"Helmet use reduces head injuries by up to 60%"

A snowHead

PG, the problem is that interventions in complex systems with many contributing factors don't necessarily have predictable outcomes like that. Medicine isn't always that predictable, that's why we need to rely on research.

A snowHead

Kramer, I assume that when sufficient research is undertaken to reach a provable and widely accepted conclusion, us mere punters will told what the best advice is?

Well, the person's real but it's just a made up name, see?

rob@rar.org.uk, In the meantime I think I'll keep wearing my helmet - just to be on the safe side wink

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rob@rar.org.uk, I'm sorry if I've upset you in any way, I certainly didn't mean to.

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I have come to the tongue and cheek conclusion that helmets should be worn at all times in all places especially on the occasion when one goes to the pub and drinks a few too many.

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Sansman, But I'm guessing that a full-face helmet might be counter-productive in such a situation Toofy Grin

After all it is free

CASPAR, but that is certainly the reason that the Camelback drink system was invented.

Sansman, Indeed, but insufficient research has been carried out in relation to the wearing of helmets in pubs when drinking a few too many to validate their use in such situations wink

In fact, wearing a helmet in such a situation may been seen as aggressive and may actually make you more likely to suffer other injuries (especially to the neck when knocking back large ones).

*Ski* the Net with snowHeads

rob@rar.org.uk, I'm not criticising anyone's decision to wear a helmet, I'm just trying to illuminate the fact that the decision for most people is based on their feelings rather than rock solid evidence of their effectiveness.

My experience has been that people tend to hold their health beliefs very dear to them, and often when you challenge those beliefs people find it uncomfortable, because they often feel that we as doctors are criticising them for holding them, when in fact all I'm trying to do is illuminate some of the issues around the subject. Sometimes the only way to do this is by challenging the basic concepts of peoples beliefs.

As I said earlier in the thread, I don't criticise anyone for wearing a helmet, I wear one myself on occassion, but I do think that people need to know a little more about the decision that they are making, and I do think that governing bodies should hold off on asking for compulsory helmet wearing until the picture is a little more clear.

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lets face it.. it will follow this trend roughly..
helmets will be made compulsory for infants as some legal case will find an operator liable for not enforcing them on a nursery slope when a kid gets hurt or worse.. the logical course of events will eventually see them made compulsory for everyone..everywhere.. i wouldnt think for one minute that any of the helmet manufacturers would in any way at all want to encourage this sequence of events.. heaven forbid no

snow reports

Kramer, I don't know, I must be missing something here. The point I made in my last post early this morning was that a helmet cushions impact to a degree. It is designed in part for that purpose, in fact. Unsurprisingly.

When my head meets a solid object my brain is for a split second in 'freefall' and collides with my skull. The force of impact is governed by a number of factors (angle of impact, speed, density and/or velocity of object collided with, etc.)

The padding on the inside of a helmet will reduce the force of impact, except in extraordinary circumstances.

It may also prevent a sharp object from penetrating the skull.

Clearly if you are travelling at 60 mph and hit a tree or a rock head on, then you're a goner, helmet or not. But I'm not talking about the extremes. I'm interested in the mid range of speeds and force of impact where a well designed helmet might reasonably be expected to significantly lessen the force of impact and/or cause a sharp object to be deflected away from the bonce.

I'm far more likely to hit a rock or a tree at 10 or 20mph. If someone can explain to me how my helmet will not significantly increase the chances of avoiding brain trauma, please do. I'm not convinced by the torque injury argument at the moment, as helmets fit snugly and I'm finding it hard to imagine circumstances where it would be an important contributory factor in increasing the severity of an injury, without a chin guard. However even if that is the case, I will take some convincing that the risk of torque injury outweighs the beneficial effect in terms of impact injuries.

I've followed the studies as best I can. To me, on balance, they read pretty clearly in favour of wearing a helmet, and I can't say that I'm surprised.

