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									                                         EUROPEAN JOURNAL OF PUBLIC HEALTH 2002; 12: 99–103

                                                               I N J U R I E S

                  Epidemiology of accidents among
                 users of two-wheeled motor vehicles
                                      A surveillance study in two Italian cities

Background: This paper describes a study on the epidemiology of accidents among users of two-wheeled motor
vehicles in two Italian cities, Rome and Naples. Methods: A surveillance study was conducted, recruiting the victims
of accidents among users of two-wheeled motor vehicles, visiting the emergency departments of two Italian hospitals.
The registration form includes personal data of the involved person, circumstances of the accident, means of arrival

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at the hospital, type of vehicles involved, helmet use, and eventually third parties involved, and data on the specific
injury diagnosis. Results: 736 injured drivers of two-wheeled motor vehicles were investigated for the study (65.1%
males, 34.9% females). The mean age of the victims was 22.92 years; 42.9% of the injuries were the result of a
single accident. In 35.5% of the injuries cars were involved and in 8.6% of the cases there was a passenger included.
Only 12% of the injured people were wearing a helmet. Most of the lesions concerns the knee or lower leg (27.5%),
followed by the head (17.5%), elbow and forearm (8.8%), wrist and hand (8.6%), shoulder and upper arm (8.4%)
and ankle and foot (6.9%). Helmet use has a protective effect (OR=0.23), whereas accidents in Naples and during
dark hours are associated with an increased risk of head injury (respectively OR=1.93, and OR=1.46). Conclusion:
In this study the lower injury risk due to the use of the helmet on the frequency and severity of head trauma was
confirmed. Moreover, the results confirm that Emergency Departments can provide essential epidemiological
information, and they have already provided clear arguments in favour of extending the compulsory use of helmets
to people above 18 years in Italy.

                               Keywords: accidents, epidemiology, Italy, two-wheeled motor vehicle

R oad traffic accidents represent an important public
health problem in both industrialized1,2 and developing
                                                                             In Italy, however, the compulsory use of helmets has until
                                                                             recently (March 2000) been restricted to persons below
countries.3 In Italy, around 270,000 road traffic accidents                  18 years of age. Italy is therefore characterized by a con-
occur annually. In 1997 this resulted in 6226 deaths, more                   siderable delay in the implementation of a helmet law
than 20% of which were the result of an accident among                       covering the whole population in comparison to other
users of two-wheeled motor vehicles.4 The number of fatal                    industrialized countries. The absence of adequate surveil-
injuries related to the use of two-wheeled motor vehicles                    lance systems could have contributed to this delay,
in Italy is high in comparison to other industrialized                       because the magnitude of the problem of accidents among
countries and it is likely that many of these fatalites could                users of two-wheeled motor vehicles has not yet become
have been prevented. In particular, head injuries and                        clear. In Italy there is still no homogeneous system of
their negative consequences are largely preventable by                       notification of road accidents at Accident and Emergency
wearing a helmet, as has been demonstrated in several                        (A&E) departments. In order to study a possible solution
studies.5–10 Moreover, it has been established that the                      to this inadequacy, an original data collection exercise for
introduction of helmet laws leads to an increasing use of                    injury surveillance was initiated.
helmets and to a reduction of the number of hospital                         After validation of a registration form a descriptive study
admissions, serious accidents, and costs related to head                     was conducted on the epidemiology of accidents among
trauma.11–14                                                                 users of two-wheeled motor vehicles in two Italian cities,
* G. LaTorre1, G. Bertazzoni2, D. Zotta3, E. van Beeck4, G. Ricciardi1       Rome and Naples. The following specific questions were
1 Chair of Hygiene, University of Cassino, Italy                             addressed:
2 A&E Department, Policlinico Umberto I, University of Rome ‘La Sapienza’,
                                                                               What is the distribution of injuries treated at an A&E
Rome, Italy
3 Nuovo Pellegrini Hospital, Department of Neurosurgery, Naples, Italy         Department among users of two-wheeled motor vehicles
4 Department of Public Health, Erasmus University, Rotterdam, The              by age, sex, and type and severity of injury?
                                                                               Does this distribution differ between Rome and Naples?
Correspondence: Giuseppe La Torre, MD MSc, Chair of Hygiene,
University of Cassino, Viale Bonomi 8, 03043 Cassino (FR), Italy,              Does this distribution differ between helmeted and non-
tel. +39 776 299788, fax +39 776 299927, e-mail:             helmeted victims?                                            99
                                          EUROPEAN JOURNAL OF PUBLIC HEALTH VOL. 12 2002 NO. 2

