To helmet or not to helmet: a global perspective on the bicycle compulsory protective helmet law.

OBJECTIVE Child injury from bike accidents is a significant component of morbidity, mortality, and health expenditure in many countries. Universal use of bicycle helmets by children could prevent between 135 and 155 deaths, and between 39,000 and 45,000 head injuries annually. Surprisingly, epidemiologic data indicate a worldwide low prevalence of helmet use. A global view on the law on the compulsory use of safety helmets involving 58 different countries is provided in order to bring this critical debate back to the table. METHODS A broad search using "bicycle-related injuries", "bicycle helmet", "bicycle helmet legislation" and "compulsory bicycle helmet law by countries" was performed in order to identify and select the most pertinent information on the issue as well as all the information available on bicycle helmet law by countries. RESULTS The papers identified permitted us to assess the main topics related to the use of bicycle helmets discussed over the years and that still relevant and without consensus even today, as well as alphabetically enlist the approach of 58 countries to the compulsory helmet law. CONCLUSIONS Our review on the many faces of the bicycle helmet use (pros and cons), personal aspects, head injuries, legislation, promotion, socioeconomic influence, and finally a global view on the law on the compulsory use of safety helmets allowed us to bring here many suggestions and a few conclusions, mainly that "to helmet or not to helmet" should not be a question anymore. A universal consensus on their compulsory use has to be achieved in order to improve children's safety.