Primary prevention of road traffic accident–related traumatic brain injuries in younger populations: a systematic review of helmet legislation

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OBJECTIVE

Road traffic accidents are the most frequent cause of severe traumatic brain injury (TBI), particularly among young populations worldwide. Helmets are proven to prevent injuries; however, estimates of helmet compliance are low globally. Surgical/critical care management of TBI is often used to treat these injuries, but primary prevention should be recommended. A key component in promoting TBI prevention among pediatric and young populations is through helmet legislation. The authors investigated helmet policies for motorcycles and bicycles globally to provide recommendations for how related legislation may impact TBI and guide advocacy in pediatric neurosurgery.

METHODS

The authors conducted a systematic review of helmet laws and/or policies by using the National Library of Medicine PubMed and SCOPUS databases. Additional articles were identified using citation searches of key publications. Abstracts from articles of all sources were read and selected for full-text review. Details of relevant full articles were extracted and analyzed for the following: bibliographic data, study aim, design and duration, study participants, intervention characteristics, and intervention effect data.

RESULTS

Of 618 search results, 53 full-text articles were analyzed for recommendations. Helmet legislation is associated with increased helmet use among bicyclists and decreased road traffic accident–related head injuries and fatalities among motorcyclists and bicyclists. Laws are more effective if comprehensive and inclusive of the following: both primary riders and passengers, all age groups, all modes of transportation made safer by helmets, a proper use clause, and standardized helmet quality measures. Cultural, socioeconomic, and infrastructural circumstances are important as well, and legislation must consider enforcement mechanisms with penalties significant enough to incentivize behavioral changes, but proportional to community socioeconomic status.

CONCLUSIONS

Compulsory use laws are the optimal primary intervention; however, concurrent programs to support financial access to helmets, change cultural attitudes, increase health literacy, and improve road infrastructure will augment legislative benefits. Pediatric neurosurgeons are caretakers of children suffering from TBI. Although extensive study has explored the surgical management of TBI, the authors believe that primary prevention is instrumental to improving outcomes and reducing injury. All helmet laws are not equal; based on these findings, a comprehensive, context-specific approach is the key to success, especially in resource-limited countries.

ABBREVIATIONS HICs = high-income countries; LMICs = low- and middle-income countries; RCT = randomized controlled trial; RTA = road traffic accident; TBI = traumatic brain injury; UI = uncertainty interval.
Article Information

Contributor Notes

Correspondence Sandi Lam: Northwestern University Feinberg School of Medicine, Chicago, IL. sandilam@luriechildrens.org.INCLUDE WHEN CITING Published online January 3, 2020; DOI: 10.3171/2019.10.PEDS19377.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Auman KMKufera JABallesteros MFSmialek JEDischinger PC: Autopsy study of motorcyclist fatalities: the effect of the 1992 Maryland motorcycle helmet use law. Am J Public Health 92:135213552002

    • Search Google Scholar
    • Export Citation
  • 2

    Bachani AMBranching CEar CRoehler DRParker EMTum S: Trends in prevalence, knowledge, attitudes, and practices of helmet use in Cambodia: results from a two year study. Injury 44 (Suppl 4):S31S372013

    • Search Google Scholar
    • Export Citation
  • 3

    Bachani AMHung YWMogere SAkunga DNyamari JHyder AA: Helmet wearing in Kenya: prevalence, knowledge, attitude, practice and implications. Public Health 144S:S23S312017

    • Search Google Scholar
    • Export Citation
  • 4

    Bianco ATrani FSantoro GAngelillo IF: Adolescents’ attitudes and behaviour towards motorcycle helmet use in Italy. Eur J Pediatr 164:2072112005

    • Search Google Scholar
    • Export Citation
  • 5

    Bonander CNilson FAndersson R: The effect of the Swedish bicycle helmet law for children: an interrupted time series study. J Safety Res 51:15222014

    • Search Google Scholar
    • Export Citation
  • 6

    Borglund STHayes JSEckes JM: Florida’s bicycle helmet law and a bicycle safety educational program: did they help? J Emerg Nurs 25:4965001999

