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Introduction: Motorcyclists are particularly vulnerable to injury when encountering large animals such as deer in the roadway. The frequency of these events, factors associated with their occurrence, and the extent of injuries sustained from such crashes are not yet well described., Methods: A review of 10 years (2012-2021) of statewide motorcycle crash reports from a single state with a large deer population was performed to ascertain the frequency of deer-associated motorcycle crashes. Environmental and roadway conditions, as well as motorcyclist age, gender, and helmet usage, were identified to determine if associations exist with the severity of injuries sustained., Results: Statewide, 8.5% of reported motorcycle crashes involved deer. Excluding the two most densely populated counties, this rose to 10.7%, with 24.1% of crashes occurring during non-daylight hours being deer related. Factors associated with increased frequency of more severe injury and death included not wearing a helmet, female gender, and rural county crash location. Death and severe injuries were reported in more than twice as many riders who were unhelmeted compared to those wearing helmets (36.1 vs 16.6%; p  < 0.01)., Conclusion: In a single midwestern state, deer represent a significant danger to motorcyclists, especially in rural settings during non-daylight hours. A cautious approach to riding during this time, utilizing available safety precautions to minimize risk of severe injury and death, and further exploration of viable interventions to reduce the likelihood of these occurrences should be considered., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction Kickboxing is a heavily participated combat sport within the UK. With the sport involving striking opponents, it is widely perceived to be associated with an elevated risk of maxillofacial injury. However, the research is limited, with gaps that require further investigation. This study aimed to assess the frequency and distribution of these injuries and whether protective modalities, including headgear and mouthguards, help reduce them.Materials and methods In total, 92 kickboxers completed an electronic questionnaire from 11 October to 11 November 2021.Results There was an incidence rate of 71.7% where participants had experienced at least one maxillofacial injury. The lip was the most affected (26.1%; p <0.05). Injury rates per participant for headgears, mouthguards and no protection were 2.1, 2.6 and 4.7, respectively.Conclusions Maxillofacial injuries in kickboxing have a prevalence of 71%. Protective equipment successfully reduced the frequency of maxillofacial injuries (p <0.05). Experience levels are a major contributor in the incidence of these injuries. Updated regulations to mandate protective equipment may significantly reduce incidence of injury. More research is required in relation to variables such as ethnicity and bone density to identify high-risk groups., Competing Interests: Ethics declaration. The authors declare no conflicts of interest. Ethical approval was gained from the University of Leeds on 29/09/2021 (approval no: FYP2021Kickboxing). Consent was implied upon submission of the questionnaire., (© 2025. The Author(s), under exclusive licence to the British Dental Association.)

Aims: Electronic (E)-scooters have become increasingly common in Ireland. Our group was the first to publish an analysis of injuries related to these devices in Ireland in 2021. Since then, the use of e-scooters has increased significantly. The primary aim of this study was to re-analyse the trend in scooter-related trauma 4 years later., Methods: We conducted a retrospective analysis over the same time period as our previous study (13 months). Seventy-six patients with e-scooter-related trauma in our emergency department (ED) were identified between June 2023 and July 2024. Medical records and patient imaging were reviewed. Injury severity score (ISS) was calculated, and results were compared to our previous study., Results: There was an increase from 22 to 76 patients presenting to our ED with an e-scooter-related injury over a 13-month period. The number of patients presenting with fractures has risen from 15 to 34 (45%). Twenty-four per cent of ED attendees required hospital admission, and 13 patients underwent surgical intervention. The average ISS was 4.3, and helmet use has decreased significantly from 40% to 8%., Conclusions: E-scooters remain to be a key contributor to emergency department presentations and complex orthopaedic injuries. The majority of patients require radiological investigation and specialist follow-up, with many needing surgical fixation. The effects of such injuries can have severe long-term consequences for patients and place financial constraints on our health system. With the rollout of e-scooter rental schemes and infrequent helmet use, one can expect the resulting trauma will continue to rise., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Introduction: Road traffic injuries are a significant public health issue in low-income and middle-income countries. This study was designed to explore the pattern and factors associated with road traffic injury in a high-risk zone of Bangladesh., Method: This mixed-method study included a total of 363 road traffic injury victims for the quantitative component, and 10 traffic-related officials and 10 drivers for the qualitative element. Data were collected using a pretested questionnaire, key informant interviews and a focus group discussion using a focus group discussion guide. Quantitative and qualitative analyses were done using Stata V.17 and NVivo V.12, respectively., Results: Most participants were male, illiterate and young (<30 years) with age averaging 31.50±9.16 years. Of all road traffic injury victims, most had mild (45.18%) injuries, and the least had severe (5.79%) injuries, with head being the most common site (34.44%). The highest proportion of injuries were sustained by motor vehicle drivers (57.58%), followed by cyclists/rickshaw pullers (22.59%) and passengers (19.83%). Most vehicles were new (75.21%), and the rest were old (24.79%). Nearly one-third of the participants did not know about driving rules. The presence of knowledge was associated with less severe injury (p = 0.031) compared with the absence of knowledge. The qualitative component of the study identified several factors related to road traffic injury, including driver factors (lack of sleep, bad driving habits and lack of helmets), driving activity factors (ignoring rules, overtaking, crossing speed limits and using bright headlights), road-related factors (broken roads, unplanned curves and angles, the need for spacious streets and the lack of appraisal of previous crash records) and traffic control factors (stringent traffic rules, effective implementation and training on using speed guns)., Conclusion: The factors related to road traffic injury identified in this study could be used to plan targeted interventions for road safety improvement., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Positional plagiocephaly is a craniofacial condition resulting from infant positioning that applies pressure consistently to a part of the skull. This study analyzed the prevalence of, and costs associated with orthotic helmet treatment for positional plagiocephaly and assessed inequities in treatment between medically underserved areas (MUAs) and non-MUAs using health insurance claims data from the Center for Health Information and Analysis (CHIA) in Massachusetts for the years 2016-2021. The mean percentage of patients receiving orthotic helmet therapy was 4.3% (SD=0.49, 95% CI=3.88-4.91, P =0.44). MUAs contained 37.2% of patients with positional plagiocephaly and 2.9% of MUA patients were treated with helmets compared with 5.2% of non-MUA patients ( P <0.01). There was a significant decline in the percentage of patients prescribed helmeting therapy over the course of the study ( P <0.01). The average copay amount for public insurance was $0.00, and for private insurance, it was $559.8 (SD=160.7, 95% CI=529.1-590.5, P <0.01). Of 3295 claims for orthotic helmet treatment, 92 were fully denied (2.8%). Private insurers issued more fully denied claims (3.8%) than public insurance (1.1%) ( P <0.01). We found that public insurance is favorable for patients seeking treatment due to a lower likelihood of full denial and lower copayments. In addition, we found that there is a significant disparity in the prevalence of helmet treatment in MUAs, and the percentage of patients treated with helmeting therapy has declined over time., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: Bicycle helmet use has repeatedly been shown to protect riders from serious injury. Despite this, a majority of children and adolescents do not regularly wear helmets. Our primary objective was to determine if an emergency department (ED)-based helmet distribution program could increase the amount of time children report wearing helmets., Methods: This was a prospective cohort study of children aged 3 to 17 years presenting to the ED of an urban, tertiary care hospital. Participants were surveyed on their helmet use habits and perceptions regarding the efficacy and importance of helmets. Participants then received a bicycle helmet along with safety counseling in the ED and bicycle safety handouts provided by the American Academy of Pediatrics. Participants were contacted for follow-up 8 weeks after enrollment., Results: We enrolled a total of 94 patients. Post-intervention surveys were obtained from 47% of participants. Our helmet program resulted in a statistically significant increase in the amount of time children reported wearing bicycle helmets. Prior to ED intervention, 48% of participants reported wearing a helmet "most of the time" or "all of the time." After participating, 86% of participants indicated that they wore a helmet "most of the time" or "all of the time." Participants indicated a variety of reasons for not wearing helmets. Of all patients contacted for follow-up, 16% indicated that they were involved in an accident after participating where the helmet they were given prevented a head injury., Conclusions: Helmet distribution programs based in the pediatric ED increase rates of bicycle helmet usage among pediatric patients. Additional study is needed to determine effect on head injury prevention., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Shared micromobility programs (SMPs) are integral to urban transport in US cities, providing sustainable transit options. Increased use has raised safety concerns, notably about helmet usage among e-scooter and e-bicycle riders. Prior studies have shown that head and upper extremity injuries have risen with SMP adoption, yet data on helmet use remains sparse., Methods: This cross-sectional observational study evaluated helmet use among 5,365 riders (e-bicycles, conventional bicycles, and e-scooters) in San Francisco during February and March 2019. Observations were made at seven key intersections during peak commute hours on clear days., Results: The majority rode conventional bicycles (77.1%), followed by e-bicycles (19.0%) and e-scooters (3.9%). Most vehicles (82.2%) were personally owned, with the remainder shared via SMPs. Helmet usage was substantially lower among SMP riders, with shared e-scooter users showing the lowest compliance. Specifically, shared e-scooter riders wore helmets 70% less frequently than personal e-scooter riders and 59% less than shared e-bike riders. Dockless e-bike riders used helmets 42% less than those on docked e-bikes., Conclusion: This study exposes significant gaps in helmet usage among SMP riders, highlighting a pressing need for public health interventions and policy adjustments to improve safety and reduce head injury risks. The findings suggest that helmet use is notably deficient among e-scooter and dockless e-bicycle riders, underscoring the urgent need for targeted safety regulations as cities continue to integrate SMPs into their transportation frameworks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Frye, Chehab, Feler, Wong, Tan, Alpers, Patel, von Hippel and Sammann.)