       What is the impact of helmet use on the frequency and                   Coma Scale (GCS) was registered, adding information
       severity of head trauma in scooter drivers attending two                concerning level of consciousness and injury severity,
       hospitals in two big Italian cities?                                    through scores about conditions related to eye opening,
                                                                               verbal and motor response, with best conditions re-
  METHODS                                                                      presented by 14–15 scores.
      Study design and setting                                                 Additional data for persons admitted to hospital were
      A surveillance study was conducted, recruiting the                       collected in collaboration with the Health Management
      victims of accidents among users of two-wheeled motor                    Office with a second registration form that includes in-
      vehicles, visiting the emergency departments of two                      formation about length of hospital stay, hospital discharge
      hospitals (Policlinico Umberto I in Rome and Nuovo                       diagnoses, need of reabilitation, diagnostic procedures
      Pellegrini in Naples). These hospitals were chosen                       and surgical interventions.
      because of their size (the biggest hospital in Rome and the
      second largest in Naples) and their central location in                  Data analysis
      these cities.                                                            We composed frequency tables in order to describe the
      A pilot study of 1 month was conducted in December                       distribution of injuries among users of two-wheeled motor
      1998, in order to validate the registration procedures and               vehicles by several characteristics. The χ2 test was used in
      forms. The definite surveillance study covered a period of               order to find statistically significant differences between
      6 months in both hospitals, from January to June 1999.                   the epidemiology of accidents in Rome and Naples, at a

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      A case was defined as an injured driver of a two-wheeled                 level of p<0.05.
      motor vehicle, 14–35 years of age visiting the emergency                 Analysis of differences between helmeted and unhelmeted
      department of one of the two participating hospitals.                    riders, and between Rome and Naples with respect to age,
                                                                               were done using the Student’s t test. Relative risks (95%
      Data collection                                                          CI) were calculated to estimate an excess risk of being
      The data collection involved medical doctors specializing                injured at a specific body region in unhelmeted versus
      in Hygiene and Preventive Medicine, neurosurgeons and                    helmeted riders. A logistic regression analysis was used to
      general surgeons of the A&E Department in Naples, and                    estimate the influence of the following variables on head
      medical doctors, general surgeons and phycologists at the                injury: helmet use (yes vs no), location of accident (city
      A&E Department in Rome. The data were collected                          centre vs outskirts or rural), day (weekend vs working
      every day. Moreover, nurses of the A&E Departments                       days), season (winter vs spring), hospital (Naples vs
      were recruited for data collection in night hours (after 8               Rome), crash type (collision vs noncollision), visibility
      p.m.). In addition, for accidents that happened during the               (dark vs daylight), passenger transport (yes/not), sex
      night, there was a linkage with Hospital Police Depart-                  (female vs male), age-group (≥18 years vs <18 years). The
      ments in order to check the completeness of the data.                    entry method was used for the analysis, with a cut-off of
      The registration form filled in at the emergency depart-                 0.10 for the significance level. Data processing, para-
      ments includes personal data of the person involved,                     metric and non-parametric tests of significance, and
      circumstances of the accident, means of arrival at the                   logistic regression analysis were performed with SPSS
      hospital, type of vehicles involved, helmet use, and,                    statistical software.
      eventually, third parties involved in the accident. The
      form also includes data on the specific injury diagnosis,             RESULTS
      according to an ICD-10 matrix system of codes with                       Table 1 shows the distribution of injured scooter drivers
      several axes representing the location and the nature of                 and their helmet use, by city, age group and sex. A total
      injury.15 For patients with head trauma the Glasglow                     of 736 injured drivers of two-wheeled motor vehicles was

