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The effectiveness of bicycle helmets: a study of 1710 casualties

McDermott FT, Lane JC, Brazenore GA, Debney EA. Journal of Trauma, 1993; 34(6):834-845.

Summary of paper (from authors' abstract)

A comparison of crashes and injuries in 366 helmeted (261 approved, 105 non-approved) and 1344 unhelmeted casualties treated from 1987 to 1989 at Melbourne and Geelong hospitals or dying before hospitalization. Head injury occurred in 21.1% of wearers of approved helmets and 34.8% of non-wearers. AIS scores were decreased for wearers of approved helmets, face injuries were reduced, and extremity/pelvic girdle injuries increased and the overall risk of HI was reduced by at least 38% and face injury by 28%. When casualties with dislodged helmets were excluded, HI was reduced 45% by approved helmets. Head injury reduction by helmets, although substantial, was less than that found in a similar study in Seattle (Thompson, Rivara and Thompson, 1989).

General observations

Helmeted cyclists had more serious non-head injuries (neck and extremities/pelvic girdle) than bareheaded cyclists. Non-approved helmets offered no significant protection against head injuries. This paper does not provide reliable evidence that helmets reduce head injuries.

Peer criticism

By Towner et al, 2002:

By Curnow, 2005:

By Keatinge and Parry, 1994:

McDermott and Lane challenged Keatinge and Parry with regard to reduced cycle use in Victoria (McDermott and Lane, 1994). They stated:

Keatinge and Parry quote a secondary source to the effect that cycle use in Victoria decreased by 40% after wearing a helmet became compulsory. Cycling by children and teenagers decreased by an average of 36% in the two years after the law was introduced, but cycling overall increased (Cameron, Vulcan, Finch and Newstead, 1994).

But Curnow, 2008 subsequently supported Keatinge and Parry:

In Victoria, surveys measured usage by comparing numbers of cyclists counted and the times taken to ride through marked areas in May 1990, just before compulsory wearing, and again in May of 1991 and 1992. The number and usage of teenagers fell by 46% and 44% respectively by 1991. The number of adults fell by 29%, but change in their usage was not measured because they were not timed in 1990. The Federal Office of Road Safety (FORS) claims an increase for adults by comparing usage after compulsory wearing with that measured in 1987/88, disregarding both a caution by the authors of the surveys that the comparison is unreliable because the earlier survey was done at a different season 3.5 years earlier, and the rising trend in cycling before 1990. The claim is erroneous.

References

AHoR, 1985

Evidence Given to the Australian House of Representatives Standing Committee on Transport Safety, Motorcycle and Bicycle Helmet Safety Inquiry. 18 Oct 1985, p. 1086.

Cameron, Vulcan, Finch and Newstead, 1994

Cameron MH, Vulcan AP, Finch CF, Newstead SV, 1994. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia - an evaluation. Accident Analysis & Prevention 1994;26(3):325-337.

Curnow, 2005

Curnow WJ, 2005. The Cochrane Collaboration and bicycle helmets. Accident Analysis & Prevention 2005;37(3):569-573.

Curnow, 2008

Curnow WJ, 2008. Bicycle helmets and public health in Australia. Health Promotion Journal of Australia 2008 Apr;19(1):10-15..

Davis, 1993

Davis, R, 1993. Death on the streets. Leading Edge Press ISBN 0948135468.

Keatinge and Parry, 1994

Keatinge R, Parry R, 1994. Protection afforded by cycle helmets. BMJ 1994;309:1441 (26 Nov).

Lane, 1986

Lane JC, 1986. Helmets for child bicyclists, some biomedical considerations. Federal Office of Road Safety, Canberra Report CR47.

McDermott and Lane, 1994

McDermott FT, Lane JC, 1994. Protection afforded by cycle helmets. British Medical Journal BMJ 1994;309:877.

Noseworthy et al, 1994

Noseworthy JH, Ebers GC, Vandervoort MK, Farquhar RE, Yetisir E, Roberts R, 1994. The impact of blinding on the results of a randomized placebo-controlled multiple sclerosis clinical trial. Neurology 1994;44:16-20.

Spaite et al, 1991

Spaite DW, Murphy M, Criss EA, Valenzuela TD, Meislin HW, 1991. A prospective analysis of injury severity among helmeted and non helmeted bicyclists involved in collisions with motor vehicles. Journal of Trauma 1991 Nov;31(11):1510-6..

Thompson, Rivara and Thompson, 1989

Thompson RS, Rivara FP, Thompson DC, 1989. A case control study of the effectiveness of bicycle safety helmets. New England Journal of Medicine 1989 v320 n21 p1361-7.

Towner et al, 2002

Towner E, Dowswell T, Burkes M, Dickinson H, Towner J, Hayes M, 2002. Bicycle helmets - a review of their effectiveness: a critical review of the literature. Department for Transport Road Safety Research Report 30.

See also