Department of Medicine, University of Southern California, Los Angeles, California; Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California.
Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California.
J Surg Res. 2021 Feb;258:307-313. doi: 10.1016/j.jss.2020.08.042. Epub 2020 Oct 9.
No states currently require adult bicycle riders to wear helmets. Opponents of a universal helmet law argue that helmets may cause a greater torque on the neck during collisions, potentially increasing the risk of cervical spine fracture (CSF). This assumption has not been supported by data for motorcyclists. Therefore, we sought to evaluate the risk of CSF and cervical spinal cord injury (CSCI) in helmeted bicyclists (HBs) versus nonhelmeted bicyclists (NHBs) involved in collisions. We hypothesize that in adult HBs, there is an increased incidence of CSF and injury but lower rates of severe head injury and mortality than in NHBs.
The Trauma Quality Improvement Program (2010-2016) was queried for adult bicyclists involved in collisions, comparing HBs with NHBs. A multivariable logistic regression model was used for analysis.
Of 25,047 bicyclists, 14,234 (56.8%) were NHBs. NHBs were more often black (13.3% versus 2.3%, P < 0.001) and screened positive for alcohol on admission (25.7% versus 4.6%, P < 0.001). NHBs had lower rates of CSF (17.7% versus 23.7%, P < 0.001) and CSCI (1.1% versus 1.9%, P < 0.001) but higher rates of mortality (4.9% versus 2.2%, P < 0.001) and a higher risk for severe head injury (odds ratio [OR]: 2.26, 2.13-2.40, P < 0.001). After adjusting for covariates, NHBs had a higher risk of mortality (OR: 2.38, 2.00-2.84, P < 0.001) but lower risk of CSF (OR: 0.66 0.62-0.71, P < 0.001) and CSCI (OR: 0.53, 0.42-0.68, P < 0.001).
HBs involved in collisions have a higher risk of CSF and CSCI; however, NHBs have a higher risk of severe head injury and mortality. Consideration for a universal helmet law among bicyclists and ongoing research regarding helmet development is needed.
目前没有任何州要求成年自行车骑手佩戴头盔。反对普遍头盔法的人认为，头盔在碰撞过程中可能会对颈部产生更大的扭矩，从而增加颈椎骨折（CSF）的风险。这一假设尚未得到摩托车手数据的支持。因此，我们试图评估在涉及碰撞的戴头盔自行车手（HBs）和未戴头盔自行车手（NHBs）中 CSF 和颈脊髓损伤（CSCI）的风险。我们假设，在成年 HBs 中，CSF 和损伤的发生率增加，但严重头部损伤和死亡率低于 NHBs。
创伤质量改进计划（2010-2016 年）被查询了涉及碰撞的成年自行车手，比较了 HBs 和 NHBs。使用多变量逻辑回归模型进行分析。
在 25047 名自行车手，14234 名（56.8%）是 NHBs。NHBs 更常是黑人（13.3%对 2.3%，P<0.001），入院时酒精筛查阳性的比例更高（25.7%对 4.6%，P<0.001）。NHBs 的 CSF 发生率较低（17.7%对 23.7%，P<0.001）和 CSCI 发生率较低（1.1%对 1.9%，P<0.001），但死亡率较高（4.9%对 2.2%，P<0.001），严重头部损伤的风险更高（优势比[OR]：2.26，2.13-2.40，P<0.001）。调整协变量后，NHBs 的死亡率风险更高（OR：2.38，2.00-2.84，P<0.001），但 CSF 发生率较低（OR：0.66，0.62-0.71，P<0.001）和 CSCI 发生率较低（OR：0.53，0.42-0.68，P<0.001）。
涉及碰撞的 HBs 发生 CSF 和 CSCI 的风险更高；然而，NHBs 发生严重头部损伤和死亡率的风险更高。需要考虑在自行车手之间实行普遍头盔法，并进行关于头盔开发的持续研究。