Introduction: This review aims to provide a comprehensive overview of electric-scooter (E-Scooter) injuries by evaluating the incidence, common mechanisms of injury, clinical outcomes, associated costs, and effective interventions for injury prevention., Methods: A literature search using PubMed, Google Scholar, EMBASE, and ProQuest was performed to identify relevant articles published between July 10, 2014, and July 10, 2024. Outcomes of interest included epidemiologic trends of E-Scooter injuries, common mechanisms of injury, associated risk factors, clinical outcomes, and interventions to decrease E-Scooter injuries., Results: A total of 41 articles were included in this study, with 39 evaluating the epidemiologic trends of e-scooter injuries, 22 the most common mechanisms of injury, 21 assessed intoxication, 15 assessed helmet usage, 33 determined patient's clinical outcomes, and 3 assessed effective interventions for decreasing the incidence of e-scooter injuries. Falls were the most common mechanism of injury; however, collisions with motor vehicles caused more severe injuries. Additionally, studies showed that up to 74 % of all E-Scooter injuries included alcohol intoxication, and over 80 % did not use a helmet leading to severe head injuries., Conclusion: The incidence of E-Scooter related injuries rose significantly in recent years. These injuries typically result from falls and MVAs and are compounded by factors including limited helmet usage and riding while intoxicated. These contribute to the poorer clinical outcomes seen with E-Scooter injuries. However, there remains a significant paucity of literature focused on the outcomes of policies and interventions designed to reduce these injuries. Further investigation must address these gaps and discrepancies to inform future policies., Competing Interests: Declaration of competing interest Authors have nothing to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Mopeds are small and move unpredictably, making them difficult for other drivers to perceive. This lack of visibility, coupled with the minimal protection that mopeds provide, can lead to serious crashes, particularly when the rider is not wearing a helmet. This paper explores the association between helmet usage and injury severity among moped riders involved in collisions with other vehicles. A series of joint bivariate probit models are employed, with injury severity and helmet usage serving as dependent variables. Data on two-vehicle moped crashes in Florida from 2019 to 2021 are collected and categorized into three periods: before, during, and after the COVID-19 pandemic. Crash involvement ratios are calculated to examine the safety risk elements of moped riders in various categories, while significant temporal shifts are also explored. The correlated joint random parameters bivariate probit models with heterogeneity in means demonstrate their superiority in capturing interactive unobserved heterogeneity, revealing how various variables significantly affect injury outcomes and helmet usage. Temporal instability related to the COVID-19 pandemic is validated through likelihood ratio tests, out-of-sample predictions, and calculations of marginal effects. Additionally, several parameters are noted to remain temporally stable across multiple periods, prompting the development of a partially temporally constrained modeling approach to provide insights from a long-term perspective. Specifically, it is found that male moped riders are less likely to wear helmets and are negatively associated with injury/fatality rates. Moped riders on two-lane roads are also less likely to wear helmets. Furthermore, moped riders face a lower risk of injury or fatality during daylight conditions, while angle crashes consistently lead to a higher risk of injuries and fatalities across the three periods. These findings provide valuable insights into helmet usage and injury severity among moped riders and offer guidance for developing countermeasures to protect them., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Conventional cycling crash data is valuable for shaping safe cycling environments but has limitations due to the rarity and under-reporting of cycling crashes. However, recent technological developments can provide information from near-crashes. the subheads should be italic, not bf. Also in the Abstract, there shouldn't be hard return between subheads, the whole section should all run together, so run up any text between subheads., Method: With Metropolitan Copenhagen as a case, this study uses a very large crowdsourced near-crash dataset from Hövding bicycle airbag helmet users and conventional police crash data to model and identify differences in the infrastructure factors influencing rates of crashes and near-crashes in these datasets., Results: In contrast to existing literature, our results show considerable differences in the factors influencing the frequency of crashes and near-crashes. The risk of crashes increases predominantly at intersections and roundabouts, whereas near-crashes are also associated with infrastructure types shared with pedestrians., Conclusion: When used complementarily, crowdsourced near-crash data can enrich the data foundation and help increase the awareness of near-crash-prone infrastructure types necessary for shaping more comprehensive cycling safety policies., Practical Applications: The findings of the study advocate for a broader perspective on cyclist safety, incorporating currently undisclosed near-crash-prone infrastructure types, such as paths shared by cyclists and pedestrians., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background/objective: Headgear designed to protect girls' lacrosse athletes is widely available and permitted for voluntary use; however, it remains unknown how policies mandating headgear use may change the sport and, particularly regarding impacts during game-play. Therefore, this study compares the impact rates and game play characteristics of girls' high school lacrosse in Florida which mandates headgear use (HM), with states having no headgear mandate (NHM)., Materials and Methods: Video from 189 randomly-selected games (HM: 64, NHM: 125) were analyzed. Descriptive statistics, Impact Rates (IR), Impact Rate Ratios (IRR), Impact Proportion Ratios (IPR), and 95% Confidence Intervals (CI) were calculated. IRRs and IPRs with corresponding CIs that excluded 1.00 were deemed statistically significant., Results: 16,340 impacts (HM:5,821 NHM: 10,519; 86.6 impacts/game, CI: 88.6-93.3) were identified using the Lacrosse Incident Analysis Instrument (LIAI). Most impacts directly struck the body ( n  = 16,010, 98%). A minority of impacts directly struck a player's head ( n  = 330, 2%). The rate of head impacts was significantly higher in the HM cohort than NHM cohort (IRR = 2.1; 95% CI = 1.7-2.6). Most head impacts ( n  = 271, 82%) were caused by stick contact in both groups. There was no difference in the proportion of penalties administered for head impacts caused by stick contact between the HM and NHM cohorts (IPR IRRHM/NHM = 0.98; CI = 0.79-1.16). However, there was a significantly greater proportion of head impacts caused by player contact that resulted in a penalty administered in the HM cohort (IPR = 1.44 CI = 1.17-1.54)., Conclusion: These findings demonstrate that mandating headgear use was associated with a two-fold greater likelihood of sustaining a head impact during game play compared to NHM states. A majority of head impacts in both HM and NHM states were caused by illegal stick contact that did not result in penalty.

