic search of three bibliographic databases (Pubmed, Embase, CINAHL).

RESULTS

Twenty-three studies met the inclusion criteria and were included in the review. Research primarily originated from Italy. Nine key themes emerged from the review: gas flow management, noise reduction, impact of gas flow and HME filters on delivered FiO₂, filtration of exhaled gas / environmental protection, PEEP monitoring, airway pressure monitoring, active humidification of gas flow, helmet fixation and tips to implement awake prone position during Helmet-CPAP.

CONCLUSIONS

A Helmet-CPAP check-list has been made of nine key interventions based on the available evidence regarding system set up, monitoring and management. Implementation of this check-list may help nurses and physicians to increase the comfort of patients treated with Helmet CPAP and enhance their compliance with long-term treatment.

Effect of different helmet types in head injuries: a case-control study in northern Ghana

BACKGROUND

Motorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana.

METHODS

A prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury.

RESULTS

After adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35).

CONCLUSION

Even in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs.

Flow generators for helmet CPAP: Which to prefer? A bench study

OBJECTIVE

To assess the different effect of filters' application during helmet-CPAP delivered with three different flow generators on the delivered fresh gas flow, FiO₂, and the noise level inside and outside the helmet.

METHODS

In a bench study, three flow generators (air-oxygen blender, turbine ventilator and Venturi system) were used to generate two different gas flows (60 L/min and 80 L/min), with a fixed FiO₂ at 0.6, to perform a helmet-CPAP on a manikin. Three different fixed PEEP valves (7.5, 10, and 12.5 cmH₂O) were applied at the expiratory port. Gas flow, FiO₂ and noise were recorded for each Flow-generator/Flow/PEEP combination, first without filter interposition and then after positioning a heat and moister exchanger filter (HMEF) at the helmet inlet port.

RESULTS

The application of the HMEF lead to a significant difference in the flow variation among the three flow generators (p < 0.001). Compared to baseline, the highest flow reduction was observed with the VENTURI (-13.4 ± 1.2 %, p < 0.001), a slight increase with the BLENDER (1.2 ± 0.5 %, p < 0.001), whereas no difference was recorded with the TURBINE (0.1 ± 0.6 %, p = 0.12). After HMEF was interposed, a significant FiO₂ variation was observed only with VENTURI (11.3 ± 1.8 %, p < 0.001). As for the noise, the TURBINE was the least noisy system, both with and without the filter interposition.

CONCLUSIONS

Flow generators used to deliver helmet-CPAP have different characteristics and responses to HMEF interposition. Users should be aware of the effects on FiO₂ and flow of the different devices in order to make a precise setup of the circuit.

Effective factors of improved helmet use in motorcyclists: a systematic review

BACKGROUND

Road traffic injuries (RTI) are one of the most prominent causes of morbidity and mortality, especially among children and young adults. Motorcycle crashes constitute a significant part of RTIs. Policymakers believe that safety helmets are the single most important protection against motorcycle-related injuries. However, motorcyclists are not wearing helmets at desirable rates. This study systematically investigated factors that are positively associated with helmet usage among two-wheeled motorcycle riders.

METHODS

We performed a systematic search on PubMed, Scopus, Web of Science, Embase, and Cochrane library with relevant keywords. No language, date of publication, or methodological restrictions were applied. All the articles that had evaluated the factors associated with helmet-wearing behavior and were published before December 31, 2021, were included in our study and underwent data extraction. We assessed the quality of the included articles using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies.

RESULTS

A total of 50 articles were included. Most evidence suggests that helmet usage is more common among drivers (compared to passengers), women, middle-aged adults, those with higher educations, married individuals, license holders, and helmet owners. Moreover, the helmet usage rate is higher on highways and central city roads and during mornings and weekdays. Travelers of longer distances, more frequent users, and riders of motorcycles with larger engines use safety helmets more commonly. Non-helmet-using drivers seem to have acceptable awareness of mandatory helmet laws and knowledge about their protective role against head injuries. Importantly, complaint about helmet discomfort is somehow common among helmet-using drivers.

