Objective. To estimate the potential benefit of increasing bicycle helmet use among children and adolescents in the United States.

Design. All bicycle-related deaths (Multiple Cause-of-Death Public Use Data Tapes, 1989 through 1992) and bicycle-related injuries treated in sampled emergency departments (National Electronic Injury Surveillance System, 1989 through 1993) were used to calculate traumatic brain injury-associated death and head injury rates per 1 000 000 US residents. Preventable injuries and deaths were estimated by calculating the populationattributable risk of head injury due to nonuse of bicycle helmets.

Patients. US residents aged 0 through 19 years who were injured or who died as a result of a bicycle crash.

Results. An average of 247 traumatic brain injury deaths and 140 000 head injuries among children and adolescents younger than 20 years were related to bicycle crashes each year in the United States. As many as 184 deaths and 116 000 head injuries might have been prevented annually if these riders had worn helmets. An additional 19 000 mouth and chin injuries were treated each year. The youngest age groups had the highest proportions of both head and mouth injuries.

Conclusion. There continues to be a need to advocate for greater use of bicycle helmets, particularly among young children. Helmet design changes should be considered to prevent mouth injuries.

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