Motorized two-wheeler users account for 45% of road fatalities in 2021 in India. Correct helmet use decreases the risk of fatalities, but information about the prevalence of correct helmet use is limited in the Indian context. This study aims to assess the prevalence of helmet use and factors associated with correct helmet use among motorized two-wheeler users in Bengaluru city, India. This observational cross-sectional assessment was conducted in a random-representative sample of 98021 motorized two-wheelers sampled from 15 intersections. Helmet use and other information were collected by trained Field Data Collectors via hand-held tablet devices and the KoBo collect application, following a globally used checklist. The prevalence of helmet use (all types) was 88% among riders and pillion together and 92.4% among riders. However, the prevalence of correct helmet use is 38% among riders, and non-standard helmet use is 27%. This study reveals a correct helmet use gap in Bengaluru city. The study recommends the need to shift enforcement, messaging, and intervention focus towards correct helmet use and the implementation of routine population-based surveillance for helmet use in the city.

Purpose: During the last few years, the number of electric scooter (e-scooter) users has risen to an all-time high. This study aimed to analyze e-scooter related accidents and trauma prevention measures in a large European city (Vienna, Austria)., Methods: This retrospective study comprises a thorough data assessment and analysis of all e-scooter related accidents between 2018 and 2021 at a large level 1 trauma center in Vienna. Based on the data analysis, risk factors were identified, and possible prevention strategies were proposed., Results: During the observed period, 1337 patients sustained an injury from an e-scooter. Of these, 1230 were injured directly while driving (92%). The remaining 107 patients (8%) were classified as non-driving injuries. 927 injuries involved males (69.3%). The mean age was 32.1 years (range 4-86 years). Of all injured patients, 429 (32.1%) sustained at least one serious injury. The most common injuries included radial head fractures and concussions. Among the accidents treated, the use of protective equipment was sporadic. For example, helmets were worn in only 13.7% of cases. Wearing a helmet reduced the number of head injuries (24% versus 46.8%). In just three years, the number of patients increased 19-fold with a focus in the summer months., Conclusion: This study shows a substantial and sustained increase in e-scooter accidents with potentially serious injuries. Helmet use was found to be an effective form of head injury prevention. Further options for using protective equipment should be evaluated to improve the safety aspects of riding e-scooters., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Austrian Workers’ Compensation Board (IRB Code EK 01/2022, approved on May 4th 2022) before data collection and analysis. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objectives. To describe the national burden of injuries associated with e-bikes, bicycles, hoverboards, and powered scooters (micromobility devices) in the United States. Methods. We compared patterns and trends for 1 933 296 estimated injuries associated with micromobility devices from 2019 to 2022 using National Electronic Injury Surveillance System data. Results. The population-based rates of e-bike and powered scooter injuries increased by 293.0% and 88.0%, respectively. When reported, powered scooter injuries had the highest proportion for alcohol use (9.0%) compared with other modes, whereas e-bike injuries had the highest proportion for motor vehicle involvement (35.4%). Internal injuries were more likely among e-bike diagnoses than hoverboard and bicycle ( P  < .05), but fractures and concussions were more likely among hoverboard diagnoses compared with all other devices ( P  < .05). When helmet use was identified in clinical notes (20.3%), helmet usage was higher among e-bike injuries (43.8%) compared with powered scooter (34.8%) and hoverboard (30.3%) injuries but lower compared with bicycle injuries (48.7%). Conclusions. The incidence of severe e-bike and powered scooter injuries increased over the 4-year period. Public health stakeholders should focus on improved surveillance and prevention of injuries associated with electric micromobility devices. ( Am J Public Health . 2024;114(12):1365-1374. https://doi.org/10.2105/AJPH.2024.307820).

This study investigates the impacts of various factors on e-bike riders' injury severity in crashes with motor vehicles, based on the in-vehicle recording video crash data in China. Variables from human factors, vehicle characteristics, road conditions, and environmental attributes are extracted from the video, especially for drivers and riders' illegal and avoidance behaviour before the crash, and sun shade canopy use. Results of mixed logit models reveal that drivers' speeding, running red lights, slow-down and swerve behaviour, light trucks, heavy trucks, and buses have significantly varied impacts on riders' injury. Moreover, both drivers and riders' illegal behaviour leads to an increased injury, while their avoidance behaviour before crashes can protect riders. In addition, types of visual obstacles, accidents occurring at night, large vehicles' involvement, and the application of sunshade canopies by riders increased the probability of severe injury, while helmet use can protect riders in accidents with motor vehicles.

Objective: To examine changes in red-light running and distracted riding among motorcyclists and cyclists before and after the 2020 implementation of the One Helmet, One Seatbelt campaign in China., Methods: We obtained 192 hours of film before (2019) and after (2021) implementation of the campaign in eight road intersections in Changsha. We calculated percentages and ratios of red-light running and distracted riding. To assess the associations between these traffic behaviours and the campaign, we used multivariable logistic regression models to calculate adjusted odds ratios (aOR)., Findings: We filmed 5256 motorcyclists and cyclists in 2019 and 6269 in 2021. Red-light running decreased from 45.1% to 41.5% during this period (ratio: 0.92; 95% confidence interval, CI: 0.88-0.96), while distracted riding increased from 3.5% to 5.0% (ratio: 1.42; 95% CI: 1.19-1.69). After adjusting for covariates, male riders were more likely to run a red light compared to female riders (aOR: 1.28; 95% CI: 1.06-1.55). Red-light running was also more likely among electric bicycle riders (aOR: 1.46; 95% CI: 1.10-1.95) and motorcyclists (aOR: 1.47; 95% CI: 1.13-1.90) compared to traditional cyclists. All types of riders were less prone to run a red light during peak hours than off-peak hours (aOR: 0.85; 95% CI: 0.73-0.99). Distracted riding was more common on weekends compared to weekdays (aOR: 3.01; 95% CI: 2.02-4.49)., Conclusion: China's national road safety campaign, which focuses on helmet and seatbelt use, was associated with reduced red-light running. Strict enforcement and targeted modifications could improve the campaign's effectiveness., ((c) 2024 The authors; licensee World Health Organization.)

