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The effect of motorcycle helmet type, components and fixation status on facial injury in Klang Valley, Malaysia: a case control study.

Ramli R, Oxley J, Hillard P, Mohd Sadullah AF, McClure R - BMC Emerg Med (2014)

Bottom Line: The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established.A binary logistic regression was conducted to examine the association between helmet characteristics and the outcomes, taking into account potential confounders such as age, riding position, alcohol and illicit substance use, type of colliding vehicle and type of collision.These findings are discussed with reference to implications for policy and initiatives addressing helmet use and wearing behaviors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, 56000 Jalan Yaacob Latif, Kuala Lumpur, Malaysia. roszalina@ppukm.ukm.edu.my.

ABSTRACT

Background: The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.

Method: 755 injured motorcyclists were recruited over a 12-month period in 2010-2011 in southern Klang Valley, Malaysia in this case control study. Of the 755 injured motorcyclists, 391 participants (51.8%) sustained facial injuries (cases) while 364 (48.2%) participants were without facial injury (control). The outcomes of interest were facial injury and location of facial injury (i.e. upper, middle and lower face injuries). A binary logistic regression was conducted to examine the association between helmet characteristics and the outcomes, taking into account potential confounders such as age, riding position, alcohol and illicit substance use, type of colliding vehicle and type of collision. Helmet fixation was defined as the position of the helmet during the crash whether it was still secured on the head or had been dislodged.

Results: Helmet fixation was shown to have a greater effect on facial injury outcome than helmet type. Increased odds of adverse outcome was observed for the non-fixed helmet compared to the fixed helmet with adjusted odds ratio (AOR) = 2.10 (95% CI 1.41- 3.13) for facial injury; AOR = 6.64 (95% CI 3.71-11.91) for upper face injury; AOR = 5.36 (95% CI 3.05-9.44) for middle face injury; and AOR = 2.00 (95% CI 1.22-3.26) for lower face injury. Motorcyclists with visor damage were shown with AOR = 5.48 (95% CI 1.46-20.57) to have facial injuries compared to those with an undamaged visor.

Conclusions: A helmet of any type that is properly worn and remains fixed on the head throughout a crash will provide some form of protection against facial injury. Visor damage is a significant contributing factor for facial injury. These findings are discussed with reference to implications for policy and initiatives addressing helmet use and wearing behaviors.

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Related in: MedlinePlus

Segment locations for damage description (visor).
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Figure 1: Segment locations for damage description (visor).

Mentions: Medical and police record data extraction form was used to obtain rider, crash, injury and treatment details. All injury diagnoses were scored and recorded using the Abbreviated Injury Scales (AIS)[24]. The face was defined as an area in front of the head between the ears and from the chin to the hairline[25]. Consistent with clinical practice, the face was categorised into upper, middle and lower face using two horizontal imaginary lines drawn through the inter-pupillary plane and across the commissure of the mouth. These divisions were included as outcomes of interest as some divisions may be more susceptible to injuries than others especially in helmet component damage. The problem of overlapping anatomy between the upper face (described as the area between the hairline to the eye brows) and the frontal region (head injury) was resolved by allocating injuries of the skin and subcutaneous tissue as the upper facial injuries while deeper structures injuries, i.e. bone and brain were grouped under head injury. This method complemented the AIS scoring. For middle and lower face injuries, injuries included those from the superficial to the deepest layer. Police-based data which included police investigation reports (witness interview, vehicle and crash site investigations and crash photographs) were collected from the respected Police Departments and clinical records which included autopsy and toxicology reports were collected from all relevant hospitals and NIFM.Helmet component laboratory analysis was performed on a sample of helmets obtained from injured participants. Helmet component variables selected for laboratory-based analysis included: type of helmet, type of visor, certified visor or otherwise, visor thickness, visor degradation (using the Fourier Transform Infrared (FTIR) spectroscopy) and visor damage. For the assessment of damage, the visor was divided into six segments according to the anatomy of the face where it coincided (FigureĀ 1). The horizontal segments represented the middle (V1 to V3) and lower face (V4 to V6), while the vertical segments represented the right side of face (V1 and V4), the centre of face (V2 and V5) and left side of the face (V3 and V6). The upper face coincided with the visor holder.