      Table 1 Distribution of injured scooter drivers and helmet use by hospital, age group and sex

                                           Rome                                                       Naples
                         M                           F                                M                            F
      Age            Helmet                       Helmet                          Helmet                       Helmet
      group        yes       no     injured    yes       no     injured         yes       no    injured   yes          no     injured   Total
      (years)      (%)       (%)      (%)      (%)       (%)      (%)           (%)       (%)     (%)     (%)          (%)      (%)      (%)
      14–17         5     12         17         4     19         23              4     90        94         0        23        23       157
                  (29.4) (70.6)      (7.3)    (17.4) (82.6)     (12.0)          (4.2) (95.8)    (38.4)     (0)     (100)      (36.0)    (21.3)
      18–23        18     61         79         8     55         63              0      88       88         0        26        26       256
                  (22.8) (77.2)     (33.8)    (12.7) (87.3)     (32.6)          (0)   (100)     (35.9)     (0)     (100)      (40.6)    (34.8)
      24–29        19         57     76         7     65         72              1     45        46         1            9     10       204
                  (25)       (75)   (32.4)     (9.7) (90.3)     (37.3)          (2.2) (97.8)    (18.8)    (10)         (90)   (15.6)    (27.7)
      30–35        13         49     62         7         28     35              1     16        17         0         5         5       119
                  (21)       (79)   (26.5)    (20)       (80)   (18.1)          (5.9) (94.1)     (6.9)     (0)     (100)       (7.8)    (16.2)

      Total        55        179    234        26        167    193              6        239   245            1       63      64        736
100                                                                                                                                     (100)
                                                                Two-wheeled motor accidents in Italy

covered in the study (65.1% males, 34.9% females)                                       a single accident, while in Naples cars were involved in
(table 1). Of these, 234 males and 193 females were from                                the majority of cases (table 2). Within our study popula-
Rome, and 245 males and 64 females from Naples (χ2                                      tion only 12% of injured people were wearing a helmet.
=47.3; p=0.000). The mean age of the victims was 22.92                                  Again we found a statistically significant difference between
(± 5.73) years and differed between Rome and Naples                                     Naples and Rome, with helmet use being more frequent
(Naples= 20.29 ± 5.17 and Rome 24.82 ± 5.36; t= –11.47;                                 in Rome (19%) (χ2 = 47.6; p=0.000). Moreover, we found
p=0.000): 21.3% were 14–17 years and 78.7% were 18–35                                   a statistically significant difference between the mean age
years of age (34.8% aged 18–23; 27.7% aged 24–29; and                                   of helmeted and unhelmeted riders (respectively 24.77 ±
16.2% aged 30–35). There was also a statistically signi-                                5.86 and 22.67 ± 5.67; t=3.24; p=0.001).
ficant difference between the two cities concerning the                                 In table 3 the distribution by location and nature of injury
month of the accident, this being more frequent during                                  is shown according to an ICD-10 matrix. More than a
winter time in Rome, and during spring time in Naples                                   quarter of the lesions concerns the knee or lower leg
(χ2 =137.75; p=0.000).                                                                  (27.5%), followed by the head (17.5%), elbow and fore-
Table 2 shows that 42.9% of the injuries were the result                                arm (8.8%), wrist and hand (8.6%), shoulder and upper
of a single road accident, without the involvement of                                   arm (8.4%) and ankle and foot (6.9%). A high frequency
other road users. On the other hand, in 44.6% of the                                    of contusions (59.9%) was observed in both hospitals,
injuries, cars were involved and in 3.7% of the cases there                             followed by abrasions (23.9%), dislocations, sprains and
was a passenger included (which is not allowed by Italian                               strains (6.6%), and open wounds (5.1%) (table 3). Table 4

