{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:36:33Z","timestamp":1793014593378,"version":"4.5.0"},"reference-count":43,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"abstract":"<jats:p>\n                    Traumatic brain injury (TBI) is a major global health burden, with sports and recreational activities accounting for approximately 10% of all TBI cases in the United States. Helmets are widely used to mitigate head injury risk, yet prior studies have reported conflicting associations between helmet use and specific head injury patterns, medical management, and outcomes across different helmet-relevant activities. The objective of this study is to examine the associations between helmet use and head injury characteristics, injury severity, and emergency department (ED) disposition among patients with helmet-associated activity-relevant TBI. We conducted a retrospective cohort study using the National Trauma Data Bank (NTDB) research dataset (2014\u20132021). Patients with TBI resulting from cycling\/motorcycling, skiing\/snowboarding, roller-skating\/skateboarding, and equestrian-related activities were included. Primary outcomes include TBI severity (based on Glasgow Coma Scale score), head injury severity scale (ISS) maximum score, loss of consciousness (LOC), intracranial hemorrhage (ICH), skull fracture, diffuse axonal injury (DAI), and ED disposition. Multivariable regression models were estimated using an inclusive analytic approach along with sensitivity analyses using complete-case analysis and multiple imputation for missing covariate data. A total of 174,892 patients were included, of whom 70,558 were helmeted and 97,606 were non-helmeted. In adjusted inclusive analyses, helmet use was associated with lower odds of more severe TBI (odds ratio [OR] = 0.60, 95% confidence interval [CI]: 0.58\u20130.61,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), higher head ISS maximum scores (OR = 0.59, 95% CI: 0.58\u20130.60,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), ICH (OR = 0.61, 95% CI: 0.60\u20130.62,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), and skull fracture (OR = 0.35, 95% CI: 0.34\u20130.36,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). Helmeted patients had slightly higher odds of LOC (OR = 1.06, 95% CI: 1.03\u20131.08;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). To assess whether this association reflected increased rotational injury, analyses restricted to patients in the International Classification of Diseases, Tenth Revision (ICD-10)-era demonstrated that helmet use was associated with lower odds of DAI (OR = 0.87, 95% CI: 0.81\u20130.93;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). Helmet use was also associated with substantially lower odds of high-acuity or adverse ED dispositions. Findings were consistent across inclusive, complete-case, and multiple imputation analyses. In conclusion, our findings suggest that helmet use in helmet-relevant activity-associated injuries is associated with reduced head injury severity, lower odds of ICH, skull fracture, DAI, and decreased need for high-acuity medical care. The observed increase in LOC among helmeted patients may reflect differences in reporting or injury biomechanics rather than greater injury severity. These findings support public health strategies to increase helmet use through policy, education, and advances in protective equipment design.\n                  <\/jats:p>","DOI":"10.1177\/08977151261481327","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:36:48Z","timestamp":1787571408000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Helmet Use on Head Injury Characteristics and Medical Management Following Helmet-Relevant Activity-Associated Traumatic Brain Injury: A 2014\u20132021 National Trauma Data Bank Retrospective Cohort Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1347-8815","authenticated-orcid":false,"given":"Austin","family":"Lui","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, Touro University California, Vallejo, California, USA."},{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finnula","family":"Mageras","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University California, Vallejo, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Olson","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University California, Vallejo, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su","family":"Phyu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen-chieh","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University California, Vallejo, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddhe","family":"Patel","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University California, Vallejo, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhiraj","family":"Sanku","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University California, Vallejo, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Roeser","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University California, Vallejo, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander F.","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phiroz E.","family":"Tarapore","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."},{"name":"Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, California, USA."},{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California, USA."},{"name":"Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9694-7722","authenticated-orcid":false,"given":"John K.","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."},{"name":"Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, California, USA."},{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey T.","family":"Manley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."},{"name":"Weill Institute for Neurosciences, Institute for Neurodegenerative Diseases, Spine Center, University of California, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"DiGiorgio","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California, USA."},{"name":"Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, California, USA."},{"name":"Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California, USA."},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA."