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The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact ( p  < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) ( p  < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.

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).)

Helmets and shoulder pads are required equipment intended to protect American football athletes by attenuating collision forces during participation. Surprisingly, research differentiating kinematics from head impacts initiated by helmets from those initiated by shoulder pads among adolescent athletes has not been completed. The current study's purpose was to determine the effects of equipment on head impact kinematics. Sixty-nine male American football athletes from three high schools wore helmets equipped with Head Impact Telemetry (HIT) System instrumentation to quantify peak linear (g) and rotational (rad/s 2 ) accelerations. Data were extracted for video-confirmed impacts during two competitions. Separate multivariable linear regressions using ordinary least squares were conducted to determine if equipment type (helmet vs. shoulder pad) was associated with log-transformed linear and rotational accelerations. In total, 1150 video-confirmed impacts involved helmet (N = 960) or shoulder pad (N = 190) initiated contact. Linear (p = 0.809) and rotational (p = 0.351) acceleration were not associated with equipment type. Head impact kinematics were similar between impacts initiated by either helmets or shoulder pads and suggests an opponent's shoulder pads and helmet can deliver comparable forces to the struck player. Equipment manufacturers may need to consider the unintended role shoulder pads may contribute to head injury risk., (© 2024. The Author(s) under exclusive licence to Biomedical Engineering Society.)

Protective headgear effects measured in the laboratory may not always translate to the field. In this study, we evaluated the impact attenuation capabilities of a commercially available padded helmet shell cover in the laboratory and on the field. In the laboratory, we evaluated the padded helmet shell cover's efficacy in attenuating impact magnitude across six impact locations and three impact velocities when equipped to three different helmet models. In a preliminary on-field investigation, we used instrumented mouthguards to monitor head impact magnitude in collegiate linebackers during practice sessions while not wearing the padded helmet shell covers (i.e., bare helmets) for one season and whilst wearing the padded helmet shell covers for another season. The addition of the padded helmet shell cover was effective in attenuating the magnitude of angular head accelerations and two brain injury risk metrics (DAMAGE, HARM) across most laboratory impact conditions, but did not significantly attenuate linear head accelerations for all helmets. Overall, HARM values were reduced in laboratory impact tests by an average of 25% at 3.5 m/s (range: 9.7 to 39.6%), 18% at 5.5 m/s (range: - 5.5 to 40.5%), and 10% at 7.4 m/s (range: - 6.0 to 31.0%). However, on the field, no significant differences in any measure of head impact magnitude were observed between the bare helmet impacts and padded helmet impacts. Further laboratory tests were conducted to evaluate the ability of the padded helmet shell cover to maintain its performance after exposure to repeated, successive impacts and across a range of temperatures. This research provides a detailed assessment of padded helmet shell covers and supports the continuation of in vivo helmet research to validate laboratory testing results., (© 2023. The Author(s) under exclusive licence to Biomedical Engineering Society.)

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.)

Objectives: Report two-years of training injury data in senior and academy professional rugby league., Design: Prospective cohort study., Methods: Match and training time-loss injuries and exposure data were recorded from two-seasons of the European Super League competition. Eleven/12 (2021) and 12/12 (2022) senior and 8/12 (2021) and 12/12 (2022) academy teams participated. Training injuries are described in detail and overall match injuries referred to for comparison only., Results: 224,000 training exposure hours were recorded with 293 injuries at the senior (mean [95 % confidence interval]; 3 [2-3] per 1000 h) and 268 academy level (2 [2-3] per 1000 h), accounting for 31 % and 40 % of all injuries (i.e., matches and training). The severity of training injuries (senior: 35 [30-39], academy: 36 [30-42] days-lost) was similar to match injuries. Lower-limb injuries had the greatest injury incidence at both levels (senior: 1.85 [1.61-2.12], academy: 1.28 [1.08-1.51] per 1000 h). Head injuries at the academy level had greater severity (35 [25-45] vs. 18 [12-14] days-lost; p < 0.01) and burden (17 [16-18] vs. 4 [4-5] days-lost per 1000 h; p = 0.02) than senior level. At the senior level, the incidence of contact injuries was lower than non-contact injuries (risk ratio: 0.29 [0.09-0.88], p = 0.02)., Conclusions: Training injuries accounted for about a third of injuries, with similar injury severity to match-play. Within training there is a higher rate of non-contact vs. contact injuries. Whilst current injury prevention interventions target matches, these data highlight the importance of collecting high quality training injury data to develop and evaluate injury prevention strategies in training., Competing Interests: Declaration of interest statement Sarah Whitehead receives funding from the Rugby Football League to undertake Injury Surveillance in Super League. Cameron Owen, Sean Scantlebury and Neil Collin's academic roles are part-funded by the Rugby Football League. James Brown has received salary contributions, travel expenses and research funding from World Rugby. Kevin Till is employed in a consultancy capacity by Leeds Rhinos. Gemma Phillips is employed in a consultancy capacity by the Rugby Football League and Hull Kingston Rovers. Laura Fairbank is employed by the Rugby Football League. Keith Stokes is employed by the Rugby Football Union. Ben Jones is employed in a consultancy capacity by Premiership Rugby, and the Rugby Football League., (Copyright © 2024 The Authors. 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.

Introduction: Brain health has been a growing concern across a wide range of contact sports in the last three decades. While most of the early brain health research was focused on identifying and preventing concussions, newer research has found that an accumulation of repetitive head impacts (RHI) are more predictive of long-term brain health than the number of concussions sustained. Consequently, being able to assess RHI in sports despite the lack of outward symptoms has become paramount in promoting the long-term health of athletes. The sport of rodeo has long been regarded as one of the most dangerous contact sports. While some epidemiological research has been done on injury rates in rodeo that has largely backed up its dangerous reputation, no research has been done into RHI in rodeo athletes., Methods: Head acceleration events (HAE) were measured in collegiate athletes competing in the "Roughstock" events of Bareback Riding, Saddle Bronc Riding and Bull Riding. HAE were recorded using impact monitoring mouthgaurds (iMG) and subsequently confirmed using video verification and submitted to statistical analysis., Results: Rodeo has a high rate of HAE across all the Roughstock events. The Bull Riding experiences the highest magnitude HAE based on both linear and rotational acceleration. These events are primarily the result of the head impacting either the ground or the animal during the dismount phase of the ride. Bareback riding experiences the highest quantity of lower magnitude HAE which mainly result from whiplash-like movement of the head during the ride., Conclusions: Rodeo athletes experience a high volume of HAE that often reach concerning magnitude. A surprising amount of the HAE are the result not of impacts, but of the whiplash-like movement that is experienced during the rides., (Copyright© South Dakota State Medical Association.)

