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Background Unhelmeted motorcyclists injured in states with lax or poorly enforced helmet safety laws are frequently seen in rural trauma centers. A trauma surgeon started a comprehensive injury prevention and research fund with outreach to a three-state trauma center catchment area promoting injury prevention at area high schools and local communities. We hypothesized that unhelmeted riders would have more severe head injuries and fatalities than helmeted riders. Methods A trauma registry review of 708 injured motorcycle riders over an 11-year period examined demographics, helmet use, and clinical outcomes of helmeted and unhelmeted riders. A full-time injury prevention coordinator collaborating with law enforcement provided electronic and mechanical simulations with discussions regarding helmet use, alcohol avoidance, and responsible motorcycle riding for area high school students. This program coincided with the second half of our 11-year study. Multiple regression analysis evaluated predictors for head injury and death. Results Unhelmeted motorcyclists suffered worse head injuries, (OR 8.8, CI 1.6-2.4, P < .001), more severe overall injury (OR 10, CI 12.7-18.6, P < .001), and higher mortality (OR 2.7, CI .02-.15, P < .001). Local motorcycle-related trauma center admissions and deaths have stabilized in recent years while statewide motorcycle crashes have increased ( P < .05). Discussion Unhelmeted motorcyclists suffer worse head injuries and mortality rates. Physician-led outreach efforts for injury prevention may be effective. Trauma surgeons have ongoing opportunities to promote responsible motorcycle riding for schools and local communities.

Background: Youth flag football participation has rapidly grown and is a potentially safer alternative to tackle football. However, limited research has quantitatively assessed youth flag football head impact biomechanics. Purpose: To describe head impact biomechanics outcomes in youth flag football and explore factors associated with head impact magnitudes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We monitored 52 player-seasons among 48 male flag football players (mean ± SD; age, 9.4 ± 1.1 years; height, 138.6 ± 9.5 cm; mass, 34.7 ± 9.2 kg) across 3 seasons using head impact sensors during practices and games. Sensors recorded head impact frequencies, peak linear ( g) and rotational (rad/s2) acceleration, and estimated impact location. Impact rates (IRs) were calculated as 1 impact per 10 player-exposures; IR ratios (IRRs) were used to compare season, event type, and age group IRs; and 95% CIs were calculated for IRs and IRRs. Weekly and seasonal cumulative head impact frequencies and magnitudes were calculated. Mixed-model regression models examined the association between player characteristics, event type, and seasons and peak linear and rotational accelerations. Results: A total of 429 head impacts from 604 exposures occurred across the study period (IR, 7.10; 95% CI, 4.81-10.50). Weekly and seasonal cumulative median head impact frequencies were 1.00 (range, 0-2.63) and 7.50 (range, 0-21.00), respectively. The most frequent estimated head impact locations were the skull base (n = 96; 22.4%), top of the head (n = 74; 17.2%), and back of the head (n = 66; 15.4%). The combined event type IRs differed among the 3 seasons (IRR range, 1.45-2.68). Games produced greater IRs (IRR, 1.24; 95% CI, 1.01-1.53) and peak linear acceleration (mean difference, 5.69 g; P = .008) than did practices. Older players demonstrated greater combined event–type IRs (IRR, 1.46; 95% CI, 1.12-1.90) and increased head impact magnitudes than did younger players, with every 1-year age increase associated with a 3.78 g and 602.81-rad/s2 increase in peak linear and rotational acceleration magnitude, respectively ( P≤ .005). Conclusion: Head IRs and magnitudes varied across seasons, thus highlighting multiple season and cohort data are valuable when providing estimates. Head IRs were relatively low across seasons, while linear and rotational acceleration magnitudes were relatively high.

We tested the filtration efficiency of Stryker T5 surgical helmets with and without the addition of a filter medium. Two particle counters were used to count the particles of sizes .5 μm, 1 μm, and 5 μm, both inside and outside the Stryker T5 helmet, concurrently. The total inward leakage (TIL) for the helmet with and without the filter was zero for 5 μm particles at all time points. The TIL (3.4) for the .5 μm particles decreased significantly after application of the filter (1.7; P = .007). We recommend that an N95 should be used inside the helmet system.

Introduction: Infection is a devasting complication after primary and revision arthroplasty. Therefore, identifying potential sources of infection can help to reduce infection rates. The aim of this study was to identify the impact and potential risk of contamination for glows and surgical helmets during arthroplasty procedures. Methods: Surveillance cultures were used to detect contamination of the glow interface during the surgery and the surgical helmets immediately at the end of the surgery. The cultures were taken from 49 arthroplasty procedures from the surgeon as well as the assisting surgeon. Results: In total, 196 cultures were taken. 31 (15.8%) of them showed a contamination. 12 (13.5%) of 98 cultures taken from the surgical helmets were positive, while 18 (18.3%) of 96 cultures taken from the gloves showed a contamination. Discussion: The study showed that during arthroplasty procedures, surgical helmets and gloves were frequently contaminated with bacteria. In 20 of 49 (40.8%) arthroplasty surgeries, either the surgical helmet or the gloves showed a contamination. Surgeons should be aware that they might be a source for infection during arthroplasty surgeries.

