Background: In the last decade the number of traumatic head injuries (THIs) admitted to Newfoundland's main neurosurgical referral centers has noticeably declined, particularly those resulting from motor vehicle accidents (MVAs). Objectives: To describe the epidemiology of THIs over the period 1985-98 and to assess any relationship between the incidence of THIs and use of helmets, seatbelts and alcohol. To determine the occurrence of these preventative measures. Methods: The charts of 2,739 patients from the greater eastern area of Newfoundland were reviewed. Other etiological factors affecting the incidence of THIs such as animal attacks, fall, brawls, sports/play, abuse, pedestrians, moose-MVAs, plane crashes, explosions, suicide attempts, being struck with a foreign object and work injuries were also examined. Sex, age, dates of injury and admission, ICD codes assigned, physiological outcome, hospital outcome and geographic location of injury were also collected. Results: Falls accounted for 31.2 percent of all THIs; MVAs, the second most common cause, accounted for 27.4 percent of all THIs. Most injuries were incurred by people ages 15 and younger (26 %). They were typically male and lived in the urban eastern area of Newfoundland. Enforcement and legislation on helmet and seatbelt use and drinking and driving were temporally associated with the observed decline in THIs. A great deal of safety education and public awareness, however, is still needed
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