Pediatric bicycle helmet legislation and crash-related traumatic brain injury in Illinois, 1999-2009

Background Bicycling is one of the most popular forms of play and exercise for children in the US. However, over 200,000 children per year are injured in bicycle crashes, and an estimated 22,000 pediatric bicycle-related traumatic brain injuries (TBIs) occur annually. Bicycle helmets are known to decrease the risk of head injury, but efficacy and magnitude of the effect of helmet legislation have not been fully elucidated. Methods This was a retrospective, observational study of children aged <18, who presented after a bicycle crash in Illinois from 1999 to 2009. Demographic information, injury types, injury severity, helmet usage, and location of injury data were collected. Multiple logistic regression analysis was used to quantify the independent effects of helmet usage on TBI. Data were compared between communities with and without helmet legislation. Results A total of 3080 pediatric bicycle-related crashes were identified. Children wearing helmets were less likely to sustain a TBI, odds ratio [OR] = 0.56 (95% confidence interval [CI] 0.37-0.84, P < 0.001). Overall 5.0% of patients were noted as wearing helmets. Black and Hispanic children were less likely to wear helmets, OR = 0.24 (95% CI 0.09-0.68, P < 0.001) and OR = 0.10 (95% CI 0.02-0.42, P < 0.001), respectively. There was no significant change in helmet usage between before and after legislation in helmet legislation areas or over time in non–helmet legislation areas. Discussion Helmet use was protective against TBI, but socioeconomic and racial disparities exist in usage. Local legislation did not appear to impact helmet usage or admissions for bicycle-related TBIs in these areas.