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. Given the lack of educational interventions for urban youth, our research team created a youth-informed, culturally relevant educational video on bike helmet safety, which was informed by focus groups with Baltimore City youth. This video, You Make the Call, linked the concept of use of cases to protect phones to use of helmets to protect heads and can be viewed at http://bit.ly/2Kr7UCN . The impact of the video as part of an intervention (coupled with a free helmet, fit instructions, and a parent guidance document) was tested with 20 parent–child dyads. The majority (80%) of youth (mean age 9.9 ± 1.8 years) reported not owning or wearing a helmet. At 1-month follow-up (n = 12, 60% response rate), helmet use was higher in the five youth reporting bike-riding after the intervention; 100% “always” used helmets compared to 0% preintervention. There were increases in youth reporting that parents required helmet use (35% pre vs. 67% post) and that is was possible to fall when bike-riding (60% pre vs. 92% post). These pilot results support the use of this video and educational intervention along with further evaluation in a larger sample size. This youth-informed and culturally tailored approach could be explored as a strategy to address other pediatric injury topics.

In the years following the introduction of legislation in Australian states mandating the wearing of helmets, there was a decline in the number of deaths. Debate has occurred, however, as to why this occurred. The Traffic Accident Reporting System database, which records data for all police-reported crashes in South Australia, was searched for all cases of deaths occurring in the state in bicycle riders aged ≤14 years from January 1982 to December 2001. The numbers of deaths were then compared over the 10-year periods before (1982–1991) and after (1992–2001) the introduction of helmet legislation, and also on a yearly basis from 1982 to 2001. Comparing the numbers of deaths in the two periods before and after helmet legislation in 1991 showed a marked decrease in cases from 36 to 12. However, in examining the numbers of deaths per year in greater detail, it appears that these were already steadily reducing from nine cases per year in 1982 (2.9/100,000) to two cases in 1991 (0.67/100,000) to a virtual plateau after 1991 (ranging from 0 to 2 cases annually). It seems that the introduction of compulsory bicycle helmet wearing in South Australia came at a time when the numbers of child cyclist deaths had been steadily declining over the preceding decade. While helmet wearing clearly protects children who are still riding bicycles, the reasons for the reduction in numbers of deaths appears more complex than legislative change and likely involves a subtle interaction with other behavioural and societal factors and preferences.

We describe the case of a coronavirus disease patient with midline who, during ventilation with continuous positive airway pressure helmet with underarm fastening straps, presented thrombosis of the axillary vein in the armpit. The tip of the midline ended in the armpit. The thrombosis has been resolved with anticoagulant therapy with low molecular weight heparin of 100 IU/kg bid without giving pulmonary embolism. In an emergency context like this, the need to resort to ventilation strategies even in departments generally not accustomed to the use of these devices and to the management of this type of patients, the need to use and adapt the available material (e.g. being unable to renounce to use underarm fastening straps) obliges us to consider the use of alternative strategies also in the field of vascular access. After this case, we began to consider techniques that allow us to prevent the catheter from ending in the armpit, with benefit. It is essential to continue to observe this patient.

Background: Concern for head injuries is widespread and has been reported by the media to be the number one cause of decreased participation in football among the American youth population. Identifying player mechanisms associated with intentional, or purposeful, head impacts should provide critical data for rule modifications, educational programs, and equipment design. Purpose: To investigate the frequency of intentional and unintentional head impacts and to examine the player mechanisms associated with intentional high-magnitude head impacts by comparing the impact mechanism distributions among session type, player position, and ball possession. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Head impact sensors and video footage of 68 players were used to analyze and classify 1319 high-magnitude impacts recorded over 1 season of youth football. Results: In total, 80% of the high-magnitude head impacts were classified as being caused by intentional use of the head. Head-to-head impact was the primary impact mechanism (n = 868; 82.7%) within the 1050 intentional high-magnitude impacts, with classifiable mechanisms, followed by head-to-body (n = 139; 13.2%), head-to-ground (n = 34; 3.2%), and head-to-equipment (n = 9; 0.9%). Head-to-head impacts also accounted for a greater proportion of impacts during practices (n = 625; 88.9%) than games, for linemen (n = 585; 90.3%) than perimeters and backs, and for ball carriers (n = 72; 79.1%) than tacklers. Conclusion: Overall, the majority of high-magnitude head impacts were intentional and resulted from head-to-head contact. The proportion of head-to-head contact was significantly higher for practices than games, linemen than backs and perimeter players, and ball carriers than tacklers.

Background. Road traffic accidents are the fourth leading cause of death in the entire population, and the first among the youth (ages 15-19 years) in Thailand. The situation in Thailand is worse than in neighboring low- to middle-income countries in the Southeast Asia region. Seventy-three percent of the deaths in the country are motorcycle drivers or passengers. Although motorcyclists (both drivers and passengers) have been obligated to wear helmets by law, the prevalence of helmet use nationwide is not high (43.7% in 2010). Methods. We performed a systematic review to examine potential social determinants of helmet use behavior (observational studies) and to summarize previous intervention studies to promote helmet use (interventional studies) in the country. Studies were identified in PubMed and Web of Science, and by additional review of Thai-written literature. Results. We identified 16 relevant studies for social determinants of helmet use and 5 relevant studies for promoting helmet use in Thailand. Our review shows that several factors such as teens and children (age), women (gender), rural areas (geography), and alcohol drinking (interaction with another behavior) are associated with non-helmet use. We also identified 4 interventional studies implemented in Thailand: 1 law enforcement program and 4 community-based educational programs. Although all the studies improved the prevalence of helmet use after the interventions, only 2 studies exceeded 50%. Conclusion. There is consistent evidence that being younger, being a woman, living in non-Bangkok areas, and drinking alcohol are associated with non-helmet use among motorcycle users in Thailand. We also observed that the effect of past intervention programs is limited.

