# Risk reduction after bicycle, scooter, and skateboard-related head injuries through helmet use and brain injury education: A trauma center quality improvement initiative

## TL;DR

A hospital program gave free helmets and education to head injury patients, improving safety awareness and helmet use.

## Contribution

A novel quality improvement initiative to increase helmet use and brain injury education in trauma patients.

## Key findings

- 100% of patients reported improved understanding of risk reduction strategies.
- 82% of patients resumed activities with consistent helmet use.
- The program was cost-effective compared to head injury treatment costs.

## Abstract

Helmets reduce head injury severity after bicycle, scooter, and skateboard injuries. Prevention of one head injury reduces lifetime risk of reinjuries. Our clinical care quality improvement initiative (QII) aimed to improve helmet usage, education, and safety awareness in head injury patients at a United States trauma center.

To assess QII feasibility.

Head injury patients presenting to emergency department (ED) after bicycle, scooter, and skateboard accidents without helmets or with lost/damaged helmets were provided helmets free-of-charge, and in-person review of traumatic brain injury education, resources, and follow-up care. Surveys on helmet use were conducted in the ED and at ≥1 telephone appointments (2-weeks to 1-year).

In 21 patients aged 37.7 ± 12.5-years, 71 % were male, 38 % had traumatic intracranial hemorrhage on head computed tomography (CT) scan, and 81 % were unhelmeted. Mechanisms included scooter (48 %), bicycle (38 %), and skateboard-related (14 %) injuries. All patients reported improved understanding of risk reduction strategies and helmet use at enrollment and follow-up. At follow-up, 11/21 patients were able to resume pre-injury bicycle, scooter, and/or skateboard-related activities, of which 82 % reported consistent helmet use. Of 10 patients unable to resume pre-injury activities, reasons included head injury (50 %), polytrauma (30 %), and concern for reinjury (30 %).

Costs of one head injury ED admission may exceed $6000, compared with $60 for one helmet. In-person provision of helmets, education, and resources is an adoptable, cost-effective intervention for improving safety awareness and reducing reinjury risk. Next steps include expanding QII implementation and refining evaluation metrics.

•Helmets reduce head injury severity, but only 18–22 % of U.S. adults wear them.•We present a quality improvement initiative (QII) to improve helmet usage.•Head injury patients were provided helmets and education in the emergency department.•In 21 patients, 100 % reported improved safety awareness and 82 % used their helmet.•Our QII is an adoptable, cost-effective intervention to improve safety awareness.

Helmets reduce head injury severity, but only 18–22 % of U.S. adults wear them.

We present a quality improvement initiative (QII) to improve helmet usage.

Head injury patients were provided helmets and education in the emergency department.

In 21 patients, 100 % reported improved safety awareness and 82 % used their helmet.

Our QII is an adoptable, cost-effective intervention to improve safety awareness.