With the introduction of mobile applications that allow short-term rentals, electric scooters (e-scooters) are gaining popularity as a means of micromobility in urban areas. The aim of the study was to assess the circumstances and causes of death in traffic accidents involving electric scooters in Poland. The inclusion criteria for the study were met by 9 cases (7 M,2F; mean age: 40.3 years). Accidents usually occur during working days during the warm months, especially during the morning traffic rush hour. Usually, these accidents involved another vehicle (4/9 cases). In addition, the victim was most often the driver (8/9 cases) and rarely uses a helmet (1/9 cases). In only two cases did the test reveal the presence of alcohol in the blood at the time of the accident. In studied cases, head injuries occurred in every case, and injuries to the limbs and chest occurred in more than half of the cases. Within the head, in addition to minor injuries like bruises and epidermal abrasions, skull fractures, and intracranial bleedings predominated. Similar minor injuries were also observed in the extremities, with significant fractures observed only in the lower extremities. Among chest injuries, lung contusions predominated. The most common cause of death was craniocerebral injury (6/9 cases), but there were two deaths each from chest injuries and polytrauma. To increase the safety of e-scooter users, it is recommended that measures be taken to educate users about the potential risks of using the vehicle and that measures be taken to increase the use of helmets, e.g. through legislative action. Further studies involving larger study groups are needed to assess the correlation between potential risk factors and the fatal outcome of the accident., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Most maxillofacial traumas are caused by road traffic collisions and, in particular, by motorcycle accidents. Helmets represent an efficient protective tool in these traumas but they do not provide complete protection. The aim of this study was to perform an epidemiological analysis of facial fractures pattern in relation to the helmet type worn during the accident. The study was a retrospective analysis of 282 patients with a diagnosis of maxillofacial fracture caused by a motorcycle accident. The patients were divided in three groups based on helmet type (Group A: full-face helmet; Group B: modular [half-face] helmet; Group C: open-face helmet). For each group, fractures type and trauma severity, using the Comprehensive Facial Injury (CFI) scale, were recorded. Results showed that isolated midface fractures were strongly related to full-face helmet wearing (p < 0.001), while mandibular fractures and panfacial trauma/combined fractures were negatively correlated (p < 0.001). Mandibular fractures (p < 0.001) and panfacial trauma/combined fractures (p < 0.001) were strongly related to open helmet. Moreover, severe trauma (CFI 8.16) was recorded for open-face helmet wearing. In conclusion, full-face helmet wearing reduced the risk of facial fracture, in particular panfacial trauma/combined fractures, while open-face helmet wearing increased the risk of these fractures., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse., Participants: 189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32)., Methods: Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning., Results: Stakeholders felt that incorporating headgear use into women's lacrosse would increase aggression and change the nature of the sport . Some felt that headgear was important for injury risk mitigation and invoked a need for research and development . Stakeholders raised the need for coaching and officiating improvement as primary injury prevention measures. Players were concerned about esthetics and performance limitations . Finally, many felt that it should be left to player choice to wear headgear or not., Conclusion: Most stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.

Background: The rise in popularity of ride share e-scooters has led to an increase in the number of e-scooter injuries, with existing literature reporting increases in rates of admission by more than 350%. In April 2023, the Broome Shire signed a contract to provide 300 e-scooters as part of a shared micro mobility platform. This study aimed to describe the demographics, clinical presentation and health system utilization of patients presenting with e-scooter-related injuries at Broome Regional Hospital (BRH)., Methods: A retrospective cohort study examined all e-scooter-related injuries presenting to BRH between April 1st 2023 and April 30th 2024. Patients with e-scooter injuries described in their Emergency Department (ED) electronic triage records were included. Data was collected from chart review., Results: A total of 190 patients were identified as having sustained an e-scooter injuries over the 12-month trial period. The median age was 26 years with equal numbers of males and females. Most injuries occurred between 6 pm and 12 am (28%) with 53% of patients reporting being intoxicated, while 75% were not wearing a helmet. Almost all patients (80%) were managed in the emergency department because of the low severity of their injuries. Of the remaining patients, 22 were admitted, with 16 transferred for tertiary-level operative management., Conclusion: The introduction of e-scooters for shared micromobility represents a new cause of trauma related presentations to BRH. Our study's results have raised awareness regarding the incidence and severity of electric scooter injuries in Broome., (© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Background: Cameroon is amongst the worst affected countries by road traffic injuries with an estimated 1443 disability-adjusted life years per 100,000 population. There have been very limited reports on the crucial prehospital response to road traffic injuries in Cameroon. This study aimed to identify prehospital factors associated with RTI mortality in Cameroon., Methods: We included patients enrolled between June 2022 and March 2023 in the Cameroon Trauma Registry. Information about prehospital factors and demographic data was obtained from patients or their proxies. We examined the association of prehospital care factors like care at the crash scene and type of transportation during crash with final patient outcome. We used Chi-squared test to investigate the association between selected independent variables and mortality. A multivariable logistic regression model was built to identify independent predictors of dying from an RTI., Results: RTIs constituted 69.5% (n = 3203) of all injuries in the Cameroon Trauma Registry. Only 20.7% (n = 102) of 4 + wheel vehicle occupants had seatbelts on and just 2.7% (n = 53) of motorcycle riders were wearing helmets during the collision. Only 4.9% (n = 156) of patients received any form of scene care. In-hospital mortality was 4.3% (n = 139) and was associated with male sex (AOR = 1.7, 95%CI = 1.08-2.80), crashing on a motorcycle (AOR = 2.08, 95%CI = 1.1-3.67) and scene care (AOR = 0.25, 95%CI = 0.04-0.80)., Conclusions: Receiving any type of care at the scene such as bleeding control or being placed in the recovery position by bystanders is associated with improved survival. Improving on existing informal prehospital care responses should be a priority in Cameroon., (© 2024. The Author(s).)

Purpose: This study explores the protective capabilities of bicycle helmets on serious head injury among bicyclists hospitalized in a Norwegian level 1 trauma centre., Method: Information on helmet use, demographic variables, Abbreviated Injury Scale (AIS) and surgical procedure codes was retrieved from the Oslo University Hospital Trauma Registry for patients with bicycle-related injuries from 2005 through 2016. Outcomes were serious head injury defined as maximum AIS severity score ≥ 3 in the AIS region Head, any cranial neurosurgical procedure, and 30-day mortality., Results: A total of 1256 hospitalized bicyclists were included. The median age was 41 years (quartiles 26-53), 73% were male, 5.3% had severe pre-injury comorbidities, and 54% wore a helmet at the time of injury. Serious head injury occurred in 30%, 9% underwent a cranial neurosurgical procedure, and 30-day mortality was 2%. Compared to non-helmeted bicyclists, helmeted bicyclists were older (43 years, quartiles 27-54, vs. 38 years, quartiles 23-53, p = 0.05), less often crashed during night-time (21% vs. 38%, p < 0.001), less frequently had serious head injury (22% vs. 38%, OR 0.29, 95% CI 0.22-0.39), and less often underwent cranial neurosurgery (6% vs. 14%, OR 0.36, 95% CI 0.24-0.54). No statistically significant difference in 30-day mortality between the two groups was found (1.5% vs. 2.9%, OR 0.50, 95% CI 0.22-1.11)., Conclusion: Helmet use was associated with fewer and less severe head injuries and fewer neurosurgical procedures. This adds evidence to the protective capabilities of bicycle helmets., (© 2024. The Author(s).)