Objective This systematic review and meta-analysis was performed to evaluate the efficacy of using a helmet for oxygen therapy in critically ill patients with respiratory failure. Methods The Cochrane Library, Embase, and PubMed databases were searched for all randomized controlled trials (RCTs) examining the efficacy of a helmet versus standard oxygen therapy or a mask in critically ill patients with respiratory failure. The quality of all included studies was evaluated by the method recommended by The Cochrane Collaboration. The systematic review and meta-analysis was conducted using Review Manager software, version 5.3 (Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Results Ten RCTs involving 708 patients were included in the present meta-analysis. The results of the meta-analysis showed that the oxygenation index, partial pressure of carbon dioxide, and complications were not significantly different between the helmet group and the standard oxygen therapy or mask group. The incidence of intubation and the mortality rate were significantly lower in the helmet group than in the standard oxygen therapy or mask group. Conclusion Delivering oxygen via a helmet can decrease the incidence of required intubation and improve the mortality rate, resulting in beneficial outcomes in critically ill patients with respiratory failure.

Context: Alpine skiing is a popular sport worldwide but has significant risk for injury. The epidemiology of skiing-related injuries has been described, which has led to the identification of risk factors for specific types of injuries. Evidence Acquisition: Pertinent literature from peer-reviewed publications was reviewed. Study Design: Clinical review. Level of Evidence: Level 5. Results: The adoption of international standards for ski-boot-binding systems has changed the profile of skiing-related injuries over time, as has the widespread use of helmets. An understanding of mechanisms of injury, risk factors, and preventative measures may decrease the incidence of skiing-related injuries. Conclusion: Advances in standards for skiing equipment have been effective at decreasing both the frequency and severity of skiing-related injuries, but additional efforts are required to improve the safety of the sport.

Background: Although batters are frequently hit by pitch (HBP) in baseball, the effect of HBP injuries remains undefined in the literature. Purpose: To determine the effect of HBP injuries in terms of time out of play, injury patterns resulting in the greatest time out of play, and the value of protective gear such as helmets and elbow pads. Study Design: Descriptive laboratory study. Methods: Based on the Major League Baseball (MLB) Health and Injury Tracking System, all injuries to batters HBP during the 2011-2015 MLB and Minor League Baseball (MiLB) seasons were identified and analyzed. Video analysis was performed on all HBP events from the 2015 MLB season. Multivariate stepwise regression analysis was utilized to determine the predictive capacity of multiple variables (velocity, pitch type, location, etc) on injury status and severity. Results: A total of 2920 HBP injuries resulted in 24,624 days missed (DM) over the 5 seasons. MLB HBP injuries occurred at a rate of 1 per 2554 plate appearances (1 per 9780 pitches thrown). Mean DM per injury were 8.4 (11.7 for MLB vs 8.0 for MiLB, P < .001). Surgery was required for 3.1% of MLB injuries and 1.2% of MiLB injuries ( P = .005). The most common body regions injured were the hand/fingers (n = 638, 21.8%), head/face (n = 497, 17.0%), and elbow (n = 440, 15.7%), and there were 146 (5.0%) concussions. Injury rates and mean DM correlated with velocity in a near linear fashion. Players hit in the head/face (odds ratio, 28.7) or distal upper extremity (odds ratio, 6.4) were more likely to be injured than players HBP in other locations. Players with an unprotected elbow missed 1.7 more days (95% CI, –4.1 to 7.6) than those with an elbow protector ( P = .554) when injured after being HBP. Conclusion/Clinical Relevance: Although HBP injuries occur infrequently in the course of normal play, they collectively represent a significant source of time out of play. The most common body regions injured include the hands/fingers and head/face, and batters hit in these locations are significantly more likely to be injured. After contusions, concussions were the most common injury diagnosis.

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. We recruited eleven 8- to 15-year-old youth to participate in focus groups to inform the creation of a video promoting helmet use. Key emerging themes included that youth were responsible for keeping themselves safe and that most youth had cell phones with cases to protect them. A video was created that linked the concept of use of cases to protect phones to use of helmets to protect heads. Soliciting information from urban youth was helpful for developing this educational video.

To investigate the differences of the head impact responses between bicyclists and motorcyclists in vehicle collisions. A series of vehicle–bicycle and vehicle–motorcycle lateral impact simulations on four vehicle types at seven vehicle speeds (30, 35, 40, 45, 50, 55 and 60 km/h) and three two-wheeler moving speeds (5, 7.5 and 10 km/h for bicycle, 10, 12.5 and 15 km/h for motorcycle) were established based on PC-Crash software. To further comprehensively explore the differences, additional impact scenes with other initial conditions, such as impact angle (0, π/3, 2π/3 and π) and impact position (left, middle and right part of vehicle front-end), also were supplemented. And then, extensive comparisons were accomplished with regard to average head peak linear acceleration, average head impact speed, average head peak angular acceleration, average head peak angular speed and head injury severity. The results showed there were prominent differences of kinematics and body postures for bicyclists and motorcyclists even under same impact conditions. The variations of bicyclist head impact responses with the changing of impact conditions were a far cry from that of motorcyclists. The average head peak linear acceleration, average head impact speed and average head peak angular acceleration values were higher for motorcyclists than for bicyclists in most cases, while the bicyclists received greater average head peak angular speed values. And the head injuries of motorcyclists worsened faster with increased vehicle speed. The results may provide even deeper understanding of two-wheeler safety and contribute to improve the public health affected by road traffic accidents.