CONCLUSIONS

To enhance helmet usage, policymakers should emphasize the vulnerability of passengers and children to RTIs, and that fatal crashes occur on low-capacity roads and during cruising at low speeds. Monitoring by police should expand to late hours of the day, weekends, and lower capacity and less-trafficked roads. Aiming to enhance the acceptance of other law-abiding behaviors (e.g., wearing seat belts, riding within the speed limits, etc.), especially among youth and young adults, will enhance the prevalence of helmet-wearing behavior among motorcycle riders. Interventions should put their focus on improving the attitudes of riders regarding safety helmets, as there is acceptable knowledge of their benefits.

A retrospective study of helmet use and head injury in severe equestrian trauma

Objectives

The aim of the study was to examine helmet use, incidence of injury, and patient outcomes in a rural cohort of equestrian accidents.

Material and Methods

EHR records of patients admitted to a Level II ACS trauma center in the North-west United States were reviewed for helmet use. Injuries were categorized according to International Classification of Diseases-9/10 code.

Results

Of 53 identified cases, helmets only reduced superficial injury (χ2 (1) = 4.837, P = 0.028). Intracranial injury rates were not different between those with and without helmets (P > 0.05).

Conclusion

In equine related injury, helmets protect against superficial injury but not intracranial injury in Western riders. More investigation is needed to assess why this is the case and determine ways to decrease intracranial injury.

Over 30-year retrospective analyses of moped-motorcycle fatal road accidents in the northern area of the Italian region of Emilia Romagna and review of the literature: Aiming for further preventive measures in the future

Road traffic injuries are a major cause of morbidity and mortality worldwide, with pedestrians and riders of two-wheeled motor vehicles being the most vulnerable. The present study aims to determine the epidemiological characteristics of fatal motorcycle crashes in a portion of the Italian region of Emilia Romagna, and to compare them with the data available in literature. Data were retrieved from autopsy reports on 350 subjects who died following road accidents involving moped or motorcycle in the cities of Parma, Piacenza, and Reggio Emilia. Two types of data were extrapolated: circumstantial and traumatological. The population was divided into subgroups according to gender, crash time, alcohol positivity, presence or absence of the helmet, and the period elapsed between the accident and death. Most of the considered road accidents occurred during the day and on weekends. 25.5 % of the victims tested positive for alcohol. As far as traumas are concerned, the limbs resulted to be the most affected body segment, followed by the head (87.4 %), the thorax (85.7 %), the abdomen (65.7 %), and lastly the neck (50.3 %). According to similar studies, the sample victim of a moped/ motorcycle accident is a young male subject. The results obtained allow us to demonstrate that the mandatory use of the helmet has reduced skull and brain injury over the years. At present, no law regulates the use of protections for other body parts. Regulatory interventions in this sense would be desirable given the ever more rapid technical evolutions in the field of motorcycles.

Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: a quasi-experimental study

Background

This study aims to test the effectiveness of an awareness-raising model designed based on the theory of planned behaviour regarding helmet use for motorcycle taxi drivers.

Methods

This quasi-experimental study took place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities, based on the theory of planned behaviour, have been implemented in the intervention area. Data relate to knowledge, attitudes and practices regarding helmet use was collected prospectively before the intervention, at the end, and 6 months later. Stata 15 was used for data analysis. Chi-square or Fisher, Student’s or Kruskal-Wallis tests was carried out. The difference-in-difference method was used to determine the specific effect of the awareness activities.

Results

After the intervention, there was an improvement in the total score in both groups compared to baseline. The total score increased by 0.2 (0.06–0.3) in the experimental group when the number of sessions attended increased by one (p = 0.005). The difference-in-difference estimator measured among subjects who attended at least one awareness session, controlling for socio-demographic variables, showed a significantly higher difference in the total score of subjects in the experimental group compared to those in the control group both at the end of the interactive sessions and 6 months later.

Conclusion

This model improves the helmet-wearing behaviour of motorbike taxi drivers in the experimental area. It could be adapted and applied to other socio-professional groups and other types of users.

