Effectiveness of bicycle helmets and injury prevention: a systematic review of meta-analyses

Büth, Carlson Moses; Barbour, Natalia; Abdel-Aty, Mohamed · 2023 · Crossref

DOI: 10.1038/s41598-023-35728-x

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Summary

This systematic review evaluates the effectiveness of bicycle helmets in preventing injuries by synthesizing findings from existing meta-analyses, laboratory simulations, and studies on injury severity factors. The research is motivated by rising cyclist fatalities and serious injuries in Europe and the United States, alongside concerns regarding under-reporting and the lack of designated cycling infrastructure. The study aims to provide a multi-perspective view of helmet protective effects, explicitly excluding the "risk compensation" hypothesis, as prior literature indicates helmet users do not exhibit increased risk-taking. The methodology involved a systematic search of Q1 and Q2 transportation journals, the TRID database, and Google Scholar, focusing on peer-reviewed articles published primarily after 2015, with exceptions for large-scale meta-analyses. The authors screened 780 records, ultimately selecting 119 papers for evaluation and identifying 10 key articles across three categories: observational studies using bicycle crash data, laboratory-based simulation studies, and general injury severity factors. The review prioritized meta-analyses to overcome the limitations of single-study geographical constraints and to address contradictory claims. Observational studies were predominantly case-control designs, which compare injury odds between helmeted and non-helmeted cyclists, as randomized controlled trials are considered unethical for crash events. The findings from observational meta-analyses confirm that helmet use significantly reduces the risk of head, brain, facial, and fatal injuries across all age groups and crash types. Specifically, Attewell et al. reported a 60% reduction in head injuries, a 58% reduction in brain injuries, and a 73% reduction in fatal injuries. Olivier and Creighton found similar significant reductions in severe injuries, while Høye’s analysis corroborated these results, showing reduced odds for head and facial injuries. However, the impact on neck injuries was found to be insignificant or near null across multiple studies. The relative benefit of helmets was noted to be higher in high-risk situations, such as cycling on shared roads. Laboratory studies indicated that head shape and size influence protective effects, though the authors criticized the lack of equity in testing conditions, as all reviewed studies utilized fifty-percentile male head and body forms. The study concludes that wearing a bicycle helmet is beneficial regardless of age, crash severity, or type, particularly for preventing severe head injuries. The authors emphasize that safety strategies should consider helmet uptake to mitigate injury risks. While observational data strongly supports helmet efficacy, the review highlights methodological limitations in laboratory testing due to standardized anthropometric models. The synthesis provides robust evidence for the protective value of helmets, reinforcing their role in public health and transportation safety policies.

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Topics

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• helmet protective
• cyclist safety