PG, you cannot have an intervention without risk, it just doesn't happen with anything in health care, there is no such thing as a free ride. It's not an argument, it's a medical fact. With every intervention you have to assess the risk/benefit equation, this applies to motorcycle helmets, seatbelts, going to the gym, lowering cholesterol, everything.

With wearing a helmet, there is going to be a downside, it remains to be seen how large that downside is compared to the benefit, but it will be there, arguing against it is as futile as arguing against gravity. Now at the moment we are uncertain as to the amount of the risk, and the amount of the benefit, but there are suggestions from the studies that have been done that both are there to some extent, as we would expect.

In your theory above, the mistake that you make is to theoretically analyse one quality of wearing a helmet in isolation of all the others. This is a logical fallacy, because you have to look at the system as a whole and not just one beneficial part of it. There is no point in the helmet protecting your head if you die or are paralysed from a neck injury, the result is just the same. You may not be convinced by this argument, but there is evidence that it is an effect that needs to be investigated further, and so it cannot be discounted out of hand. Similarly there is evidence that wearing a helmet may put people at a higher risk of getting a more serious injury, possibly through the effect that it has on their behaviour, possibly due to the fact that they are less likely to have good peripheral vision as they are more likely to be wearing goggles, or possibly through some other hypothesis that we have yet to discover.

We can argue about the validity of each hypothesis for the downside until the cows come home, it doesn't matter, the downside is there, shown by some of the evidence so far, and cannot be ignored. The evidence from all three studies at the moment suggests that the benefits probably outweigh the risks, but it is not overwhelmingly conclusive. It remains to be seen whether this will be shown in future research, as mentioned before it hasn't yet with cycle helmets.

You know it makes sense.

Kramer, sorry but you have misread my points. There is no logical fallacy as I specifically went out of my way to stress that I had read those studies to which I have access, was taking the neck injury element into account, and was most certainly not "discounting it out of hand".

In my two posts I was inviting comment at least as much as stating a point of view, which you seem to have singularly failed to notice. Peripheral vision and behaviour are issues that have been raised in earlier studies - and we have discussed these before - but in the three I have seen either in detail or in precis form they are not found to be significant factors, relative to the suggested benefits of decreasing the severity of the impact injuries themselves through the wearing of a well-fitting helmet.

No one has stated that there is overwhelmingly conclusive evidence either way, least of all me, but I fail to be convinced by a reply that did not directly address the points I raised on the issue of force of impact, in any respect other than the glib suggestion that I was foolishly guilty of ignoring alternative possibilities.

My posts, to me at any rate, simply echo the study findings you yourself have suggested are the case. "The benefits probably outweigh the risks". That or the alternative conclusion, to a greater or lesser extent, is all a study of this nature is ever going to find anyway.

"Complex systems", "contributory factors", "predictability of outcome"? Somewhat patronising, your earlier post. I am as aware as you of the importance of these factors. In fact I could suggest that you have ignored your own advice by being somewhat selective in addressing the points I made, and in the manner of interpreting them.

Sorry but I have, in good faith, looked at all the arguments put forward, in this and previous threads, and politely raised issues that concern me. I was certainly not critical of your approach or views, but do not react well to being talked down to. (As you've probably noticed before) wink

.

Otherwise you'll just go on seeing the one name:

PG, I have neither talked down to you, nor patronised you, merely tried to explain the complexities of critical appraisal of a medical paper to you, something that I imagined that you don't know very much about, seeing as though you're not in the business. Sorry if this comes across as talking down, my intention was to try and explain things from the basics. Sorry to contradict some of the things that you write, but you are making some quite elementary EBM mistakes, and I have been trying to point out some of your errors as politely as possible. Perhaps if you could let me know your experience of critical reading of medical research, and practice of EBM then I could get the level correct, so that I don't come across as talking down? wink

In your example above, you ask

A snowHead

Kramer, I am a technical translator, qualified to post grad level. The subjects I specialise in require a similar level of understanding.