Due to the escalating occurrence and high casualty rates of accidents involving Electric Two-Wheelers (E2Ws), it has become a major safety concern on the roads. Additionally, with the widespread adoption of current autonomous driving technology, a greater challenge has arisen for the safety of vulnerable road participants. Most existing trajectory planning methods primarily focus on the safety, comfort, and dynamics of autonomous vehicles themselves, often overlooking the protection of vulnerable road users (VRUs), typically E2W riders. This paper aims to investigate the kinematic response of E2Ws in vehicle collisions, including the 15 ms Head Injury Criterion (HIC 15 ). It analyzes the impact of key collision parameters on head injuries, establishes injury prediction models for anticipated scenarios, and proposes a trajectory planning framework for autonomous vehicles based on predicting head injuries of VRUs. Firstly, a multi-rigid-body model of two-wheeler-vehicle collision was established based on a real accident database, incorporating four critical collision parameters (initial collision velocity, initial collision position, and collision angle). The accuracy of the multi-rigid-body model was validated through verifications with real fatal accidents to parameterize the collision scenario. Secondly, a large-scale effective crash dataset has been established by the multi-parameterized crash simulation automation framework combined with Monte Carlo sampling algorithm. The training and testing of the injury prediction model were implemented based on the MLP + XGBoost regression algorithm on this dataset to explore the potential relationship between the head injuries of the E2W riders and the crash variables. Finally, based on the proposed injury prediction model, this paper generated a trajectory planning framework for autonomous vehicles based on head collision injury prediction for VRUs, aiming to achieve a fair distribution of collision risks among road users. The accident reconstruction results show that the maximum error in the final relative positions of the E2W, the car, and the E2W rider compared to the real accident scene is 11 %, demonstrating the reliability of the reconstructed model. The injury prediction results indicate that the MLP + XGBoost regression prediction model used in this article achieved an R 2 of 0.92 on the test set. Additionally, the effectiveness and feasibility of the proposed trajectory planning algorithm were validated in a manually designed autonomous driving traffic flow scenario., 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. Published by Elsevier Ltd.)

Aim: Crying seems to be a common trigger for abusive head trauma (AHT), which is the leading cause of fatalities from physical abuse in infants. Our objective was to evaluate knowledge of AHT, crying infants and correct behavioural measures in a general population., Methods: An online questionnaire (LimeSurvey) was created to assess the risk of shaking. The online survey contained a total of 41 questions, including a demonstration of a previously recorded video in which an infant doll is shaken., Results: A total of 319 people, 245 of them (76.8%) with own children, participated in the study. Almost all respondents (98.4%) were aware of serious injuries due to shaking, even to the point of death (98.1%). Most participants (97.5%) had heard the term 'shaking trauma' prior but did not receive any professional information, neither before nor after birth (85.2% or 86%), or during follow-up examinations (88.5%). The majority of the participants (95%) considered that useful coping strategies in infant crying were inappropriate., Conclusion: The consequences of shaking an infant were common knowledge in a normal population, whereas there was a knowledge gap regarding the management of excessive crying infants. Prevention programmes should mainly focus on male caregivers during postnatal care., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Objectives: To describe the frequency, type, and severity of health problems in long-track speed skating to inform injury prevention strategies., Methods: We prospectively collected weekly health and sport exposure data on 84 highly trained Dutch athletes aged 15-21 years during the 2019/2020 season using the Oslo Sports Trauma Research Centre questionnaire on Health Problems and the trainers' documentation. We categorised health problems into acute or repetitive mechanisms of injury or illness and calculated incidences (per 1000 sports exposure hours), weekly prevalence and burden (days of time loss per 1000 sports exposure hours) related to the affected body region., Results: We registered 283 health problems (187 injuries, 96 illnesses), yielding an average weekly prevalence of health problems of 30.5% (95% CI 28.7% to 32.2%). Incidence rates were 2.0/1000 hours for acute mechanism injuries (95% CI 1.5 to 2.5) and 3.2/1000 hours for illnesses (95% CI 2.6 to 3.9). For acute mechanism injuries the head, shoulder and lumbosacral region had the highest injury burden of 5.6 (95% CI 4.8 to 6.5), 2.9 (95% CI 2.3 to 3.5) and 2.2 (95% CI 1.7 to 2.8) days of time loss/1000 hours, respectively. For repetitive mechanism injuries, the knee, thoracic spine, lower leg and lumbosacral region had the highest injury burden, with 11.0 (95% CI 9.8 to 12.2), 6.8 (95% CI 5.9 to 7.7), 3.9 (95% CI 3.2 to 4.6) and 2.5 (95% CI 1.9 to 3.1) days of time loss/1000 hours, respectively., Conclusion: Our study demonstrated a high prevalence of acute and repetitive mechanism injuries in speed skating. These results can guide future research and priorities for injury prevention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The current study aimed to assess the protective performance of helmets equipped with multi-directional impact protection system (MIPS) under various oblique impact loads., Methods: Initially, a finite element model of a bicycle helmet with MIPS was developed based on the scanned geometric parameters of an actual bicycle helmet. Subsequently, the validity of model was confirmed using the KASK WG11 oblique impact test method. Three different impact angles (30°, 45°, and 60°) and 2 varying impact speeds (5 m/s and 8 m/s) were employed in oblique tests to evaluate protective performance of MIPS in helmets, focusing on injury assessment parameters such as peak linear acceleration (PLA) and peak angular acceleration (PAA) of the head., Results: The results demonstrated that in all impact simulations, both assessment parameters were lower during impact for helmets equipped with MIPS compared to those without. The PAA was consistently lower in the MIPS helmet group, whereas the difference in PLA was not significant in the no-MIPS helmet group. For instance, at an impact velocity of 8 m/s and a 30° inclined anvil, the MIPS helmet group exhibited a PAA of 3225 rad/s 2 and a PLA of 281 g. In contrast, the no-MIPS helmet group displayed a PAA of 8243 rad/s 2 and a PLA of 292 g. Generally, both PAA and PLA parameters decreased with the increase of anvil angles. At a 60° anvil angles, PAA and PLA values were 664 rad/s 2 and 20.7 g, respectively, reaching their minimum., Conclusion: The findings indicated that helmets incorporating MIPS offer enhanced protection against various oblique impact loads. When assessing helmets for oblique impacts, the utilization of larger angle anvils and rear impacts might not adequately evaluate protective performance during an impact event. These findings will guide advancements in helmet design and the refinement of oblique impact test protocols., (Copyright © 2024 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

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).)

Head acceleration events (HAEs) are acceleration responses of the head following external short-duration collisions. The potential risk of brain injury from a single high-magnitude HAE or repeated occurrences makes them a significant concern in sport. Instrumented mouthguards (iMGs) can approximate HAEs. The distinction between sensor acceleration events, the iMG datum for approximating HAEs and HAEs themselves, which have been defined as the in vivo event, is made to highlight limitations of approximating HAEs using iMGs. This article explores the technical limitations of iMGs that constrain the approximation of HAEs and discusses important conceptual considerations for stakeholders interpreting iMG data. The approximation of HAEs by sensor acceleration events is constrained by false positives and false negatives. False positives occur when a sensor acceleration event is recorded despite no (in vivo) HAE occurring, while false negatives occur when a sensor acceleration event is not recorded after an (in vivo) HAE has occurred. Various mechanisms contribute to false positives and false negatives. Video verification and post-processing algorithms offer effective means for eradicating most false positives, but mitigation for false negatives is less comprehensive. Consequently, current iMG research is likely to underestimate HAE exposures, especially at lower magnitudes. Future research should aim to mitigate false negatives, while current iMG datasets should be interpreted with consideration for false negatives when inferring athlete HAE exposure., (© 2024. Crown.)

