Transport, Occupational and Environmental Epidemiology Research and Surveillance Unit (UMRESTTE), French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), Lyon-Bron, France.
Inj Prev. 2012 Feb;18(1):27-32. doi: 10.1136/ip.2011.031815. Epub 2011 May 23.
Previous case-control studies on bicycle helmet efficacy are mostly Anglo-Saxon, and based on data from the early 1990s when hard-shell helmets were common.
In France, the Rhône county (1.6 million inhabitants) is covered by a road trauma registry that includes emergency department visits, hospital admissions, and fatalities. Over the 1998-2008 period, 13,797 cyclist casualties were identified. The injuries sustained were coded using the Abbreviated Injury Scale (AIS) for injuries to the head (AIS1+ and AIS3+), face (AIS1+), or neck (AIS1+). The study uses a case-control design where the control group includes cyclists injured below the neck-that is, not injured in the region associated with the helmet. We first adjusted for age, gender, and type of crash, as in a previously published Cochrane review. Then we adjusted for injury severity based on non-head, face, or neck injury, and when relevant, for crash location: type of road, urban/rural area.
The fully adjusted ORs of helmeted versus unhelmeted cyclists are: for AIS1+ head injuries, 0.69 (95% CI 0.59 to 0.81); for AIS3+ head injuries sustained in urban areas, 0.34 (95% CI 0.15 to 0.65), those sustained in rural areas, 0.07 (95% CI 0.02 to 0.23); for AIS1+ facial injuries, 0.72 (95% CI 0.62 to 0.83); and for AIS1+ neck injuries, 1.18 (95% CI 0.94 to 1.47).
This study confirms the protective effect for head and facial injuries, even though soft-shell helmets have now become more common. The reduction of risk is greater for serious head injuries. The study is inconclusive about the risk for neck injuries.
之前关于自行车头盔功效的病例对照研究主要是英裔美国人进行的，并且基于 20 世纪 90 年代初硬壳头盔较为常见时的数据。
在法国，罗纳县（拥有 160 万居民）有一个道路创伤登记处，其中包括急诊科就诊、住院和死亡病例。在 1998 年至 2008 年期间，共确定了 13797 名自行车事故伤亡人员。使用损伤严重度评分（Abbreviated Injury Scale，AIS）对头部（AIS1+和 AIS3+）、面部（AIS1+）或颈部（AIS1+）的损伤进行编码。该研究采用病例对照设计，对照组包括颈部以下受伤的自行车骑手，即头盔保护区域未受伤的骑手。我们首先按照之前发表的 Cochrane 综述，按年龄、性别和事故类型进行调整。然后根据非头部、面部或颈部损伤的严重程度进行调整，并且在相关情况下，根据事故地点（道路类型、城市/农村地区）进行调整。
经完全调整后，戴头盔与未戴头盔的自行车骑手的比值比（odds ratio，OR）分别为：AIS1+头部损伤为 0.69（95%置信区间 0.59 至 0.81）；在城市地区发生的 AIS3+头部损伤为 0.34（95%置信区间 0.15 至 0.65），在农村地区发生的 AIS3+头部损伤为 0.07（95%置信区间 0.02 至 0.23）；AIS1+面部损伤为 0.72（95%置信区间 0.62 至 0.83）；AIS1+颈部损伤为 1.18（95%置信区间 0.94 至 1.47）。
本研究证实了即使现在更常见使用软壳头盔，头盔仍对头和面部损伤具有保护作用。对于严重的头部损伤，风险降低的幅度更大。对于颈部损伤的风险，本研究没有得出结论。
