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Lidless cyclists more likely to suffer serious head injuries, finds study at Sydney hospital

An Australian doctor who works in a busy accident & emergency department has conducted research that he claims supports keeping the country’s compulsory helmet laws, contradicting a study earlier this year that recommended repealing the legislation.

According to a report in the Herald Sun newspaper, in a letter to the Medical Journal of Australia summarising his research, Dr Michael Dinh of Sydney’s Royal Prince Alfred Hospital (RPA) said between 2008 and June 2010, some 287 cyclists had been admitted to the hospital’s trauma department.

Of those, 241 had been wearing a cycle helmet at the time of the accident, while 46 had not. The research found that 13% of the injured cyclists not wearing a helmet had suffered serious head injuries, compared to 3% of those who had been wearing one.

Dr Dinh’s letter stated: "It is the opinion of the trauma service at the RPA ... that mandatory bicycle helmet laws be maintained and enforced as part of overall road safety strategies."

Earlier this year, as reported on road.cc, two researchers at Sydney University claim that the compulsory bicycle helmet law, introduced in 1991, did not work and had requested a trial to be held to help ascertain what might happen if the law were repealed.

Associate Professor Dr Chris Rissel and a colleague at the university’s school of public health acknowledged that there had been a decline in head injuries since helmets were made compulsory, but said that was due to factors besides the wearing of a helmet itself, including improvements in road safety.

At the time, Dr Rissel said: ''I believe we'd be better off without it [compulsory helmet laws]. I'd recommend a trial repeal in one city for two years to allow researchers to make observations and see if there's an increase in head injuries, and on the basis of that you could come to some informed policy decision.”

Dr Rissel also pointed out that for many people, compulsory helmet laws are a deterrent to cycling in the first place since they reinforce the impression that cycling is an inherently dangerous activity, and that fewer people cycling in itself has a negative impact on wider general public health.

His research was partly based on a comparison of the ratio of head injuries to arm injuries found in cyclists admitted to hospital between 1988 and 2008, and therefore covering a longer period than this latest study, including a period before helmets were made compulsory.

Dr Rissel maintained that unless increased use of helmets had led to a reduction in the rate of head injuries, the ratio would be expected to have remained unchanged. Instead, he discovered that most of the decline in the rate of head injuries had taken place before compulsion.

He added that following the introduction of compulsory helmet laws, he and his fellow researchers observed ''a continued but declining reduction in the ratio of head injuries to arm injuries [and] … it is likely that factors other than the mandatory helmet legislation reduced head injuries''.

The issue of helmet compulsion is an emotive one in Australia, dividing even cycling lobbyists into pro and anti camps. Dr Rissel’s suggestion of a trial assessment, for example, received the backing of Stephen Hodge of the Cycling Promotion Fund, which promotes safe cycling in Australia, but was rejected by the chief executive of the cycling lobby group, Bike NSW, Omar Khalifa.

Meanwhile, police in Queensland, where as we reported earlier this month officers deflated the tyres on the bike of a teenage boy they discovered cycling without a helmet to prevent him from riding home, have come under criticism after it was revealed that other officers were riding round on quad bikes with no protective headgear.

A reader of the Sunshine Coast Daily sent the newspaper pictures of two helmetless officers riding their quad bikes, which can reach speeds in excess of 50 kilometres an hour on public roads. In the UK, Black Sabbath frontman turned reality TV star Ozzy Osbourne and comedian Rik Mayall both hit the headlines when injured in quad bike accidents.

A spokeswoman for Queensland Police told the Sunshine Coast Daily: “The quad bikes are registered for use on Queensland roads and under legislation, helmets are not required for the riders of quad bikes.”

She added: “The police were legally permitted to not wear helmets while riding the quad bikes. However, it is illegal to ride a bicycle or motorbike in Queensland without a helmet.”

The newspaper points out that it is illegal for members of the public to take to the state’s roads on quad bikes.
 

Born in Scotland, Simon moved to London aged seven and now lives in the Oxfordshire Cotswolds with his miniature schnauzer, Elodie. He fell in love with cycling one Saturday morning in 1994 while living in Italy when Milan-San Remo went past his front door. A daily cycle commuter in London back before riding to work started to boom, he's been news editor at road.cc since 2009. Handily for work, he speaks French and Italian. He doesn't get to ride his Colnago as often as he'd like, and freely admits he's much more adept at cooking than fettling with bikes.

12 comments

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DNAse [28 posts] 6 years ago
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Hmm, it's not hard to prove that helmets protect heads but it is another matter entirely to prove that they are an effective road safety aid.

As is highlighted in the piece, studies that differentiate head injuries from general injuries monitor the effectiveness of helmets *far* better than just looking at head injuries in isolation. In such a case the complete picure is missed. Doctors are not necessarily experts in statistical analysis or road safety!