Developing vehicle finite element (FE) models that match real accident-involved vehicles is challenging. This is related to the intricate variety of geometric features and components. The current study proposes a novel method to efficiently and accurately generate case-specific buck models for car-to-pedestrian simulations. To achieve this, we implemented the vehicle side-view images to detect the horizontal position and roundness of two wheels to rectify distortions and deviations and then extracted the mid-section profiles for comparative calculations against baseline vehicle models to obtain the transformation matrices. Based on the generic buck model which consists of six key components and corresponding matrices, the case-specific buck model was generated semi-automatically based on the transformation metrics. Utilizing this image-based method, a total of 12 vehicle models representing four vehicle categories including family car (FCR), Roadster (RDS), small Sport Utility Vehicle (SUV), and large SUV were generated for car-to-pedestrian collision FE simulations in this study. The pedestrian head trajectories, total contact forces, head injury criterion (HIC), and brain injury criterion (BrIC) were analyzed comparatively. We found that, even within the same vehicle category and initial conditions, the variation in wrap around distance (WAD) spans 84-165 mm, in HIC ranges from 98 to 336, and in BrIC fluctuates between 1.25 and 1.46. These findings highlight the significant influence of vehicle frontal shape and underscore the necessity of using case-specific vehicle models in crash simulations. The proposed method provides a new approach for further vehicle structure optimization aiming at reducing pedestrian head injury and increasing traffic safety., 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 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Context: Guardian Caps (GCs) are currently the most popular external helmet add-on designed to reduce the magnitude of head impacts experienced by American football players. Guardian Caps have been endorsed by influential professional organizations; however, few studies evaluating their efficiency are publicly available., Objective: To present preliminary on-field head kinematics data for National Collegiate Athletic Association (NCAA) Division I American football players using instrumented mouthguards through closely matched preseason workouts with and without GCs., Design: Case series., Setting: The 2022 American football preseason., Patients or Other Participants: Twenty-five male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 participants, 7 completed all 6 workouts using their instrumented mouthguards., Main Outcome Measure(s): Peak linear acceleration (PLA), peak angular acceleration (PAA), and total impacts were collected via instrumented mouthguards during 3 preseason workouts using traditional helmets (TRAD condition) and 3 using a TRAD and GCs (GC condition). The TRAD and GC values for PLA, PAA, and total impacts were evaluated using analyses of variance., Results: No difference was present between the collapsed mean values for the entire sample between the TRAD and GC conditions for PLA (TRAD = 16.3g ± 2.0g, GC = 17.2g ± 3.3g, P = .20), PAA (TRAD = 992.1 ± 209.2 rad/s2, GC = 1029.4 ± 261.1 rad/s2, P = .51), or the total number of impacts (TRAD = 9.3 ± 4.7, GC = 9.7 ± 5.7, P = .72). Similarly, no difference was observed between the TRAD and GC conditions for PLA (TRAD = 16.1g ± 1.2g, GC = 17.2g ± 2.79g, P = .32), PAA (TRAD = 951.2 ± 95.4 rad/s2, GC = 1038.0 ± 166.8 rad/s2, P = .29), or total impacts (TRAD = 9.6 ± 4.2, GC = 9.7 ± 5.04, P = .32) between sessions for the 7 players who completed all 6 workouts., Conclusions: These data suggested no difference in head kinematics data (PLA, PAA, and total impacts) when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players., (© by the National Athletic Trainers' Association, Inc.)

Objective: The Finnish national Traffic Safety Strategy 2022-2026 seeks to halve the number of road fatalities and serious injuries from 2020 to 2030. The strategy states that better information on bicycle crashes is needed for safety promotion. The aim of this study was to describe the demographics, injury characteristics, alcohol involvement, and helmet use of severely injured cyclists and to compare single bicycle crashes (falling alone or hitting a fixed object) to collisions., Material and Methods: We identified all bicycle crashes between 2006 and 2021 from the Helsinki Trauma Registry (HTR). Variables analysed were basic patient demographics, Abbreviated Injury Scale (AIS) codes, AIS 3+ injuries, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS), 30-day in-hospital mortality, ICU length of stay, injury mechanism, alcohol use by the injured cyclists, and helmet use., Results: Of the 325 severe (NISS >15) cycling injury patients in the HTR, 53.5 % were injured in single crashes and 46.5 % in collisions with a moving object. Most (71.4 %) patients were men and mean age of all patients was 54.1 years (SD 16.7). Alcohol was detected in 23.1 % of cases and more often in single crashes (32.8 %) than in collisions (11.9 %). Less than a third (29.2 %) of all cyclists wore a helmet; those who wore a helmet had fewer serious (AIS 3+) head injuries than those who did not. Cyclists injured in collisions had higher ISS and NISS scores than those injured in single crashes. Serious (AIS 3+) injuries in extremities or in pelvic girdle were more common in collisions than in single crashes., Conclusions: Among severely injured cyclists, single bicycle crashes were more common; alcohol was more often detected in single bicycle crashes than in collisions. Overall injury severity was higher in collisions than in single crashes. Helmet users had less AIS 3+ head injuries than non-users. Attention should be focused on preventing alcohol-related cycling injuries, promoting use of bicycle helmets, and more precise and comprehensive documentation of bicycle crashes in health care units., Competing Interests: Declaration of Competing Interest The authors declare that there are no financial or personal relationships with other people or organizations that could cause conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Due to religious tenets, Sikh population wear turbans and are exempted from wearing helmets in several countries. However, the extent of protection provided by turbans against head injuries during head impacts remains untested. One aim of this study was to provide the first-series data of turbans' protective performance under impact conditions that are representative of real-world bicycle incidents and compare it with the performance of bicycle helmets. Another aim was to suggest potential ways for improving turban's protective performance. We tested five different turbans, distinguished by two wrapping styles and two fabric materials with a size variation in one of the styles. A Hybrid III headform fitted with the turban was dropped onto a 45 degrees anvil at 6.3 m/s and head accelerations were measured. We found large difference in the performance of different turbans, with up to 59% difference in peak translational acceleration, 85% in peak rotational acceleration, and 45% in peak rotational velocity between the best and worst performing turbans. For the same turban, impact on the left and right sides of the head produced very different head kinematics, showing the effects of turban layering. Compared to unprotected head impacts, turbans considerably reduce head injury metrics. However, turbans produced higher values of peak linear and rotational accelerations in front and left impacts than bicycle helmets, except from one turban which produced lower peak head kinematics values in left impacts. In addition, turbans produced peak rotational velocities comparable with bicycle helmets, except from one turban which produced higher values. The impact locations tested here were covered with thick layers of turbans and they were impacted against flat anvils. Turbans may not provide much protection if impacts occur at regions covered with limited amount of fabric or if the impact is against non-flat anvils, which remain untested. Our analysis shows that turbans can be easily compressed and bottom out creating spikes in the headform's translational acceleration. In addition, the high friction between the turban and anvil surface leads to higher tangential force generating more rotational motion. Hence, in addition to improving the coverage of the head, particularly in the crown and rear locations, we propose two directions for turban improvement: (i) adding deformable materials within the turban layers to increase the impact duration and reduce the risk of bottoming out; (ii) reducing the friction between turban layers to reduce the transmission of rotational motion to the head. Overall, the study assessed Turbans' protection in cyclist head collisions, with a vision that the results of this study can guide further necessary improvements for advanced head protection for the Sikh community., (© 2024. The Author(s).)

