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Featured Article
Effect of Italy’s Motorcycle Helmet Law on Traumatic Brain Injuries
Servadei F, Begliomini C, Gardini E, Giustini M, Taggi F, Kraus J. Effect of Italy's motorcycle helmet law on traumatic brain injuries. Injury Prevention. 2003;9(3):257-260.
In Italy, mopeds – low powered two wheeled motorcycles – are ubiquitous. They are inexpensive transportation, and for the young, a first opportunity to be independent and mobile.
Italy had about 3.5 million motorcycles and 7.0 million mopeds in use in 2000. Two-wheeled motorized injuries were also great – there were annually about 385,000 motorcycle/moped crash injuries treated in emergency departments, 75,000 hospital admissions, and 1,500 fatalities (1).
Because of this high number of injuries and fatalities, a national law was adopted in March 2000, that made compulsory the use of an approved helmet for all motorbike, motorcycle, and moped drivers and their passengers, independent of their age. This law was a dramatic change from a 1986 law that required helmet use for all motorcycle drivers and for moped drivers only when less than 18 years old. This law proved difficult for the police to enforce, since they had difficulty determining the ages of moped riders. Also, the 1986 law was developed on the premise that older riders had an adequate perception of the risks and benefits of wearing crash helmets. Data from crash studies, however, show that the largest proportion of crashes involved riders over 18 years (2-4).
Dr. Franco Servadei, and his colleagues at the WHO Neurotrauma Collaborating Center, located in the Ospedale “M Bufalini”, Cesna, Italy, evaluated the impact of the 2000 universal helmet law both in terms of helmet use and changes in brain injuries. They carried out their evaluation in the Romagna region of Italy.
National Survey
The Italian National Health Institute conducted a national survey to measure helmet use. During a five-month period from February to June 2000, 57 local health care units conducted observational surveys, observing about 300,000 moped riders. After the law was passed in March 2000, the survey found that helmet use increased to 90-95 percent in northern and central areas of Italy, higher than wearing in southern Italy (50-70 percent), and significantly higher than pre-law rates.
Helmet Use in Romagna
Prior to the passage of the law, helmet use was 19.5 percent in a sample of more than 25,000 motorcycle and moped riders. Following passage, during a period of law enforcement, the usage increased to 97.5 percent in almost 40,000 riders.
Traumatic Brain Injury
Using data collected at a regional referral hospital for neurotrauma, Servadei and his colleagues evaluated the impact the law had on traumatic brain injury (TBI) by examining admissions and diagnoses of TBI during the one-year period prior to and after March 2000. During this period, the incidence of admissions decreased significantly by 31.4 percent. Measured using number of registered mopeds as the unit of exposure, rates declined from 63 per 100,000 registered mopeds to 43, a decrease of 31.7 percent.
EDITOR’S COMMENTS:
Although this study is limited to one region in Italy, it confirms findings from other countries that the universal wearing of helmets for moped and motorcycle rides results in a decrease of admissions and diagnoses for TBI (2-4). The study also confirms that a universal and enforceable helmet law increases helmet wearing rates remarkably.
REFERENCES
1. LaTorre G, Bertazzoni G, Zotta D, van Beeck E, Ricciardi G. Epidemiology of accidents among users of two-wheeled motor vehicles. A surveillance study in two Italian cities. European Journal of Public Health. 2002;12(2):99-103.
2. Romano PS, McClaughlin E. Helmet use and fatal motorcycle injuries in California, 1987-1988. J Head Trauma Rehabil. 1991 1991;6:21-27.
3. Clarke JA, Langley JD. Disablement resulting from motorcycle crashes. Disabil. Rehabil. 1995 1995;17:377-385.
4. Bjornsteg BL, Bylund PO, Lekander T, al. e. Motorcycle fatalities in Sweden. Acta Chirurgica Scandinavia. 1985 1985;151:577-581.
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