Fatal cycling injuries.

Cycling accidents are responsible for significant morbidity and mortality, especially in boys under the age of 16. While most cycling injuries result from simple falls from the bicycle, the majority of fatalities are caused by head injuries resulting from accidents involving motor vehicles. It is estimated that up to 85% of all cycling fatalities caused by head injuries could be prevented by the use of an appropriate cycling helmet. Although the majority of adult cyclists wear helmets the reverse is true for children, who comprise the greatest proportion of all cyclists. Intensive educational programmes increase the number of cycling helmets that are sold, but have a lesser effect on the number used while cycling. Legislation, compassionately enforced on minors, i.e. with an understanding attitude towards their developmental stage, is the only proven technique that substantially improves rates of helmet use by young cyclists. Such legislation reduces their morbidity and mortality from head injuries. This article reviews the epidemiological factors associated with traumatic cycling injuries and the nature of these injuries. Special attention is paid to head injuries and the evidence that these are largely preventable with the use of appropriate 3-layered cycling helmets, the features of which are detailed. Factors promoting or discouraging helmet use by children are reviewed. These include the following factors: age, since helmet use is highest in mature cyclists and lowest in children because of negative peer pressure; parental example, including an attitude of safety consciousness and parental concern; higher levels of education; access to discounted helmets; public campaigns to promote helmet use; and, most importantly, appropriate legislation. But it is clear that appropriate legislation making helmet use compulsory for all cyclists is the only effective method for increasing helmet use, especially by young cyclist. Such legislation would reduce a mortality rate among young cyclists that has been equated to the mortality caused by some childhood infections in the pre-vaccination era. Some argue that physicians have a particular responsibility for promoting effective legislation for mandatory helmet use so that young children can be 'vaccinated' against the risk of the modern childhood epidemic; fatal head injury while cycling.