Objective: This study identifies risk factors for late positional plagiocephaly (PP) diagnosis and impact on helmet therapy., Design: We conducted a retrospective review of all patients diagnosed with PP over 10 years at five Southern California hospitals., Setting: Patients diagnosed with PP at an included hospital., Patients: 25,332 patients were diagnosed with PP over 10 years., Interventions: Patients diagnosed with PP early (< = 6 months) and late (>6 months) were compared., Main Outcome Measures: Cohorts were evaluated for demographics, gestational history, associated conditions, and hospitalizations through direct comparison, logistic regression, and correlation analyses. Rates of referrals and helmet orders were compared., Results: Of patients reviewed, 4.8% (n  =  1216) were diagnosed late. On multivariate analysis, late diagnoses were more likely Hispanic or Black/African-American. Early gestational age, hydrocephalus, and VP shunt were more frequent in late diagnoses. Patients diagnosed late had longer NICU and overall hospital stays. Earlier gestational age, longer NICU or overall hospital stay correlated with later age at PP diagnosis. 8.9% of patients were referred for helmet therapy evaluation. Patients diagnosed late were 2.63 and 1.64 times as likely to be referred and require helmet therapy, respectively., Conclusions: Patients who are Hispanic or Black/African-American, premature, have hydrocephalus, or VP shunt have higher rates of delayed PP diagnosis. Shorter gestational age or longer NICU or hospital stay correlates with later diagnosis, which increases helmet therapy requirements. Additional interventions are needed for at risk patients to routinely evaluate for and minimize the risk of developing PP., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Off-road vehicle (ORV) and motorcycle use is common in Canada; however, risk of serious injury is heightened when these vehicles are operated without helmets and under the influence of alcohol. This study evaluated the impact of alcohol intoxication on helmet non-use and mortality among ORV and motorcycle crashes., Methods: Using data collected from the Nova Scotia Trauma Registry, a retrospective analysis (2002-2017) of ORV and motorcycle crashes resulting in major traumatic brain injury was performed. Patients were grouped by blood alcohol concentration (BAC) as negative (< 2 mmol/L), legally intoxicated (2-17.3 mmol/L) or criminally intoxicated (> 17.3 mmol/L). Logistic regression models were constructed to test for helmet non-use and mortality., Results: A total of 424 trauma patients were included in the analysis (220 ORV, 204 motorcycle). Less than half (45%) of patients involved in ORV crashes were wearing helmets and 65% were criminally intoxicated. Most patients involved in motorcycle crashes were helmeted at time of injury (88.7%) and 18% were criminally intoxicated. Those with criminal levels of intoxication had 3.7 times the odds of being unhelmeted and were 3 times more likely to die prehospital compared to BAC negative patients. There were significantly increased odds of in-hospital mortality among those with both legal (OR = 5.63), and criminal intoxication levels (OR = 4.97) compared to patients who were BAC negative., Conclusion: Alcohol intoxication is more frequently observed in ORV versus motorcycle crashes. Criminal intoxication is associated with helmet non-use. Any level of intoxication is a predictor of increased in-hospital mortality., Competing Interests: Declarations. Competing interests: The authors have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Motorcycle crashes are a major source of road traffic deaths in northern Ghana. Helmet use has been low. The last time it was formally assessed (2010), helmet use was 30.0% (34.2% for riders and 1.9% for pillion riders). We sought to determine the current prevalence of helmet use and its associated factors among motorcyclists in northern Ghana., Methods: Cross-sectional observations of motorcycle helmet use were conducted among 3853 motorcycle riders and 1097 pillion riders in the Northern Region at 12 different locations near intersections, roundabouts and motorcycle bays. Modified Poisson regression was used to assess the factors associated with helmet use., Results: The prevalence of helmet use was 22.1% overall: 26.7% among motorcycle riders and 5.7% among pillion riders. On the multivariable regression analysis, the prevalence of helmet use among motorcycle riders was 69% higher during the day compared with the night, 58% higher at weekend compared with weekday, 46% higher among males compared with females, but it was 18% lower on local roads compared with highways, 67% lower among young riders compared with the elderly and 29% lower when riding with pillion rider(s)., Conclusion: Despite small increases in motorcycle helmet use among pillion riders, helmet use has declined overall over the past decade. Immediate actions are needed to promote helmet use among motorcyclists in northern Ghana. This calls for a multisectoral approach to address the current low helmet use, targeting young riders, female riders, pillion riders, evening riding and riding on local roads., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although motorcycle helmets can save lives in case of a crash, no helmet use data are available for many countries. When data is available, it is often only analysed as a global average, preventing targeted road safety education and legislative action. In this study, we conducted a detailed analysis of motorcycle helmet use in the capital of Madagascar., Methods: Using a cross-sectional observational field survey framework, we observed 17 230 individual motorcycles. We systematically recorded motorcycle riders' helmet use, position on the motorcycle, rider numbers and gender., Results: We found a general helmet use of 76.1%. Observed drivers had a significantly higher helmet use (84.6%) than passengers (47.7%), and subsequently helmet use per motorcycle decreased significantly when the number of riders per motorcycle increased. Female drivers had significantly higher helmet use than male drivers, and female passengers had significantly higher helmet use than male passengers. That is, on the same position of the motorcycle, female riders behaved safer than male riders. However, since female riders were more often passengers than drivers, their average helmet use was lower than that of male riders overall. Contrary to findings from other countries, motorcycle helmet use did not differ significantly throughout the day but was relatively constant., Conclusion: Our results show the potential for injury and fatality prevention in Madagascar through increased passenger helmet use. This increase would also proportionally benefit female riders more than male riders. Findings regarding road safety legislation's applied impact, education, enforcement and future research needs are discussed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Analysis of data from bicycle accidents reveals that handlebar impacts are a significant cause of injury, particularly among children. Despite existing safety regulations, such as helmet requirements, little attention is given to abdominal injuries. The aim of this study is to investigate the influence of handlebar ends on abdominal loading during bicycle crashes., Methods: This study delves into the impact of five different handlebar designs on abdominal injuries during bicycle crashes, using finite element simulations with detailed Human Body Models (HBMs) of a six-year-old child (PIPER child model, Version 0.99.0). Four impact locations were identified in the injury scenario, selected according to the anatomical location of the most commonly injured organs, liver, pancreas, spleen and abdomen., Results: Grip design features, such as shape and rigidity, significantly influence injury outcomes. Grips designed specifically for children demonstrate superior performance in reducing abdominal loading and injury metrics compared to standard grips. The highest injury potential was seen in a damaged handlebar end., Conclusion: These findings underscore the importance of improved handlebar designs and standardized safety measures, especially for children. Implementation of such measures could mitigate the significant health and economic burden associated with handlebar-related injuries and enhance overall bicycle safety for children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Arneitz, Erlinger, Klug, Senica, Kuenzer, Spitzer, Schalamon and Schalamon.)

As the popularity of electric bicycles (e-bikes) continues to surge, the number of accidents involving them has commensurately increased. A significant factor contributing to the high fatality rate in these accidents is the low usage of helmets among e-bike riders. Helmets have been proven to reduce the severity of injuries, yet their usage remains unexpectedly low. This issue is particularly pronounced among college students, the primary buyer group for e-bikes. Regrettably, there is a lack of research exploring their intentions to wear helmets. Understanding determinants of their intentions to wear helmets is crucial in promoting safe e-bike travel. Therefore, the present study aims to develop an integrated theoretical model that combines the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM) to examine the factors influencing e-bike riders' helmet-wearing intentions among college students. Additionally, two variables-descriptive norms and law enforcement-are incorporated. The results indicate that the integrated model accounts for 76% of the variance in helmet-wearing intention, surpassing single-theory models. Specifically, the TPB accounts for 65%, while the HBM explains 53%. Notably, law enforcement emerges as the most influential factor, highlighting the crucial role of enforcing regulations and promoting awareness. Other significant factors include subjective and descriptive norms, attitudes, perceived benefits, perceived susceptibility, perceived barriers, and perceived severity. These findings provide valuable insights for policy development and targeted interventions aimed at improving helmet wear rates among e-bike riders, especially among the college student population.

Introduction: Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma., Methods: Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses., Results: Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5)., Conclusions: Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala., (Published by Elsevier Inc.)

Road traffic injuries present a significant public health burden, especially in developing countries. This systematic review and meta-analysis synthesized global evidence on motorcycle helmet use prevalence by including 299 records across 249 articles involving 5,006,476 participants from 1982 to 2022. The findings revealed a declining trend in helmet use prevalence over the past four decades, with an overall prevalence of 48.71%. The meta-regression analysis did not find any statistically significant change in the overall prevalence. Subgroup analysis showed higher helmet use prevalence in observation/survey records (54.29%) compared to crashed patient records (44.84%). Riders/Motorcyclists demonstrated a higher likelihood of wearing helmets than passengers in both observation/survey records (62.61 vs. 28.23%) and crashed patient records (47.76 vs. 26.61%). Countries with mandatory helmet use laws had higher helmet usage prevalence compared to those without (52.26 vs. 37.21%). The African continent had the lowest helmet use rates, while Latin America and the Caribbean regions had higher rates. This study provides a comprehensive overview of global helmet use prevalence, emphasizing disparities between high and low-income countries, variations in law enforcement, and trends over four decades. Targeted interventions are necessary to improve helmet-wearing habits, especially among passengers and regions with low usage rates. Effective legislation and awareness campaigns are crucial for promoting helmet use and reducing road traffic injuries burden.