The aim of our study was to assess the impact of helmet legislations on the incidence and the mortality rate of motorcycle collision (MCC)-related traumatic brain injury (TBI) in young adult trauma patients. A 1-year (2011) retrospective analysis was performed of all patients under 21 years old with trauma-related hospitalization using the Nationwide Inpatient Sample database (representing 20% of all in-patient admissions). Patients with MCC were identified using E-codes. States were classified into three groups based on helmet legislations: universal age helmet legislation

Background: Despite a high reported incidence rate of concussion, little is known about the on-field characteristics of injurious head impacts in National Football League (NFL) games. Purpose: To characterize on-field features (location, player position, and time during game) and biomechanical features (anticipation status, closing distance, impact location and type) associated with concussions in NFL games over a 4-season period (2010-2011 to 2013-2014). Study Design: Descriptive epidemiology study. Methods: We analyzed video of a subset of reported, in-game concussions for the 2010-2011 to 2013-2014 seasons. These videos represented a sample of injuries that were diagnosed and reported on the same day and that could be clearly associated with an in-game collision as captured on video. We determined anticipation status, closing distance, impact location on the injured player’s helmet, and impact type (helmet-to-helmet, helmet-to-body, or helmet-to-ground). Associations between these variables were analyzed by use of descriptive statistics and tests of association. Results: A total of 871 diagnosed concussions were reported as occurring during NFL preseason, regular season, and postseason games for the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 seasons. A total of 1324 games were played during this period, giving a concussion incidence rate of 0.658 per game (95% CI, 0.61-0.70). From the video-reviewed subset (n = 429; 49.3%), the majority of injurious impacts occurred with good anticipation (57.3%) and Conclusion: In-game concussions in the NFL occurred through a diverse variety of mechanisms, surprisingly tended to be well-anticipated, and, also surprisingly, occurred with

Background:Investigation into the effect of cumulative subconcussive head impacts has yielded various results in the literature, with many supporting a link to neurological deficits. Little research has been conducted on men’s lacrosse and associated balance deficits from head impacts.Hypotheses:(1) Athletes will commit more errors on the postseason Balance Error Scoring System (BESS) test. (2) There will be a positive correlation to change in BESS scores and head impact exposure data.Study Design:Prospective longitudinal study.Level of Evidence:Level 3.Methods:Thirty-four Division I men’s lacrosse players (age, 19.59 ± 1.42 years) wore helmets instrumented with a sensor to collect head impact exposure data over the course of a competitive season. Players completed a BESS test at the start and end of the competitive season.Results:The number of errors from pre- to postseason increased during the double-leg stance on foam ( P < 0.001), tandem stance on foam ( P = 0.009), total number of errors on a firm surface ( P = 0.042), and total number of errors on a foam surface ( P = 0.007). There were significant correlations only between the total errors on a foam surface and linear acceleration ( P = 0.038, r = 0.36), head injury criteria ( P = 0.024, r = 0.39), and Gadd Severity Index scores ( P = 0.031, r = 0.37).Conclusion:Changes in the total number of errors on a foam surface may be considered a sensitive measure to detect balance deficits associated with cumulative subconcussive head impacts sustained over the course of 1 lacrosse season, as measured by average linear acceleration, head injury criteria, and Gadd Severity Index scores. If there is microtrauma to the vestibular system due to repetitive subconcussive impacts, only an assessment that highly stresses the vestibular system may be able to detect these changes.Clinical Relevance:Cumulative subconcussive impacts may result in neurocognitive dysfunction, including balance deficits, which are associated with an increased risk for injury. The development of a strategy to reduce total number of head impacts may curb the associated sequelae. Incorporation of a modified BESS test, firm surface only, may not be recommended as it may not detect changes due to repetitive impacts over the course of a competitive season.

Introduction: Helmet use is well known to greatly reduce the risk of head injury in both bicycle and motorcycle riding. However, helmet buckle position may increase the risk of injury to the neck cartilages. We present a series of cases in which thyroid cartilage fracture is presumed to arise from the position of the helmet buckle during a crash. Our objective with this case series is to outline an unusual series of cases and review the literature regarding laryngeal injuries secondary to helmet impact. Design: Single institution case series. Materials and Methods: We present 3 adult patients with laryngeal fractures following bicycle and motorcycle accidents. Medical records were reviewed for history. Results: All patients in this series presented with voice or swallowing complaints and were found to have thyroid cartilage fractures. It was determined that the buckle of the helmet was positioned overlying the larynx during these accidents, so the impact and flexion of the head and neck may have produced sufficient force against it to fracture the cartilage. A literature search yielded works supporting helmet use for head and brain protection but only a single report of laryngeal injuries secondary to helmet use. Conclusions: Though wearing a helmet is protective against head injuries, it may create serious risk to the neck cartilages when the buckle is positioned adjacent to the larynx. Rare but serious, neck cartilage fracture should be considered in helmeted cycling accidents. It may be reasonable to advance a helmet design that positions the buckle and other nonpliable components laterally, away from neck cartilages.