American Football Helmet Effectiveness Against a Strain-Based Concussion Mechanism

Brain strain is increasingly being used in helmet design and safety performance evaluation as it is generally considered as the primary mechanism of concussion. In this study, we investigate whether different helmet designs can meaningfully alter brain strains using two commonly used metrics, peak maximum principal strain (MPS) of the whole brain and cumulative strain damage measure (CSDM). A convolutional neural network (CNN) that instantly produces detailed brain strains is first tested for accuracy for helmeted head impacts. Based on N = 144 impacts in 12 impact conditions from three random and representative helmet models, we conclude that the CNN is sufficiently accurate for helmet testing applications, for elementwise MPS (success rate of 98.6%), whole-brain peak MPS and CSDM (coefficient of determination of 0.977 and 0.980, with root mean squared error of 0.015 and 0.029, respectively). We then apply the technique to 23 football helmet models (N = 1104 impacts) to reproduce elementwise MPS. Assuming a concussion would occur when peak MPS or CSDM exceeds a threshold, we sweep their thresholds across the value ranges to evaluate the number of predicted hypothetical concussions that different helmets sustain across the impact conditions. Relative to the 12 impact conditions tested, we find that the "best" and "worst" helmets differ by an average of 22.5% in terms of predicted concussions, ranging from 0 to 42% (the latter achieved at the threshold value of 0.28 for peak MPS and 0.4 for CSDM, respectively). Such a large variation among helmets in strain-based concussion predictions demonstrate that helmet designs can still be optimized in a clinically meaningful way. The robustness and accuracy of the CNN tool also suggest its potential for routine use for helmet design and safety performance evaluation in the future. The CNN is freely available online at https://github.com/Jilab-biomechanics/CNN-brain-strains .

Current Review of Traumatic Optic Neuropathy and Traumatic Brain Injury among Military Service Members

Traumatic optic neuropathy (TON) is a form of optic nerve damage that while rare in the general population, is commonly associated with traumatic brain injury (TBI). With increasingly high rates of TBI in the military community, our service members and veterans represent a population where traumatic optic neuropathy is prevalent. Parachute jumpers have been identified as a high-risk group for under-reported head injury and therefore many cases of TBI are easily overlooked. With recent insights into the limitations of the veteran's disability exam, we review the current understanding of TON and propose an updated protocol for TON evaluation. We also urge for development of safer helmet design to reduce and prevent further cases of TBI, mTBI, and TON in our military personnel.

Electric Scooter-Related Trauma in Korea

BACKGROUND

The number of users of electric scooters, which provide swift and convenient mobility options, has increased sharply over recent years as their distribution as a shared service has expanded. Although the number of accidents and related damage has increased accordingly, limited research has analyzed data on the new types of accidents arising from electric scooters. This study aimed to analyze data on trauma characteristics due to accidents that occurred during electric scooter use.

METHODS

A retrospective chart review was conducted for patients who visited the regional trauma center of our institute due to electric scooter accidents from April 2018 to October 2021. Information was extracted on helmet-wearing status, sex, age, drinking status, accident timeframe, accident mechanism, electric scooter proficiency (period of use), injury severity, severe trauma, lethality, admission to the intensive care unit, surgery under general anesthesia, and the trauma region.

RESULTS

Among the 108 patients involved in electric scooter accidents, 92 patients were not wearing a helmet. Eighty-nine patients (85.2%) were male. The average age of the patients without a helmet was 31.3 years, while that of patients with a helmet was 34.1 years. The most frequent causes of accidents were lack of electric scooter operation experience and falling off the scooter due to obstacles (90 cases). Whether surgery was performed under general anesthesia was not associated with helmet use or non-use, although all patients who underwent facial fracture surgery were not wearing a helmet.

CONCLUSION

The craniofacial region was most frequently affected in electric scooter accidents and wearing a helmet was the best way to prevent craniofacial trauma. Although helmet-wearing is mandatory, the majority of treated patients were not wearing a helmet at the time of injury. Thus, there is an urgent need to introduce a helmet rental system, as well as strict legal requirements, to improve this situation.

Barriers and factors associated with the use of helmets by Motorcyclists: A scoping review

Road Traffic Injuries (RTIs) have imposed a great global burden on public health. Motorcyclists and pedestrians comprise the most significant proportion of this burden. Several studies have demonstrated a link between helmet wearing and a decline in the impact of RTIs in motorcyclists. In this study, we aimed to review the barriers to helmet utilization by motorcyclists. This scoping review has been conducted in accordance with the guidelines for the systematic review of observational studies and the PRISMA Checklist. The search was conducted by using related keywords in EMBASE, PubMed, Scopus, and Cochrane Library. Four independent reviewers carried out the screening. The main outcomes of interest were barriers to helmet usage among motorcyclists, drawn from the finally included studies. Fifty-three records were selected for data extraction. According to these reports, the barriers and factors associated with helmet usage among motorcyclists were categorized into five entities as: legislations/enforcement strategies, helmet disadvantages (discomfort, visual/auditory blockage, and thermal dysregulation), risky behaviors (riding while drunk or high on drugs), sex and/or age factors, and the location and time of the injury event (rural vs. urban locations, day vs. night riding). From the perspective of policymakers, the findings of this review are of utmost importance and could be used in addressing the challenge of inadequate compliance with helmet use.

