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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Emergency Medicine 1/2014

The effect of motorcycle helmet type, components and fixation status on facial injury in Klang Valley, Malaysia: a case control study

BMC Emergency Medicine > Ausgabe 1/2014
Roszalina Ramli, Jennifer Oxley, Peter Hillard, Ahmad Farhan Mohd Sadullah, Roderick McClure
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-227X-14-17) contains supplementary material, which is available to authorized users.

Competing interests

There were no competing interests during the conduct of this study.

Authors’ contributions

RR and RM designed the study, guided data collection and designed the analysis and revised the paper. RR designed the data collection tool, collected data for the whole study and trained the contracted staff who collected data in one hospital, analyzed the data, drafted and revised the paper. JO contributed to all aspects of the design and conduct of the study, guided data collection and revised the draft. PH and AFS contributed to specific aspects of the design and conduct of the study in accordance with their specialist expertise and contributed to the review and revisions of the paper. All authors read and approved the final manuscript.



The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.


755 injured motorcyclists were recruited over a 12-month period in 2010–2011 in southern Klang Valley, Malaysia in this case control study. Of the 755 injured motorcyclists, 391participants (51.8%) sustained facial injuries (cases) while 364 (48.2%) participants were without facial injury (control). The outcomes of interest were facial injury and location of facial injury (i.e. upper, middle and lower face injuries). A binary logistic regression was conducted to examine the association between helmet characteristics and the outcomes, taking into account potential confounders such as age, riding position, alcohol and illicit substance use, type of colliding vehicle and type of collision. Helmet fixation was defined as the position of the helmet during the crash whether it was still secured on the head or had been dislodged.


Helmet fixation was shown to have a greater effect on facial injury outcome than helmet type. Increased odds of adverse outcome was observed for the non-fixed helmet compared to the fixed helmet with adjusted odds ratio (AOR) = 2.10 (95% CI 1.41- 3.13) for facial injury; AOR = 6.64 (95% CI 3.71-11.91) for upper face injury; AOR = 5.36 (95% CI 3.05-9.44) for middle face injury; and AOR = 2.00 (95% CI 1.22-3.26) for lower face injury. Motorcyclists with visor damage were shown with AOR = 5.48 (95% CI 1.46-20.57) to have facial injuries compared to those with an undamaged visor.


A helmet of any type that is properly worn and remains fixed on the head throughout a crash will provide some form of protection against facial injury. Visor damage is a significant contributing factor for facial injury. These findings are discussed with reference to implications for policy and initiatives addressing helmet use and wearing behaviors.
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