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are there any comparison studies that examine the severity of traumatic injury in incidents where riders are wearing helmets vs. not wearing helmets?

feeling safe and being safe are two very different things

This is a very important point.

severity of traumatic injury

Good question. I dont' completely understand the answer, though.

Some of this is that they want to compare "people with a certain seriousness of injury."

They want to say, "For those that were hurt bad this group had more head injury and this group had more non-head injury."

Rivara paper (ANTI-HELMET #1) and I'm guesing the others uses what appears to be this:

http://www.trauma.org/archive/scores/iss.html

Rivara puts the out come as binary, Good or Bad. Below a cutpoint is one category and "bad or dead" as the other.

My guess is this:

After you go to the ER?

They send you home or (maybe) keep you overnight? Good.

They send you to the operating room, multiple-day admission, or the morgue? Bad.

"Is he f*cked, yes or no?" They aren't cutting it much finer than that.

They have to be very careful. If a guy shows up with a broken arm and cracked tooth on a saturday night in Hospital A, he gets the same rating as a guy with the same busted arm and knicked tooth in Hospital B on Tuesday morning. Easy to say, hard to do.

The other papers are similar.

Robinson (ANTI-HELMET 2) Looked at guys that were admitted - that is, anyone the ER wouldn't send home. ("Does he walk away? Yes/no?")

His question: The guys with helmets that didn't walk out of the ER? What percentage of them went to neuro? (versus, say, had to have their legs fixed)

Robinson is pretty clear: The same percentage as guys without helmets that didn't walk out of the ER and went to neuro.

The guys that oppose Robinsons results? They say, "We passed the helmet law and now we have fewer head injuries in bikers."

Sounds good, yes?

Robinson says, "All at the same time, you passed the helmet law, you lowered the DUI cutpoint, you started enforcing the DUI and speeding laws, you redesigned the roads, and now you have fewer head injuries in bikers. Sure. What is it you can say about helmets?"

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There are better ways to do it, but they are very difficult, expensive, and time-consuming to do. Have trained medical staff chase around every brained-damaged bike messenger in the country for a few years.

Mick, thanks for all your time looking in to this. I know I FEEL safer with a helmet, science or no. As for Denmark, etc. most of the video I see is of cyclist going way below 15(?) MPH. Maybe a helmet is only (statisticly) good above a determined risk level - sorta like fire sprinkelers in commercal buildings.

"We passed the helmet law and now we have fewer head injuries in bikers."

This is what's called "time-trend analysis" and it's very tricky to do it right. Too much of the time, people who use this already have a foregone conclusion. Their mind is made up, don't confuse them with none of that there fancy thinking. Or worse, they know that the analysis is flawed but they're using a bogus analysis to push their own agenda.

A classic example is the Pastafarians' famous analysis of the cause of global warming. They put it down to a shortage of pirates. Fewer pirates, higher global temperatures, QED.

Of course, it's an easier tactic when the conclusion is politically comfortable.

if you FEEL safer, that means absolutely nothing; when someone rolls over you because they dropped their cig in their lap or had to look "real quick" at who was calling them on the phone, how safe are you?

a more important concept to understand than wearing a helmet is to avoid being a sitting duck allowing your life to be placed into someone else's hands other than your own.

If you think there's a way you can "avoid being a sitting duck" you're delusional. There are certainly things you can do to reduce your risk but the reality is as long as you're on the road you're constantly just a dropped cig or quick phone check or tangled flip-flop away from oblivion, and your life is very much in the hands of everyone that passes you.

FWIW, I have no idea if wearing a helmet is ever going to do me one bit of good, but I wear one anyways.

On another note -- there is a lot of research on the prevention of TBI through helmet use in various sports: hockey and football, mostly, but I'm sure there are others. Skiing, maybe. Isn't any of that relevant to cycling?

Also, there is an increasing amount of data that suggest that even minor brain injuries can have lasting consequences, particularly if repeated. Minor, in the sense that you don't even go to the ER at all. Granted, this isn't the statistic that the fanatics crow about, but it's "common sense".

This looks like it might be an interesting overview of time-trend analysis -- if you're at Pitt. http://www.jstor.org/pss/30141214

@salty: you may not be able to completely avoid being a sitting duck, but you can still avoid being a sitting to as great an extent as possible. No reason not to learn how.

Well, maybe this is a different thread, but what are your suggestions to avoid the types of situations that unixd0rk described?

I certainly think there are plenty of things you can do to make you a safer rider, from the routes you select to your lane position to assuming every car you see is going to pull out or turn in front of you. But, even that is impractical to some extent, unless you're planning to stop at every intersection and let all the cars go first, you're still at risk.

Distracted drivers running you over is another issue, though. Considering even a "good" pass isn't that far from being run over, I don't think it's practical to assume you'll be able to notice the car is going to hit you in time to be able to get out of the way. Thankfully, this type of accident is rare (although we've heard here about two fatalities in the past month - Don Parker and John Anczarski), but I honestly don't think there's much you can do to protect yourself. And that's not even considering things like the psycho in SF who went around hitting people deliberately.

Of course, all of this applies to a lot more than just cyclists getting hit by cars. There's risk in everything, and not all of it is completely under our control.

Personal helmet use has kept me out of the hospital story:

I was riding to work sometime in winter a few years ago and hit a patch of black ice. I went from riding to back-of-the-head-hit-the-asphalt in like two seconds. The impact was hard enough to cause me to phase out for a second like a radio going out of tune. Closest analogy I can recall it to is being hit in the back of the head with a bat (which I have) If I hadn't worn a helmet I imagine it would have been a lot lot lot worse. After a motorist stopped and asked if I was okay, I got off the ground and continued to work.

When I was younger (a freshman in high school) I didn't wear a helmet.

One time cycling home from school after a field trip I went unconscious while riding and landed face first in asphalt. Half my face was dead skin and I probably had some kind of minor concussion, had an ambulance ride, x-rays, and had to deal with my family asking me stuff like my name every two hours and had what felt like the worst hangover ever for two days. Also had to apply anti-bacterial cream to my face for like a week while the skin healed.

So if you're considering not wearing a helmet, I would recommend reconsidering. Also factor in that these studies probably don't pick up all the instances like mine where I (or other people) didn't go to a hospital and didn't report "Hey, my helmet worked!"

I used to think "Hey, I know what I'm doing, I don't need a helmet" but often times when you need the helmet, the reasons that caused the need are out of your control

Salty, the cig in the lap or the hornet in the cabin are hard to take preventative action for. Some people recommend using a mirror and being aware of the erratic behavior behind you and heading for the ditch, but I think these are pretty rare. However, the "eyes off the road" distracted driving is something we can influence, imperfectly. Motorists choose when to be distracted by things. They choose a time when they expect there to be nothing happening that requires their attention. (If you sit at a highway onramp, I'll wager you never see someone texting.) But they make this choice with about five neurons. So it's easy for them to unconsciously discount a cyclist as being irrelevant. It's important for us to dscourage them from discounting us.