    • Search Google Scholar
    • Export Citation
  • 7

    Bruns J JrHauser WA: The epidemiology of traumatic brain injury: a review. Epilepsia 44 (s10):2102003

  • 8

    Cameron T: Self-insured health care plans: are they fair to employees with HIV/AIDS? J Health Soc Policy 10:23401998

  • 9

    Carpenter CSStehr M: Intended and unintended consequences of youth bicycle helmet laws. J Law Econ 54:3053242011

  • 10

    Castle SLBurke RVArbogast HUpperman JS: Bicycle helmet legislation and injury patterns in trauma patients under age 18. J Surg Res 173:3273312012

    • Search Google Scholar
    • Export Citation
  • 11

    Centers for Disease Control and Prevention: Mandatory bicycle helmet use—Victoria, Australia. MMWR Morb Mortal Wkly Rep 42:3593631993

    • Search Google Scholar
    • Export Citation
  • 12

    Centers for Disease Control and Prevention: Traumatic brain injury & concussion: severe TBI. (https://www.cdc.gov/traumaticbraininjury/severe.html) [Accessed October 25 2019]

    • Export Citation
  • 13

    Chiu WTKuo CYHung CCChen M: The effect of the Taiwan motorcycle helmet use law on head injuries. Am J Public Health 90:7937962000

    • Search Google Scholar
    • Export Citation
  • 14

    Conrad PBradshaw YSLamsudin RKasniyah NCostello C: Helmets, injuries and cultural definitions: motorcycle injury in urban Indonesia. Accid Anal Prev 28:1932001996

    • Search Google Scholar
    • Export Citation
  • 15

    Coté TRSacks JJLambert-Huber DADannenberg ALKresnow MJLipsitz CM: Bicycle helmet use among Maryland children: effect of legislation and education. Pediatrics 89:121612201992

    • Search Google Scholar
    • Export Citation
  • 16

    Craft GVan Bui TSidik MMoore DEderer DJParker EM: A comprehensive approach to motorcycle-related head injury prevention: experiences from the field in Vietnam, Cambodia, and Uganda. Int J Environ Res Public Health 14:142017

    • Search Google Scholar
    • Export Citation
  • 17

    Dellinger AMKresnow MJ: Bicycle helmet use among children in the United States: the effects of legislation, personal and household factors. J Safety Res 41:3753802010

    • Search Google Scholar
    • Export Citation
  • 18

    Dennis JRamsay TTurgeon AFZarychanski R: Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis. BMJ 346:f26742013

    • Search Google Scholar
    • Export Citation
  • 19

    Durkin MSLaraque DLubman IBarlow B: Epidemiology and prevention of traffic injuries to urban children and adolescents. Pediatrics 103:e741999

    • Search Google Scholar
    • Export Citation
  • 20

    Finch CF: Teenagers’ attitudes towards bicycle helmets three years after the introduction of mandatory wearing. Inj Prev 2:1261301996

    • Search Google Scholar
    • Export Citation
  • 21

    Fuentes CEugnia Gras MFont-Mayolas SBertran CSullman MJMBallester D: Expectations of efficacy, social influence and age as predictors of helmet-use in a sample of Spanish adolescents. Transp Res Part F Traffic Psychol Behav 13:2892962010

    • Search Google Scholar
    • Export Citation
  • 22

    Gilchrist JSchieber RALeadbetter SDavidson SC: Police enforcement as part of a comprehensive bicycle helmet program. Pediatrics 106:692000

    • Search Google Scholar
    • Export Citation
  • 23

    Grant DRutner SM: The effect of bicycle helmet legislation on bicycling fatalities. J Policy Anal Manage 23:5956112004

  • 24

    Ha NTEderer DVo VAHPham AVMounts ANolen LD: Changes in motorcycle-related injuries and deaths after mandatory motorcycle helmet law in a district of Vietnam. Traffic Inj Prev 19:75802018