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law). Again, it becomes clear that there are large differ-                              shows the frequency distribution of head trauma by nature
ences between Naples and Rome. It can be noted that in                                  of injury and city. It is clear that in Naples the share of
Rome almost two-thirds of the injuries were the result of                               severe injuries (fractures and blood vessel injuries) is
                                                                                        higher than in Rome (table 4). For what concerns GCS,
Table 2 Third parties involved in scooter accidents, by hospital                        all injured scooter drivers wearing the helmet had a score
                       Rome                    Naples                     Total         of 14–15, while for people not wearing the helmet, 0.6%
Third party
involved           n          %              n           %            n           %     and 3% had a score ≤13 in Rome and Naples, respectively.
No body           276      64.6               40        12.9         316     42.9       Again, there is a difference between the two cities, with
Car               117      27.4              211        68.3         328     44.6       the worst GCS scores being more frequent in Naples (χ2
Scooter                                                                                 =22.32; p=0.00017). Both in Rome and Naples no scooter
passenger          15         3.5            12          3.9         27       3.7       driver wearing a helmet had a GCS score under 14.
Others             19         4.5             46        14.9          65      8.8       Table 5 compares the risk of being injured at a specific
                                                                                        body region of helmet users and non-users respectively.
Total             427      58.0              309        42.0         736 100            Only head trauma seems to be influenced by helmet use,
                                                                                        with a nearly sixfold increase among non-users
χ = 201.96; p=0.000
                                                                                        (RR=5.73), while injuries to thorax, abdomen and ex-

Table 3 ICD-10 matrix indicating the distribution and severity of lesions of injured scooter drivers

                                                     Abdomen Shoulder                                              Knee
                                                     and lower    and   Elbow                  Wrist               and     Ankle Multiple
                                                    back, pelvis upper   and                   and      Hip and   lower     and   body
                       Head         Neck     Thorax and spine     arm  forearm                 hand      thigh      leg     foot regions Total (%)
Abrasion                 49                                     3             22       70       42        27      170       21       46    450 (23.9)
Contusion               201                        33          66            111       90       92        81      300       72       78   1124 (59.9)
Open wound               58                                     1                 3     2        8         3       14        6        2     97     (5.1)
Fracture                 14                         1                             8     3       15         2       18        8              69     (3.7)
sprain and strain                    63                         4             13                 4         4       15       21             124     (6.6)
Injury to nerves
and spinal cord
Injury to blood
vessels                   7                                                                                1                                  8    (0.4)
Injury to muscle
and tendon                                                                                       1         2                                  3    (0.2)
Crushing injury                                                                                                              1                1    (0.1)
Injury to
internal organs                                                 1                                                                             1    (0.1)

Total (%)               329          63            34          75            157      165      162       120      517      129      126    1877
                        (17.5)       (3.4)         (1.8)       (4)            (8.4)    (8.8)    (8.6)     (6.4)   (27.5)    (6.9)    (6.7) (100)
                                     EUROPEAN JOURNAL OF PUBLIC HEALTH VOL. 12 2002 NO. 2

      tremity occurred with identical frequency in helmeted               An adequate surveillance system may support policy
      and unhelmeted scooter riders (table 5). The results of the         decision making. Our findings on the lower injury risk
      logistic regression analysis are presented in table 6. Of the       arising from the wearing of helmets are in agreement with
      factors explored, three were significantly and inde-                existing literature. Helmet efficacy in head trauma pre-
      pendently associated with head injury, at the 0.10 level.           vention in accidents among two-wheeled motor vehicles
      Helmet use has a protective effect (OR=0.23; 95% CI:                has been supported by pre and post studies.1,7,12,17,18
      0.0263–0.4816), whereas accidents in Naples and during              Unhelmeted riders are more severely injured, nearly three
      dark hours are associated with an increased risk of head            times more likely to sustain head trauma and nearly four
      injury (respectively OR=1.93; 95% CI: 1.2377–3.0216;                times more likely to receive a severe or critical head injury
      and OR=1.46; 95% CI: 0.9419–2.2638). Type of day,                   than helmeted riders. The average hospital stay for un-
      season, crash, age and sex, and passenger transport were            helmeted motorcyclists is longer, and costs more per case,
      not significantly associated with head injury (table 6).            so helmet use is strongly associated with reduced
                                                                          probability and severity of injury, economic impact and
   DISCUSSION                                                             need for rehabilitation.9–11,13,19–24 Helmets prevent
    This study has produced information on the distribution               head injury in motorcycle and moped accidents,
    of injuries among users of two-wheeled motor vehicles in              especially in those crashes involving relatively low kinetic
    Italy, for a period of six months. It has shown that the              energy transfers. Moped accidents are so similar to motor-
    majority of victims is male (65%), older than 18 years                cycle accidents that it seems unjustified to regard mopeds

