Abstract：
BACKGROUND: New York City (NYC) has made significant roadway infrastructure improvements, initiated a bicycle share program, and enacted Vision Zero, an action plan to reduce traffic deaths and serious injuries. The objective of this study was to examine whether bicycle helmets offer a protective advantage against traumatic brain injury (TBI) within a contemporary dense urban setting with a commitment to road safety.
METHODS: A prospective observational study of injured bicyclists presenting to a Level I trauma centre was performed. All bicyclists arriving within 24 h of injury were included. Data were collected between February, 2012 and August, 2014 and included demographics, imaging studies (e.g. computed tomography (CT)), injury patterns, and outcomes including Glasgow Coma Scale (GCS) and Injury Severity Score.
RESULTS: Of 699 patients, 273 (39.1%) were wearing helmets at the time of injury. Helmeted bicyclists were more likely to have a GCS of 15 (96.3% [95% Confidence Interval (CI), 93.3-98.2] vs. 87.6 [95% CI, 84.1-90.6]) at presentation. Helmeted bicyclists underwent fewer head CTs (40.3% [95% CI, 34.4-46.4] vs. 52.8% [95% CI, 48.0-57.6]) and were less likely to sustain intracranial injury (6.3% [95% CI, 2.6-12.5] vs. 19.7% [14.7-25.6]), including skull fracture (0.9% [95% CI, 0.0-4.9] vs. 15.3% [95% CI, 10.8-20.7]) and subdural hematoma (0.0% [95% CI, 0.0-3.2] vs. 8.1% [95% CI, 4.9-12.5]). Helmeted bicyclists were significantly less likely to sustain significant TBI, i.e. Head AIS ≥3 (2.6% [95% CI: 0.7-4.5] vs.10.6% [7.6-12.5]). Four patients underwent craniotomy while three died; all were un-helmeted. A multivariable logistic regression model showed that helmeted bicyclists were 72% less likely to sustain TBI compared with un-helmeted bicyclists (Adjusted Odds Ratio 0.28, 95% CI 0.12-0.61).
CONCLUSIONS: Despite substantial road safety measures in NYC, the protective impact of simple bicycle helmets in the event of a crash remains significant. A re-assessment of helmet laws for urban bicyclists is advisable to most effectively translate Vision Zero from a political action plan to public safety reality.
METHODS: A prospective observational study of injured bicyclists presenting to a Level I trauma centre was performed. All bicyclists arriving within 24 h of injury were included. Data were collected between February, 2012 and August, 2014 and included demographics, imaging studies (e.g. computed tomography (CT)), injury patterns, and outcomes including Glasgow Coma Scale (GCS) and Injury Severity Score.
RESULTS: Of 699 patients, 273 (39.1%) were wearing helmets at the time of injury. Helmeted bicyclists were more likely to have a GCS of 15 (96.3% [95% Confidence Interval (CI), 93.3-98.2] vs. 87.6 [95% CI, 84.1-90.6]) at presentation. Helmeted bicyclists underwent fewer head CTs (40.3% [95% CI, 34.4-46.4] vs. 52.8% [95% CI, 48.0-57.6]) and were less likely to sustain intracranial injury (6.3% [95% CI, 2.6-12.5] vs. 19.7% [14.7-25.6]), including skull fracture (0.9% [95% CI, 0.0-4.9] vs. 15.3% [95% CI, 10.8-20.7]) and subdural hematoma (0.0% [95% CI, 0.0-3.2] vs. 8.1% [95% CI, 4.9-12.5]). Helmeted bicyclists were significantly less likely to sustain significant TBI, i.e. Head AIS ≥3 (2.6% [95% CI: 0.7-4.5] vs.10.6% [7.6-12.5]). Four patients underwent craniotomy while three died; all were un-helmeted. A multivariable logistic regression model showed that helmeted bicyclists were 72% less likely to sustain TBI compared with un-helmeted bicyclists (Adjusted Odds Ratio 0.28, 95% CI 0.12-0.61).
CONCLUSIONS: Despite substantial road safety measures in NYC, the protective impact of simple bicycle helmets in the event of a crash remains significant. A re-assessment of helmet laws for urban bicyclists is advisable to most effectively translate Vision Zero from a political action plan to public safety reality.
