Motorcycle helmet use, incidence of head injury, and cost of hospitalization.

Abstract

Few public safety measures have aroused the controversy generated by mandatory motorcycle helmet legislation. Arguments against the legislation include restriction of hearing and peripheral vision allegedly caused by helmets, the relative lack of cervical spine protection afforded by helmets, and violation of the fundamental notion of freedom of choice for motorcyclists. Prompted by the reintroduction of mandatory helmet legislation in the California State Assembly, data from motorcycle accident casualties cared for at a designated trauma center were reviewed retrospectively. Trauma clinicians are well aware of the management dilemmas associated with severe head injuries. Despite significant developments in early recognition, rapid transport,’ and aggressive treatment, mortality from head injuries remains high.l Studies have shown that patients with head injuries generally have longer stays in both intensive care units and acute care hospitals2 The long-term care needs, limits of rehabilitation, and varying degrees of permanent disability add to the magnitude of this health care problem. The impact of helmet use on motorcycle casualties has been studied in several states; all studies that compared patients with helmets to those without have reported a higher incidence of head injury among nonhelmeted cyclists. Lloyd and associates3 reported on 160 patients in Texas and noted a head injury rate 2 to 3 times greater among nonhelmeted cyclists than those wearing helmets. Rivara and associates4 reviewed 100 patients injured in motorcycle crashes in Arizona; 57% of these patients sustained head injuries. Further, McSwain and Petrocelli’s review5 of motorcycle casualties in four states noted that head injury was more likely to be the most severe injury of the nonhelmeted cyclists. As expected, the patient groups with longer lengths of stay also have higher charges. When attempting to correlate injury severity with cost, O’Malley and associates2 demonstrated that cost is largely dependent on length of stay and they concurred with other investigators who have shown longer lengths of stay for head-injured-patients. Most authors focused the attention on acute care costs as represented by charges, but there also have been attempts to estimate long-term costs. Rivara and associates4 followed patients for a mean time of 20 months and noted that 23% of direct costs were for rehabilitation or readmission. The Arizona study also considered lost productivity and reported a number of patients on subsistence or disability programs after injury, none of whom had required public assistance before their injuries4 Using census reports for potential earnings in 1980, Lloyd and associates3 estimated the “social costs” to be $180 million. Although widely variable, these figures represent a range of total costs for head-injured patients not addressed by initial hospitalization charges.