Background:  Between 3 and 15% of winter sports-related injuries are related to head injuries, which are the primary cause of mortality and disability among skiers. Despite the widespread adoption of helmets in winter sports, which has reduced the incidence of direct head injury, there is a paradoxical trend of an increasing number of individuals wearing helmets sustaining diffuse axonal injuries (DAI), which can result in severe neurologic sequelae., Methods:  We retrospectively reviewed 100 cases collected by the senior author of this work from 13 full winter seasons during the period from 1981 to 1993 and compared them with 17 patients admitted during the more shortened 2019 to 2020 ski season due to COVID-19. All data analyzed come from a single institution. Population characteristics, mechanism of injury, helmet use, need for surgical treatment, diagnosis, and outcome were collected. Descriptive statistics were used to compare the two databases., Results:  From February 1981 to January 2020, most skiers with head injuries were men (76% for the 1981-1993 and 85% for 2020). The proportion of patients aged over 50 increased from <20% in 1981 to 65% in 2020 ( p  < 0.01), with a median age of 60 years (range: 22-83 years). Low- to medium-velocity injuries were identified in 76% (13) of cases during the 2019 to 2020 season against 38% (28/74) during the 1981 to 1993 seasons ( p  < 0.01). All injured patients during the 2020 season wore a helmet, whereas none of the patients between 1981 and 1993 wore one ( p  < 0.01). DAI was observed in six cases (35%) for the 2019 to 2020 season against nine cases (9%) for the 1981 to 1993 season ( p  < 0.01). Thirty-four percent (34) of patients during the 1981 to 1993 seasons and 18% (3) of patients during the 2019 to 2020 season suffered skeletal fractures ( p  = 0.02). Among the 100 patients of the 1981 to 1993 seasons, 13 (13%) died against 1 (6%) from the recent season during care at the hospital ( p  = 0.15). Neurosurgical intervention was performed in 30 (30%) and 2 (12%) patients for the 1981 to 1993 and 2019 to 2020 seasons, respectively ( p  = 0.003). Neuropsychological sequelae were reported in 17% (7/42) of patients from the 1981 to 1993 seasons and cognitive evaluation before discharge detected significant impairments in 24% (4/17) of the patients from the 2019 to 2020 season ( p  = 0.29)., Conclusion:  Helmet use among skiers sustaining head trauma has increased from none in the period from 1981 to 1993 to 100% during the 2019 to 2020 season, resulting in a reduction in the number of skull fractures and deaths. However, our observations suggest a marked shift in the type of intracranial injuries sustained, including a rise in the number of skiers experiencing DAI, sometimes with severe neurologic outcomes. The reasons for this paradoxical trend can only be speculated upon, leading to the question of whether the perceived benefits of helmet use in winter sports are actually misinterpreted., Competing Interests: None declared., (Thieme. All rights reserved.)

From a global perspective, low helmet-wearing rates in children are an ongoing concern. International studies show adult helmet-wearing rates are consistently higher than those of children. Research also shows parents are highly influential in promoting healthy behavior in their children. Parent-focused helmet-wearing campaigns are a practical way to actively feature parents influencing helmet-wearing in children. The current study obtained anonymous parent-focused survey data on parent and child helmet-wearing practices, perceived affects of helmet use on children's health, and beliefs about brain injury prevention from a sample of Vietnams parents. Findings from this study are consistent with previous international research that shows adults wear helmets at higher rates than children. Data from this study may help those responsible for child helmet safety campaigns develop more effective child helmet-wearing campaigns, particularly in Southeast Asian countries., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article

Objective: To compare traumatic spinal injury patterns between motorcyclists and occupants of other nonheavy motor vehicles using data from the National Spinal Cord and Column Injury Registry of Iran., Methods: All drivers/riders and passengers of motorcycles, cars, pick-up trucks, and vans registered between January 2017 to July 2023, met the inclusion criteria for the present study. The logistic regression models were used to compare the patterns of vertebral fracture between the 2 groups., Results: One thousand seven hundred twenty-six spinal fracture patients were identified, 385 (22.3%) motorcyclists and 1341 (77.7%) car occupants with mean ages 33.2 ± 14.3 and 36.1 ± 13.6 years, respectively (P < 0.001). Only 45 (11.7%) motorcyclists used helmets, whereas 856 (63.8%) car occupants used seat belts (P < 0.001). The average numbers of fractured vertebrae were 3.9 ± 1.4 and 3.7 ± 1.1 among car occupants and motorcyclists, respectively (P = 0.004). The proportions of motorcyclists and car occupants with injuries in each spinal region are as follows: lumbar (50.5% of motorcyclists vs. 40.4% of car occupants; P = 0.003), thoracic (39.2% vs. 30.9%; P = 0.01), cervical (24.3% vs. 37.0%; P < 0.001), and sacral (1.3% vs. 7.5%; P < 0.001). The AO Spine type C injuries were present in 6.1% of motorcyclists and 10.1% of car occupants (P = 0.03)., Conclusions: Motorcyclists were younger, less educated, had a higher proportion of males, and less commonly used safety devices than car occupants. The most commonly fractured spine region among both groups was the lumbar region. The cervical and sacral vertebrae fractures were significantly more common in car occupants, whereas the thoracic and lumbar vertebrae fractures were significantly more common in motorcyclists., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: to describe traffic accidents involving motorcyclists and analyze the association between possession of a motorcycle driver's license and use of helmets according to the severity of injuries., Methods: a cross-sectional study was conducted among all patients hospitalized in the traumatology and orthopedics sector of a public reference hospital in northeastern Brazil., Results: 170 patients were surveyed, the majority were male (95.9%). Their ages ranged from 18 to 67 years. Most were black or brown (52.3%), had completed elementary school (58.9%) and had monthly income smaller than two minimum wages (56.5%). An association was found between being licensed to drive a motorcycle and wearing a helmet. Among those who suffered moderate injuries, this association was OR=5.66(1.85-17.23) and among those who suffered severe injuries it was OR=13.57(2.82-65.14)., Conclusions: people who were licensed to drive motorcycles used a helmet as protective equipment more often and, in accidents, suffered fewer injuries.

Road traffic accident is a leading cause of death and various life deformities worldwide. This burden is even higher among motorcycle riders in lower-to-middle-income countries. Despite the various interventions made to address the menace, the fatalities continue to be on the ascendency. One major area that has received little attention is the attitude and behaviour of motorcycle riders. The present study aimed to examine the contribution of traffic Locus of Control (LoC) and health belief on road safety attitude and behaviour. 317 motorcycle riders participated in the study. The participants completed a questionnaire comprising various sections such as motorcycle riding behaviour, road safety attitude, risk perception, the intention to use helmets, and traffic LoC. The results showed a significant positive correlation between road safety attitude and behaviour (r (295) = .33, p < .001). Drifting towards internal LoC was associated with more positive behaviour on the roads (r (295) = -.23, p < .001). Intention to use helmet, health motivation, perceived susceptibility, perceived benefits, and perceived barriers were the factors in the health belief model that were associated with road safety attitude (r (295) = .404, p < .001). Finally, the multiple linear regression model showed that road safety attitude and traffic LoC made significant contributions to road user behaviour [F(3, 293) = 13.73, p < .001]. These findings have important implications towards shaping responsible behaviour among motorcycle riders., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mohammed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Large language models (LLMs) have potential to increase the efficiency of information extraction from unstructured clinical notes in electronic medical records., Objective: To assess the utility and reliability of an LLM, ChatGPT-4 (OpenAI), to analyze clinical narratives and identify helmet use status of patients injured in micromobility-related accidents., Design, Setting, and Participants: This cross-sectional study used publicly available, deidentified 2019 to 2022 data from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System, a nationally representative stratified probability sample of 96 hospitals in the US. Unweighted estimates of e-bike, bicycle, hoverboard, and powered scooter-related injuries that resulted in an emergency department visit were used. Statistical analysis was performed from November 2023 to April 2024., Main Outcomes and Measures: Patient helmet status (wearing vs not wearing vs unknown) was extracted from clinical narratives using (1) a text string search using researcher-generated text strings and (2) the LLM by prompting the system with low-, intermediate-, and high-detail prompts. The level of agreement between the 2 approaches across all 3 prompts was analyzed using Cohen κ test statistics. Fleiss κ was calculated to measure the test-retest reliability of the high-detail prompt across 5 new chat sessions and days. Performance statistics were calculated by comparing results from the high-detail prompt to classifications of helmet status generated by researchers reading the clinical notes (ie, a criterion standard review)., Results: Among 54 569 clinical notes, moderate (Cohen κ = 0.74 [95% CI, 0.73-0.75) and weak (Cohen κ = 0.53 [95% CI, 0.52-0.54]) agreement were found between the text string-search approach and the LLM for the low- and intermediate-detail prompts, respectively. The high-detail prompt had almost perfect agreement (κ = 1.00 [95% CI, 1.00-1.00]) but required the greatest amount of time to complete. The LLM did not perfectly replicate its analyses across new sessions and days (Fleiss κ = 0.91 across 5 trials; P < .001). The LLM often hallucinated and was consistent in replicating its hallucinations. It also showed high validity compared with the criterion standard (n = 400; κ = 0.98 [95% CI, 0.96-1.00])., Conclusions and Relevance: This study's findings suggest that although there are efficiency gains for using the LLM to extract information from clinical notes, the inadequate reliability compared with a text string-search approach, hallucinations, and inconsistent performance significantly hinder the potential of the currently available LLM.