Analyzing pediatric bicycle injuries using geo-demographic data

PURPOSE

Bicycle accidents are potentially preventable, and helmets can mitigate the severity of injuries. The purpose of the study it to investigate geo-demographic areas to establish prevention policies and targeted programs.

METHODS

From October 2013 to March 2020 all bicycle injuries at a Level 1 trauma center were collected for ages ≤18 years. Demographics, injuries, and outcomes were analyzed. Incidents were aggregated to zip codes and the Local Indicators of Spatial Association (LISA) statistic was used to test for spatial clustering of injury rates per 10,000 children.

RESULTS

Over the 8-year time period, 77 cases were identified with an average age of 13±4 years, 83% male and 48% non-Hispanic white. The majority of patients (98%) were not wearing a helmet. Loss of consciousness was reported in 44% and 21% sustained a traumatic brain injury. Twenty-eight percent required ICU care and 36% required operative interventions. There was only 1 mortality in the cohort (<1%).Injuries were more common in lower household income zip codes (Figure 1). Six zip codes encompassing several interstate exits and the connected heavy-traffic roadways comprise a statistically significant cluster of pediatric bicycle accidents (Figure 1).

CONCLUSION

Low-income neighborhoods and those near major roadways held the highest risk for pediatric bicycle accidents. Use of helmets was extremely low in the patient population, with high rates of traumatic brain injury. With this information, targeted programs to address high-risk intersections, helmet access, and safety education can be implemented locally.

Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO2/FiO2 Ratio a Predictor of Success

In acute respiratory failure due to severe coronavirus disease 2019 (COVID-19) pneumonia, mechanical ventilation remains challenging and may result in high mortality. The use of noninvasive ventilation (NIV) may delay required invasive ventilation, increase adverse outcomes, and have a potential aerosol risk to caregivers. Data of 30 patients were collected from patient files and analyzed. Twenty-one (70%) patients were weaned successfully after helmet-NIV support (NIV success group), and invasive mechanical ventilation was required in 9 (30%) patients (NIV failure group) of which 8 (26.7%) patients died. In NIV success vs failure patients, the mean baseline PaO₂/FiO₂ ratio (PFR) (147.2 ± 57.9 vs 156.8 ± 59.0 mm Hg; p = 0.683) and PFR before initiation of helmet (132.3 ± 46.9 vs 121.6 ± 32.7 mm Hg; p = 0.541) were comparable. The NIV success group demonstrated a progressive improvement in PFR in comparison with the failure group at 2 hours (158.8 ± 56.1 vs 118.7 ± 40.7 mm Hg; p = 0.063) and 24 hours (PFR-24) (204.4 ± 94.3 vs 121.3 ± 32.6; p = 0.016). As predictor variables, PFR-24 and change (delta) in PFR at 24 hours from baseline or helmet initiation (dPFR-24) were significantly associated with NIV success in univariate analysis but similar significance could not be reflected in multivariate analysis perhaps due to a small sample size of the study. The PFR-24 cutoff of 161 mm Hg and dPFR-24 cutoff of -1.44 mm Hg discriminate NIV success and failure groups with the area under curve (confidence interval) of 0.78 (0.62-0.95); p = 0.015 and 0.74 (0.55-0.93); p = 0.039, respectively. Helmet interface NIV may be a safe and effective tool for the management of patients with severe COVID-19 pneumonia with acute respiratory failure. More studies are needed to further evaluate the role of helmet NIV especially in patients with initial PFR <150 mm Hg to define PFR/dPFR cutoff at the earliest time point for prediction of helmet-NIV success. How to cite this article Jha OK, Kumar S, Mehra S, Sircar M, Gupta R. Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO₂/FiO₂ Ratio a Predictor of Success. Indian J Crit Care Med 2021;25(10):1137-1146.

