{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:59:47Z","timestamp":1790359187868,"version":"4.1.0"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"abstract":"\n Background<\/jats:title>\n Head injuries are a leading cause of life-threatening injury and death in bicyclist crashes. This study explored real-world crash reconstructions of US bicyclists struck by passenger vehicles to identify if wearing a helmet influenced the occurrence of different types of head injuries.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Real-world crash reconstructions of 91 helmeted and 204 unhelmeted bicyclists struck by passenger vehicles were examined. Data included medical codes of head injuries, injury attribution, medical imaging, bicyclist demographics and descriptions of crash configuration. Head and facial injuries were categorised based on severity and type of injury. A logistic regression controlling for crash factors was performed to compare the odds of head injuries by helmet status.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Fewer cranial fractures (OR: 0.039; p=0.03) and intracranial haemorrhages (OR: 0.0696; p=0.04) were observed for helmeted bicyclists. All severe head injuries for helmeted and unhelmeted bicyclists were attributed to primary impact with the vehicle, and for 9 out of 13 cases the location was where vehicle countermeasures such as an external airbag could be effective. For concussion-level injuries, 50% of helmeted and 43% of unhelmeted injuries were judged to be from secondary contact with the ground.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Preventing life-threatening bicyclist injuries will require more than helmet redesigns. Vehicle countermeasures, such as windshield airbags or bicyclist autobrake systems, can supplement helmets for protecting bicyclists.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Helmeted bicyclists struck by passenger vehicles in the USA had fewer severe head injuries compared with unhelmeted bicyclists. However, no protective effect of helmets was observed for concussion-type injuries.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/ip-2026-046370","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:20:17Z","timestamp":1790356817000},"page":"ip-2026-046370","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Head injuries sustained by helmeted and unhelmeted bicyclists in US passenger vehicle-to-bicyclist crashes"],"prefix":"10.1136","author":[{"given":"Jessica","family":"Drake","sequence":"first","affiliation":[{"name":"Insurance Institute for Highway Safety, Ruckersville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7180-7113","authenticated-orcid":false,"given":"Becky","family":"Mueller","sequence":"additional","affiliation":[{"name":"Insurance Institute for Highway Safety, Ruckersville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"2026092510201080000_ip-2026-046370v1.1","unstructured":"Insurance Institute for Highway Safety . Pedestrians and bicyclists. Arlington (VA): IIHS; 2024. Available: https:\/\/www.iihs.org\/topics\/pedestrians-and-bicyclists"},{"key":"2026092510201080000_ip-2026-046370v1.2","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jth.2018.06.002","article-title":"Are head injuries to cyclists an important cause of death in road travel fatalities?","volume":"10","author":"Martin","year":"2018","journal-title":"J Transp Health"},{"key":"2026092510201080000_ip-2026-046370v1.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540240046029"},{"key":"2026092510201080000_ip-2026-046370v1.4","doi-asserted-by":"publisher","DOI":"10.1080\/13588260903102484"},{"key":"2026092510201080000_ip-2026-046370v1.5","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.amjsurg.2016.05.021","article-title":"Bicycle helmets work when it matters the most","volume":"213","author":"Joseph","year":"2017","journal-title":"Am J Surg"},{"key":"2026092510201080000_ip-2026-046370v1.6","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.jss.2020.08.009","article-title":"Helmet usage reduces serious head injury without decreasing concussion after bicycle riders crash","volume":"257","author":"Alfrey","year":"2021","journal-title":"J Surg Res"},{"key":"2026092510201080000_ip-2026-046370v1.7","unstructured":"U.S. Consumer Product Safety Commission . Safety standard for bicycle helmets. Code of Federal Regulations, Title 16, Part 1203. Washington (DC): U.S. Government Printing Office, 1998."},{"key":"2026092510201080000_ip-2026-046370v1.8","unstructured":"Bland ML , McNally C , Rowson S . STAR methodology for bicycle helmets . Blacksburg (VA): Virginia Tech Helmet Lab, 2018."},{"key":"2026092510201080000_ip-2026-046370v1.9","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s10439-019-02330-0","article-title":"Development of the STAR evaluation system for assessing bicycle helmet protective performance","volume":"48","author":"Bland","year":"2020","journal-title":"Ann Biomed Eng"},{"key":"2026092510201080000_ip-2026-046370v1.10","unstructured":"Association for the Advancement of Automotive Medicine . Abbreviated injury scale (AIS): 2015 revision. Chicago (IL) AAAM; 2015."},{"key":"2026092510201080000_ip-2026-046370v1.11","unstructured":"Virginia Tech Helmet Lab . Bicycle helmet ratings: 2025 edition. Blacksburg (VA): Virginia Tech; 2025. Available: https:\/\/www.helmet.beam.vt.edu\/bicycle-helmet-ratings.html"},{"key":"2026092510201080000_ip-2026-046370v1.12","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1177\/03611981211001377","article-title":"Potential effectiveness of bicycle-automatic emergency braking using the Washtenaw Area Transportation Study Data Set","volume":"2675","author":"Haus","year":"2021","journal-title":"Transp Res Rec"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2026-046370","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:20:20Z","timestamp":1790356820000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2026-046370"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":12,"alternative-id":["10.1136\/ip-2026-046370"],"URL":"https:\/\/doi.org\/10.1136\/ip-2026-046370","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"value":"1353-8047","type":"print"},{"value":"1475-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]}}}