    • Search Google Scholar
    • Export Citation
  • 25

    Hagel BELee RSKarkhaneh MVoaklander DRowe BH: Factors associated with incorrect bicycle helmet use. Inj Prev 16:1781842010

  • 26

    Hassan AJokar TORhee PIbraheem KKulvatunyou NAnderson KT: More helmets fewer deaths: motorcycle helmet legislation impacts traumatic brain injury-related mortality in young adults. Am Surg 83:5415462017

    • Search Google Scholar
    • Export Citation
  • 27

    Hoye A: Recommend or mandate? A systematic review and meta-analysis of the effects of mandatory bicycle helmet legislation. Accid Anal Prev 120:2392492018

    • Search Google Scholar
    • Export Citation
  • 28

    Hung DVStevenson MRIvers RQ: Prevalence of helmet use among motorcycle riders in Vietnam. Inj Prev 12:4094132006

  • 29

    Huybers SFenerty LKureshi NThibault-Halman GLeBlanc JCClarke DB: Long-term effects of education and legislation enforcement on all-age bicycle helmet use: a longitudinal study. J Community Health 42:83892017

    • Search Google Scholar
    • Export Citation
  • 30

    Ichikawa MChadbunchachai WMarui E: Effect of the helmet act for motorcyclists in Thailand. Accid Anal Prev 35:1831892003

  • 31

    James SLTheadom AEllenbogen RGBannick MSMontjoy-Venning WLucchesi LR: Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18:56872019

    • Search Google Scholar
    • Export Citation
  • 32

    Jewett ABeck LFTaylor CBaldwin G: Bicycle helmet use among persons 5 years and older in the United States, 2012. J Safety Res 59:172016

    • Search Google Scholar
    • Export Citation
  • 33

    Ji MGilchick RABender SJ: Trends in helmet use and head injuries in San Diego County: the effect of bicycle helmet legislation. Accid Anal Prev 38:1281342006

    • Search Google Scholar
    • Export Citation
  • 34

    Kanny DSchieber RAPryor VKresnow MJ: Effectiveness of a state law mandating use of bicycle helmets among children: an observational evaluation. Am J Epidemiol 154:107210762001

    • Search Google Scholar
    • Export Citation
  • 35

    Karkhaneh MKalenga JCHagel BERowe BH: Effectiveness of bicycle helmet legislation to increase helmet use: a systematic review. Inj Prev 12:76822006

    • Search Google Scholar
    • Export Citation
  • 36

    Karkhaneh MRowe BHSaunders LDVoaklander DCHagel BE: Bicycle helmet use four years after the introduction of helmet legislation in Alberta, Canada. Accid Anal Prev 43:7887962011

    • Search Google Scholar
    • Export Citation
  • 37

    Karkhaneh MRowe BHSaunders LDVoaklander DCHagel BE: Trends in head injuries associated with mandatory bicycle helmet legislation targeting children and adolescents. Accid Anal Prev 59:2062122013

    • Search Google Scholar
    • Export Citation
  • 38

    Kendrick DRoyal S: Inequalities in cycle helmet use: cross sectional survey in schools in deprived areas of Nottingham. Arch Dis Child 88:8768802003

    • Search Google Scholar
    • Export Citation
  • 39

    Kett PRivara FGomez AKirk APYantsides C: The effect of an all-ages bicycle helmet law on bicycle-related trauma. J Community Health 41:116011662016

    • Search Google Scholar
    • Export Citation
  • 40

    Kraus JFPeek CMcArthur DLWilliams A: The effect of the 1992 California motorcycle helmet use law on motorcycle crash fatalities and injuries. JAMA 272:150615111994

    • Search Google Scholar
    • Export Citation
  • 41

    La Torre GVan Beeck EBertazzoni GRicciardi W: Head injury resulting from scooter accidents in Rome: differences before and after implementing a universal helmet law. Eur J Public Health 17:6076112007

    • Search Google Scholar
    • Export Citation
  • 42

    Le LCBlum RW: Road traffic injury among young people in Vietnam: evidence from two rounds of national adolescent health surveys, 2004–2009. Glob Health Action 6:192013

