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Policy statement

Effectiveness of bicycle helmets in preventing head injury in children: case-control study

Thomas S, Acton CH, Nixon J, Battistutta D, Pitt WR, Clark R.
BMJ, 1994;308:173-176

This is not a complete Commentary but a summary of observations and criticisms that have been made relating to this paper

Summary of paper (based on authors' abstract)

445 children presenting with bicycle related injuries to two large children's hospitals in Brisbane, Australia took part in a questionnaire-based study. The cases comprised 102 children with injuries to the upper head, the controls were 278 child cyclists with injuries other than to the head or face A further 65 children with injuries to the face were considered as an extra comparison group. Most children (230) were injured after losing control and falling from their bicycle. Only 31 had contact with another moving vehicle. Children with head injury were significantly more likely to have made contact with a moving vehicle than control children. Head injuries were more likely to occur on paved surfaces than on grass, gravel or dirt. Wearing a helmet reduced the risk of head injury by 63% and loss of consciousness by 86%.

General observations

Peer criticism

 Based on Towner et al, 2002:


The study has compared quite different groups of children, lacks important checks on its findings and is not robust. The authors' conclusion that this work justifies legislation to enforce helmet use among children is not valid.


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.