Impact of Helmet Use on Local Pediatric Trauma Outcomes to Guide Injury Prevention Initiatives

Peter J. Keefe, BS
Tommy Kim, BA
Jeremy Aidlen, MD
Kaitlyn Wong, MD, PhD, MPH
Jonathan Green, MD, MSCI
Michael Hirsh, MD
Muriel Cleary, MD, MHS

In this study, we evaluated the incidence of helmet use in pediatric patients that presented to a Level I trauma center following a bicycle, motorcycle (MC), all terrain vehicle (ATV), or skating accident. We analyzed the rates of intracranial injury in patients with helmets compared to patients without helmets. The objective of this study was to better understand the local community's injury prevention needs.

IRB approval was obtained to query a Level I Trauma Registry Database. All trauma activations between January 1st, 2017, and December 31st, 2021 for patients aged 0 to 18 years were analyzed. We specifically looked at the cumulative incidence of trauma activations caused by bicycle, motorcycle, or skating accidents and calculated helmet rates within each type of accident. In addition, patients were categorized into age groups of 1-4, 5-9, 10-14, 15-18. The primary outcome was to examine intracranial injury, defined by ICD10 Diagnosis codes. Chi-squared analysis was used to determine statistically significant differences between patient cohorts.

The 5-year number of bicycle related trauma activations was 108, motorcycle was 66, ATV was 26, and skating was 13. The rates of patients who were not wearing helmets were 68% for bicycle-related traumas, 20% for motorcycle traumas, 54% for ATV traumas, and 85% for skating traumas. The rate of patients not wearing helmets in bicycle related traumas decreased as age increased (age group 1-4: n=3, 0%; group 5-9: n=22, 59.1%; group 10-14: n=63, 71.4%; group 15-18: n=20, 75%).

For bicycle-related traumas, there were fewer intracranial injuries in children who wore helmets (helmet: 12 (34.3%), no helmet: 44 (60.3%); p=0.011). The rates of intracranial injuries were lower in children who wore helmets for MC traumas (helmet: 22 (41.5%), no helmet: 8 (61.5%)), ATV traumas (helmet: 3 (25%), no helmet: 8 (57.1%)), and skate traumas (helmet: 1 (50%), no helmet: 8 (72.7%)); however, these were not statistically significant differences.

The rates of helmet use are uniformly low amongst pediatric non-MC trauma patients, with an inverse relationship between helmet use and age among bicycle specific trauma. These results underscore the importance of bicycle helmet use in the pediatric population. Furthermore, the data highlights a need for improved helmet use in the local community. Future efforts are needed to evaluate why helmet use within this patient population is unsatisfactory and identify potential interventions, which may include increased education or access to safety gear.

1. Although national data is important, evaluation of local community data could help better guide injury prevention efforts.
2. Despite knowing the importance of using helmets, use among children in our community is suboptimal.
3. Proper helmet usage in children is critically important to decrease rates of intracranial injury.