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Fit of bicycle safety helmets and risk of head injuries in children
  1. Frederick P Rivara1,
  2. Susan J Astley2,
  3. Sterling K Clarren3,
  4. Diane C Thompson4,
  5. Robert S Thompson5
  1. 1Harborview Injury Prevention and Research Center and the Departments of Epidemiology and Pediatrics, University of Washington, Seattle
  2. 2Department of Epidemiology, University of Washington
  3. 3Department of Pediatrics, University of Washington
  4. 4Harborview Injury Prevention and Research Center
  5. 5Group Health Cooperative of Puget Sound
  1. Correspondence to:
 Dr F P Rivara, Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Ave, Seattle, WA 98104, USA


Background—Although bicycle helmets are effective in preventing head and brain injury, some helmeted individuals nevertheless sustain head injury. One of the possible reasons may be poor fit of the helmet on the head. This study was undertaken to examine the relationship between helmet fit and risk of injury.

Methods—1718 individuals who were helmeted riders in a crash were queried on helmet fit and position. A sample of 28 children 2–14 years of age who sustained a head injury while wearing a bicycle helmet and 98 helmeted individuals of the same age treated in the same hospital emergency departments for injuries other than to the head, underwent anthropometric measurements of helmet fit. Measurements were made of the child's head, the helmet, and on a cast made of the child's head.

Results—Individuals whose helmets were reported to fit poorly had a 1.96-fold increased risk of head injury compared with those whose helmets fit well. Children with head injuries had helmets which were significantly wider than their heads compared with children without head injuries. Helmet fit was poorer among males and among younger children.

Conclusions—Poor fit of helmets may be associated with an increased risk of head injury in children, especially in males. Helmets may not be designed to provide optimal protection.

  • bicycle helmets
  • helmet fit

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