Nonhelmeted Patients Research Articles

Injury patterns and outcomes in motorcycle passengers.

Contemporary trauma literature on injuries to motorcycle passengers is scarce. The aim of this study was to examine the injury patterns and outcomes of motorcycle passengers with regard to helmet use. We hypothesized that helmet utilization affects both injury type and outcomes. The National Trauma Data Bank was queried for all motorcycle passengers who were injured in traffic accidents. Participants were stratified according to helmet utilization into helmeted (HM) and nonhelmeted (NHM) groups. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups. A total of 22,855 patients were included for analysis, of which 57.1% (13,049) used helmet. The median age was 41years (IQR 26-51), 81% were female, and 16% of patients required urgent operation. NHM had higher risk of major trauma (ISS > 15: 26.8% vs 31.6%, p < 0.001). The most frequently injured body region in NHM was the head (34.6% vs 56.9%, p < 0.001), whereas in HM patients was the lower extremities (65.3% vs 56.7%, p < 0.001). NHM patients were more likely to require admission to the ICU, mechanical ventilation, and had significantly higher mortality rate (3.0% vs 6.3%, p < 0.001). The strongest predictors of mortality were GCS < 9 on admission, hypotension on admission, and severe head injury. Helmet utilization was associated with decreased odds of death (OR 0.636; 95% CI 0.531-0.762; p < 0.001). Motorcycle collisions can lead to significant injury burden and high mortality in motorcycle passengers. Middle-age females are disproportionally affected. Traumatic brain injury is the leading cause of death. Helmet use is associated with decreased risk of head injury and death.

Outcome of head injury in motorbike riders.

To determine the impact of helmet wearing on traumatic brain injury. We analyzed 400 cases of traumatic brain injury (TBI) in motorbike riders with and without helmet, from July 2017 to December 2020 presenting to the neurosurgery department at Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan. The medical records were analyzed for CT scan findings, length of hospital stay, complications (mortality and disability), Glasgow Coma Scale (GCS) and Glasgow outcome score (GOS) at time of discharge. A total of 400 patients with head injury due to motorbike accidents were included and all were male patients. They were equally divided into two groups, 200 in Group-A (with helmet) and 200 in Group-B (without helmet). Majority of the unhelmeted patients i.e. 102 (51%), needed admission in the Intensive Care Unit (ICU) compared to 70 (35%) in helmeted. When comparing non-helmeted patients to helmeted patients, the total median length of hospital stay was greater among non-helmeted patients (10 vs 05 days). Mortality was higher among non-helmeted patients seen in 50 (25%) as compared to 14 (7%) in helmeted patients. Overall, the good outcome was observed in 119 (59.5%) patients in Group-A as compared to70 (35%) patients in Group-B while 81 (40.5%) showed bad outcome in Group-A and 130 (64%) in Group-B. The failure to wear a helmet was found to be strongly linked with abnormal neuroimaging more complications, poor outcome and lower GCS on discharge as compared to patients using helmet. Lack of helmet use is linked to abnormal brain imaging, more complications, and a longer stay in the hospital after a head injury.

Motorcycle crashes and upper extremity trauma.

Objectives: Upper extremity injuries following motorcycle crashes (MCC) incur increased healthcare costs and rehabilitation needs. We aim to characterize the epidemiology of MCC upper extremity injuries and identify factors that influence the severity of and cost of care for upper extremity injuries. Methods: We performed a retrospective cohort analysis of 571 patients with upper extremity injuries after MCC at a level 1 trauma center from 2002 to 2013. We collected data pertaining to demographics, helmet use, toxicology, bony injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hospital length of stay (LOS), and cost. Continuous variables were compared using t-test or Wilcoxon rank test, depending on data distribution, and dichotomous variables were compared using Pearson’s chi-squared or Fisher’s exact tests. Regression models were used to evaluate the effect of intoxication or helmets on injury location, severity, cost of care, and LOS. Results: The incidence of MCC upper extremity injury was 47.5%, with hand and forearm fractures the most common injuries (25.5% and 24.7% of total injuries). Intoxicated patients were more likely to have a high cost of care (p = 0.012), extended LOS (p = 0.038), plastic surgery involvement in their care (p = 0.038), but fewer upper extremity bony injuries (p = 0.019). Non-helmeted patients sustained less upper extremity bony injuries (p < 0.001) and upper extremity soft tissue injuries (p = 0.001), yet more severe injuries (ISS ≥ 30, p = 0.006 and GCS < 9, p < 0.01) than helmeted patients. Conclusion: Upper extremity injuries are common in motorcyclists. Despite vital protection for the brain and maxillofacial injury, helmeted MCC patients have an increased incidence of upper extremity injuries compared to non-helmeted patients, but overall have less severe injuries. Intoxicated patients have fewer upper extremity bony injuries, but the higher cost of care, and extended LOS. Therefore, even with the increased risk of injury helmets may expose to the upper extremity, helmets reduced overall morbidity and mortality. In addition to mandatory helmet laws, we advocate for further development of safety equipment focusing specifically on the prevention of upper extremity injuries.