    • Search Google Scholar
    • Export Citation
  • 43

    Leblanc JCBeattie TLCulligan C: Effect of legislation on the use of bicycle helmets. CMAJ 166:5925952002

  • 44

    Lin MRKraus JF: A review of risk factors and patterns of motorcycle injuries. Accid Anal Prev 41:7107222009

  • 45

    Liu BCIvers RNorton RBoufous SBlows SLo SK: Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev (1):CD0043332008

    • Search Google Scholar
    • Export Citation
  • 46

    Loubeau PR: Exploration of the barriers to bicycle helmet use among 12 and 13 year old children. Accid Anal Prev 32:1111152000

  • 47

    Lu THLai CHChiang TL: Reducing regional inequality in mortality from road traffic injuries through enforcement of the mandatory motorcycle helmet law in Taiwan. Inj Prev 18:1501572012

    • Search Google Scholar
    • Export Citation
  • 48

    Maas AIStocchetti NBullock R: Moderate and severe traumatic brain injury in adults. Lancet Neurol 7:7287412008

  • 49

    Macpherson ASpinks A: Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries. Cochrane Database Syst Rev (3):CD0054012008

    • Search Google Scholar
    • Export Citation
  • 50

    Macpherson AKMacarthur C: Bicycle helmet legislation: evidence for effectiveness. Pediatr Res 52:4722002

  • 51

    Markowitz SChatterji P: Effects of bicycle helmet laws on children’s injuries. Health Econ 24:26402015

  • 52

    Meehan WP IIILee LKFischer CMMannix RC: Bicycle helmet laws are associated with a lower fatality rate from bicycle-motor vehicle collisions. J Pediatr 163:7267292013

    • Search Google Scholar
    • Export Citation
  • 53

    Nguyen HTPassmore JCuong PVNguyen NP: Measuring compliance with Viet Nam’s mandatory motorcycle helmet legislation. Int J Inj Contr Saf Promot 20:1921962013

    • Search Google Scholar
    • Export Citation
  • 54

    Ni HSacks JJCurtis LCieslak PRHedberg K: Evaluation of a statewide bicycle helmet law via multiple measures of helmet use. Arch Pediatr Adolesc Med 151:59651997

    • Search Google Scholar
    • Export Citation
  • 55

    Olivier JWalter SRGrzebieta RH: Long term bicycle related head injury trends for New South Wales, Australia following mandatory helmet legislation. Accid Anal Prev 50:112811342013

    • Search Google Scholar
    • Export Citation
  • 56

    Olsen CSThomas AMSingleton MGaichas AMSmith TJSmith GA: Motorcycle helmet effectiveness in reducing head, face and brain injuries by state and helmet law. Inj Epidemiol 3:82016

    • Search Google Scholar
    • Export Citation
  • 57

    Pai CWChen YCLin HYChen PL: A population-based case-control study of hospitalisation due to head injuries among bicyclists and motorcyclists in Taiwan. BMJ Open 7:e0185742017

    • Search Google Scholar
    • Export Citation
  • 58

    Parkin PCHu XSpence LJKranz KEShortt LGWesson DE: Evaluation of a subsidy program to increase bicycle helmet use by children of low-income families. Pediatrics 96:2832871995

    • Search Google Scholar
    • Export Citation
  • 59

    Parkin PCSpence LJHu XKranz KEShortt LGWesson DE: Evaluation of a promotional strategy to increase bicycle helmet use by children. Pediatrics 91:7727771993

    • Search Google Scholar
    • Export Citation
  • 60

    Passmore JWNguyen LHNguyen NPOlivé JM: The formulation and implementation of a national helmet law: a case study from Viet Nam. Bull World Health Organ 88:7837872010

    • Search Google Scholar
    • Export Citation
  • 61

    Peeters Wvan den Brande RPolinder SBrazinova ASteyerberg EWLingsma HF: Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien) 157:168316962015

