B. C. Gulack1, B. R. Englum1, K. L. Rialon1, L. J. Talbot1, J. E. Keenan1, H. E. Rice1, J. E. Scarborough1, O. O. Adibe1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction: Despite numerous nationwide campaigns to increase helmet use among pediatric cyclists, as well as data demonstrating a significant survival advantage for patients who wear a helmet, a substantial number of children are still injured while riding without a helmet. There is further concern that the number of patients who ride without a helmet may be significantly different across racial and socio-economic divides. To better understand this issue, we performed the following study to determine demographics associated with helmet use, particularly along racial and socioeconomic lines.
Methods: The National Trauma Data Bank (NTDB) was queried during the years of 2007, 2010, and 2011 for patients under the age of 16 who were involved in a bicycle accident (ICD-9 code 826.1). Patients were excluded if they were transferred to another facility, or if their helmet status was unknown. Patients were grouped based on whether or not they had a helmet on during the accident. Groups were compared with regards to baseline characteristics. Multivariable logistic regression was then used to determine factors significantly associated with helmet use. Age, gender, race, region, and payer status were included in the model.
Results: Of the 7,678 patients included in the analysis, 1,695 (22.1%) were wearing a helmet during their cycling accident. The overall median age was 11 years (Interquartile rage [IQR]: 7,13 years), and 1,741 (22.7%) patients were female. On univariable analysis, non-helmeted riders were significantly more likely to be Black/African-American (10.1% vs 3.7%, p<0.001), and more likely to be insured by Medicaid (32.8% vs 14.3%, p<0.001). Following adjustment with multivariable logistic regression, Black/African-American patients continued to have a significantly decreased odds of having been wearing a helmet during their accident compared to White/Caucasian patients (adjusted odds ratio [AOR] (95% confidence interval [CI]): 0.40 (0.30, 0.53). Patients on Medicaid also had a significantly decreased odds of having been wearing a helmet compared to patients on private insurance (AOR (95% CI): 0.33 (0.28, 0.38)).
Conclusion: Patients who are Black/African-American or who are on Medicaid are significantly less likely to be wearing a helmet when involved in a bicycle accident. Further efforts in education to promote helmet use need to be directed towards these groups.