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    (80%) and not wearing a helmet (88%). It has also shown
    that the epidemiology of injuries may differ by city. In this      Table 4 Nature of head injuries by hospital
    study we found striking differences between Rome and                                     Rome                Naples         Total
    Naples, and this is very interesting considering that the                              n       %           n       %          n
    chosen hospitals have a central location in both cities,            Abrasion           23    16.4          26     13.8        49
    and that people attending the two hospitals are com-                Contusion          92    65.7        109      57.7       201
    parable. In Naples, for example, there are more cars                Open wound         21    15.0          37     19.6        58
    involved, the mean age of the victims is lower, injury              Fracture            4      2.9         10      5.3        14
    severity is higher and helmet use is even less frequent than        Injury to blood
    in Rome. These results suggest that the different road              vessels             0      0            7      3.7         7
    behaviours in the two cities may be due to different civic
    cultures. Finally, in our study the lower injury risk due to        Total             140                189                 329
    the use of the helmet on the frequency and severity of               2
                                                                       χ = 15.99; p=0.000
    head trauma was confirmed. Our study demonstrates that
    the observed differences in the rate of head injury among
    helmeted and unhelmeted scooter riders are not ex-                 Table 5 Percentage of injuries, by helmet use and body region
    plained by differing crash factors, such as type of crash,          Body region         Unhelmeted        Helmeted          RR
    localization, type of day and season, age and sex, and              Head                   26.42             4.61           5.73
    passenger transport.                                                Thorax                  2.39             2.05           1.16
    The results make it clear that injury surveillance systems          Abdomen                 5.28             5.64           0.93
    may produce valuable information. Surveillance can be               Extremity              90.50           87.69            1.03
    defined as ‘the ongoing systematic collection, analysis
    and interpretation of health
    data essential to the plan- Table 6 Results of the logistic regression analysis
    ning, implementation and Variable                                 B              SE          Sig            OR           95% CI
    evaluation of public health Helmet use                        –1.4552          0.3697      0.0001         0.2334      0.0263–0.4816
    practice, closely integrated City/rural                       –0.0233          0.1684      0.8901         0.9770      0.7023–1.3589
    with the timely dissemina- Winter/spring                       0.1949          0.1818      0.2837         1.2152      0.8509–1.7353
    tion of these data to those Weekend/working day                0.0870          0.2093      0.6776         1.0909      0.7239–1.6441
    who need to know’.16 Naples/Rome                               0.6595          0.2277      0.0038         1.9339      1.2377–3.0216
    Surveillance depends on Collision/non collision               –0.0609          0.2022      0.7634         0.9410      0.6330–1.3985
    the willingness of clinicians Dark/daylight                    0.3786          0.2237      0.0906         1.4602      0.9419–2.2638
    to cooperate in registration Passenger transport/not           0.1277          0.4029      0.7514         1.1362      0.5158–2.5027
    activities. In our study we Female/male                       –0.0256          0.1776      0.8856         0.9748      0.6881–1.3805
    found satisfactory complete- >18 years/<18 years               0.0924          0.2041      0.6508         1.0968      0.7352–1.6363
    ness of data collection, based
    on registration procedures Constant                           –1.0906          0.3595      0.0024
    and forms that were adjusted
    at the suggestion of Dependent variable = Head lesion
                                     –2 Log Likelihood 898.795
    clinicians during a pilot χ2 = 48.424, p=0.0000
102 study.
                                                  Two-wheeled motor accidents in Italy