Epidemiology of Maxillofacial Traumatisms in French Alps Metropole (Grenoble) Specificity for the mountain sports and evolution in the last 40 years

INTRODUCTION

Over the years, several studies have been carried in the Teaching Hospital of Grenoble, analysing the epidemiology of facial injuries. The aim of this study was to gather and compare the previous works, focusing on the injuries caused by mountains sports. The evolution of mountain sports trauma in the last 40 years was studied, and observations on the protective action on the face and facial bones of the helmet were made.

MATERIALS AND METHODS

The data from all facial injuries treated in the years 2016 and 2017 were collected, and a retrospective study was performed. It was supplemented by the data of 3 articles (1981, 1992, 2006) and a thesis (1985).

RESULTS

Localizations of the fractures, when not discriminated according to causes, were consistently the same in our study than in previous works, with 66% of upper 2/3 of the face fractures, and 22% of lower 1/3 fractures. When filtering only mountain sports traumatisms, a significant decrease of upper 2/3 facial injuries was observed in the current study compared to the 1981, 1985 and 2006 data. This drop tallies with the period where the use of the helmet generalized. The evolution of mountain sports practices, the improvement of protective personal equipment and of the security on sport sites triggered a real diminution of mid and upper face traumatisms.

Brain trauma exposure for American tackle football players 5 to 9 and 9 to 14 years of age

American football helmets used by youth players are currently designed and tested to the same standards as professionals. The National Operating Committee on Standard and Safety requested research aiming at understanding the differences in brain trauma in youth American football for players aged five to nine and nine to fourteen years old to inform a youth specific American football standard. Video analysis and laboratory reconstructions of head impacts were undertaken to measure differences in head impact frequency, event types, and magnitudes of maximum principal strain (MPS) for the two age groups. Overall frequencies and frequencies for five categories of MPS representing different magnitudes of risk were tabulated. The MPS categories were very low (<0.08), low (0.08-0.169), medium (0.17-0.259), high (0.26-0.349) and very high (>0.35). Both cohorts experienced a majority of head impacts (>56%) at very low magnitude of MPS. Youth American football players aged 9-14 yrs. sustained a greater frequency of head impacts at MPS between 0.08 and 0.169 % associated with changes in brain structure and function. There were no differences in overall frequency, or in frequency of head impacts in other categories of MPS. The proportion of impacts considered injurious (MPS > 0.08) was greater in the 5-9 group (44%), than the 9-14 group (39%), and impacts above 0.35 % were only reported for the younger age group. The larger helmet-to-shoulder ratio in the younger age groups may have contributed to this finding suggesting that youth American football players under the age of nine would benefit from a child-specific football helmet.

Head Kinematics and Injury Metrics for Laboratory Hockey-Relevant Head Impact Experiments

Investigating head responses during hockey-related blunt impacts and hence understanding how to mitigate brain injury risk from such impacts still needs more exploration. This study used the recently developed hockey helmet testing methodology, known as the Hockey Summation of Tests for the Analysis of Risk (Hockey STAR), to collect 672 laboratory helmeted impacts. Brain strains were then calculated from the according 672 simulations using the detailed Global Human Body Models Consortium (GHBMC) finite element head model. Experimentally measured head kinematics and brain strains were used to calculate head/brain injury metrics including peak linear acceleration, peak rotational acceleration, peak rotational velocity, Gadd Severity Index (GSI), Head Injury Criteria (HIC₁₅), Generalized Acceleration Model for Brain Injury Threshold (GAMBIT), Brain Injury Criteria (BrIC), Universal Brain Injury Criterion (UBrIC), Diffuse Axonal Multi-Axis General Equation (DAMAGE), average maximum principal strain (MPS) and cumulative strain damage measure (CSDM). Correlation analysis of kinematics-based and strain-based metrics highlighted the importance of rotational velocity. Injury metrics that use rotational velocity correlated highly to average MPS and CSDM with UBrIC yielding the strongest correlation. In summary, a comprehensive analysis for kinematics-based and strain-based injury metrics was conducted through a hybrid experimental (672 impacts) and computational (672 simulations) approach. The results can provide references for adopting brain injury metrics when using the Hockey STAR approach and guide ice hockey helmet designs that help reduce brain injury risks.