Introduction: This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents., Methods: Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated., Results: Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients., Conclusions: Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages., 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 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Head impacts in bicycle accidents are typically oblique to the impact surface and transmit both normal and tangential forces to the head, causing linear and rotational head kinematics, respectively. Traditional expanded polystyrene (EPS) foam bicycle helmets are effective at preventing many head injuries, especially skull fractures and severe traumatic brain injuries (TBIs) (primarily from normal contact forces). However, the incidence of concussion from collisions (primarily from rotational head motion) remains high, indicating need for enhanced protection. An elastomeric honeycomb helmet design is proposed herein as an alternative to EPS foam to improve TBI protection and be potentially reusable for multiple impacts, and tested using a twin-wire drop tower. Small-scale normal and oblique impact tests showed honeycomb had lower oblique strength than EPS foam, beneficial for diffuse TBI protection by permitting greater shear deformation and had the potential to be reusable. Honeycomb helmets were developed based on the geometry of an existing EPS foam helmet, prototypes were three-dimensional-printed with thermoplastic polyurethane and full-scale flat and oblique drop tests were performed. In flat impacts, honeycomb helmets resulted in a 34% higher peak linear acceleration and 7% lower head injury criteria (HIC15) than EPS foam helmets. In oblique tests, honeycomb helmets resulted in a 30% lower HIC15 and 40% lower peak rotational acceleration compared to EPS foam helmets. This new helmet design has the potential to reduce the risk of TBI in a bicycle accident, and as such, reduce its social and economic burden. Also, the honeycomb design showed potential to be effective for repetitive impact events without the need for replacement, offering benefits to consumers., (Copyright © 2024 by ASME.)

Background: Motorcycle crashes pose a persistent public health problem with disproportionate rates of severe injuries and mortality. This study aims to analyze injury patterns and outcomes with regard to helmet use. We hypothesized that helmet use is associated with fewer head injuries and does not increase the risk of cervical spine injuries., Methods: The National Trauma Data Bank was queried for all motorcycle driver crashes between 2007-2017. Univariable analysis was used to compare demographics, clinical data, injury patterns using abbreviated injury scale, and outcomes between helmeted motorcycle drivers and non-helmeted motorcycle drivers who were injured in traffic crashes. Independent factors associated with mortality were determined by regression analysis after adjustment for potential confounders., Results: A total of 315,258 patients were included for analysis, 66 % of these patients were helmeted. The sample was 92.5 % male and the median age was 41 years. Non-helmeted motorcycle drivers were more likely to sustain severe head trauma (head abbreviated injury scale ≥ 3: 28.5 % vs. 13.3 %, p < 0.001), had higher intensive care unit-admission (38 % vs. 30.2 %, p<0.001), mechanical ventilation (20.1 % vs. 13 %, p<0.001) and overall mortality rates (6.2 % vs. 3.9 %, p<0.001). Cervical spine injuries occurred in 10.6 % of non-helmeted motorcycle drivers and in 9.5 % of helmeted motorcycle drivers (p<0.001). Helmet use was identified as an independent factor associated with lower mortality [OR 0.849 (0.809-0.891), p<0.001]., Conclusion: Helmet use is protective for severe head injuries and associated with decreased mortality. Helmet use was not associated with increased rates of cervical spine injuries. On the contrary, fewer injuries were observed in helmeted motorcycle drivers. Public health initiatives should be aimed at enforcement of universal helmet laws within the United States and across the world., Competing Interests: Declaration of Competing Interest The authors listed have no conflicts of interest and these data have not been published elsewhere., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Water-related recreational activities, including swimming and diving, are widespread. However, they carry a significant risk of craniofacial injuries. Despite the popularity of these activities, comprehensive data on injuries beyond drowning remain scant. This study addresses this gap by providing valuable epidemiological insight into the nature, prevalence, and demographic patterns of craniofacial injuries related to water sports activities., Methods: The authors queried the NEISS database for craniofacial injuries related to swimming, diving, and water sports from 2013 to 2022. Data were analyzed for demographics, anatomic locations of injuries, and the activities leading to these injuries., Results: Between 2013 and 2022, a total of 952,111 craniofacial injuries were associated with swimming and water sports. Of these, 510,706 (53.6%) were male patients, and 441,405 (46.4%) were female. This indicates that males were 1.16 times more likely to sustain such injuries. The age groups most affected were 0 to 9 and 10 to 19 years. Anatomic locations impacted were as follows: ears (58.1%), head (16.8%), face (13.9%), neck (4.8%), eyeballs (4.4%), and mouth (2%). Leading causes were identified as swimming and water sports activities (66.5%), swimming pools and equipment (28.2%), diving or diving boards (4.7%), and scuba diving (0.5%). Notably, 89.2% of patients with diving-related injuries and 99.1% with swimming-related injuries were not admitted to the hospital., Conclusions: This study offers critical epidemiological data to supplement targeted prevention strategies and resource allocation in managing craniofacial injuries associated with water activities. The findings highlight the urgent need for specialized care and serve as a foundation for future preventive initiatives., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The anatomy of children's heads is unique and distinct from adults, with smaller and softer skulls and unfused fontanels and sutures. Despite this, most current helmet testing standards for children use the same peak linear acceleration threshold as for adults. It is unclear whether this is reasonable and otherwise what thresholds should be. To answer these questions, helmet-protected head responses for different ages are needed which is however lacking today. In this study, we apply continuously scalable PIPER child head models of 1.5, 3, and 6 years old (YO), and an upgraded 18YO to study child helmet protection under extensive linear and oblique impacts. The results of this study reveal an age-dependence trend in both global kinematics and tissue response, with younger children experiencing higher levels of acceleration and velocity, as well as increased skull stress and brain strain. These findings indicate the need for better protection for younger children, suggesting that youth helmets should have a lower linear kinematic threshold, with a preliminary value of 150g for 1.5-year-old helmets. However, the results also show a different trend in rotational kinematics, indicating that the threshold of rotational velocity for a 1.5YO is similar to that for adults. The results also support the current use of small-sized adult headforms for testing child helmets before new child headforms are available., Competing Interests: The author PH is co-inventor of the helmet technology Mips. The authors AvS, MF and PH are all employees at Mips AB. Author XL received contracted private funds from Mips AB that supported the work This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Li 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.)

Objectives: Head injuries resulting from e-scooter use have led to calls for helmet use to be promoted or mandatory. Helmet use is mandatory for e-scooters in Australia but observational studies have reported significant levels of nonuse, particularly by riders of shared e-scooters. The aim of this study is to understand whether nonuse in the mandatory context is a consistent behavior for an individual or is situationally-influenced, and what are the factors associated with nonuse., Methods: An online survey was completed between 2022 and 2023 by 360 adult e-scooter riders in Canberra, Australia. Riders were asked whether they had worn a helmet on their last ride and how often they had not worn a helmet when riding in the last 30 days. The survey also asked about rider characteristics (demographics, frequency of e-scooter and bicycle use, perceived risk of e-scooter use, e-scooter ownership, and risky behaviors while riding), trip duration and perceptions of the helmet requirement (knowledge of and support for the law)., Results: Respondents were mostly male, young, highly educated, and full-time workers. Of the 29.1% of riders who reported riding without a helmet in the last 30 days, 24.4% had worn a helmet at least once during that period and 4.8% had consistently not worn a helmet. Younger age, shared e-scooter use and more frequent riding frequency (shared e-scooters only) were associated with helmet nonuse in the bivariate analyses but not in the logistic regression. Logistic regression showed that the independent predictors of helmet nonuse were the number of risky riding behaviors, lack of knowledge, and lack of support for the law., Conclusions: Most nonuse of helmets in a mandatory context seems to be situational, rather than consistent. Many of the factors associated with nonuse of helmets for e-scooters are similar to those reported for bicycles. Nonuse of helmets appears to be one of a number of risky behaviors performed by riders, rather than being primarily an outcome that is specific to factors associated with helmets (e.g., concerns about hygiene, discomfort or availability).

