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Author Notes:


BT, MA, KF, and AL conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript. YX and SG carried out the initial analyses and finial analysis for the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Thank you to Dr. Claudia Morris and Dr. Chris Rees for their non-financial support for this project. This study was funded in part by the Wilbur and Hilda Glenn Family Foundation. Thank you to the Trauma Registry at Children’s Healthcare of Atlanta.

The authors declare that there are no known competing interests or financial relationships relevant to this article to disclose.


Research Funding:

There has been no significant financial support for this work.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • COVID-19
  • Helmet
  • Bicycle
  • ATV
  • Pediatrics
  • RACE

Changes in pediatric injuries sustained while engaged in activities where helmet usage is recommended during the COVID-19 pandemic


Journal Title:



Volume 10, Number SUPPL 1


, Pages 38-38

Type of Work:

Article | Final Publisher PDF


Background: Unintentional injuries, including traumatic brain injuries (TBI), are the leading cause of pediatric morbidity and mortality in the USA. Helmet usage can reduce TBI incidence and severity; however, the epidemiology of pediatric TBI and helmet use is ever evolving. With lifestyle changes potentially accelerated by the pandemic, we predicted a decrease in helmet utilization with an associated increase in TBI during the pandemic compared to the pre-pandemic period. Results: There were 1093 patients that presented with AWHUR injuries from 2018 to 2020 with an annual increase from 263 patients in 2018 up to 492 in 2020. The most frequently implicated mechanisms included bicycles (35.9%), ATVs (20.3%), skateboards (11.6%), scooters (8.3%), and dirt bikes (7.4%). Unhelmeted patients increased from 111 (58.7%) in 2018 to 258 (64.8%) in 2020. There was not a significant difference in the proportion of injuries that were unhelmeted from 38.9% in 2018–2019 to 35.2% in 2020 (p = 0.30), as well as the proportion of head injuries from 2018 to 2019 (24.3%) to 2020 (29.3%) (p = 0.07). A significant increase was seen in neurosurgical consultation from 17 (6.5%) in 2018 to 87 (17.7%) in 2020 (p = 0.02). Notably, there was an increase in the percentage of publicly insured patients presenting with injuries from AWHUR during 2020 (p < 0.001); this group also had suboptimal helmet usage. Conclusion: This study found an increase in patients presenting with injuries sustained while engaged in AWHUR in relation to the COVID-19 pandemic. Concerningly, there was a trend toward decreased helmet utilization and increased injury severity markers. Further analysis is needed into the communities impacted the most by AWHUR injuries.

Copyright information:

© The Author(s) 2023

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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