as harmless ‘bicycles with a helper motor’. So the need for              4     ISTAT-ACI. Statistica degli incidenti stradali: anno 1997
                                                                      (Traffic accidents statistics: year 1997). Annuario, Roma; National
formal registration and helmet laws for mopeds is                     Institute of Statistics, 1998.
apparent.17 Compulsory helmet laws should therefore not                  5     Coleman P, Munro J, Nicholl J, Harper R, Kent G, Wild D.
be limited to motorcyclists but also focus on all moped               The effectiveness of interventions to prevent accidental injury to
                                                                      young persons aged 15-24 years: a review of the evidence. York:
riders, and probably also bicyclists.25                               Med Care Res Unit 1996:1-89.
But in spite of the great potential of wearing a helmet to               6     Cryer PC, Davidson L, Styles CP, Langley JD. Descriptive
protect road users from head injury, our study has shown              epidemiology of injury in the south east: identifying priorities for
                                                                      action. Public Health 1996;110:331-8.
a very low rate of helmet use among drivers of two-                      7     Guillen Grima F, Aguinaga Ontoso I, Aguinaga Ontoso E.
wheeled motor vehicles in Italy. There is a sort of hostility         Helmet use by drivers and passengers of motorcycles in Pamplona
towards the helmet, that is often considered ‘useless,                (Spain). Eur J Epidemiol 1995;11:87-9.
                                                                         8     Johnson RM, McCarthy MC, Miller SF, Peoples JB.
ridiculous, antiaesthetic, uncomfortable’ especially by               Craniofacial trauma in injured motorcyclists: the impact of the
young people.26 The scarce application of this correct                helmet usage. J Trauma 1995;38:876-8.
road behaviour reflects the fact that in our country only                9     Kelly P, Sanson T, Strange G, Orsay E. A prospective study
                                                                      of the impact of helmet usage on motorcycle trauma. Ann Emerg
the ‘threat for a severe accident’ and the ‘fear for a fine’          Med 1991;20:852-6.
seem to be efficient stimuli to persuade one to use                     10     Offner PJ, Rivara FP, Maier RV. The impact of motorcycle
helmets.27                                                            helmet use. J Trauma 1992;32:636-41.
                                                                        11     Kraus JF, Peek C. The impact of two related prevention
Our surveillance system suggests that Italian legislation             strategies on head injury reduction among nonfatally injured
on the compulsory use of safety helmets has so far been