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions., 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: Many children with physical disabilities need additional postural support when sitting and supplementary padding is used on standards approved child restraints to achieve this when traveling in a motor vehicle. However, the effect of this padding on crash protection for a child is unknown. This study aimed to investigate the effect of additional padding for postural support on crash protection for child occupants in forward facing child restraints., Methods: Forty frontal sled tests at 49 km/h were conducted to compare Q1 anthropometric test device (ATD) responses in a forward-facing restraint, with and without additional padding in locations to increase recline of the restraint, and/or support the head, trunk and pelvis. Three padding materials were tested: cloth toweling, soft foam, and expanded polystyrene (EPS). The influence of padding on head excursion, peak 3 ms head acceleration, HIC15, peak 3 ms chest acceleration and chest deflection were analyzed., Results: The influence of padding varied depending on the location of use. Padding used under the restraint to increase the recline angle increased head injury metrics. Toweling in multiple locations which included behind the head increased head excursion and chest injury metrics. There was minimal effect on injury risk measures with additional padding to support the sides of the head or the pelvis position. Rigid EPS foam, as recommended in Australian standards and guidelines, had minimal effect on injury metrics when used inside the restraint, as did tightly rolled or folded toweling secured to the restraint at single locations around the body of the child., Conclusions: This study does not support the use of postural support padding to increase recline of a forward-facing restraint or padding behind the head. Recommendations in published standards and guidelines to not use foam that is spongy, soft or easily compressed, with preference for secured firm foam or short-term use of tightly rolled or folded toweling under the child restraint cover is supported. This study also highlights the importance of considering the whole context of child occupant protection when using additional padding, particularly the change in the child's seated position when adding padding in relation to the standard safety features of the restraint.

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation., Competing Interests: Competing interests None., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Problem: E-scooters are a new form of mobility used more frequently in urban environments worldwide. As there is evidence of an increased risk of head injuries, helmets are recommended and (less frequently) legislated. Denmark has enacted mandatory e-scooter helmet use legislation from January 1, 2022. So far, it is unclear how this newly implemented law influenced helmet use of e-scooter riders in Denmark immediately after its implementation., Method: In this observational study, we register and compare e-scooter helmet use before the mandatory helmet use legislation (December 2021) and after (February 2022). As observational survey data collection in the field can be highly time-consuming, we conducted a video-based observation survey. We trained and applied a computer vision algorithm to automatically register e-scooter helmet use in the video data., Results: The trained algorithm produces accurate helmet use data, which does not differ significantly from human-registered helmet use. In applying the algorithm to video data collected in December 2021 and February 2022, we register an overall e-scooter helmet use of 4.4% in n = 1054 riders. Splitting the observation between the time before and after the implementation of the helmet use law reveals a significant increase in helmet use from 1.80% to 5.56%., Discussion: In this study, we successfully train and apply an object detection algorithm to register accurate helmet use data in videos collected in Copenhagen, Denmark. Using this algorithm, we find a significant impact of a new mandatory e-scooter helmet use law on e-scooter riders' helmet use behavior. Limitations of the study as well as future research needs, are discussed., Practical Applications: Computer vision algorithms can be used for accurate e-scooter helmet assessments. Implementing a mandatory helmet use law can increase helmet use of e-scooters at specific observation sites., 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 © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Motorcycle accidents cause millions of deaths and injuries globally. It is estimated that billions of dollars would be saved in the United States alone if safety equipment, such as helmets and eye protection, was ubiquitously worn. Legislation concerning eye protection specifically is understudied and poorly characterized., Method: We reviewed all motorcycle-related safety equipment laws in all 50 states of the United States for information regarding eye protection. We graded the rigor of each statute using our six-category Eye Safety Metric and performed a comparative analysis of statutes across all jurisdictions., Results: Fourteen states did not have any statutes regarding eye protection. Among states that did, 23 states had weak statutes (0-2 points), 20 states had moderately stringent statutes (3-4 points), and 7 states had strong statutes (5-6 points). States in western United States tended to have less strict eye protection laws. Twenty-six states had eye protection exemptions for windshields, which are a poor form of eye protection. Six states that had universal helmet laws had no laws requiring eye protection., Conclusions: We characterized eye protection legislation across the country and found great diversity in the stringency of laws across all jurisdictions. Despite only two states lacking helmet laws, we found that 14 states lacked eye protection laws. These findings from our Eye Safety Metric can be used as a springboard for future research, which can be used to determine the need for and significance of eye safety legislation for motorcyclists and to inform legislative decision-making., Practical Applications: With this research, we hope to further the understanding of legislation regarding eye protection for motorcyclists and help policymakers identify states that need improved eye safety standards., 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 © 2023. Published by Elsevier Ltd.)

