Introduction: Head injury is a major cause of bicycling-related disability and death, and more likely to occur in unhelmeted riders. Legislation regarding helmet use varies by province. In Ontario, helmet use is not mandatory for cyclists >= age 18, and approximately 50 % of adult cyclists do not routinely wear helmets. Non-legislative approaches to increase helmet use have included education, public health campaigns, and helmet giveaways, but sustained effect is typically limited. The goal of the HEADSTRONG Behaviour Study is to identify injured adult cyclists who do not regularly wear helmets, and effect sustained helmet use. The strategy incorporates evidence-based elements of health behaviour change, including: reducing barriers, education and modelling, providing necessary materials, and social support. Methods: Prospective cohort study in downtown Toronto teaching hospital, launched Nov 2015. ED clinician (EP or NP) will recruit injured cyclists (consecutive, convenience sample) who report not regularly wearing a helmet nor owning a suitable one. Study endpoint: 100 enrolled (to estimate prevalence of usage of +/- 10%, alpha 0.05, power >90%, assuming 80% study completion and 50 % helmet wearing at 12 months). Exclusion criteria: unable to consent, admitted to hospital, age <18. Each element of the HEADSTRONG Behaviour Strategy is intended to facilitate patient adoption and maintenance of the desired behaviour, including: 1) enrolment/education by research associate while still in the ED; 2) provision and fitting of a free bicycle helmet; 3) social contract commitment and tailored reminders to document ongoing helmet use: participant agrees to respond to brief electronic survey follow-ups at two weeks, two months, six months, and twelve months; 4) social media engagement with participation in the HEADSTRONG Twitter group, which engages other enrolees and cycling advocacy groups; 5) peer nomination: the participant who is complying with the social contract is encouraged to nominate an uninjured non helmet-wearing colleague to enrol in the study. Results: Primary outcomes include: recruitment rate, enrolment, and sustained participation through follow-up period. Secondary outcomes include age, gender and social demographics of helmet recipients, and participation of peers. Conclusion: Discussion of strategy and interim results at six month interval will be presented at CAEP.

Introduction: Six Canadian provinces recently made bicycle helmet mandatory and subsequent data concerning hospitalization rates after head injuries in cyclists were controversial. Furthermore, there remains an important proportion of participants who don’t wear a helmet in sporting activity. We thus wanted to estimate the impact of helmet use in sport injuries on the risk of hospitalization. Methods: Study participants were patients of all age presenting at the emergency department of the Hôpital de l’Enfant-Jésus du CHU de Québec for a trauma that occurred in a sport in which it’s possible to wear a helmet. Data were collected from information provided by the patient and from the Canadian Hospitals Injury Reporting and Prevention Program’ (CHIRPP) database. Descriptive and multivariate analyses have been carried out using these data. We performed binomial logistic regression analyzes to estimate the risk adjusted for potentially confounding variables: age, sex and number of injuries. Results: Most patients included in the study (n=169) were males (69.8%) aged between 10 and 30 years (50.3%). Sports most frequently involved in trauma were cycling (31.4%), downhill skiing (18.3%), snowboarding (14.8%), hockey (11.8%), and skateboarding (5.9%). Overall, 70.4% of patients were wearing a helmet at the time of injury. Helmet use in sports was associated with a reduction of 52% of the risk of hospitalization (RR: 0.48 [CI: 95%: 0.25-0.93]) after a trauma. In addition, patients not wearing a helmet had higher proportions of intracranial hemorrhage (10% vs. 1.7%) and skull fracture (8% vs 2.5%). Conclusion: Results suggest that helmet use decreases the risk of hospitalization for trauma sustained in sports in which it’s possible to wear a helmet.

Objective: To determine if health outcomes and demographics differ according to helmet status between persons with cycling-related traumatic brain injuries (TBI).Methods: This is a retrospective study of 128 patients admitted to the Montreal General Hospital following a TBI that occurred while cycling from 2007-2011. Information was collected from the Quebec trauma registry and the coroner’s office in cases of death from cycling accidents. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated were length of stay (LOS), extended Glasgow outcome scale (GOS-E), injury severity scale (ISS), discharge destination and death.Results: 25% of cyclists wore a helmet. The helmet group was older, more likely to be university educated, married and retired. Unemployment, longer intensive care unit (ICU) stay, severe intracranial bleeding and neurosurgical interventions were more common in the no helmet group. There was no significant association between the severity of the TBI, ISS scores, GOS-E or death and helmet wearing. The median age of the subjects who died was higher than those who survived. Conclusion: Cyclists without helmets were younger, less educated, single and unemployed. They had more severe TBIs on imaging, longer LOS in ICU and more neurosurgical interventions. Elderly cyclists admitted to the hospital appear to be at higher risk of dying in the event of a TBI.