And then there is the question of who was responsible for causing the head injury in the first place. Would a doctor advocate the complusory wearing of bullet-proof vests to reduce gunshot wounds?

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stevboss [19 posts] 6 years ago
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Wrong one, it was Rik Mayall...

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purplecup [217 posts] 6 years ago
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In a society where helmet use is compulsory, is it any surprise that the folks that are breaking the law are the more reckless ones? this is just a classic case of cause and effect getting mixed up.

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Simon_MacMichael [2466 posts] 6 years ago
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stevboss wrote:

Wrong one, it was Rik Mayall...

Of course it was, the People's Poet... suitably amended. Cheers  1

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Simon_MacMichael [2466 posts] 6 years ago
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Another Aussie doctor getting involved in the helmet debate - this one got yelled at to stop by four police officers for riding lidless:

http://www.theurbancountry.com/2010/11/doctor-busted-on-bike.html

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OldRidgeback [2660 posts] 6 years ago
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Wish those Aussies would put a lid on this fuss

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anthonyo [1 post] 6 years ago
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The article's conclusion is based on only 26 unhelmeted riders over three years. Maybe the results can be attributed to their age group, behaviour or state of alcohol consumption. We do not know and the Doctor doesn't appear to know either.

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Monstermunch [7 posts] 6 years ago
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6 unhelmeted cyclists had serious head injuries. This is not a big enough sample to draw any real conclusions from. HE also does not take account of other factors, like how many cyclists wear helmets, their cycling style etc. It reminds me of the 85% figure so readily banded around.
Also as an Asthma specialist, I would have thought Dr Dinh would want to encourage people out of their cars, and to exercise.

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Sakurashinmachi [49 posts] 6 years ago
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"The issue of helmet compulsion is an emotive one in Australia, dividing even cycling lobbyists into pro and anti camps. Dr Rissel’s suggestion of a trial assessment, for example, received the backing of Stephen Hodge of the Cycling Promotion Fund, which promotes safe cycling in Australia, but was rejected by the chief executive of the cycling lobby group, Bike NSW, Omar Khalifa."

Umm, no - it's an emotive issue in the UK. It's just not an issue in Australia.

I'd never heard of the Cycling Promotion Fund - turns out that it's a bicycle industry group, not a cyclists group - and nowhere on its website does it advocate the repeal of the helmet laws. In fact it has lots of photos of people wearing them and lists them in a beginners article as an accessory you will need. Mr Hodge appears to be quite good at giving sound bites for the media but knowing some of the CPF members I'd be surprised if they agreed with him on this or if his comments represented the CPF's official view.

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Sakurashinmachi [49 posts] 6 years ago
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"As a public protest, Chris Rissel, an associate professor in Sydney University's school of public health, has stopped wearing his cycling helmet. Last month Rissel co-wrote a paper published in the Journal of the Australasian College of Road Safety that looked at the number of cycling-related injuries admitted to NSW hospitals between 1989 - a year before helmets were made mandatory in this state - and in 2008. It found an initial small drop in the number of cycling head injuries, with figures flat ever since."

Neurosurgeon Jeffrey Rosenfeld "who steers the National Trauma Research Institute's neurotrauma evidence translation committee at the Alfred Hospital in Melbourne" and is "former head of the Royal Australasian College of Surgeons' Victorian Road Trauma Committee" said the following in an article in the SMH:

"Rissel's paper on the NSW figures is "fairly flimsy", with inconsistent injury data, no observational figures on helmet wearing before and after legislation, and including only cyclists admitted to hospital, which leaves out patients who died before getting to hospital, were treated as outpatients, or were so protected they did not need to go to a hospital. The Rissel paper also relied on the ratio of head to arm injuries, but that ratio can be altered by changes to either category. "It's a limited paper which didn't go to a very notable journal," McDermott says. "I think if it went to any reputable journal they would have sent it back and said, 'Rewrite it.'"

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OldRidgeback [2660 posts] 6 years ago
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By comparison, the data used to prepare the report on motorcyclist injuries before and post laws on helmet wearing in the UK came from a rather wider source. Accidents statistics from right across the UK were used. And, as previously mentioned, the issue of helmet use amongst motorcyclists is entirely different from that of cyclists. Basically, motorcycles move faster so the risk of head injury is greater in the event of a spill while motorcycle helmets are also more substantial and offer far greater protection than any flimsy cycle helmet.

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tim.churches [2 posts] 4 years ago
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Readers need to be aware that the research by Chris Rissel and Alex Voukelatos referred to in this article was found to contain serious arithmetic and data errors, and was subsequently retracted by the scientific journal which published it - see http://goo.gl/m1biA