摘要：
背景：纽约市（NYC）对道路基础设施进行了重大改进，发起了自行车共享计划，并颁布了零愿景，减少交通事故死亡和重伤的行动计划。这项研究的目的是研究自行车头盔是否在当代密集的城市环境中对创伤性脑损伤（TBI）具有保护优势，并致力于道路安全。
方法：对前往I级创伤中心的受伤骑自行车者进行了前瞻性观察研究。包括受伤后24小时内到达的所有骑自行车的人。数据是在2月之间收集的，2012年8月,2014年，包括人口统计，成像研究（例如计算机断层扫描（CT）），损伤模式,结果包括格拉斯哥昏迷量表（GCS）和损伤严重程度评分。
结果：在699名患者中，273人（39.1%）在受伤时戴着头盔。头盔骑自行车的人更有可能GCS为15（96.3％[95％置信区间（CI），93.3-98.2]vs.87.6[95%CI，84.1-90.6])。头盔骑自行车的人头部CT较少（40.3%[95%CI，34.4-46.4]与52.8%[95%CI，48.0-57.6]），并且不太可能遭受颅内损伤（6.3%[95%CI，2.6-12.5]vs.19.7%[14.7-25.6])，包括颅骨骨折（0.9%[95%CI，0.0-4.9]vs.15.3%[95%CI，10.8-20.7]）和硬膜下血肿（0.0%[95%CI，0.0-3.2]vs.8.1%[95%CI，4.9-12.5]）。头盔骑自行车的人明显不太可能维持显著的TBI，即头部AIS≥3（2.6%[95%CI：0.7-4.5]vs.10.6%[7.6-12.5]）。四名患者接受了开颅手术，三名死亡；所有人都没有头盔。多变量逻辑回归模型显示，与未戴头盔的骑自行车者相比，戴头盔的骑自行车者维持TBI的可能性降低了72％（调整后的赔率比0.28，95％CI0.12-0.61）。
结论：尽管纽约市采取了大量的道路安全措施，简单的自行车头盔在发生碰撞时的保护影响仍然很大。建议重新评估城市骑自行车者的头盔法，以最有效地将“零愿景”从政治行动计划转化为公共安全现实。
方法：对前往I级创伤中心的受伤骑自行车者进行了前瞻性观察研究。包括受伤后24小时内到达的所有骑自行车的人。数据是在2月之间收集的，2012年8月,2014年，包括人口统计，成像研究（例如计算机断层扫描（CT）），损伤模式,结果包括格拉斯哥昏迷量表（GCS）和损伤严重程度评分。
结果：在699名患者中，273人（39.1%）在受伤时戴着头盔。头盔骑自行车的人更有可能GCS为15（96.3％[95％置信区间（CI），93.3-98.2]vs.87.6[95%CI，84.1-90.6])。头盔骑自行车的人头部CT较少（40.3%[95%CI，34.4-46.4]与52.8%[95%CI，48.0-57.6]），并且不太可能遭受颅内损伤（6.3%[95%CI，2.6-12.5]vs.19.7%[14.7-25.6])，包括颅骨骨折（0.9%[95%CI，0.0-4.9]vs.15.3%[95%CI，10.8-20.7]）和硬膜下血肿（0.0%[95%CI，0.0-3.2]vs.8.1%[95%CI，4.9-12.5]）。头盔骑自行车的人明显不太可能维持显著的TBI，即头部AIS≥3（2.6%[95%CI：0.7-4.5]vs.10.6%[7.6-12.5]）。四名患者接受了开颅手术，三名死亡；所有人都没有头盔。多变量逻辑回归模型显示，与未戴头盔的骑自行车者相比，戴头盔的骑自行车者维持TBI的可能性降低了72％（调整后的赔率比0.28，95％CI0.12-0.61）。
结论：尽管纽约市采取了大量的道路安全措施，简单的自行车头盔在发生碰撞时的保护影响仍然很大。建议重新评估城市骑自行车者的头盔法，以最有效地将“零愿景”从政治行动计划转化为公共安全现实。