Context: Concussive injuries are at the forefront of sports medicine research. Recently, researchers have used a variety of head- and helmet-based impact-monitoring devices to quantify impacts sustained during contact sport participation. This review provides an up-to-date collection of head accelerometer use at the youth, high school, and collegiate levels. Evidence Acquisition: PubMed was searched for articles published between 1980 and 2015 using the terms accelerometer and concussion, impact sensor and concussion, head impact telemetry system, head impact telemetry, and linear acceleration and concussion. An additional Google search was performed to capture devices without publications. Study Design: Clinical review. Level of Evidence: Level 4. Results: Twenty-four products track and/or record head impact for clinical or research use. Ten of these head impact devices have publications supporting their utility. Conclusion: Head impact measuring devices can describe athlete exposure in terms of magnitude and/or frequency, highlighting their utility within a multimodal approach for concussion assessment and diagnosis.

Context: Concussive injuries are at the forefront of sports medicine research. Recently, researchers have used a variety of head- and helmet-based impact-monitoring devices to quantify impacts sustained during contact sport participation. This review provides an up-to-date collection of head accelerometer use at the youth, high school, and collegiate levels. Evidence Acquisition: PubMed was searched for articles published between 1980 and 2015 using the terms accelerometer and concussion, impact sensor and concussion, head impact telemetry system, head impact telemetry, and linear acceleration and concussion. An additional Google search was performed to capture devices without publications. Study Design: Clinical review. Level of Evidence: Level 4. Results: Twenty-four products track and/or record head impact for clinical or research use. Ten of these head impact devices have publications supporting their utility. Conclusion: Head impact measuring devices can describe athlete exposure in terms of magnitude and/or frequency, highlighting their utility within a multimodal approach for concussion assessment and diagnosis.

Background: Women’s field lacrosse is described as a noncontact game relying primarily on rules to decrease the risk of head injuries. Despite not allowing head contact, however, concussions continue to be reported in women’s field lacrosse. Purpose: To assess the ability of men’s lacrosse helmets to decrease linear and angular acceleration for different striking techniques in women’s field lacrosse. Study Design: Controlled laboratory study. Methods: A helmeted and unhelmeted Hybrid III 50th Percentile headform was attached to a Hybrid III neckform and were subjected to impacts by 8 striking techniques. Eleven athletic females completed 5 slashing techniques, while physical reconstruction equipment was used to simulate falls and shoulder and ball impacts to the head. Three trials were conducted for each condition, and peak resultant linear and angular accelerations of the headform were measured. Results: Falls produced the highest linear and angular acceleration, followed by ball and high-velocity stick impacts. Low-velocity stick impacts were found to produce the lowest linear and angular accelerations. Men’s lacrosse helmets significantly decreased linear and angular accelerations in all conditions, while unhelmeted impacts were associated with high accelerations. Conclusion: If women’s field lacrosse is played within the rules, only falls were found to produce high linear and angular acceleration. However, ball and high-velocity stick impacts were found to produce high linear and angular accelerations. These linear and angular accelerations were found to be within the ranges reported for concussion. When the game is not played within the rules, men’s lacrosse helmets provide an effective method of reducing linear and angular accelerations. Thus, women’s field lacrosse may be able to reduce the occurrence of high linear and angular acceleration impacts by having governing bodies improving rules, implementing the use of helmets, or both. Clinical Relevance: Identifying striking techniques that produce high linear and angular acceleration specific to women’s lacrosse and measuring the capacity of a men’s lacrosse helmet to reduce linear and angular acceleration.

Background: Significant attention has been directed toward the immediate and long-term effects of sport-related concussions on athletes participating in contact sports, particularly football. The highest level of football, the National Football League (NFL), has received significant attention and criticism regarding player management and safety after mild traumatic brain injury (mTBI). Several review articles have reported data related to concussion in the NFL, but a succinct review and synthesis of data regarding NFL concussions is currently lacking. Purpose: To (1) review systematically the published data regarding concussion in the NFL and assess limitations of the studies, (2) elucidate areas where further research is needed, and (3) identify methods to improve future investigations of concussion in the NFL. Study Design: Systematic review of literature. Methods: English-language titles and abstracts published between 1900 and September 2014 were searched systematically across electronic databases, and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed journal articles were included if they contained NFL concussion data with or without additional associated long-term effects. Reviews, editorials, letters to the editor, and comments were not included. Results: Of the 344 records screened for review, 88 articles were assessed for eligibility. There were 31 studies that met the inclusion criteria and formed the basis of the evidence synthesis. Included in the current review were 8 case-control studies (Oxford Centre for Evidence-Based Medicine evidence level 3b), 6 descriptive epidemiological studies (level 4), 6 cross-sectional studies (level 4), 6 cohort studies (level 2b), and 5 case series (level 4). Conclusion: The study of concussions in the NFL has been limited by lack of recent empirical data, reliance on self-reported concussion history, and ascertainment bias of brains donated for autopsy studies. The scientific community as well as the public should be cautious in interpreting the current literature surrounding concussion.