The effect of motorcycle helmet type, components and fixation status on facial injury in Klang Valley, Malaysia: a case control study.

Ramli R, Oxley J, Hillard P, Mohd Sadullah AF, McClure R - BMC Emerg Med (2014)

Segment locations for damage description (visor).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126353&req=5

Figure 1: Segment locations for damage description (visor).
Mentions: Medical and police record data extraction form was used to obtain rider, crash, injury and treatment details. All injury diagnoses were scored and recorded using the Abbreviated Injury Scales (AIS)[24]. The face was defined as an area in front of the head between the ears and from the chin to the hairline[25]. Consistent with clinical practice, the face was categorised into upper, middle and lower face using two horizontal imaginary lines drawn through the inter-pupillary plane and across the commissure of the mouth. These divisions were included as outcomes of interest as some divisions may be more susceptible to injuries than others especially in helmet component damage. The problem of overlapping anatomy between the upper face (described as the area between the hairline to the eye brows) and the frontal region (head injury) was resolved by allocating injuries of the skin and subcutaneous tissue as the upper facial injuries while deeper structures injuries, i.e. bone and brain were grouped under head injury. This method complemented the AIS scoring. For middle and lower face injuries, injuries included those from the superficial to the deepest layer. Police-based data which included police investigation reports (witness interview, vehicle and crash site investigations and crash photographs) were collected from the respected Police Departments and clinical records which included autopsy and toxicology reports were collected from all relevant hospitals and NIFM.Helmet component laboratory analysis was performed on a sample of helmets obtained from injured participants. Helmet component variables selected for laboratory-based analysis included: type of helmet, type of visor, certified visor or otherwise, visor thickness, visor degradation (using the Fourier Transform Infrared (FTIR) spectroscopy) and visor damage. For the assessment of damage, the visor was divided into six segments according to the anatomy of the face where it coincided (FigureĀ 1). The horizontal segments represented the middle (V1 to V3) and lower face (V4 to V6), while the vertical segments represented the right side of face (V1 and V4), the centre of face (V2 and V5) and left side of the face (V3 and V6). The upper face coincided with the visor holder.

Bottom Line: The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established.A binary logistic regression was conducted to examine the association between helmet characteristics and the outcomes, taking into account potential confounders such as age, riding position, alcohol and illicit substance use, type of colliding vehicle and type of collision.These findings are discussed with reference to implications for policy and initiatives addressing helmet use and wearing behaviors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, 56000 Jalan Yaacob Latif, Kuala Lumpur, Malaysia. roszalina@ppukm.ukm.edu.my.

ABSTRACT

Background: The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.

Method: 755 injured motorcyclists were recruited over a 12-month period in 2010-2011 in southern Klang Valley, Malaysia in this case control study. Of the 755 injured motorcyclists, 391 participants (51.8%) sustained facial injuries (cases) while 364 (48.2%) participants were without facial injury (control). The outcomes of interest were facial injury and location of facial injury (i.e. upper, middle and lower face injuries). A binary logistic regression was conducted to examine the association between helmet characteristics and the outcomes, taking into account potential confounders such as age, riding position, alcohol and illicit substance use, type of colliding vehicle and type of collision. Helmet fixation was defined as the position of the helmet during the crash whether it was still secured on the head or had been dislodged.

Results: Helmet fixation was shown to have a greater effect on facial injury outcome than helmet type. Increased odds of adverse outcome was observed for the non-fixed helmet compared to the fixed helmet with adjusted odds ratio (AOR) = 2.10 (95% CI 1.41- 3.13) for facial injury; AOR = 6.64 (95% CI 3.71-11.91) for upper face injury; AOR = 5.36 (95% CI 3.05-9.44) for middle face injury; and AOR = 2.00 (95% CI 1.22-3.26) for lower face injury. Motorcyclists with visor damage were shown with AOR = 5.48 (95% CI 1.46-20.57) to have facial injuries compared to those with an undamaged visor.

Conclusions: A helmet of any type that is properly worn and remains fixed on the head throughout a crash will provide some form of protection against facial injury. Visor damage is a significant contributing factor for facial injury. These findings are discussed with reference to implications for policy and initiatives addressing helmet use and wearing behaviors.

Show MeSH
Related in: MedlinePlus