Bicycle-associated head injuries and deaths in the United States from 1984 through 1988: how many are preventable?

Bicycle safety helmets may prevent a large number of head injuries and deaths caused by bicycle accidents. A survey of death certificates and emergency room reports from 1984 to 1988 found that 2,985 or 62% of all bicycle-associated deaths were caused by head injuries. Collisions with automobiles caused 87.3% of these deaths. Emergency room reports listed 902,752 head injuries caused by bicycle accidents, accounting for 32% of all bicycle accident injuries. Children under 15 years of age accounted for 41% of the head-injury deaths and 76% of the non-fatal head injuries. One death per day and one head injury every four minutes may be prevented if cyclists wear safety helmets.
Objective.-To estimate the potential benefits from more widespread bicycle safety helmet use. Design. - Review of death certificates and emergency department injury data for 1984 through 1988. Categorization of deaths and injuries as related to bicycling and head injury Using relative risks of 3.85 and 6.67 derived from a case-control study and varying helmet usage from 10% to 100%, population attributable risk was calculated to estimate preventable deaths and injuries. Setting. - Entire United States. Main Outcome Measures.-Numbers of US residents coded as dying from bicycle-related head injuries, numbers of persons presenting to emergency departments for bicycle-related head injuries, and numbers of attributable bicycle-related deaths and head injuries. Main Results.From 1984 through 1988, bicycling accounted for 2985 head injury deaths (62% of all bicycling deaths) and 905 752 head injuries (32% of persons with bicycling injuries treated at an emergency department). Forty-one percent of head injury deaths and 76% of head injuries occurred among children less than 15 years of age. Universal use of helmets by all bicyclists could have prevented as many as 2500 deaths and 757 000 head injuries, ie, one death every day and one head injury every 4 minutes. Conclusions. - Effective community-based education programs and legislated approaches for increasing bicycle safety helmet usage have been developed and await only the resources and commitment to reduce these unnecessary deaths and injuries. (JAMA. 1991;266:3016-3018)