Shafi S, Gilbert J C, Loghmanee F, Allen J E, Caty M G, Glick P L, Carden S, Azizkhan R G
Department of Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
J Pediatr Surg. 1998 Feb;33(2):317-21. doi: 10.1016/s0022-3468(98)90454-7.
The regional pediatric trauma center in Buffalo, NY, has been active in pediatric injury prevention programs, including community education and distribution of bicycle helmets, since 1990. Since June 1, 1994, the use of bicycle safety helmets for children under 14 years of age has been mandated by a state law in New York. The authors undertook this study to assess the impact of this legislation on the frequency of helmet use in children involved in bicycle crashes presenting to the regional pediatric trauma center, and to assess the impact of helmet use on the number and severity of head injuries.
Bicycle crash victims (n = 208) admitted to a regional pediatric trauma center from 1993 to 1995 were studied retrospectively. Head injuries were classified as concussion alone, skull fractures, intracranial hemorrhages (ie, epidural, subdural, and subarachnoid), cerebral contusions, or diffuse cerebral edema alone (without any other intracranial injury). Helmeted children (HC) were compared with nonhelmeted children (NHC) using chi2 and Fisher's Exact test. P value less than .05 was considered significant.
Only 31 children (15%) wore helmets at the time of the crash. Helmet use increased from 2%, during the period of education alone, to 26% after the legislation went into effect (P < .00001). The proportion of children suffering head injuries was similar in both groups (HC, 68%; NHC, 61%; P = NS). However, the type of head injury was different. HC were more likely to sustain concussion alone (HC, 65%; NHC, 44%; P < .03). HC were less likely to have skull fractures (HC, 0%; NHC, 13%; P < .02), and exhibited a trend toward less intracranial hemorrhages (HC, 0%; NHC, 9%; P = NS), cerebral contusions (HC, 3%; NHC, 5%; P = NS), and cerebral edema (HC, 0%; NHC, 0.6%; P = NS). Excluding the isolated concussions, head injuries were noted in only one HC, compared with 30 NHC (P < .04). None of the three children who died wore helmets at the time of the crash, and all died of multiple head injuries.
The bicycle helmet safety law resulted in a 13-fold increase in the use of bicycle helmets among the children admitted to a regional pediatric trauma center after bicycle crashes, but the helmet use remains inadequate. Helmet use reduced the severity of head injuries, and might have prevented deaths caused by head injuries.
纽约州布法罗市的地区儿科创伤中心自1990年起就积极参与儿科伤害预防项目，包括社区教育和自行车头盔的分发。自1994年6月1日起，纽约州法律规定14岁以下儿童必须佩戴自行车安全头盔。作者开展这项研究，旨在评估该立法对前往地区儿科创伤中心就诊的自行车事故儿童佩戴头盔频率的影响，并评估头盔使用对头部受伤数量和严重程度的影响。
对1993年至1995年入住地区儿科创伤中心的自行车事故受害者（n = 208）进行回顾性研究。头部损伤分为单纯脑震荡、颅骨骨折、颅内出血（即硬膜外、硬膜下和蛛网膜下腔出血）、脑挫伤或单纯弥漫性脑水肿（无任何其他颅内损伤）。使用卡方检验和费舍尔精确检验对佩戴头盔儿童（HC）和未佩戴头盔儿童（NHC）进行比较。P值小于0.05被认为具有统计学意义。
只有31名儿童（15%）在事故发生时佩戴了头盔。头盔使用率从仅开展教育期间的2%增加到立法生效后的26%（P < 0.00001）。两组中头部受伤儿童的比例相似（HC组为68%；NHC组为61%；P = 无统计学意义）。然而，头部损伤的类型有所不同。HC组更易仅发生脑震荡（HC组为65%；NHC组为44%；P < 0.03）。HC组发生颅骨骨折的可能性较小（HC组为0%；NHC组为13%；P < 0.02），且颅内出血（HC组为0%；NHC组为9%；P = 无统计学意义）、脑挫伤（HC组为3%；NHC组为5%；P = 无统计学意义）和脑水肿（HC组为0%；NHC组为0.6%；P = 无统计学意义）有减少趋势。排除单纯脑震荡，仅1名HC组儿童有头部损伤，而NHC组有30名（P < 0.04）。三名死亡儿童在事故发生时均未佩戴头盔，且均死于多处头部损伤。
自行车头盔安全法使地区儿科创伤中心收治的自行车事故后儿童佩戴自行车头盔的使用率提高了13倍，但头盔使用率仍不足。佩戴头盔降低了头部损伤的严重程度，并可能预防了因头部损伤导致的死亡。
