News

When Margaret Keresteci's 19-year-old daughter went horseback riding in Ottawa last weekend, she was taken aback when asked to wear a protective helmet while on her trail ride -- it's not the law, and she had never been asked to sport one in the past.

But small moves such as this one are responsible for the significant decline the Canadian Institute for Health Information has charted in the number of people admitted to hospital for traumatic head injuries during the past decade, it says.

"To me, it spoke to the fact that people are thinking more consciously about prevention," said Ms. Keresteci, the lead investigator of CIHI's analysis. "We're seeing similar preventative measures in snowboarding, skiing, rock climbing -- the activities these kids are involved in."

In 2004, 16,811 people were admitted to hospitals for head injuries, down almost 35 per cent from 25,665 in 1995. The decrease is "extremely encouraging," Ms. Keresteci said, because, "normally in health care, we see changes that are incremental -- 5- or 10-per-cent improvement -- and we're usually encouraged by that."

Injuries among Canadians aged 19 and younger were cut in half during the same period, although they still made up the largest proportion of those hospitalized for traumatic head injuries in 2004 (30 per cent). Those 60 and older came in second with 29 per cent of all cases.

For Canadians as a whole, head injuries were most often caused by falls, followed by motor vehicle and bicycle accidents.

What was most alarming from the results of the CIHI study was that severe head injuries (for which people are normally admitted to an intensive-care unit or airlifted to a specialized trauma facility) went up by 46 per cent during the past decade. It will be important to pinpoint why this is, Ms. Keresteci said, because trauma to the head is unlike most other injuries.

"It's not like a broken arm where you go in, you get a cast, you come home and it eventually heals. Quite often with head injuries, even those that aren't that severe, there's really a life-long impact."

That can include cognitive impacts, which can affect career and education paths; physical impacts, which can require relearning skills such as speaking and writing; and behavioural impacts, which can lead to decreased attention spans and learning disabilities.

The health implications are that much more considerable in children, who are the most at risk for developing physical and behavioural disabilities from head injuries, according to a specialist at the Hospital For Sick Children's Safe Kids Network.

Head injuries have a greater effect on children because their heads are proportionately large for their bodies, "so when they fall, the head is the leading point of impact," said Laveena Sethia, a spokeswoman for Safe Kids Canada. They also have lower levels of development and may not have the skills that are necessary to navigate around traffic, she said.

Both Ms. Keresteci and Ms. Sethia attribute an increase in overall helmet use as a major factor in the improvement.

Mandatory-helmet laws have been implemented in six provinces -- British Columbia, Alberta, Ontario, New Brunswick, Nova Scotia and Prince Edward Island -- during the past decade. Only those under 18 in Ontario and Nova Scotia are required by law to wear helmets while cycling, but in the other four provinces, all cyclists must wear helmets.

"It's been shown in a Canada-wide, four-year study that head injuries among children and youth cyclists in provinces with helmet legislation are 25 per cent lower than those in provinces without any legislation," Ms. Sethia said.

Cycling was the leading cause of head injuries in those under 18, at 28 per cent, compared with 8 per cent in adults, because the human skull can survive the impact of going 7 to 10 kilometres an hour, but children often cycle at 11 to 16 km/h.

She said helmet legislation covering similar sports such as in-line skating and skateboarding could be beneficial, but it would take several years to see the effects of those laws in hospital admittance.