Background: The epidemiology of football-related concussions has been extensively examined. However, although football players experience more at-risk exposure time during practices than competitions, there is a dearth of literature examining the nature of the activities or equipment worn during practice. In particular, varying levels of equipment worn during practices may place players at varying levels of risk for concussion. Purpose: To describe the epidemiology of NCAA men’s football concussions that occurred during practices from the 2004-2005 to 2008-2009 academic years by amount of equipment worn. Study Design: Descriptive epidemiology study. Methods: Men’s collegiate football data from the National Collegiate Athletic Association Injury Surveillance System (NCAA ISS) during the 5-year study period were analyzed. Injury rates and injury rate ratios (RRs) were reported with 95% confidence intervals. Results: During the study period, 795 concussions were reported during practices, resulting in an injury rate of 0.39 per 1000 athlete-exposures (AEs) (95% CI, 0.36-0.42). Among NCAA divisions, Division III had the highest concussion rate (0.54/1000 AEs), followed by Division I (0.34/1000 AEs) and Division II (0.24/1000 AEs) (all P values for RRs comparing divisions Conclusion: Practice concussion rates are highest during fully padded practices, preseason practices, and scrimmages, suggesting that the nature, focus, and intensity of football practices affect concussion risk. In addition, coaching staff should continue to closely monitor player safety during scrimmages. Meanwhile, future surveillance should examine whether removing scrimmages, particularly those that are not fully padded, will meaningfully reduce the incidence and rate of concussions.

Background: An athlete is thought to reduce head acceleration after impact by contracting the cervical musculature, which increases the effective mass of the head. Purpose: To compare the odds of sustaining higher magnitude in-season head impacts between athletes with higher and lower preseason performance on cervical muscle characteristics. Study Design: Cohort study; Level of evidence, 2. Methods: Forty-nine high school and collegiate American football players completed a preseason cervical testing protocol that included measures of cervical isometric strength, muscle size, and response to cervical perturbation. Head impact biomechanics were captured for each player using the Head Impact Telemetry System. A median split was used to categorize players as either high or low performers for each of the following outcome measures: isometric strength (peak torque, rate of torque development), muscle size (cross-sectional area), and response to cervical perturbation (stiffness, angular displacement, muscle onset latency). The odds of sustaining moderate and severe head impacts were computed against the reference odds of sustaining mild head impacts across cervical characteristic categorizations. Results: Linemen with stronger lateral flexors and composite cervical strength had about 1.75 times’ increased odds of sustaining moderate linear head impacts rather than mild impacts compared with weaker linemen. Players who developed extensor torque more quickly had 2 times the increased odds of sustaining severe linear head impacts (odds ratio [OR], 2.10; 95% CI, 1.08-4.05) rather than mild head impacts. However, players with greater cervical stiffness had reduced odds of sustaining both moderate (OR, 0.77; 95% CI, 0.61-0.96) and severe (OR, 0.64; 95% CI, 0.46-0.89) head impacts compared with players with less cervical stiffness. Conclusion: The study findings showed that greater cervical stiffness and less angular displacement after perturbation reduced the odds of sustaining higher magnitude head impacts; however, the findings did not show that players with stronger and larger neck muscles mitigate head impact severity.

Purpose. Traumatic brain injury is a leading cause of death in bicycle crashes. The factors associated with bicycle helmet use in young children with diverse ethnic and socioeconomic backgrounds have not been studied. The purpose of this study was to identify barriers to helmet use in young children in an urban elementary school. Design. Qualitative content analysis with semistructured interviews, observational field notes, and artifacts. Setting. Urban elementary school. Participants. Seventeen students whose age ranged from 5 to 7 years and whose ethnic background was identified as African American (14) or Caucasian (3). Method. Children participated in a brain safety fair that included presentations and activities. Semistructured, pre- and postexperience interviews were completed. Observations of the students participating in the activities and reflective art projects from the students were collected. Results. The analysis found the following barriers to helmet use: (a) lack of access to a helmet, (b) poor fit of helmets due to hairstyles, and (c) lack of knowledge regarding helmet use. Conclusion. The present study suggests that the issue of helmet design and comfort for younger children with variable hairstyles needs to be addressed in order to increase helmet use in this population.

Motorcycles are an important form of transportation in Uganda, and are involved in more road traffic injuries than any other vehicle. The majority of motorcycles in Uganda are used as motorcycle taxis, better known locally as boda bodas. Research shows that a motorcycle helmet is effective at reducing a rider's risk of death and head injury. As part of the Uganda Helmet Vaccine Initiative (UHVI), researchers collected baseline and formative evaluation data on boda boda operators' helmet attitudes, beliefs, and behaviors to inform UHVI activities. Researchers collected data on motorcycle helmet-related attitudes and beliefs through focus group discussions and structured roadside interviews, and researchers conducted roadside observations to collect data on helmet-wearing behaviors. Of the 12,189 motorcycle operators and passengers observed during roadside observations, 30.8% of drivers and

