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news
White cycle helmetCanadian research claims cyclists with helmets three times less likely to die from head injury
New research published in the Canadian Medical Association Journal claims that cyclists wearing a helmet are three times less likely to die from head injuries than those who are not.
The researchers say that their study supports calls for the introduction of compulsory helmet laws across Canada for all age groups.
However, concerns have been raised locally regarding the validity of the methodology employed, based on an adjusted odds ratio, which does not take account of relative risk, and which it is said may significantly exaggerate the effect of the claimed findings.
The team studied Ontario Chief Coroner’s records relating to 129 people who died in bicycle-related incidents in the province from 2006 to 2010, three in four of whom had been involved in a collision with a motor vehicle.
The other fatalities resulted from an incident involving another cyclist, a pedestrian or other object and, in 10 per cent of cases, a fall. Males accounted for 86 per cent of the victims, with ages ranging from 10 to 83.
“Helmets save lives,” insists Dr. Nav Persaud of St. Michael’s Hospital in Toronto, who led the research.
“There are about 70 cycling deaths in Canada every year, and based on our study, we estimate we could prevent about 20 of them with helmets.
“We found that 88 per cent of people who died were 18 years of age or older, which is important because the helmet legislation in Ontario currently only applies to those younger than 18 years,” he added.
While Alberta also requires only under-18s to wear a helmet, in the provinces of British Columbia, New Brunswick, Nova Scotia and Prince Edward Island, all cyclists must wear one, irrespective of age.
He acknowledged, however, that making road conditions safer for cyclists in the first place would also lead help reduce casualties.
“Helmets only prevent injuries after a collision takes place,” he explained. “It would be better to prevent the collision from taking place at all. And infrastructure changes like building separated cycle lanes prevent collisions from taking place.
“That being said, even if we had a perfect cycle infrastructure, cyclists would still interact with cars at intersections, for example, so helmets would still be important.”
Opponents of compulsory helmet legislation, including organisations in the UK such as Sustrans and the CTC, believe it should be left to the individual to choose, pointing out that in places where they have been made mandatory, the number of cyclists has reduced, and that the general health benefits of regular cycling mean it is preferable to encourage more people to ride bikes rather than enacting laws that may deter them.
The CTC also cites several research papers published that found no link between the proportion of cyclists wearing helmets and any the safety of cyclists.
In a description of the background to the research in the Canadian article’s abstract, it was claimed: “Cycling fatalities [are] a leading cause of death among young adults worldwide.”
According to a report published earlier this year in partnership with The Lancet, Unicef said that “in middle- and high-income countries, cars are the biggest killers” among young people aged 10-19.
In Great Britain, an average of 10 children under 16 years have been killed while cycling during each of the past five years.
There’s no way of knowing how many of those fatalities involved head injuries, nor how many of the children were wearing a helmet and if they weren't, whether one may have possibly helped prevent the fatality.
During the same period, four times as many child pedestrians – 42 in an average year – were killed in Britain in road traffic collisions, according to Department for Transport figures.
While Unicef cites injury as the leading cause of death for adolescents worldwide, it’s a broad category that includes “road traffic injuries; injuries such as falls, burns, poisoning and drowning; and injuries from violence, including armed violence.”
Simon joined road.cc as news editor in 2009 and is now the site’s community editor, acting as a link between the team producing the content and our readers. A law and languages graduate, published translator and former retail analyst, he has reported on issues as diverse as cycling-related court cases, anti-doping investigations, the latest developments in the bike industry and the sport’s biggest races. Now back in London full-time after 15 years living in Oxford and Cambridge, he loves cycling along the Thames but misses having his former riding buddy, Elodie the miniature schnauzer, in the basket in front of him.
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85 comments
In all the helmet debate, I have still, yet, to come across a person who has come off their bike, landed on their spam and who says they were lucky to not have been wearing a helmet...
A few years ago, I was riding along a lane in Essex quite fast (about 25mph) when I hit a tree root under the Tarmac which knocked the bars out of my hands.
