Helmets for preventing injury in motorcycle riders

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Abstract
Motorcycle crash victims form a high proportion of those killed or injured in road traffic crashes. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes. To assess the effects of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes. We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2007), MEDLINE (up to April 2007), EMBASE (up to April week 16, 2007), CINAHL (January 1982 to February 2003), TRANSPORT (up to issue 12, 2006) (TRANSPORT combines the following databases: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Websites of traffic and road safety research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles. We considered studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. We included any studies that compared an intervention and control group. Therefore the following study designs were included: randomised controlled trials, non‐randomised controlled trials, cohort, case‐control and cross‐sectional studies. Ecological and case series studies were excluded. Two authors independently screened reference lists for eligible articles. Two authors independently assessed articles for inclusion criteria. Data were extracted by two independent authors using a standard extraction form. Sixty‐one observational studies were selected of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for death and head injury outcomes. Motorcycle helmets were found to reduce the risk of death and head injury in motorcyclists who crashed. From four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction. Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. Further well‐conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists. 安全帽用以預防機車騎士受傷 機車事故受害者在因道路交通事故死亡或受傷者中佔有高的比例。機車事故造成的頭部受傷是造成嚴重罹病及死亡常見的原因。直覺上似乎安全帽應該可以保護頭部防止受傷，但是有使用機車安全帽會減少騎士視野並增加頸部受傷的爭議。這篇回顧將整理目前可得的證據有關機車事故中安全帽及它們對死亡率和頭部，臉部及頸部受傷的影響。 評估帶機車安全帽對於減少機車事故死亡率及頭部，頸部受傷的影響。 我們檢索the Cochrane Injuries Group Specialised Register，Cochrane Central Register of Controlled Trials (考科藍圖書館2007年，第2期)，MEDLINE (至2007年4月)，EMBASE (至2007年4月第16週)，CINAHL (1982年1月至2003年2月)，TRANSPORT (至2006年，第12期) (TRANSPORT結合以下資料庫: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD)，ATRI (Australian Transport Index) (1976至2003年2月)，檢索Science Citation Index相關的文獻。道路及交通安全研究的網站，包括搜尋政府機構。評估回顧標題的參考文獻，已確認的研究及參考書目以確認相關的文章。 我們考量調查發生事故的機車騎士族群的研究，評估使用安全帽作為介入措施及包含以下一種或多種結果：死亡，頭部，頸部或臉部受傷。我們納入任何研究有關比較介入措施與對照組。所以納入以下的研究設計：隨機對照試驗(randomised controlled trials)，非隨機對照試驗(nonrandomised controlled trials)，世代(cohort)，病例對照(casecontrol)及橫斷性研究(crosssectional studies)。排除生態學的及病例系列研究。 兩名作者分別審閱合格文章的參考文獻。兩名作者分別評估文章以符合納入條件。由兩名作者分別採用標準的摘錄格式以摘錄資料。 納入共61篇各種品質的觀察性研究。儘管方法學不同，結果仍有高度的一致性，特別是有關死亡及頭部受傷的結果。發現機車安全帽可以減少事故中機車騎士死亡及頭部受傷的風險。四篇高品質的研究估計安全帽可以減少42%的死亡風險(OR 0.58, 95% CI 0.50 to 0.68)，及六篇高品質的研究估計安全帽可以減少69%的頭部受傷風險(OR 0.31, 95% CI 0.25 to 0.38)。發現無充分的證據以估計機車安全帽相較於無安全帽對於臉部或頸部受傷的效果。然而，品質較差的研究認為安全帽對於頸部受傷的風險沒有影響，及臉部受傷有保護作用。沒有充分證據證明是否不同類型的安全帽對於減少受傷有較多或較少的好處。 在機車騎士發生事故中，機車安全帽減少死亡及頭部受傷的風險。需要進一步建立良好的研究以確定安全帽及不同類型安全帽對於死亡率，頭部，頸部和臉部受傷的影響。然而，結果認為全球致力於減少道路交通受傷也許促進機車騎士增加安全帽的使用。 本摘要由高雄榮民總醫院金沁琳翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 結果顯示安全帽可以減少機車騎士頭部受傷及死亡。在交通事故中機車騎士是具有高風險的，特別是頭部受傷。回顧相關研究後推論安全帽減少約69%的頭部受傷風險及約42%的死亡風險。此外，迄今為止，無充分證據比較不同形式安全帽的效果。有些研究認為安全帽也許可以保護頭部以防臉部受傷及安全帽而對於頸部受傷沒有影響，但需要有更多的研究以獲得確切的答案。這篇回顧支持為了騎士安全全世界應積極鼓勵使用安全帽的觀點。