Using data from the 2022 Korea Community Health Survey (n = 13 320), this study investigated helmet use and related factors among Korean adults using personal mobility devices, without distinguishing between private and hired users. Among mobility device users, 32.1% responded that they always wore a helmet. The proportion of helmet use was 35.2% among men, 25.8% among women, 29.2% among those aged 19-44 years, 42.3% among those aged 45-64 years and 26.6% among those aged 65 years or older. Furthermore, those who drank less frequently and were physically active were more likely to wear helmets. Moreover, people who always wore a seat belt when driving a car or sitting in the rear seat and people who always wore a helmet when riding a motorcycle were more likely to wear a helmet while using electric personal mobility devices. Approximately one-third of users always wore a helmet. The helmet-wearing rate was related to general characteristics such as gender and education level, and to safety behaviors such as wearing a seat belt when driving a car, sitting in the rear seat of a car, or when riding a motorcycle. In addition to considering personal characteristics investigated in this study, the helmet-wearing rate should be improved through policies or systems at the national or regional levels., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

This study investigates the impact of helmet use on the incidence of facial fractures in bicycle accidents. Analyzing data from hospitalized bicyclists between 2005 and 2016, the research focused on the correlation between helmet usage and various facial fractures. The study included 1256 bicyclists with known helmet use, among whom 277 individuals (22%) were identified with a total of 521 facial fractures. The findings revealed a significant reduction in the likelihood of facial fractures among helmeted cyclists compared with those without helmets (odds ratio, 0.65; confidence interval, 0.50-0.85; P=0.002). Specifically, the odds of sustaining fractures in the zygoma, orbit, nose, and maxilla were decreased by 47%, 46%, 43%, and 33%, respectively, among helmeted cyclists. However, helmet use did not significantly alter the odds of mandible fractures. Overall, the use of helmets in bicycling significantly lowered the risk of midface fractures but showed no notable effect on mandible fractures in severe cycling incidents., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: To outline the profile of patients with facial trauma, victims of motorcycle accidents, treated at the Hospital da Restauração, Recife/PE, Brazil, from December 2020 to July 2021., Methods: The collection was carried out through questionnaire and analysis of medical records. Data were analyzed descriptively, as well as Pearson's chi-square test or Fisher's exact test., Results: Among the patients, 88.6% were male, 47.5% were between 18 and 29 years old, and 59.6% lived in rural areas; 72.15% of the victims used the motorcycle for work and 43.52% were working at the time of the accident. Most victims did not have a national motorcycle license (62%) and were not wearing a helmet at the time of the accident (60%), with 37.6% wearing a full-face helmet, 16.5% an open helmet, and 5.9% an articulated full-face helmet. Soft tissue injuries were the most prevalent. Zygomatic complex fractures were the most common facial fractures and were significantly associated with helmet use and type., Conclusions: Most victims of motorcycle accidents are young adult men, without a regular driver's license and residing in rural areas. Preventive and educational actions and continuous traffic inspections are necessary to minimize these accidents., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Background & objectives To assess the pattern of non-compliance to childhood safety practices among parents of children between one and five yr of age and to determine the reasons behind the same. Methods A descriptive, cross-sectional study was conducted on 120 children between one and five yr of age through a questionnaire-based interview of the primary carer. Poor compliance was defined as compliance to <85 per cent of the recommended practices. Results Of the total 48 injuries, 32 were serious (66.6%). Falls and burns/scalds were the two common types of injuries. Nearly three-fourths (72.5%) of families showed overall poor compliance. Poorest compliance was observed towards four safety practices namely, helmet wearing, restricting number of pillion riders to two on a two-wheeler, seatbelt wearing in a car and avoiding food items with a high risk of choking in children <3 yr. Parental perception of 'unnecessary' and 'lack of knowledge' were the main reasons behind non-compliance. Interpretation & conclusions Low compliance among families occurred with respect to safety on motor vehicles and avoidance of choking hazards. Change of parental perception and improved awareness is necessary for the prevention of unintentional childhood injuries.

Introduction: Wearing a helmet reduces the risk of head injuries substantially in the event of a motorcycle crash. Countries around the world are committed to promoting helmet use, but the progress has been slow and uneven. There is an urgent need for large-scale data collection for situation assessment and intervention evaluation., Methods: This study proposes a scalable, low-cost algorithm to estimate helmet-wearing rates. Applying the state-of-the-art deep learning technique for object detection to images acquired from Google Street View, the algorithm has the potential to provide accurate estimates at the global level., Results: Trained on a sample of 3995 images, the algorithm achieved high accuracy. The out-of-sample prediction results for all three object classes (helmets, drivers, and passengers) reveal a precision of 0.927, a recall value of 0.922, and a mean average precision at 50 (mAP50) of 0.956., Discussion: The remarkable model performance suggests the algorithm's capacity to generate accurate estimates of helmet-wearing rates from an image source with global coverage. The significant enhancement in the availability of helmet usage data resulting from this approach could bolster progress tracking and facilitate evidence-based policymaking for helmet wearing globally., (© 2024. The Author(s).)