Identifying Factors Associated with Head Impact Kinematics and Brain Strain in High School American Football via Instrumented Mouthguards

Repeated head impact exposure and concussions are common in American football. Identifying the factors associated with high magnitude impacts aids in informing sport policy changes, improvements to protective equipment, and better understanding of the brain's response to mechanical loading. Recently, the Stanford Instrumented Mouthguard (MiG2.0) has seen several improvements in its accuracy in measuring head kinematics and its ability to correctly differentiate between true head impact events and false positives. Using this device, the present study sought to identify factors (e.g., player position, helmet model, direction of head acceleration, etc.) that are associated with head impact kinematics and brain strain in high school American football athletes. 116 athletes were monitored over a total of 888 athlete exposures. 602 total impacts were captured and verified by the MiG2.0's validated impact detection algorithm. Peak values of linear acceleration, angular velocity, and angular acceleration were obtained from the mouthguard kinematics. The kinematics were also entered into a previously developed finite element model of the human brain to compute the 95th percentile maximum principal strain. Overall, impacts were (mean ± SD) 34.0 ± 24.3 g for peak linear acceleration, 22.2 ± 15.4 rad/s for peak angular velocity, 2979.4 ± 3030.4 rad/s² for peak angular acceleration, and 0.262 ± 0.241 for 95th percentile maximum principal strain. Statistical analyses revealed that impacts resulting in Forward head accelerations had higher magnitudes of peak kinematics and brain strain than Lateral or Rearward impacts and that athletes in skill positions sustained impacts of greater magnitude than athletes in line positions. 95th percentile maximum principal strain was significantly lower in the observed cohort of high school football athletes than previous reports of collegiate football athletes. No differences in impact magnitude were observed in athletes with or without previous concussion history, in athletes wearing different helmet models, or in junior varsity or varsity athletes. This study presents novel information on head acceleration events and their resulting brain strain in high school American football from our advanced, validated method of measuring head kinematics via instrumented mouthguard technology.

Improper Fit in American Youth Football Helmets Across One Competitive Season

Improper helmet fit is related to sport-related concussion symptomology. The objective of this study was to determine the prevalence of improperly fit helmets in American youth tackle football players across one competitive season. Four recreation leagues including 147 players (45.2 ± 14.7 cm, 147.5 ± 9.0 kg), aged 7-12 years, participated in pre-season and post-season data collection timepoints. Participant and league demographics were collected at pre-season. Helmet fit was assessed at pre- and post-season using a 13-item checklist. A helmet was defined as improperly fit if failed to comply with or more of the checklist items. Most players (84%) rented helmets from the league. At preseason, 71.4% of helmets, and at post-season 79.6%, were improperly fit with no significant change over time (p = 0.14). Of the 105 improperly fit helmets at the start of the season, 61% were still considered improperly fit at post season. The 11-12 year old age group had significantly more improperly fit helmets than the 7-10 year old age group at post-season (p = 0.033), but not pre-season (p = 0.655). American youth football players depend on the league to fit their helmet. Most players did not meet at least one checklist criteria. Helmets improperly fit at preseason were still not fit at post.

A case report: resolution of Chiari I malformation after helmet therapy for deformational brachycephaly

Positional plagiocephaly is the most common cause of cranial asymmetry. Deformational brachycephaly denotes a head shape characterized by occipital flattening and increased bilateral width, which can also be caused by external deformation of the moldable infant cranium in positional bilateral posterior plagiocephaly. There are reports of craniosynostosis associated with Chiari I malformation (CIM), possibly caused by decreased posterior fossa volume and related to increased intracranial pressure. To the best of our knowledge, this is only the second case report demonstrating acquired CIM in a child with positional brachycephaly. Of note, the fact that the CIM resolved after helmet therapy could support the hypothesis that CIM is associated with decreased volume of the posterior fossa. However, these two conditions may be independent of one another. More research is needed to identify an association between the two conditions.

non-helmeted motorcyclists in a rural state

INTRODUCTION

Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders.

METHODS

Retrospective review (2014-2018) of a single level 1 trauma center's registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student's t-test or Pearson's χ²p-value ≤0.05 as significant. State Department of Transportation data registry for state level mortality and collision incidence over the same time period was also obtained.

RESULTS

Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS.

CONCLUSIONS

Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.