},{"name":"Philip R Lee Institute for Health Policy Studies, University of California San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.3171\/2017.10.JNS17352"},{"key":"e_1_3_2_3_1","first-page":"659652","article-title":"Traumatic brain injury in sports: A review","volume":"2012","author":"Sahler CS","year":"2012","unstructured":"2.Sahler CS, , Greenwald BD. Traumatic brain injury in sports: A review. Rehabil Res Pract 2012;2012:659652.","journal-title":"Rehabil Res Pract"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2021.0062"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.2.JNS151972"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.091080"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2021.12.023"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/02688697.2017.1409874"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.12809\/hkmj208934"},{"key":"e_1_3_2_10_1","volume-title":"National Trauma Data Standard Data Dictionary","author":"Surgeons ACo","year":"2025","unstructured":"9.Surgeons ACo. National Trauma Data Standard Data Dictionary. American College of Surgeons: Chicago, IL; 2025."},{"key":"e_1_3_2_11_1","volume-title":"JAMA Guide to Statistics and Methods","author":"Hashmi ZG","year":"2019","unstructured":"10.Hashmi ZG, , Kaji AH, , Nathens AB. Practical guide to surgical data sets: National Trauma Data Bank (NTDB). In: JAMA Guide to Statistics and Methods. (Livingston EH, , Lewis RJ., eds). McGraw-Hill Education: New York, NY; 2019."},{"key":"e_1_3_2_12_1","first-page":"7577","article-title":"Global neurotrauma surveillance: Are national databases overrated? comment on \u201cneurotrauma surveillance in national registries of low- and middle-income countries: A scoping review and comparative analysis of data dictionaries","volume":"12","author":"Boeck MA","year":"2023","unstructured":"11.Boeck MA, , Ssenyonjo H, , Kobusingye OC. Global neurotrauma surveillance: Are national databases overrated? comment on \u201cneurotrauma surveillance in national registries of low- and middle-income countries: A scoping review and comparative analysis of data dictionaries. Int J Health Policy Manag 2023;12:7577.","journal-title":"Int J Health Policy Manag"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyab359"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.1.FOCUS15612"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.07.009"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.4097\/kjae.2016.69.1.8"},{"issue":"4","key":"e_1_3_2_18_1","first-page":"e20210292","article-title":"Nonparametric statistical tests: Friend or foe","volume":"47","author":"Politi MT","year":"2021","unstructured":"17.Politi MT, , Ferreira JC, , Patino CM. Nonparametric statistical tests: Friend or foe? J Bras Pneumol 2021;47(4):e20210292.","journal-title":"J Bras Pneumol"},{"issue":"382","key":"e_1_3_2_19_1","first-page":"427","article-title":"A network algorithm for performing fisher\u2019s exact test in r \u00d7 c contingency tables","volume":"78","author":"Mehta CR","year":"1983","unstructured":"18.Mehta CR, , Patel NR. A network algorithm for performing fisher\u2019s exact test in r \u00d7 c contingency tables. J Am Stat Assoc 1983;78(382):427\u2013434.","journal-title":"J Am Stat Assoc"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1968.tb00759.x"},{"issue":"3","key":"e_1_3_2_21_1","first-page":"1","article-title":"Mice: Multivariate imputation by chained equations in R","volume":"45","author":"van Buuren S","year":"2011","unstructured":"20.van Buuren S, , Groothuis-Oudshoorn K. Mice: Multivariate imputation by chained equations in R. J Stat Soft 2011;45(3):1\u201367.","journal-title":"J Stat Soft"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1996.10476908"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.12.094"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2009.058271"},{"issue":"2","key":"e_1_3_2_25_1","first-page":"Cd001855","article-title":"Helmets for preventing head and facial injuries in bicyclists","volume":"1999","author":"Thompson DC","year":"2000","unstructured":"24.Thompson DC, , Rivara FP, , Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev 2000;1999(2):Cd001855.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2010.09.006"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1580\/08-WEME-OR-244R1.1"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.12.PEDS10415"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/0956797615620784"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000527"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsr.2018.10.006"},{"key":"e_1_3_2_32_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2013.00015"},{"key":"e_1_3_2_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-014-1171-9"},{"key":"e_1_3_2_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldac002"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4000249"},{"key":"e_1_3_2_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2010.08.009"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-011-0322-5"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1123\/jab.2014-0223"},{"key":"e_1_3_2_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/0001-4575(91)90045-7"},{"key":"e_1_3_2_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410120611"},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/450195"},{"key":"e_1_3_2_42_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027845"},{"key":"e_1_3_2_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546504264580"},{"key":"e_1_3_2_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-016-0586-4"}],"container-title":["Journal of Neurotrauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08977151261481327","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08977151261481327","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08977151261481327","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:32:18Z","timestamp":1793014338000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08977151261481327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":43,"alternative-id":["10.1177\/08977151261481327"],"URL":"https:\/\/doi.org\/10.1177\/08977151261481327","relation":{},"ISSN":["0897-7151","1557-9042"],"issn-type":[{"value":"0897-7151","type":"print"},{"value":"1557-9042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"08977151261481327"}}