Although helmet use has been compulsory for motorcycle drivers and passengers in Thailand since the enactment of the Helmet Act in 1994, recent surveys show that the prevalence of helmet usage remains low, particularly among passengers. This paper has sought to explore motorcyclists’ awareness of helmet law enforcement in Thailand and examine whether it affects their helmet use behaviour. A total of 2,429 drivers and 1,328 passengers in urban cities nationwide were interviewed in 2009, and the data were analysed using a multivariate ordered logit regression technique. About 60% of the drivers and only 28% of the passengers reported that they always wore a motorcycle helmet. Apart from basic demographics (i.e. age and gender) and riding frequency, our analysis reveals that the awareness of helmet law enforcement was among the contributing factors influencing the use of motorcycle helmets in Thailand. Regardless of riding position, the prevalence of helmet use tended to be greater among those frequently observing the police’s checkpoints for helmet wearing and those perceiving the high risk of being caught for non-helmet use. However, the use of helmets appeared to be lower among drivers who perceived the checkpoints to take place at the same times and locations, which were likely predicted. For motorcycle passengers, it was found that the low prevalence of helmet use was potentially attributable to the absence of knowledge on the compulsory helmet law for passengers and the perception that the law was not enforced by the police. Thus, if motorcycle helmet use in Thailand is to be increased, considerable efforts need to be given to increasing the perceived risk of apprehension for non-helmet use (e.g. more police presence and random scheduling of enforcement activities), improving the awareness of the existing helmet law for passengers, and ensuring that helmet wearing by passengers is more strictly enforced.

Background: Participation in sports is a popular activity for children across the country. Prevention of sports-related injuries can be improved if details of injuries are documented and studied. Methods: A retrospective medical record review of injuries that occurred as a direct result of sports participation (both organized and non-organized play) from November 2006 to November 2007. Because the vast majority of injuries were a result of participation in football or basketball, these injuries were focused upon. The injuries specifically examined were closed head injury (CHI), lacerations and fractures. Results: There were 350 football and 196 basketball injuries (total 546). Comparing injuries between the two groups fractures were found to be more prevalent in football compared to basketball (z = 2.14; p = 0.03; 95%CI (0.01, 0.16)). Lacerations were found to be less prevalent among helmeted patients than those without helmets. (z = 2.39; p = 0.02; 95%CI (-0.17,-0.03)). CHI was more prevalent among organized play compared to non-organized (z = 3.9; p Conclusions: Football and basketball related injuries are common complaints in a pediatric Emergency Department. Frequently seen injuries include CHI, fractures and lacerations. In our institution, fractures were more prevalent among football players and CHI was more prevalent among organized sports participants.

Personal protective equipment (PPE) is the least desirable way to ensure workplace safety, and it is difficult to use consistently. Hard hats are different; they have cachet and are often worn even when they are not required. We investigated the history of this personal protective equipment to see if there were any lessons that could be applied to other forms of PPE. We learned that what makes hard hats special are social factors that are specific to a certain time and place. The importance of social factors illuminates the requirement that cultural and social norms of workers be included in any kind of worker safety and health training.

Head injuries are a major cause of morbidity and mortality worldwide, many resulting from sporting activities. There is a constant need in the head protection industry for improved methods to manage impacts and to reduce the risk of mild and severe head injuries. Contemporary head protection primarily consists of foam with several inherent disadvantages, including a limited ability to provide effective energy absorption under both low and high impact velocities. Recently, thin-walled collapsible chambers were engineered to address this problem and have been implemented into sport helmets. The chambers consist of four engineering elements which define their dynamic performance: geometry, air volume, material, and venting system. This research analysed the contribution of air flow through an orifice to the chamber's management of impact energy. The objective of this study was to determine the effect of the chamber's vent diameter and material stiffness on peak force and venting rate during an impact. Two material stiffnesses (thermoplastic polyurethane 45D and thermoplastic polyurethane 90A) and five vent diameters (1 mm, 2 mm, 3 mm, 4 mm, and 5 mm) were tested at three inbound velocities (1.3 m/s, 2.3 m/s, and 3.0 m/s). Each chamber was impacted ten times using a monorail drop system. Analysis of the results revealed that the material stiffness, vent diameter, and inbound velocity all had a significant effect on peak force and venting rate ( p

Background Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine. Purpose To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players. Study Design Descriptive laboratory study. Methods Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31 youth football players (8-14 years). Each child was imaged while wearing helmet and shoulder pads, without equipment, and with shoulder pads only. Two independent observers measured cervical spine angulation as Cobb angle from C1 to C7 and subaxial angulation from C2 to C7. We calculated intraclass correlation coefficients for intraobserver reliability analysis and compared Cobb and C2 to C7 angles between equipment conditions with t tests. Results Interobserver analysis showed excellent reliability among measurements. Cobb and subaxial angle measurements indicated significantly greater cervical lordosis while children wore shoulder pads only, compared with the other 2 conditions (no equipment and helmet and shoulder pads) (P < .001). There was no statistically significant difference in either Cobb or C2-C7 angles between fully equipped (helmet + shoulder pads) and no-equipment conditions (P >.05). Conclusions Equipment removal for the youth football athlete with suspected cervical spine injury should abide by the “all or none” policy that has been widely accepted for adult athletes. Helmet and shoulder pads should be left in place during emergency transport of the suspected spine-injured youth athlete. Clinical Relevance Despite differences in head to torso size ratios between youth and adult players, helmet removal alone is not recommended for either during emergency transportation.

The authors' Level I trauma center has advocated the use of ski helmets for several years and in 1998, undertook a social-marketing campaign and a helmet loaner program to increase helmet use among skiers and snowboarders. The loaner program's effect on helmet acceptance was measured by comparing helmet acceptance in participating rental stores with acceptance in nonparticipating stores during 3 years. For the 1998-1999 season, 13.8% of renters in the participating stores accepted a helmet compared to 1.38% in the nonparticipating stores (p < .01); for 2000-2001, 33.5% to 3.93% (p < .01); and for 2001-2002, 30.3% to 4.48% (p < .01). The authors believe that efforts to increase helmet use—by increasing education and public awareness and decreasing barriers, such as through helmet loaner programs or routinely including helmets in rental packages—have significant potential to decrease the incidence and severity of brain injuries from skiing and/or snowboarding accidents in Colorado.