Background: Hockey is a high-impact sport that carries a risk of injury. No national-level studies defining the burden of injury in this sport have yet been performed. This study sought to analyze patient demographics, injury types and severity, and outcomes after trauma sustained while playing hockey., Methods: Retrospective analysis of hockey-related injuries was performed using the National Trauma Data Bank (NTDB) (2007-2018). Patients were identified based on ICD-9 and -10 codes without exclusions. Demographics, clinical/injury data, and outcomes were examined using univariate analysis. Subgroup analysis was performed by patient sex., Results: Hockey injuries (n = 306) comprised <1% of the NTDB. Median age was 15 years [IQR 13-25] (range 5-71). Most patients (n = 279, 91%) were male. Lower extremities were the most frequently injured body region (n = 88, 29%). Head injuries occurred in 19% (n = 57). Facial injuries occurred in 6% (n = 17). Tooth loss was infrequent (n = 2, 1%). One (<1%) death occurred after a hockey-related brain injury. Clinical/injury data between male and female hockey players were comparable apart from a significantly higher rate of upper extremity fractures among the female cohort (22% vs 4%, P < .001)., Conclusion: Perceptions that hockey players may frequently sustain head, face, and tooth injuries from collisions, fighting, or stick/puck impacts were not supported by this national-level study, in which lower extremity fractures were the most common injury. While hockey injury prevention equipment has primarily focused on head/face protection (eg, helmets and mouthguards), this analysis suggests increased focus on extremity protective measures is warranted., 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: Using a bicycle helmet reduces the risk of serious head injuries among cyclists substantially. This makes it highly relevant to increase the use of helmets and to measure the prevalence of bicycle helmet use over time and across different groups., Method: Since 2004, the use of bicycle helmets in Denmark has been measured observationally in two nationwide time series: one among cyclists in city traffic across all age groups, and one among cycling school children (aged 6-16) around schools. The observations have been conducted on a regular basis in different parts of the country following the same methodology over the years., Results: Bicycle helmet use among cyclists in city traffic in Denmark has increased from 6% in 2004 to 50% in 2022. Among cycling school children, helmet use has increased from 33% in 2004 to 79% in 2022. Throughout the years, helmet wearing rates have been highest among young children and lowest among young adults. Since 2015, female cyclists in city traffic have had a slightly higher helmet use than male cyclists., Discussion: Several factors might have affected bicycle helmet use in Denmark. One possible factor is a nationwide focus on traffic safety education and behavior change campaigns to encourage helmet wearing. Furthermore, among stakeholders on cycling safety there has been consensus on recommending bicycle helmet use and supporting the promotion of helmets while not recommending or promoting helmet legislation. Finally, more safety-oriented behavior in road traffic in general, and self-reinforcing effects of increased helmet use have plausibly been important factors., Practical Applications: Increasing bicycle helmet use in a country where cycling is popular is possible in the absence of mandatory bicycle helmet legislation. Persistent behavior change campaigning and education, stakeholder consensus, higher levels of road safety-oriented behaviors, and self-reinforcing processes could potentially be important factors., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The author of the study works at the Documentation Office at the Danish Road Safety Council. The data for the study has been gathered and analysed by the author and other employees and former employees at the Documentation Office. The Documentation Office serves as the independent monitoring and evaluation unit at the Danish Road Safety Council., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: All-terrain vehicles (ATVs) pose a significant risk for morbidity and mortality amongst children. We hypothesize that current vague legislation regarding helmet use impacts injury patterns and outcomes in pediatric ATV accidents., Methods: The institutional trauma registry was queried for pediatric patients involved in ATV accidents from 2006 to 2019. Patient demographics and helmet wearing status were identified in addition to patient outcomes, such as injury pattern, injury severity score, mortality, length of stay, and discharge disposition. These elements were analyzed for statistical significance., Results: 720 patients presented during the study period, which were predominantly male (71%, n = 511) and less than 16 years old (76%, n = 543). Most patients were not wearing a helmet (82%, n = 589) at time of injury. Notably, there were 7 fatalities. A lack of helmet use is positively associated with head injury (42% vs 23%, P < .01), intracranial hemorrhage (15% vs 7%, P = .03), and associated with lower Glasgow Coma Scale (13.9 vs 14.4, P < .01). Children 16 years and older were least likely to wear a helmet and most likely to incur injuries. Patients over 16 years had longer lengths of stay, higher mortality, and higher need for rehabilitation., Conclusion: Not wearing a helmet is directly correlated with injury severity and concerning rates of head injury. Children 16 years and older are at greatest risk for injury, but younger children are still at risk. Stricter state laws regarding helmet use are necessary to reduce pediatric ATV-related injury burden., Level of Evidence: level III retrospective comparative study., 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: In aircraft crashes, injuries to the head and upper torso are frequently reported, with head injury reported most frequently of all body regions. Because preventing flail of the head and body is of utmost importance for occupant survival, the Aircraft Crash Survival Design Guide (ACSDG), the guide to crashworthy aircraft design, published flail envelopes. However, the ACSDG flail envelopes are based on a single test with an anthropomorphic test device subjected to a frontal acceleration. In this article, human research volunteer (HRV) response data are used to calculate head flail corridors and evaluate the ACSDG flail envelopes., Materials and Methods: Data from HRV sled tests were obtained from the historical Naval Biodynamics Laboratory collection of the Biodynamics Data Resource. Digitized high-speed film for each test was tracked and processed to represent the head flail response in a format amenable to corridor development. Time-based and position-based head flail corridors were developed for groups of exposure-matched tests and then compared to the ACSDG flail envelopes., Results: A collection of 714 HRV sled tests conducted in six different impact directions ranging from 3 to 15 g was used to develop time-based and position-based head flail corridors for 39 match groups. The ACSDG vertical limit and anteroposterior limit and curve were not exceeded by the flail corridors, but the lateral limit and curve were exceeded by 4.6 cm to 15.8 cm., Conclusions: The flail corridors provide a useful baseline for representing the well-restrained occupant response at lower, non-injurious exposure levels and across multiple impact directions. Under these conditions, the ACSDG lateral limit and curve are not adequate. At higher exposure levels or with modified restraints, seating, or equipment, the ACSDG vertical limit and anteroposterior limit and curves may also be inadequate., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Motorcycle road traffic collisions are a major cause of mortality in the United States. We aimed to analyze the temporal and statewide trends in motorcycle collision fatalities (MCFs) nationwide and their association with state laws regarding motorcycle helmet requirements, lane splitting, speeding, intoxicating driving, and red light cameras., Methods: A retrospective review of United States MCF/capita from 2015 to 2019 was performed using the Fatality Analysis Reporting System database. MCF/capita was defined as a motorcyclist death per 100 000 motorcyclist registrations. Independent-samples t-test and ANOVA were used to determine differences, with significance defined as P < .05. Linear regression analysis and Pearson's correlation were used to further determine associations between variables., Results: The majority of fatalities occurred in males (n = 21 354, 91.0%), ages 25-54 (n = 13 728, 58.5%), and Caucasians (n = 19 195, 81.8%). A total of 24 states and DC exhibited positive trends in MCF/capita from 2015 to 2019. There was no significant difference in MCF/capita between states who had mandatory helmet laws for all, partial requirements, and states with no law (63.4 vs 54.3 vs 33.6, P = .360). Among fatalities involving alcohol, a significantly greater number of MCF/capita were found above the legal limit of .08 compared to the group with a blood alcohol concentration of .01-.07 (17.8 vs 4.5, P < .001)., Conclusion: Motorcyclist fatalities continue to pose a public health risk, with 24 states showing an upward trend. Additional interventions and laws are needed to decrease the number of motorcyclist deaths. Further strategy on implementation and enforcement of helmet laws and alcohol consumption may be an essential component., 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: Two-wheeler riders frequently sustain injuries to the head and face in real-world crashes, including traumatic brain injury, basilar skull fracture, and facial fracture. Different types of helmets exist today, which are recognized as preventing head injuries in general; however, their efficacy and limitations in facial impact protection are underexplored. Biofidelic surrogate test devices and assessment criteria are lacking in current helmet standards. This study addresses these gaps by applying a new, more biofidelic test method to evaluate conventional full-face helmets and a novel airbag-equipped helmet design. Ultimately, this study aims to contribute to better helmet design and testing standards., Methods: Facial impact tests at two locations, mid-face and lower face, were conducted with a complete THOR dummy. Forces applied to the face and at the junction of the head and neck were measured. Brain strain was predicted by a finite element head model taking both linear and rotational head kinematics as input. Four helmet types were evaluated: full-face motorcycle and bike helmets, a novel design called a face airbag (an inflatable structure integrated into an open-face motorcycle helmet), and an open-face motorcycle helmet. The unpaired, two-sided student's t-test was performed between the open-face helmet and the others, which featured face-protective designs., Results: A substantial reduction in brain strain and facial forces was found with the full-face motorcycle helmet and face airbag. Upper neck tensile forces increased slightly with both full-face motorcycle (14.4%, p >.05) and bike helmets (21.7%, p =.039). The full-face bike helmet reduced the brain strain and facial forces for lower-face impacts, but not for mid-face impacts. The motorcycle helmet reduced mid-face impact forces while slightly increasing forces in the lower face., Significance of Results: The chin guards of full-face helmets and the face airbag protect by reducing facial load and brain strain for lower face impact; however, the full-face helmets' influence on neck tension and increased risk for basilar skull fracture need further investigation. The motorcycle helmet's visor re-directed mid-face impact forces to the forehead and lower face via the helmet's upper rim and chin guard: a thus-far undescribed protective mechanism. Given the significance of the visor for facial protection, an impact test procedure should be included in helmet standards, and the use of helmet visors promoted. A simplified, yet biofidelic, facial impact test method should be included in future helmet standards to ensure a minimum level of protection performance., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors work at Autoliv, located in Vårgårda, Sweden. Autoliv (www.autoliv.com) develops, manufactures, and sells protective safety systems to car manufacturers. Results from this study may impact how Autoliv chooses to develop its products., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study used finite element models to investigate the efficacy of seated pedestrian protection equipment in vehicle impacts. The selected safety equipment, a lap belt, an airbag vest, and a bicycle helmet, were chosen to mitigate the underlying biomechanical causes of seated pedestrian injuries reported in the literature. The impact conditions were based on the three most dangerous impact scenarios from a previous seated pedestrian impact study. Serious injury (AIS 3+) risks were compared with and without protective equipment. A 50th percentile male occupant model and two generic vehicle models, the family car (FCR) and sports utility vehicle (SUV), were used to simulate vehicle collisions. Three impact conditions were run with every combination of protective equipment (n = 24). The helmet reduced head and brain injury risks from the vehicle-head and ground-head contacts. The airbag reduced the head injury risk in the FCR vehicle-head contact but increased the brain injury risks in the SUV impacts from increased whiplash. The lap belt increased head injury risks for both the FCR and the SUV impacts because it created a stronger FCR vehicle-head contact and SUV ground-head contact. When the belt and airbag were used together the head injury risks dramatically decreased because the pedestrian body impacted the ground arm or leg first and slowly rolled onto the ground which resulted in softer ground-head contacts and in two instances, no ground-head contact. Only the helmet proved effective in all impact conditions. Future testing must be completed before recommending the belt or airbag for seated pedestrians., (© 2023. The Author(s) under exclusive licence to Biomedical Engineering Society.)