The only mistake being made is your jumping to conclusions about the thrust and content of my points. Your responses so far are hardly "evidence-based", and you have misunderstood the gist of my posts.

Your final point simply echoes my own. It is just stating the blindingly obvious. The only qualitative difference is that I appear more prepared to take the various study findings, on a broad level ("the benefits probably outweigh the risks" - your words), into account.

I am interested in the extent to which the wearing (and design specs) of a helmet will lessen the force of impact across a significant range of 'borderline' injuries, and thereby reduce the incidence of serious/fatal head trauma (fractures, severe concussion, brain trauma). I personally am not inclined to go faster while wearing a helmet, and I can hear perfectly well with the design I wear. Peripheral vision is fine, aided by the fact that I overcompensate by looking around before making changes of direction, particularly if the pistes are busy. I also believe that those who have grown up from an early age wearing a helmet all the time will be unlikely to suffer from the 'excess confidence' argument, and will have learned to compensate for any restricted vision and hearing. They represent an ever-growing proportion of snowsports practitioners.

I was, specifically, looking at an important factor that influences my personal choice of whether or not to wear a helmet. My vision and hearing are not impaired because of the care I take while skiing, and I get my pleasure out of carving my way down the hill - speed doesn't interest me.

The standard/quality of helmets currently in the marketplace is a key issue. Some years ago the specs were estimated not to provide significant protection over 12 mph (for direct impacts, protection from more or less glancing blows would be greater, but let's stick to the simple head-on crash with a solid object). Below 12 mph tests on cadavers in one US study were used to indicate how the helmets of that period either prevented or significantly improved the extent of trauma.

I'm not sure what protection manufacturers claim the current specs to provide. The 12 mph head-on impact figure dates back to 1997.

I presume that I am not alone, so the points I raised will be important to those who ski in a similar manner. I need to know whether the torque injury effect is more or less significant in relation to the importance of the range of impact injuries that could be lessened from hospital cases to bad headaches.

A snowHead

PG can I just clear up whether you are formally trained in the critical appraisal of medical research or not? If it's just an informal qualification, please could you clarify exactly what your experience in critical appraisal of medical research has been?

There's a funny thing about psychological effects, and that is, that when directly questioned, most people feel that they are immune to them, as they claim to compensate for them by changing the behaviour. It would seem that they act on a subconscious level, and nevertheless have an effect. I believe that very few, if any people are immune to these effects.

Once again by concentrating on the cadaver studies, you're concentrating purely on the physical protection aspects of helmets, whereas you have to look at all aspects of their function to get a meaningful answer, physical, psychological, and any other unknown effects. Cadaver studies are useful to identify aspects of injury biomechanics that may be useful in preventing injuries, but they are nowhere near definitive proof. Cadavers and living people act and react in very different ways. wink

Anyway, I'm sorry to keep on banging on about this, but to just concentrate on the effects of helmets reducing physical force on the head and brain without taking account of other factors is likely to lead to a misleading result, and so cannot really be considered to be good analysis.

Well, the person's real but it's just a made up name, see?

Kramer,

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In answer to your last question, the effects on headinjuries are very likely to outweigh the risk of neck injuries, although we cannot be sure. It is likely that the increased incidence of severe injuries that was shown in helmet wearers in one study was due to the fact that helmet wearers were a self selecting population who were likely to take more risks.

I'm not saying that wearing a helmet is the wrong thing to do, all I'm saying that some of the reasoning that people use to justify wearing them, and more importantly to influence other people wearing them doesn't always stand up to scientific scrutiny, and that this issue is far from decided yet, and we may well find out that they don't have an overall protective effect.

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Just one last point, as PP said in an earlier post, the studies so far have been grade 4 or 3b evidence at best, so very prone to giving incorrect or misleading results, and so have to be read with that in mind.

Then you can post your own questions or snow reports...