This paper reviews economic evaluations of motorcycle helmet interventions in preventing injuries. A comprehensive literature review focusing on the e fectiveness of motorcycle helmet use, and on mandatory helmet laws and their enforcement was done. When helmet laws were lifted between 1976-80, 48 states within the USA experienced a cost of $342,047 per excess fatality of annual net savings. Helmet laws in the USA had a benefit-cost ratio of 1.33 to 5.07. Taiwan witnessed a 14% decline in motorcycle fatalities and a 22% reduction of head injury fatalities with the introduction of a helmet law. In Thailand, where 70-90% of all crashes involve motorcycle, after enforcement of a helmet law, helmet-use increased five-fold, the number of injured motorcyclists decreased by 33.5%, head injuries decreased by 41.4%, and deaths decreased by 20.8%. There is considerable evidence that mandatory helmet laws with enforcement alleviate the burden of tra fic injuries greatly. For low and middle-income countries with high rates of motorcycle injuries, enforced, mandatory motorcycle helmet laws are potentially one of the most cost-e fective interventions available. Asia Pac J Public Health 2007; 19(2): 16—22.

Catastrophic cervical spine injuries can lead to devastating consequences for the collision athlete. Improved understanding of these injuries can lead to identification of risk factors, early diagnosis, and effective on-field management. This article is the second in a 2-part series. The first part, published in the June 2004 issue, reviewed the current concepts regarding the epidemiology, functional anatomy, and diagnostic considerations relevant to cervical spine trauma in collision sports. In this article, the principles of on-field emergency care of the spine-injured athlete are reviewed. The authors discuss the need for effective pre-event planning, on-field evaluation and management of cervical spine injuries, and the transition of care from the playing field to the emergency room. The protocol for equipment removal, when necessary, is also reviewed. An organized, rapid approach to the management of cervical spine–injured collision athletes can help to optimize the outcomes of these catastrophic injuries.

In response to political pressure, the state of Florida repealed its mandatory motorcycle helmet-use law for all operators and passengers older than the age of 21, effective July 1, 2000. Using monthly data and a multiple time-series design, the authors assessed the effect of this law change on serious injury and fatality rates for motorcycle riders aged 21 and older. Controls for serious injury and fatality rates for motorcycle riders younger than 21 years of age were included in the analyses. Maximum-likelihood results showed that the repeal of the mandatory helmet-use law in Florida had little observable effect on serious injuries or on fatalities that resulted from motorcycle crashes. Policy implications of these findings are discussed, and explanations are given as to why the repeal of the mandatory motorcycle helmet-use law in Florida was inconsequential.

BackgroundImplementation of prevention programs for bicycle safety should be based on a good understanding of the profile of bicycle accidents. The objective of this study was to investigate the differences in the severity of bicycle-related injuries when comparing with various risk factors, and to utilize this information to formulate the intervention measures.MethodsA retrospective review was conducted on all patients (n=116) who were treated for bicycle-related injuries within a period of 66 days at the emergency department of a district hospital in Tai Po, New Territories.ResultsSchool-aged children, especially boys, were more commonly injured. The head and lower extremities were the common sites of injuries. Female gender (χ2=4.39; P2=12.61; PConclusionTai Po district had a high incidence of bicycle accidents due to its geographical location. Population at a greater risk for bicycle injury was the male gender school-aged children and therefore prevention program should be targeted at them.

This study examined parental perceptions of the benefits and barriers to bicycle helmet use and their level of knowledge about bicycle safety issues. A school-based bicycle safety education program was taught to first- and second-grade students in a rural/suburban school district by a graduate nursing student. Pender’s Health Promotion Model was the theoretical framework used to guide this research study. A parent Bicycle Helmet Questionnaire (BHQ) developed by the author was the tool used to gather data. The study determined that parents of children in schools that received the educational intervention prior to completing the questionnaire had significantly higher knowledge level scores and that the majority of parents were in favor of bicycle helmet legislation for children. The implications from this research study include the importance of bicycle safety education interventions for students and parents and the need to implement bicycle helmet legislation.

ObjectiveThis study was designed to evaluate the effectiveness of helmet therapy (DOC band) in the correction of patients with moderate to severe posterior deformational plagiocephaly.DesignIn this prospective study, the infants were evaluated using 18 anthropometric measurements.PatientsThe charts of 248 patients seen between August 1, 1995, and July 31, 1999, were reviewed, and 125 met the criteria for inclusion in the study. All the patients had posterior deformational plagiocephaly with no other craniofacial deformities or medical conditions. Treatment was instituted prior to 1 year of age, and all patients were compliant with DOC band usage and had complete anthropometric measurements.ResultsThe study recorded a 41.56% (p < .001) reduction in cranial vault asymmetry and a 40.23% (p < .001) reduction in cranial base asymmetry. Orbitotragial asymmetry was improved 18.72% (p = .0738). The age at which treatment was begun was not a significant factor in predicting treatment outcomes.