We analyzed and compared the effectiveness of the rotating seat of autonomous vehicles and that of an airbag in traditional vehicles as head protection measures in a frontal crash. Driver frontal crash models of traditional and autonomous vehicles and a head finite element model were established. Four evaluation indexes were used for comparison. The airbag proved more effective than seat rotation in terms of injury criteria and brain tissue injury risk under frontal crash conditions with and without brake involvement. A segmented protection measure based on crash acceleration values is proposed to improve crash safety in future autonomous vehicles.

Despite electric scooter use has proliferated in Italy since 2019, actionable data regarding injury incidence and patterns associated with electric scooter accidents are limited. This study aims at analyzing the rate, clinical, and demographic features of electric scooter accidents accessed to the Emergency Department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). This retrospective study included all patients older than 18 years riding an electric scooter in the ED from June 2019 to April 2022. Personal data, injury circumstances, helmet use, and health data were collected. Abbreviated Injury Scale (AIS) codes of all diagnoses were recorded, and the Injury Severity Score (ISS) was calculated for each patient. The analysis includes 92 patients admitted to the ED due to an e-scooter accident during the study period, with an increase in years. Thirty-two patients presented bone fractures especially concerning the extremities and the face districts. The median Injury Severity Score in the study cohort was 3, with the highest AIS represented by AIS Pelvic-Extremity and AIS External. Moreover, statistical significance was found between AIS Head-Neck and severity of trauma. E-scooters have become a familiar sight in cities worldwide recently, with many new companies renting them for use. But their arrival has also brought new safety concerns. Although most injuries reported are minor, the meager rate of helmet use is critical. Implementing compulsory helmet use for electric scooters for all ages could be a protective factor for being patient with head trauma on urban streets., (© 2022. The Author(s).)

Abstract: Head impacts during blind football are common and have high injury rates; however, their characteristics and impact are still underreported. We compared head impact characteristics in blind football players with and without falls on all 18 official blind football match videos from the Tokyo 2020 Paralympic games. The rate of head impacts with falls was significantly higher in the preliminary phase, offense phase, and during dribbling. Significant differences in the region of the head impacted were also observed among the impact subjects/objects. The findings in this study would contribute to the development of injury prevention measures to minimize head injuries from head impact in blind football., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background/aim: During sports activities, teeth-related contact can cause injury to both ally and opponent players, which can lead to potential infections and aesthetic problems. However, the extent of such injuries remains unclear. This study aimed to clarify the frequency and situation of head injuries caused by teeth (HICBT) occurring under the supervision of schools in Japan., Material and Methods: HICBT records were extracted from the Japan Sport Council data on head injuries occurring reported during the 7-year period from 2012 to 2018 under the supervision of schools in Japan., Results: Of the total 463,527 head injury cases during the study period, 4495 cases (approximately 1%) were HICBT. Of the HICBT cases, 3650 (81.20%) were related to sports and athletic activity. Such injuries were reported to occur most often during basketball with a rate of 57.07% and 50.43%; soccer/futsal was the next most common sport with a rate of 13.38% and 24.01% in junior high school and high school students. Tag games were responsible for a similar number of HICBT cases at 22.73% and 39.03% in kindergartens and elementary school students., Conclusions: A total of 4495 cases of HICBT were identified, accounting for about 1% of all head injuries under the supervision of schools in Japan during the study period. This result reminds us that our teeth could be the weapon against the players during sports events. HICBTs occurring during basketball and soccer/futsal, in which mouthguards are not mandatory, were conspicuous among junior and senior high school students. Active use of mouthguards in various sports will protect players as well as their teammates and opponents. Sports dentists should encourage the revision of rules, such as mandating the use of mouthguards, in popular sports with a high incidence of HICBT, such as basketball and soccer/futsal., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: The paper addresses an important accident type that involves children in bicycle seats - the bicycle fall over. It is a significant and common accident type and many parents have been reported to experience this type of "close call." The fall over occurs at low velocities and even while a bicycle is standing still, and may result from a split-second lack of attention on behalf of the accompanying adult (e.g. while loading groceries, i.e. while not being exposed to traffic per se). Moreover, irrespective of the low velocities involved, the trauma that may result to the head of the child is considerable and may be life-threatening, as shown in the study., Method: The paper presents two methods to address this accident scenario in a quantitative way: in-situ accelerometer-based measurement and numerical modeling approaches. It is shown that the methods produce consistent results under the prerequisites of the study. They are therefore promising methods to be used in the study of this type of accident., Results: The importanance of the protective role of a child helmet is without discussion in everyday traffic.However, this study draws attention to one particular effect observed in this accident type: that the geometry of the helmet may at times expose the child's head to considerably larger forces, by having contact with the ground. The study also highlights the importance of neck bending injuries during bicycle fall over, which are often neglected in the safety assessment - not only for children in bicycle seats. The study concludes that considering only head acceleration may lead to biased conclusions about using helmets as protective devices., (Copyright © 2023 National Safety Council and Elsevier Ltd. All rights reserved.)

To mitigate the risk of injuries, many countries recommend bicycle helmets. The current paper seeks to examine the effectiveness of bicycle helmets by performing a systematic review focusing on meta-analyses. First, the current paper explores the findings of studies that employ meta-analyses using bicycle crash data. Second, the results are discussed considering the findings from research analyzing bicycle helmet effectiveness in a laboratory using simulation, and then are complemented with key methodological papers that address cycling and the overall factors contributing to the injury severity. The examined literature confirms that wearing a helmet while cycling is beneficial, regardless of age, crash severity, or crash type. The relative benefit is found to be higher in high-risk situations and when cycling on shared roads and particularly preventing severe head injuries. The results from the studies performed in laboratories also suggest that the shape and size of the head itself play a role in the protective effects of helmets. However, concerns regarding the equitability of the test conditions were found as all reviewed studies used a fifty-percentile male head and body forms. Lastly, the paper discusses the literature findings in a broader societal context., (© 2023. The Author(s).)

