OBJECTIVE: To establish the number of fatal pedal cycle accidents occurring in the Sheffield and Barnsley area, UK, and to investigate the possible benefits of helmet wearing by cyclists. DESIGN: All medicolegal investigations into fatal road traffic accidents in the areas of Sheffield and Barnsley (total population 757,300) were reviewed to identify cases in which pedal cyclists had died. The necropsy reports of the cases were compared with those of an equal number of controls (pedestrians and motor vehicle occupants) which were matched by sex, age and year of death. RESULTS: 28 deaths occurred in the last 15 years giving a mortality of 0.25/100,000 per annum, which is lower than the rate for the UK as a whole (0.43/100,000), but in five cases the accidents which eventually led to death occurred outside the area under study. These deaths represented 3.3% of road traffic deaths between 1979 and 1993. Over 80% of both cases and controls had severe head injuries, but the controls had suffered more fatal injuries to other parts of the body. None of the cyclists had worn helmets and, in order to assess the maximum possible benefit of helmet wearing, it was assumed that a helmet would have saved all those who only had head injuries. It was found that helmets might have saved 14 lives in 15 years. A similar calculation based on the controls suggests that if all pedestrians and vehicle occupants had worn helmets, 175 lives might have been saved in the same period. CONCLUSIONS: There is no justification for compelling cyclists to wear helmets without taking steps to improve the safety of all road users.
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