I parted company from the bike and slid about 50 yards along the road on my head (without helmet) and shoulder.
The only injury was loss of skin, unlike a previous occasion when I'd come off at low speed after hitting a kerb while wearing a helmet. I slid on my helmet a few feet. This resulted in a painfully stiff neck for a week.
deleted.
Whilst its not pleasant to hurt oneself the fact you hurt your neck whilst wearing a helmet may or may not have had anything to do with it. Your neck is very delicate and any sudden movements regardless of speed can aggravate it, hence the whiplash injuries even at low speed. This can be caused by the neck being at an unusual angle causing the muscles / tendons / ligaments to spasm causing the pain and stiffness.
Now i'm not saying the helmet was not responsible just that your injury can be easily caused with or without the wearing of a helmet.
If I hadn't been wearing a helmet, my head would have slid rather than being yanked round. Wearing a helmet made the crash worse.
No probs mate i accept what you say. Having bust my neck i know how sore they get
Why does every study like this seem to bring all the helmet refuseniks out of the woodwork? What is it about the prospect of wearing a lid that they find so odious? It's not like they're even that expensive.
Surely, even if the science is not 100 per cent clear, it's worth hedging one's bets? Surely it doesn't take a rocket scientist to work out that smacking one's head against the road/car bonnet/random object is going to be more painful without a big wedge of styrofoam in between? I'm all for freedom of choice but honestly...
Before I got into cycling, I used to do a bit of rock climbing. Exactly the same fierce debate about helmets happened amongst climbers. And again, those who opposed them were generally the same people who were eventually killed or seriously injured by falling rocks. I guess ultimately you can lead the horse to water...
Why do helmet evangelists always use jokey terms like "lid"? Don't they want adult discussion? But I digress:
Apart from the science being considerably less than 100% clear - it is suggested by some that helmet-wearing not only discourages the healthy activity of cycling, but even makes cycling injuries worse in some cases - sure, it may be worth hedging your bets. Just don't make helmet-wearing compulsory, which is what will happen if hordes of cyclists start wearing helmets for no good reason.
Rock climbing is obviously risky. Cycling isn't.
Really johnS ? Maybe you should try my 10 mile daily commute. I gladly wear a helmet...
Really johnS ? Maybe you should try my 10 mile daily commute. I gladly wear a helmet...
So I take it you fall off on a regular basis during your commute? Maybe you are the problem?
If you climb higher than the height of a person sitting on a bicycle a fall is going to do you more danger than a fall from a bike.
If you are hit by a car whilst cycling I am yet to see proof that a helmet prevents, leg, arm, spinal facial or and body injuries.
stevebull-01 wrote:
Rock climbing is obviously risky. Cycling isn't.
Really johnS ? Maybe you should try my 10 mile daily commute. I gladly wear a helmet...
So I take it you fall off on a regular basis during your commute? Maybe you are the problem?
If you climb higher than the height of a person sitting on a bicycle a fall is going to do you more danger than a fall from a bike.
You do realise that rock climbers use ropes and protection (nuts, cams, slings) to limit their chance of falling far? In fact, if seconding you probbaly wouldn;t even fall as far as falling off a bike.
Whereas coming off a bike onto the road at 20 odd mph hurts like hell. I have been more badly injured cycling than climbing.
Having said all that, how much help is an inch of polystyren going to be in a 20 mph crash?
I think we're at cross-purposes. I crashed about four times during 30 years of commuting 35km a day (that's more than 200,000km), never with serious injury, never wearing a helmet. As I said, cycling isn't obviously risky. And is a lot less risky than rock-climbing.
Actually, angelfishsolo, I've never fell off my bike. The point I was making is that cycling is risky. Of course wearing a helmet isn't going to necessarily stop serious or fatal injury, but as part of being safe on the bike surely it helps
Most shell type cycle helmets are useless flimsy things. You might as well wear a paper plate on your head tied on with a bit of string as the protection offered isn't as different as you might think. Unless you wear a proper competition type full face cycle helmet or at least a skate type lid, then safety is marginal. A shell type helmet is more for decoration than protection.