Head injuries are common for cyclists involved in collisions. Such collision scenarios result in a range of injuries, with different head impact speeds, angles, locations, or surfaces. A clear understanding of these collision characteristics is vital to design high fidelity test methods for evaluating the performance of helmets. We review literature detailing real-world cyclist collision scenarios and report on these key characteristics. Our review shows that helmeted cyclists have a considerable reduction in skull fracture and focal brain pathologies compared to non-helmeted cyclists, as well as a reduction in all brain pathologies. The considerable reduction in focal head pathologies is likely to be due to helmet standards mandating thresholds of linear acceleration. The less considerable reduction in diffuse brain injuries is likely to be due to the lack of monitoring head rotation in test methods. We performed a novel meta-analysis of the location of 1809 head impacts from ten studies. Most studies showed that the side and front regions are frequently impacted, with one large, contemporary study highlighting a high proportion of occipital impacts. Helmets frequently had impact locations low down near the rim line. The face is not well protected by most conventional bicycle helmets. Several papers determine head impact speed and angle from in-depth reconstructions and computer simulations. They report head impact speeds from 5 to 16 m/s, with a concentration around 5 to 8 m/s and higher speeds when there was another vehicle involved in the collision. Reported angles range from 10° to 80° to the normal, and are concentrated around 30°-50°. Our review also shows that in nearly 80% of the cases, the head impact is reported to be against a flat surface. This review highlights current gaps in data, and calls for more research and data to better inform improvements in testing methods of standards and rating schemes and raise helmet safety., (© 2023. The Author(s).)

Context: Toppling televisions (TVs) are a source of childhood injury but meta-analysis has not assessed the likelihood of TV injuries in children., Objective: To present pooled results for injuries, following a systematic review., Data Sources: MEDLINE, Scopus, Google Scholar and EMBASE databases were searched to 5 December 2022., Study Selection: Included studies met the following criteria: (1) assessed toppling TV injuries in paediatric populations; (2) reported point estimates as an OR or enabled its calculation and (3) used a comparison group., Data Extraction: A standardised form was used to include information on publication year, study design, population type, country, sample size, mean age, risk factors, point estimates or data used to calculate ORs., Results: A total of 12 803 TV injuries were identified (five studies). Head and neck injuries (OR: 2.13, 95% CI: 1.21 to 3.75) and hospital admission (OR: 2.28, 95% CI: 1.80 to 2.90) were more likely in children aged under 6 years than over 6 years. Conversely, torso injuries were less likely in younger children (OR: 0.60, 95% CI: 0.51 to 0.70). Children under 6 were two and a half times more likely to die or be admitted to an intensive care unit (ICU) as a result of toppling TVs, although this was not statistically significant. Males did not sustain more TV injuries than females., Conclusions: Children aged under 6 years are more likely to die, sustain head injuries and require hospital treatment from toppling TVs. Strategies for injury prevention must go beyond warning labels to include community education, promotion and use of tip restraint devices, mandatory safety standards and a commitment from manufacturers to improve TV sets stability., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Kickboxing is a combat sport that encompasses various forms of competition. K1 kickboxing is conducted without any restrictions on the force of strikes, and the bout can end prematurely through a knockout. Headgear has been introduced in amateur kickboxing to safeguard the head. However, scientific studies have shown that despite their use, serious head injuries can still occur. The aim of this study was to evaluate the temporal structure of the bout by calculating the number of head strikes in K1 kickboxing bouts with and without headgear., Methods: Thirty K1 kickboxing bouts were analyzed, with 30 participants included in the study. The fights were conducted according to the World Association Kickboxing Organization (WAKO) rules. The bouts consisted of three rounds of 2 min each, with a 1 min break between rounds. Sparring pairs were arranged according to weight categories. The first bouts were conducted without headgear, and two weeks later, the fights were repeated with WAKO-approved headgear. The number of head strikes was assessed retrospectively by analyzing video recordings of the bouts, categorizing strikes as hand or foot strikes, and differentiating between strikes that hit the head directly or indirectly., Results: The results showed statistically significant differences between bouts with and without headgear in terms of the number of strikes to the head ( p = 0.002), strikes directly to the head ( p < 0.001), all hand strikes to the head ( p = 0.001), hand strikes directly to the head ( p = 0.003), and foot strikes directly to the head ( p = 0.03). Higher values were observed in bouts with headgear., Conclusions: Headgear increases the probability of direct strikes to the head. Therefore, it is important to familiarize kickboxers with the use of headgear in their sport to minimize head injuries.

Skull fracture and brain injury are frequent head injuries in electric two-wheeler (ETW) accidents, and the type of helmet and impact conditions affect the effectiveness of the helmet in protecting the rider's head. The purpose of this study was to conduct in-depth reconstructions of rider's head-to-ground impacts in ten ETW accidents by using a multi-body system combined with a finite element approach and to evaluate the effect of two typical full-face helmets (FFH) and one half-coverage helmet (HCH) through head accelerations and intracranial biomechanics injury metrics in ground impacts. The results showed that all three helmets reduced the risk of skull fracture in most cases, however, FFH performed better due to its wider protection area. In addition, three helmets showed varying degrees of overall reduction in measuring all indicators of brain injury. Although the effectiveness of the helmets on angular acceleration was largely influenced by the angle and location of impact, it was certain that wearing an FFH was more likely to reduce rotational head movements than an HCH, and that the FFH also offered the better advantage in reducing diffuse axonal injury (DAI) risk due to its better resistance to ejection in a crash.

Objective: Head injuries are common injuries in E-scooter accidents which have dramatically increased in recent years. The head impact conditions and helmet performance during E-scooter accidents are barely investigated. This study aims to characterize the head-ground impact biomechanics and evaluate bicycle helmet protection in typical E-scooter falls., Method: The finite element (FE) model of a hybrid III dummy riding an E-scooter was developed and validated. The FE model with and without a bicycle helmet was used to reproduce twenty-seven E-scooter falls caused by the collision with a curb, in which different riding speeds (10, 20, and 30 km/h), curb orientations (30, 60, and 90°), and E-scooter orientations (-15, 0, and 15°) were simulated. Head-ground impact velocities and locations were evaluated for the unhelmeted configurations while the helmet performance was evaluated with the reduction of head injury metrics., Results: E-scooter falls always resulted in an oblique head-ground impact, with 78 % on the forehead. The mean vertical and tangential head-ground impact velocities were respectively 5.7 ± 1.5 m/s and 3.7 ± 2.0 m/s. The helmet significantly (p < 0.1) reduced the head linear acceleration, angular velocity, HIC&#95;36, and BrIC, but not the angular acceleration. However, even with the helmet, the head injury metrics were mostly above the thresholds of severe head injuries., Conclusion: Typical E-scooter falls might cause severe head injuries. The bicycle helmet was efficient to reduce head injury metrics but not to prevent severe head injuries. Future helmet standard evaluations should involve higher impact energy and the angular acceleration assessment in oblique impacts., 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 © 2022 Elsevier Ltd. All rights reserved.)

Background: Motorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana., Methods: A prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury., Results: After adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35)., Conclusion: Even in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)