The effectiveness of different types of motorcycle helmets - A scoping review

BACKGROUND

Protective helmets may reduce the risk of death and head injury in motorcycle collisions. However, there remains a large gap in knowledge regarding the effectiveness of different types of helmets in preventing injuries.

OBJECTIVE

To explore and evaluate the effectiveness of different types of motorcycle helmets; that is the association between different helmet types and the incidence and severity of head, neck, and facial injuries among motorcyclists. Also, to explore the effect of different helmet types on riders.

METHODS

A systematic search of different scientific databases was conducted from 1965 to April 2019. A scoping review was performed on the included articles. Eligible articles were included regarding defined criteria. Study characteristics, helmet types, fixation status, retention system, the prevention of injury or reduction of its severity were extracted.

RESULTS

A total of 137 studies were included. There was very limited evidence for the better protection of full-face helmets from head and facial injury compared to open-face and half-coverage helmets. There was however scarce evidence for the superiority of a certain helmet type over others in terms of protection from neck injury. The retention system and the fixation status of helmets were two important factors affecting the risk of head and brain injury in motorcyclists. Helmets could also affect and limit the riders in terms of vision, hearing, and ventilation. Multiple solutions have been discussed to mitigate these effects.

CONCLUSION

Full-face helmets may protect head and face in motorcycle riders more than open-face and half-coverage helmets, but there is not enough evidence for better neck protection among these three helmet types. Helmets can affect the rider's vision, hearing, and ventilation. When designing a helmet, all of these factors should be taken into account.

Motorcycle crashes and upper extremity trauma

Objectives: Upper extremity injuries following motorcycle crashes (MCC) incur increased healthcare costs and rehabilitation needs. We aim to characterize the epidemiology of MCC upper extremity injuries and identify factors that influence the severity of and cost of care for upper extremity injuries. Methods: We performed a retrospective cohort analysis of 571 patients with upper extremity injuries after MCC at a level 1 trauma center from 2002 to 2013. We collected data pertaining to demographics, helmet use, toxicology, bony injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hospital length of stay (LOS), and cost. Continuous variables were compared using t-test or Wilcoxon rank test, depending on data distribution, and dichotomous variables were compared using Pearson’s chi-squared or Fisher’s exact tests. Regression models were used to evaluate the effect of intoxication or helmets on injury location, severity, cost of care, and LOS. Results: The incidence of MCC upper extremity injury was 47.5%, with hand and forearm fractures the most common injuries (25.5% and 24.7% of total injuries). Intoxicated patients were more likely to have a high cost of care (p = 0.012), extended LOS (p = 0.038), plastic surgery involvement in their care (p = 0.038), but fewer upper extremity bony injuries (p = 0.019). Non-helmeted patients sustained less upper extremity bony injuries (p < 0.001) and upper extremity soft tissue injuries (p = 0.001), yet more severe injuries (ISS ≥ 30, p = 0.006 and GCS < 9, p < 0.01) than helmeted patients. Conclusion: Upper extremity injuries are common in motorcyclists. Despite vital protection for the brain and maxillofacial injury, helmeted MCC patients have an increased incidence of upper extremity injuries compared to non-helmeted patients, but overall have less severe injuries. Intoxicated patients have fewer upper extremity bony injuries, but the higher cost of care, and extended LOS. Therefore, even with the increased risk of injury helmets may expose to the upper extremity, helmets reduced overall morbidity and mortality. In addition to mandatory helmet laws, we advocate for further development of safety equipment focusing specifically on the prevention of upper extremity injuries.

Use of Helmet CPAP in COVID-19 - A practical review

Helmet CPAP (H-CPAP) has been recommended in many guidelines as a noninvasive respiratory support during COVID-19 pandemic in many countries around the world. It has the least amount of particle dispersion and air contamination among all noninvasive devices and may mitigate the ICU bed shortage during a COVID surge as well as a decreased need for intubation/mechanical ventilation. It can be attached to many oxygen delivery sources. The MaxVenturi setup is preferred as it allows for natural humidification, low noise burden, and easy transition to HFNC during breaks and it is the recommended transport set-up. The patients can safely be proned with the helmet. It can also be used to wean the patients from invasive mechanical ventilation. Our article reviews in depth the pathophysiology of COVID-19 ARDS, provides rationale of using H-CPAP, suggests a respiratory failure algorithm, guides through its setup and discusses the issues and concerns around using it.