Only 1 in 10 children involved in a bicycle accident was wearing a helmet, a review of emergency department records in Los Angeles County shows.

“We found decreased use among older children, minority groups, and those of lower socioeconomic status,” said Veronica Sullins, MD, from Harbor-UCLA Medical Center in Torrance, California.

Bicycle-related injuries are responsible for more than 250,000 visits to the emergency department and nearly 200 deaths a year. California has the second highest number of cyclist fatalities.

The use of a bicycle helmet reduces head injuries by 63% to 88%, but a small number of children younger than 15 years wear helmets, Dr. Sullins reported.

She presented the research here at the American Academy of Pediatrics 2013 National Conference and Exhibition.

Dr. Sullins and her team reviewed information from the Trauma and Emergency Medicine Information System for patients younger than 18 years. The median age of the children was 13 years, and 64% were male.

The primary end points were the association between helmet use and age, sex, insurance status, and race or ethnicity.

Only 11% Wore Helmets

Of the 1248 children identified, 11% were wearing helmets when their injuries occurred. Of these, 13.8% were younger than 12 years and 9.8% were 12 years or older.

Helmet use was 47% more likely in the younger age group (P < .03), was 10 times more likely in white children than in children from a minority group (P < .0001), and was twice as likely in children covered by private insurance as in those covered by public or no insurance (P < .0001).

There were no differences in any of the primary end points between the helmeted and unhelmeted groups. However, “we should note that of the 9 total deaths, 8 children were not wearing helmets,” Dr. Sullins said.

On multivariable logistic regression analysis, helmet use did not increase the need for emergency surgery, mortality, or length of hospital stay, after adjustment for age, race and ethnicity, and injury severity score.

Only injury severity score increased the risk for all outcomes. For every 1-point increase in injury severity score, length of stay increased by 0.4 days (P < .0001). Private insurance decreased the length of stay.

“Overall, less than 1% of patients died, few required emergency surgery (5.9%), permanent disability was very low (0.5%), but temporary disability was high (65.4%),” she said.

On the basis of the findings, Dr. Sullins and her team recommend that middle schools, high schools, low-income communities, and minority populations in Los Angeles County be targeted for bicycle safety programs.

Targeted Education

“This study picked up some remarkable trends in the difference in helmet use across different socioeconomic groups,” said Tanzid Shams, MD, who leads the concussion and brain injury program at the Floating Hospital for Children at Tufts Medical Center in Boston. “We need to look more closely at why this disparity exists.”

He told Medscape Medical News that “we want all children to wear helmets. One effective strategy would be to develop targeted campaigns that positively reinforce healthy habits.”

“The governing bodies for sports such as skateboarding and BMX can really get behind a campaign that encourages wearing helmets anytime one is riding a bicycle. I believe that a consistent message from role models can be highly effective,” said Dr. Shams.

He noted that in addition to emphasizing the value of helmets to parents, pediatricians should stress the importance of a proper fit.

“Very frequently, I see a child wearing a helmet that is loosely dangling off the head. When purchasing a bicycle helmet, one-size-fits-all may not be the best approach. The key is to go for a snug fit that does not constrict circulation or vision,” he explained.

“Several helmet manufacturers offer adjustable inner harnesses that allow for fit adjustments as the head of the child grows,” Dr. Shams said. “This feature is a good investment in terms of protecting the child from potential head trauma.”