I certainly don't consider myself a refusenik. What does bother me is the lack of evidence, or the dismissal of anyone daring to question the (potential) failings of helmets. Comparison with rock climbing is spurious; clearly a lump of rock landing on your head is going to hurt/damage and it's likely that you'll not be able to react in any way. i.e. you won't know it's coming. If coming off a bike, it's likely that you'll try to compensate and having something which (effectively) makes your head larger can cause problems. If you doubt this, try wearing a hard hat (like builders have to wear) in a confined space and not banging your head.
I think the whole black and white argument is unhelpful. We need to be given the facts (pros and cons) in order to allow us to make an informed choice.
As it happens, I choose to race so I choose to wear a helmet to comply with racing requirements. I could choose not to, but I'd feel happier if proper empirical evidence were provided. This is unlikely as it's impossible to precisely compare/replicate accidents with and without helmets.
If you've not already seen it, here's my kind of reasoning:
http://fiftyyearsandcounting.wordpress.com/2012/08/09/speed-kills/
Gasman Jim: No offence, but you are professionally biased. Like a policeman who believes nearly all people are dodgy scum, because their job constantly has them in contact with those kinds of people, and rarely with good people. Your job constantly brings you into contact with victims of trauma - and likely more severe trauma, for those being wheeled into your OR.
Agree though it is also important to look at non-fatal trauma, simply for statistical reasons, if nothing else.
It is also important to include the general cycling population, including the minor and non-accident-having cyclists, for the same statistical reasons. Unfortunately, hospital-record studies (the most common) can not do this.
When are we going to see research finding that not driving into cyclists is the key to reducing cyclists' head injuries?
Death isn't the only end point which should be considered when discussing the merits of wearing helmets. I would say non-fatal traumatic brain injury occurs more frequently than death and is more likely to be reduced in severity or even prevented by wearing a helmet.
Of course I'm no expert, I'm just a consultant anaesthetist with nearly 20 years experience of dealing with trauma. I've seen enough to make sure I NEVER cycle without a helmet.
Of course on the roads better separation of cars and bikes would be ideal, but wearing a helmet is one of the few things we can do something about ourselves.
I am curious if you cycle wearing leg and arm protection, since as someone being involved in the medical profession I'm certain the majority of cycling injuries you'll encounter will be to the limbs. Perhaps all cyclists should adopt the protection used by downhill MTB racers and BMX racers and use body armour, knee/shin guards and a full face motocross type helmet. Those flimsy shell type helmets road cyclists wear are useless anyway.
Just curious, like, but does this mean you also wear a helmet when travelling in a car or when you are crossing the road as a pedestrian? Have you also seen injuries which were potentially caused by helmets?
I'm not saying I doubt your expertise, but I'm not sure your reasoning stands up to scrutiny. I'm happy to be convinced otherwise.
As a medical professional I am sure you know that Cycle helmets are specified by their manufacturers as meeting one or more of the international standards for this equipment. All of the standards test the helmet's protection of only a decapitated headform, (i.e. one with no body attached); and all tests involve only low speed impacts. Impact speeds are less than 6.6 m/s (24 km/h or 15 mph), and in some cases, barely 5 m/s (18 km/h or 11 mph). Unlike seatbelt tests, helmet test standards do not realistically replicate serious crashes.
My injuries for Mountain Biking were a broken wrist, compressed spine and rotator cuff injury. I wore a helmet at all times. I was traveling a lot faster than 11mph and my helmet was not SNELL certified.
As such I can conclude the following. The helmet did not prevent the injuries I sustained.
You're right - you are no expert. You can cite your personal experience but it is just that - personal. It is not scientifically compiled or statistically validated. You have no control group. You are apparently looking at head injury without considering limb and torso injuries, which are more prevalent in incidents with vehicles, especially HGVs, in urban situations.