Electric scooter (ES)-related injuries are increasing but poorly described. Clinicians need more information to be prepared for these patients. We supposed two prevalent patterns of patients: mildly injured (predominant upper-limb injuries) and severely injured (predominant head trauma). This study aims to understand the frequency of ES-related injuries and patients' characteristics despite the heterogeneity of data currently available. A systematic review with a proportion meta-analysis was conducted on studies with a multidisciplinary description of ES-related injuries in adult patients (PROSPERO-ID: CRD42022341241). Articles from inception to April 2023 were identified in MEDLINE, Embase, and Cochrane's databases. The risk of bias was evaluated using ROBINS-I. Twenty-five observational studies with 5387 patients were included in the meta-analysis, depending on reported data. Upper-limb (31.8%) and head (19.5%) injuries are the most frequent (25/25 studies included). When injured while riding, 19.5% of patients are intoxicated with drugs/alcohol, and only 3.9% use a helmet, increasing the possibility of severe injuries. About 80% of patients are victims of spontaneous falls. Half of the patients self-present to the ED, and 69.4% of cases are discharged directly from the ED. Studies' limitations include an overall moderate risk of bias and high heterogeneity. Electric scooter-related accidents are commonly associated with upper-limb injuries but often involve the head. Spontaneous falls are the most common mechanism of injury, probably related to frequent substance abuse and helmet misuse. This hot topic is not adequately investigated due to a lack of data. A prospective registry could fill this gap., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To describe the incidence of head and neck trauma related to electric bicycles and to characterize head and neck injury patterns seen in electric bicycle (eBike) users versus pedal bicyclists in the United States., Methods: The National Electronic Injury Surveillance System (NEISS) was queried from 2009 to 2020 for patients with head and neck injuries related to electric and pedal bicycles. Extracted data included patient demographics, injury patterns, hospital admission, and helmet use. Univariate chi-squared analyses were performed to compare demographics and injury patterns between bicycle groups. Effect sizes were reported with Cramer V values (V)., Results: The incidence of eBike-related head and neck injuries increased from 2993 in 2009 to 9916 in 2020. Compared to pedal bicycle users, eBike users were more likely to have head injuries (60.4% vs. 52.0%) and fractures (10.9% vs. 6.0%), and were more likely to require hospitalization (20.6% vs. 10.4%). The effect size of helmet use was significantly greater in eBike users compared to pedal bicyclists when examining distributions of age group (V = 0.203 vs. V = 0.079), injury location (V = 0.220 vs. V = 0.082), and injury type (V = 0.162 vs. V = 0.059). Helmeted injuries in eBike users more commonly involved neck injuries and sprains, rather than head injuries and fractures., Conclusion: Head and neck trauma related to eBike use is increasing in the United States. Injury patterns and admission rates reflect greater injury severity in eBike users compared to pedal bicyclists. Helmet use may be particularly beneficial in mitigating head and neck injury in eBike users., Level of Evidence: 3 Laryngoscope, 134:2734-2740, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Methods: A cross-sectional survey was conducted using a structured questionnaire involving 402 motorcyclists from four major southeastern towns, comprising 350 (86.07%) males and 52 (12.93%) females. The chi-square test was applied in bivariate analysis, and binary multivariable logistic regression was performed to determine the risk factors of road traffic crashes., Results: This study's findings revealed that the overall reported prevalence of road traffic crashes involving motorcycle drivers over one year was 68.66%. Multivariable logistic regression analysis revealed several factors that significantly impacted road traffic crashes. These factors included driving without a valid driving license, the young age (<20) of motorcyclists, driving in rainy weather, exceeding the speed limit, per-week working hours, smoking status, motorcycle ownership, the brand of motorcycle, and not wearing a helmet while driving., Conclusion: The study findings highlight the need for improving motorcycle safety by implementing measures such as imposing per-week work hour limits for riders, enforcing traffic regulations, and promoting helmet use among motorcycle drivers. The results of this study draw attention to the Bangladesh Road Transport Authority (BRTA) and motorcycle drivers in the country to decrease motorcycle crashes and the severity of injuries by implementing efficient guidelines and strategies for driving motorcycles. The findings of this study can assist policymakers and concerned authorities in taking the essential steps to lessen road traffic crashes among motorcyclists in Bangladesh., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Md. Mamun Miah et al.)

Purpose: In modern societies, motorcycle accidents have become a great problem for health systems worldwide. In Spain, the size and the power of the engine of 2-wheel vehicles determine the type of driving license and the age at which these vehicles can be used (mopeds and motorcycles, which at the same time can have a small or large engine capacity). The objective of the present study was to analyze and characterize low- and high-power motorcycle accidents in Spain, between 2014 and 2020, both included and compared these categories with each other., Methods: Retrospective, descriptive, and observational study of motorcycle and moped accidents in Spain between 2014 and 2020, both included., Results: The mortality of motorcycle accident riders in Spain is associated with males aged between 30 and 40 years old, with a high-power motorcycle, and an A or A1 driver's license, who is 6.7 times more likely to die in crossings and highways than a moped, while wearing a helmet, and if not, this increases to 4.89 times. During the COVID-19 pandemic, an increase in death at 24 h after a high-power motorcycle accident was observed, as compared with a large reduction in the total medical assistance provided in 2019-2020., Conclusions: High-power motorcycles had higher scores in mortality and morbity rates than low-power ones, with a significant increase in mortality during the pandemic, even though number of accidents and medical assistance provided were drastically reduced., (© 2023. The Author(s).)

Background and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years-2022 and 2023-after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1-Q3, 20.25-37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted.

Objectives: In Denmark, the use of bicycles is widespread, and head injuries are often seen in cyclists involved in collisions. Despite the well-known effects of using a helmet to reduce head injuries, using helmets is not mandatory in Denmark. The primary objective of this study was to provide data regarding injury outcomes and helmet usage., Methods: Participants were bicyclists who sustained head injuries in bicycle collisions and were assessed by the Copenhagen Emergency Medical Services between 1 January 2016; and 15 June 2019. Patients with suspected head injury were identified in an electronic prehospital patient record. Data were linked to the Danish National Patient Registry to retrieve the diagnosis and were categorized into head injury or no head injury based on the diagnosis. Adjusted logistic regression analyses were reported with odds ratios and corresponding confidence intervals to assess the risk of head injury while adjusting for risk factors like age, sex, alcohol consumption, occurrence during weekends and traumatic brain injury., Results: A total of 407 patients were included in this study. Within this entity, 247 (61%) had sustained a head injury. The use of a helmet was reported in one-third of the included patients. Among the head-injured patients, 13% sustained moderate to severe head injuries. Patients with suspected alcohol involvement were significantly less likely to report the use of a helmet. Helmet use reduced the risk of head injury with an odds ratio of 0.52, (95% CI 0.31 - 0.86). In high-energy trauma, the use of a helmet showed a significant reduction in the risk of sustaining a head injury with an odds ratio of 0.28, (95% CI 0.12 - 0.80)., Conclusions: In this study, using a helmet was associated with a significantly decreased risk of head injury; this association was even more significant in high-energy trauma.

Introduction: In 2022; South Korea had 3.3 million daily bicycle users and around 13,000 crashes with 190 fatalities annually. While helmets are known to prevent head injuries, research on their effectiveness in preventing fatalities is lacking. This study explores factors influencing bicycle-related fatalities and examines if helmets reduce the risk of death in road traffic incidents., Methods: This case-control study used data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) from 2011 to 2021; analyzing 76,983 bicycle injury cases. Of these, 282 fatalities were identified as the case group, and 1,112 controls were randomly selected based on gender, age, and year of visit. The study examined risk factors for bicycle fatalities and used conditional logistic regression to assess the impact of helmet use on traumatic brain injury and in-hospital mortality., Results: In this study of 1,394 patients (282 cases and 1,112 controls), 11.1% were wearing helmets at the time of the crash. The majority of cases involved males (88%) and individuals aged 60-79 years (58.6%). Cases were more likely to occur between 00:00-06:00 and 18:00-00:00 and involved a higher proportion of non-helmeted riders (96.1% vs. 87.1%). Bicycle fatalities were more often due to collisions with automobiles (67.7%), while non-fatal injuries were mainly from crashes without a collision (45.8%). Head injuries were common in both groups, but traumatic brain injury (TBI) was significantly higher among cases (41.5% vs. 11.9%). Key factors associated with ED mortality included the time of injury, alcohol use, crashes on national highways, no helmet use, and collisions with automobiles. Helmet use was associated with a non-significant 35% lower risk of TBI and a significant 63% lower risk of ED mortality., Conclusions: Key risk factors for fatal bicycle injuries included being aged 60-79, male, involved in nighttime crashes, collisions with automobiles, not wearing a helmet, and sustaining a traumatic brain injury (TBI). Helmet use was linked to lower rates of TBIs and reduced mortality. To decrease bicycle-related deaths, stronger legal regulations, educational efforts, and improved infrastructure are essential, along with further interventions and research to effectively tackle these issues.