Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries

An Erratum to this article was published on 04 November 2014



Traumatic brain injury is a leading cause of disability in bicycle riders. Preventive measures including bicycle helmet laws have been highlighted; however, its protective role has always been debated. The aim of this study was to determine the utility of bicycle helmets in prevention of intra-cranial hemorrhage. We hypothesized that bicycle helmets are protective and prevent the development of intra-cranial hemorrhage.


We performed a 4-year (2009–2012) retrospective cohort analysis of all the patients who presented with traumatic brain injury due to bicycle injuries to our level 1 trauma center. We compared helmeted and non-helmeted bicycle riders for differences in the patterns of injury, need for intensive care unit admissions and mortality.


A total of 864 patients were reviewed of which, 709 patients (helmeted = 300, non-helmeted = 409) were included. Non-helmeted bicycle riders were more likely to be young (p < 0.001) males (p = 0.01). There was no difference in the median ISS between the two groups (p = 0.3). Non-helmeted riders were more likely to have a skull fracture (p = 0.01) and a scalp laceration (p = 0.01) compared to the helmeted riders. There was no difference in intra-cranial hemorrhage between the two groups (p = 0.1). Wearing a bicycle helmet was not independently associated (p = 0.1) with development of intra-cranial hemorrhage.


Bicycle helmets may have a protective effect against external head injury but its protective role for intra-cranial hemorrhage is questionable. Further studies assessing the protective role of helmets for intra-cranial hemorrhage are warranted.

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Conflict of interest

The authors Bellal Joseph, Viraj Pandit, Bardiya Zangbar, Mustafa Amman, Mazhar Khalil, Terence O’Keeffe, Tahereh Orouji, Anum Asif, Abdullah Katta, Daniel Judkins, Randall S. Friese, and Peter Rhee declare no identifiable conflict of interest.

Ethical standard

This study has been approved by the Institutional Review Board at the University of Arizona, College of Medicine and this human study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Correspondence to B. Joseph.

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Joseph, B., Pandit, V., Zangbar, B. et al. Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries. Eur J Trauma Emerg Surg 40, 729–732 (2014).

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  • Helmet laws
  • Traumatic brain injury
  • Bicycle injury