You are not taken account of what non-trauma doctors such as cardiovascular, obesity, diabetes and other specialists might have to say.
It is better than the old " a helmet saved my life" canard, but only just.
The key missing relative risk is that cyclists that tend to wear helmets also tend to cycle more, cycle more prudently, use lights & hi-viz at night, and maintain their bikes properly etc.
You can make this observation yourself quite easily; the cyclist that scuttles across the road in front of you, without looking, with no lights on a broken BSO won't be wearing a helmet. (not to say that some helmet wearing cyclists also put themselves in danger just that a lower proportion of them do).
I'm not sure I agree. Plenty of people wear helmets while riding inappropriately or in an unsafe manner. Even some MAMILs with all the gear ride like dicks. Have you not heard of risk compensation?
http://waronthemotorist.wordpress.com/2011/07/25/risk-compensation-and-b...
It's OK, I can tell you're no expert on cycle helmets.
How does putting patients to sleep mean you to know more than the rest of us about the effectiveness of cycle helmets? Did you interview the patients and/or police forensic teams about the incident as well? Did you then inspect a significant sample of post-impact helmets? One could argue your conclusion is an emotional one due to what you've encountered rather than it be a decision based on the science. What about all the cyclists etc that have fallen yet not required surgery and quizzed them about whether they were wearing a helmet at the time?
Because it prompts all the blindly faithful evangelists to cry "You really should wear a helmet!" as if it's some kind of magic answer.
Are you really suggesting that every bare-headed cyclist will inevitably die from a blow to the head while out riding? There are weirdo religious groups desperate for idiots like you to help them spread their message.
Most of us arguing against you are not refuseniks. I wear one most of the time now, even in bed (you can't be too careful, you know). Lots of people have cycled for many years without one so don't see it as an essential survival aid. More important is the risk of creeping compulsion. Helmet compulsion has shown to be counterproductive and damaging to the health of the population as a whole. You don't have to be a brain surgeon, anaesthetist, lawyer or rock climber to work that one out.
Look at the incident types. "Collision with motor vehicle" covers 77% of the fatalities, regardless of whether or not they were wearing helmets. Surely there is a better lesson to learn here than "cyclists should wear helmets"? (Regardless of your opinion on that matter - mine is that helmets could help you in certain circumstances, in others there may be better ways to reduce injury risks).
A pet flaw of mine with helmet studies: Didn't consider alcohol intoxication. Not much excuse for this flaw, as it would be recorded in the records they were using (more reliably than helmet usage). From US and NL public accident data, alcohol intoxication is present in a significant number of fatalities (forget exactly how much, I think order 30 to 40% in US case, I remember it being more in NL). My educated guess is that alcohol intoxication correlates strongly with not wearing a helmet (in which case) - which will skew the conclusion a little if not accounted for.
Another flaw: It's not a population study (these are admittedly very expensive to do, and so they're rare). It's only looking at fatalities. Everyone who had an accident, went to hospital but didn't die: excluded. Everyone who had an accident, but didn't go to hospital: excluded. Everyone who cycled but didn't have an accident: excluded. Everyone who lived longer because cycling allowed them to make exercise a normal part of their life: excluded.
Narrow data-sets run the risk of not being representative of the full population. E.g. 86% of the cases in this study were male - why are there are so few women? Are only 14% of cyclists in Toronto female? Perhaps what this study is saying is more about males and/or those who end-up in fatal accidents being bigger risk takers, than anything about helmets?
Narrow data-sets or hypotheses can lead to conclusions that are only narrowly applicable - missing important factors. Also, as the study says "Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury." - association does not, per se, mean causation.
How do the dutch manage to have such good, population wide cycling safety, while pretty much never wearing helmets? Does the extremely high-rate of cycling the Netherlands have any part to play in the Netherlands having *half* the rate of obesity as the UK?
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