Association Between Helmet Use and the Frequency of Maxillofacial Injuries After Bicycle- or Scooter-Related Accidents in Children

Background:

In the Netherlands, more than 15,000 children visit the emergency department (ED) after bicycle or scooter accidents annually, frequently presenting with maxillofacial injuries. Despite evidence that helmet use reduces injuries in the general population, research focusing on maxillofacial injuries in children is still limited. 

Purpose:

The study purpose was to estimate and compare the frequencies of bicycle- or scooter-related maxillofacial injuries between helmeted and unhelmeted pediatric riders. 

Study design, setting, sample:

This single-center retrospective cohort study was conducted at the Erasmus Medical Center in Rotterdam, the Netherlands. Patients aged <18 years who visited the ED after a bicycle or scooter accident between June 2017 and December 2023 were included. Bicycle spoke injuries were excluded. 

Independent variable:

The independent variable was helmet use, coded as helmeted or unhelmeted. 

Main outcome variable:

Maxillofacial injury status (present or absent) was the primary outcome. The secondary outcome was the type of maxillofacial injury (soft tissue, fracture or dentoalveolar). Covariates Subject characteristics (age, sex) and accident characteristics (type of vehicle, type of rider) were determined as covariates. 

Analyses:

Descriptive and analytical statistics were calculated with the threshold for statistical significance set at P < .05. Multiple logistic regression analysis was used to compare pediatric subjects with and without maxillofacial injuries. 

Results:

Overall, 56,000 trauma patients were screened. 210 (100%) subjects were included in the study sample with a median age of 16 (interquartile range 13 to 17) and 144 (68.6%) were male. 100 (47.6%) subjects wore a helmet. The frequency of maxillofacial injuries was 28 (28.0%) in the helmeted and 51 (46.4%) in the unhelmeted group with a relative risk (RR) of 0.60 (95% CI 0.42 to 0.89, P = .008). The odds ratio for maxillofacial injuries was 0.52 (95% CI 0.28 to 0.97, P = .041) for helmeted subjects after regression analysis. Additionally, helmet use was associated with a lower risk for soft tissue injury (RR 0.56; 95% CI 0.38 to 0.82; P = .003) and maxillofacial fractures (RR 0.38 95% CI 0.16 to 0.95; P = .037). 

Conclusions and relevance:

Helmet use among children is inversely associated with risk of maxillofacial injury following a bicycle or scooter accident. These findings are considered relevant in future helmet legislation for children.