Helmets for preventing injury in motorcycle riders: Cochrane systematic review

Abstract

Assessed as up to date: 2007/10/24

Background

Motorcycle crash victims form a high proportion of those killed or injured in road traffic crashes. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes.

Objectives

To assess the effects of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes.

Search strategy

We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2007), MEDLINE (up to April 2007), EMBASE (up to April week 16, 2007), CINAHL (January 1982 to February 2003), TRANSPORT (up to issue 12, 2006) (TRANSPORT combines the following databases: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Websites of traffic and road safety research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles.

Selection criteria

We considered studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. We included any studies that compared an intervention and control group. Therefore the following study designs were included: randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded.

Data collection and analysis

Two authors independently screened reference lists for eligible articles. Two authors independently assessed articles for inclusion criteria. Data were extracted by two independent authors using a standard extraction form.

Main results

Sixty-one observational studies were selected of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for death and head injury outcomes. Motorcycle helmets were found to reduce the risk of death and head injury in motorcyclists who crashed. From four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction.

Authors' conclusions

Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

Author(s)

Liu Bette C, Ivers Rebecca, Norton Robyn, Boufous Soufiane, Blows Stephanie, Lo Sing Kai

Summary

Helmets are shown to reduce motorcyclist head injury and death

Motorcyclists are at high risk in traffic crashes, particularly for head injury. A review of studies concluded that helmets reduce the risk of head injury by around 69% and death by around 42%. There is, so far, insufficient evidence to compare the effectiveness of different types of helmet. Some studies have suggested that helmets may protect against facial injury and that they have no effect on neck injury, but more research is required for a conclusive answer. The review supports the view that helmet use should be actively encouraged worldwide for rider safety.

Reviewer's Conclusions

Implications for practice

Observational studies that control for confounders demonstrate that helmets are effective in reducing head injuries in motorcyclists who crash by 69% and death by 42%. There is some evidence to suggest that the effect on mortality may be modified by other crash factors such as speed at impact. Currently no conclusive evidence exists on the effect of motorcycle helmets on neck or facial injuries.

Implications for research

Further high quality studies are required to address the issue of whether motorcycle helmets influence neck injury, facial injury and the effects of motorcycle speed on the risk of death for motorcycle riders wearing helmets. In addition, the effectiveness of different helmet types needs to be addressed in a well conducted controlled trial. Issues of cost-effectiveness and enforcement of industry approved helmets are further issues that need to be considered.

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