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                                                                      motorcycle riders, California, 1991-1993. J Neurotrauma
applied insufficiently, which could in part be due to lack            1995;12:873-81.
                                                                        12     Marchi AG, Messi G, Porebski E, Loschi L. Evaluation of
of law enforcement by the police.                                     the usefulness of the motorcycle helmet in adolescents in Trieste.
But on the other hand, during our study period, a large               Minerva Pediatr 1989;41:329-33.
number of scooter drivers was still not obliged to wear a               13     McSwain NE jr, Belles A. Motorcycle helmets: medical
                                                                      costs and the law. J Trauma 1990;30:1189-97.
helmet : persons above 18 years of age. Our surveillance                14     Nurchi GC, Golino P, Floris F, Meleddu V, Coraddu M.
system suggests that this may have led to unnecessary                 Effect of the law on compulsory helmets in the incidence of head
health damage.                                                        injuries among motorcyclists. J Neurosurg Sci 1987;31:141-3.
                                                                        15     Larsen CF. The value of ICD-10 in producing AIS
As with all surveillance-based research, our study has                information. In: Rogmans WHJ, Mulder S. Measuring the severity
suffered from several limitations. First of all, not all factors      and costs of accidental injuries. Amsterdam: ECOSA, 1998.
that may influence the likelihood and severity of                       16     Center for Disease Control. Comprehensive plans for
                                                                      epidemiologic surveillance. Atlanta: Center for Disease Control, 1986.
accidents, such as speed at impact and alcohol concentra-               17     Matzsch T, Karlsson B. Moped and motorcycle accidents:
tion in blood, could be recorded. Secondly, the sample                similarities and discrepancies. J Trauma 1986;26(6):538-43.
selection at two hospitals ensures that all riders in this              18     Taggi F. Safety helmet law in Italy. Lancet 1988;1(8578):182.
                                                                        19     Chiu WT, Kuo CY, Hung CC, Chen M. The effect of the
surveillance study are injured. But, if helmet use is able to         Taiwan motorcycle helmet use law on head injuries. Am J Public
reduce injury severity, helmeted scooter riders are                   Health 2000;90(5):793-6.
probably underrepresented, which could have led to an                   20     Eldford RW. Prevention of motor vehicle accident injuries.
                                                                      In: Canadian Task Force on the Periodic Health Examination.
underestimation of the usefulness of wearing a helmet.                Canadian guide to clinical preventive health care. Ottawa: Health
Considering the results of this study conducted in only               Canada, 1994:514-24.
two Italian cities, the next step, in order to monitor the              21     Peek-Asa C, Kraus JF. Estimates of injury impairment after
                                                                      acute traumatic injury in motorcycle crashes before and after
epidemiology of scooter accidents, could be repeating the             passage of a mandatory helmet use law. Ann Emerg Med
study after the implementation of the new law on                      1997;29(5):630-6.
mandatory helmet use for the whole population, and                      22     Rowland J, Rivara F, Salzberg P, Soderberg R, Maier R,
                                                                      Koepsell T. Motorcycle helmet use and injury outcome and
implementing the surveillance system at the national                  hospitalization costs from crashes in Washington State. Am J
level. The results from this surveillance study have con-             Public Health 1996;86:41-5.
firmed that emergency departments can provide essential                 23     Sarkar S, Peek C, Kraus JF. Fatal injuries in motorcycle
                                                                      riders according to helmet use. J Trauma 1995;38:242-5.
epidemiological information,28 and, considering that                    24     Sosin DM, Sacks JJ. Motorcycle helmet-use laws and head
almost 80% of injured scooter drivers were 18–35 years of             injuriy prevention. JAMA 1992;267(12):1649-51.
age, they have already provided clear arguments in favour               25     Van Camp LA, Vanderschot PM, Sabbe MB, Delooz HH,
                                                                      Goffin J, Broos PL. The effect of helmets on the incidence and
of extending the compulsory use of helmets to people                  severity of head and cervical spine injuries in motorcycle and
above 18 years in Italy.                                              moped accident victims: a prospective aanalysis based on
                                                                      emergency department and trauma centre data. Eur J Emerg Med
 REFERENCES                                                             26     EURISPES. Due ruote con sicurezza: studio sulla prevenzione
                                                                      e protezione degli infortuni stradali su moto e motocicli (Safe
   1     Taggi F. Efficacia dell’uso del casco nella riduzione
                                                                      two-wheeled motor vehicles: study on the prevention of road
dell’incidenza e della gravità del trauma cranico secondario alla
                                                                      accidents with motorvehicles and scooter). Roma: Eurispes, 1984.
guida dei motoveicoli (Effectiveness of helmet use in reducing
                                                                        27     ISPO-ACI. La comunicazione sulla sicurezza stradale
incidence and severity of head injuries among motorcyclists).
                                                                      (Communication and road safety). Roma: Automobil Club Italy, 1999.
Proceedings of Stresa Conference, 88-99, 1997.
                                                                        28     Gorman DR, Ramsay LJ, Wilson GS, Freeland P. Using
   2     Van Beek EF, Van Roijen L, Mackenbach JP. Medical costs
                                                                      routine accident and emergency department data to describe
and economic production losses due to injuries in the
                                                                      local injury epidemiology. Public Health 1999;113:285-9.
Netherlands. J Trauma 1997;42:1116-23.
   3     Soderlund N, Zwi AB. Traffic related mortality in
industrialized and less developed countries. WHO Bull                 Received 15 August 2000, accepted 9 January 2001
1995;73:175-82.                                                                                                                                103

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