Kramer,

After all it is free

I use to ride my bike to work with no cycle helmet, until the day I got knocked off by a car comming up behind me, now I always wear one.
IF I had not jumped to one side therefore banging my head on the kerb the car would have ran over me, my good fortune. This was over 10 years ago, I still got a bad case of whiplash/stiff neck from the concussion. If I was wearing a helmet at the time the force mayhave lessened the neck truma as well as they are designed to absorb some of the impact.
I dont know if it would have made the difference but like I say I always wear one nowadays. Funny how I dont wear one on the slopes. rolling eyes

I feel safer and that is what counts in my book. Very Happy

Kramer,

Be sensible if your head is going to hit something it is better to have protection. The chances of it happening may be so small that as a person you decide not to wear a helmet (my choice) but if your head hits something hard you wish you were wearing a helmet. If the force is so great that you get neck damage due to the extra weight of the helmet then the more reason the helmet was needed.

Personally I do not agree with the argument that if you wear a helmet you become more reckless. I can see the argument in a car where you get the feeling of safety but there is too much exposure when skiing.

P.S I have no medical background however I have seen the damage a light blow does to an unprotected skull.

*Ski* the Net with snowHeads

Kramer, I'm sure you stated earlier that you have yet to actually read the latest American study, and have only seen the summary.

Nothing that I have written justifies your comment that I have "concentrated" on any single individual study. That is yet another mischaracterisation of my position.

There is a significant difference between discussing elements of a study, and concentrating or relying on it. By suggesting the latter, you have distorted the sense of my words. Frankly, as you have transformed what was a genuine query into some kind of medical third degree (a cheap shot), this is a complete waste of time and effort. Inferring that I lack methodological sophistication is equally cheap.

I wish to look at an element of the equation and you refuse to look at it in isolation, on the basis that to do so demonstrates some sort of inadequate analytical ability. Personally I prefer to resolve complex propositions and concepts into their elements. I have never suggested that other factors are not relevant - those are words you have put in my mouth.

You raise the question of the psychology behind my comments. I find that ironic. The irrationality involved in jumping to inappropriate interpretations of my posts, deliberately or otherwise, would worry me far more. I tend to overanalyse. You seem to want to pigeonhole me. Breaking down a study into its component parts is perfectly standard procedure, yet you consistently misrepresent my argument.

Sorry, but I've reread your previous comments and I still find them occasionally disdainful and condescending. There is clearly no point in continuing this farcical exchange any longer. You are welcome to the last word. I shall find some sensible answers elsewhere about the degree of protection provided by helmets in the range of scenarios that affect me.

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cmyers_uk I'm afraid that vastly oversimplifies the case.

Again we're getting bogged down in the details, but there is a study that seemed to show that helmet wearers were more likely to get involved in more serious injuries than non helmet wearers, and that they were more likely to die because of it, for an unknown reason. The study was not particularly powerful and is low grade evidence, but this issue needs more research, but until then we don't know exactly what the cause is, whether it is psychological or something else. The effect has been shown, it now needs to be explained or refuted. The psychological effect is one hypothesis for the cause, but that's not really important, what matters is that the effect is there and needs to be explained.

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PG I'm sorry that you read my answers that way and feel like that.

I am not saying that you have concentrated on one particular study, rather that-

Seriously heartfelt apologies to any and all that have felt offended by what I've written, not my intention at all.

You know it makes sense.

Otherwise you'll just go on seeing the one name:

I really must crack the whip and get the Chief Smilie Maker to build a Yawning smilie -

I've not read most of this thread so I'm not about to try to adjudicate on "how we got here". I suspect it was probably a topic of value once but the general tone of these last few posts is all too familiar and, I suspect, totaly tedious to any but a curator of early 21st century pedantry.

Topic locked on grounds that an unsafe proportion of recent contributions to this thread may exhibit symptoms of PMT.

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"Helmet use reduces head injuries by up to 60%"

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