    • Search Google Scholar
    • Export Citation
  • 62

    Roozenbeek BMaas AIRMenon DK: Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol 9:2312362013

  • 63

    Saeed MSiddiqui SMKhan URSwaroop M: Perceptions regarding helmet use: a cross-sectional survey of female pillions in Karachi, Pakistan. J Surg Res 211:2612652017

    • Search Google Scholar
    • Export Citation
  • 64

    Saunders RNAdams NSChapman AJDavis ATKoehler TJDurling LT: The impact of the repeal of Michigan’s universal helmet law on traumatic brain injury: a statewide analysis. Am J Surg 215:4244272018

    • Search Google Scholar
    • Export Citation
  • 65

    Schieber RAKresnow MJSacks JJPledger EEO’Neil JMToomey KE: Effect of a state law on reported bicycle helmet ownership and use. Arch Pediatr Adolesc Med 150:7077121996

    • Search Google Scholar
    • Export Citation
  • 66

    Scuffham PALangley JD: Trends in cycle injury in New Zealand under voluntary helmet use. Accid Anal Prev 29:191997

  • 67

    Servadei FBegliomini CGardini EGiustini MTaggi FKraus J: Effect of Italy’s motorcycle helmet law on traumatic brain injuries. Inj Prev 9:2572602003

    • Search Google Scholar
    • Export Citation
  • 68

    Shadish WRCook TDCampbell DT: Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston: Houghton Mifflin Company2002

    • Search Google Scholar
    • Export Citation
  • 69

    Shafi SGilbert JCLoghmanee FAllen JECaty MGGlick PL: Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma center. J Pediatr Surg 33:3173211998

    • Search Google Scholar
    • Export Citation
  • 70

    Supramaniam Vvan Belle GSung JFC: Fatal motorcycle accidents and helmet laws in Peninsular Malaysia. Accid Anal Prev 16:1571621984

    • Search Google Scholar
    • Export Citation
  • 71

    Teschke KKoehoorn MShen HDennis J: Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share. BMJ Open 5:e0080522015

    • Search Google Scholar
    • Export Citation
  • 72

    Thompson DCRivara FPThompson R: Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev (2):CD0018552000

    • Search Google Scholar
    • Export Citation
  • 73

    Tsai MCHemenway D: Effect of the mandatory helmet law in Taiwan. Inj Prev 5:2902911999

  • 74

    Vulcan APCameron MHWatson WL: Mandatory bicycle helmet use: experience in Victoria, Australia. World J Surg 16:3893971992

  • 75

    Weiss HAgimi YSteiner C: Youth motorcycle-related brain injury by state helmet law type: United States, 2005–2007. Pediatrics 126:114911552010

    • Search Google Scholar
    • Export Citation
  • 76

    Wesson DEStephens DLam KParsons DSpence LParkin PC: Trends in pediatric and adult bicycling deaths before and after passage of a bicycle helmet law. Pediatrics 122:6056102008

    • Search Google Scholar
    • Export Citation
  • 77

    WHO: Motorcycle helmet laws and helmet standard. WHO.int (https://www.who.int/gho/road_safety/legislation/situation_trends_motorcycle_helmet/en/) [Accessed October 25 2019]

    • Search Google Scholar
    • Export Citation
  • 78

    Williams CWeston RFeinglass JCrandall M: Pediatric bicycle helmet legislation and crash-related traumatic brain injury in Illinois, 1999–2009. J Surg Res 222:2312372018

    • Search Google Scholar
    • Export Citation
  • 79

    Zamani-Alavijeh FBazargan MShafiei ABazargan-Hejazi S: The frequency and predictors of helmet use among Iranian motorcyclists: a quantitative and qualitative study. Accid Anal Prev 43:156215692011

    • Search Google Scholar
    • Export Citation
  • 80

    Zhang JNorton RTang KCLo SKJiatong ZWenkui G: Motorcycle ownership and injury in China. Inj Control Saf Promot 11:1591632004

    • Search Google Scholar
    • Export Citation
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