Primary prevention

Use of helmets during recreational activities has improved safety in the civilian population. Studies on sports such as rugby, cricket, American football, and ice hockey (where padded headgear may be used) have demonstrated a significant reduction in severe head trauma and skull and facial fractures.[16][17] Studies of recreational activities such as snowboarding, skiing, all terrain vehicle riding, and bicycling have also demonstrated a significant risk reduction in head trauma with helmet use.[18][19][20][21] Studies on helmet use in riders of bicycles, all-terrain vehicles, and motorcycles have consistently demonstrated a significant reduction in death and head injury.[22] In motorcycle riders who crash, a reduction of almost 70% of head injuries has been reported as a result of wearing helmets.[23][24]

However, data from the military have demonstrated a disturbingly high rate of traumatic brain injury, including skull fractures, even with the presence of personal protective gear, including helmets.[8] Gunshot wounds to the head in military personnel wearing helmets actually intensified rather than diminished the damage done by the missile and the severity of head injury.[25] A possible explanation is that combat-related head injuries often result from high-velocity missiles, or from explosions. High-velocity missiles will be able to penetrate more deeply through a helmet than low-velocity missiles. Even if a high-velocity bullet does not penetrate the helmet, the force behind the missile is capable of fracturing the skull through the helmet and injuring the underlying brain. Additionally, injury from explosions is, in part, caused by blast effect, and these pressure waves may not be stopped by personal protective gear.

Primary prevention policy to strengthen family functioning, such as intensive home-visiting programmes with parent training, may be beneficial.[26] Family-specific programmes for inflicted head injury prevention, involving educational videos in neonatal units with a signed agreement by parents not to shake their baby, have also shown some benefits.[27] Public and professional awareness campaigns may also be beneficial, although evaluation of effect is difficult.

Secondary prevention

Refer people with a head injury to investigate its causes and manage contributing factors, if appropriate. This could include, for example, referral for a falls assessment or to safeguarding services.[28] Ensure a clinician with expertise in non-accidental injuries in children is involved in any suspected case of non-accidental injury in a child.[28] See our topic Child abuse.

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