Sport-Related Traumatic Brain Injury with and without Helmets in Children

World Neurosurg. 2018 Mar;111:e434-e439. doi: 10.1016/j.wneu.2017.12.094. Epub 2017 Dec 23.


Background: Soccer, bicycling, and horseback riding are sports most commonly associated with traumatic brain injury (TBI) in Germany. The latter 2 sports activities are commonly practiced with helmets, and data on helmet use and usefulness vary widely.

Methods: On Ethics Committee approval, a retrospective analysis was performed for patients age 5-17 between January 2009 and August 2014 based on a diagnosis of TBI, using the electronic patient file for 2 university hospital locations. Descriptive data analysis and multivariate and univariate logistic regression were used to calculate odds ratios (ORs).

Results: A total of 380 children were identified, including 162 females (42.6%) and 218 males (57.4%), with a mean age of 11.9 ± 3.8 years. Activities included bicycling (n = 64), horseback riding (n = 19), and soccer (n = 16). Helmet use was documented in 26 patients (14 cyclists, 12 riders), and nonuse was documented in 20 (all cyclists). Compared with not wearing a helmet, wearing a helmet was associated with a trend toward lower odds of loss of consciousness (OR, 0.7; 95% confidence interval [CI], 0.18-2.52). A cohort of 251 patients with non-sports-related TBI (NSTBI) served as a control group for further analyses. Compared with the NSTBI group, the odds of amnesia were 2.9 times greater (95% CI, 1.1-21.6) in the patients with a riding-related TBI and 4.8 times greater (95% CI, 0.3-239) in those with a cycling-related TBI, and the odds of epidural hematoma were 2.2 times greater (95% CI, 0.4-12.3) in those with a cycling-related TBI and 4.9 times greater (95% CI, 0.5-50.4) greater in those with a soccer-related TBI.

Conclusions: We gained important epidemiologic data on pediatric TBI in our region. Despite the descriptive nature of the data, a trend toward reduced odds of loss of consciousness was seen in the helmet wearers. Nevertheless, serious injury can occur despite helmet use.

Keywords: Bicycling; Children; Helmets; Horseback riding; Soccer; Sports injuries; Traumatic brain injury.

MeSH terms

  • Adolescent
  • Athletic Injuries / epidemiology*
  • Athletic Injuries / prevention & control
  • Brain Injuries, Traumatic / epidemiology*
  • Brain Injuries, Traumatic / prevention & control
  • Child
  • Child, Preschool
  • Female
  • Germany
  • Head Protective Devices / statistics & numerical data*
  • Humans
  • Male
  • Retrospective Studies