Helmet shielding effect in mandibular fractures during road traffic accident.

Objective:The objectives of this study are to evaluate the proportion of helmeted and nonhelmeted patients sustaining mandibular fractures.Materials and Methods:A retrospective study was conducted on 200 patients reporting to oral and maxillofacial surgery (OMFS) unit, trauma center, and department of OMFS. A predesigned questionnaire was used to collect the necessary data. Patients were evaluated for age, gender, mode of transport (2/4 wheeler), presence of safety measure at the time of accident (helmet/seatbelt), maxillofacial injury in two wheeler (with helmet and without helmet), type of impact, and its association to maxillofacial fractures, particularly site of maxillofacial fractures. The association between mode of injury, presence of safety measures, impact type, and site of maxillofacial injuries was assessed using the Chi-square test. P < 0.5 was considered statistically significant.Results:The mean age of patients was 30 years, and approximately 92.5% of accidents patients were male. In this study, 35% nonhelmeted riders were reported head injury and 5% of the helmeted rider reported head injury. 54.5% of the patients suffered frontal impact, 28% collision, and 17.5% lateral slide collision. Head injuries are the main cause of death among the riders of all two wheelers. Lateral sliding collision injuries (17.5%) resulted 60.6% of the fractures mandible, 24.2% midface injury, and associated injury (15.15%).Conclusion:The use of helmet is strongly recommended to prevent head injuries and facial injuries. In the nonhelmeted riders in motorcycle accidents, the incidence of mandible fractures increases proportionally.

Severity and predictors of head injury due to bicycle accidents in Western Australia.

Head and face injuries are the second most frequently reported injuries among bicyclists. Recently, helmet usage has increased, and in some countries, helmet laws have been introduced. However, subsequent changes in the incidence and severity of traumatic brain injury (TBI) are unknown, and data on neurosurgical interventions are lacking. Therefore, we analyzed a cohort of bicyclists with TBI, in a state with an enforced helmet law, and compared our results with the available literature. Patient data of bicycle accidents that occurred between January 2008 and January 2015 were extracted from the state trauma registry, and the corresponding patient files and CT scans were comprehensively reviewed. Of the 1019 patients admitted due to bicycle accidents, 187 patients suffered from TBI. Most cases were mild; however, 72 involved intracranial hemorrhages. Of the TBI patients, 113 were wearing helmets. CT scans were performed on 168 TBI patients, 120 of whom had a Rotterdam CT score of 1, with no difference between helmeted and non-helmeted patients. Open head injury (p < 0.05) and epidural hematomas were significantly less frequent among helmet wearers (p = 0.03). Ten patients required surgery; helmet use and neurosurgical involvement were not significantly correlated. Patients who wore helmets were significantly less likely to suffer from epidural hematomas and open head injuries. While TBI severity was not significantly different between helmeted and non-helmeted bicyclists, the overall occurrence of TBI and moderate to severe TBI among all admissions was lower than that seen in comparable studies from countries without helmet laws.

Impact of helmet use on traumatic brain injury from road traffic accidents in Cambodia

ABSTRACTObjective: Rapid urbanization and motorization without corresponding increases in helmet usage have made traumatic brain injury due to road traffic accidents a major public health crisis in Cambodia. This analysis was conducted to quantify the impact of helmets on severity of injury, neurosurgical indication, and functional outcomes at discharge for motorcycle operators who required hospitalization for a traumatic brain injury following a road traffic accident in Cambodia.Methods: The medical records of 491 motorcycle operators who presented to a major tertiary care center in Cambodia with traumatic brain injury were retrospectively analyzed using multivariate logistic regression.Results: The most common injuries at presentation were contusions (47.0%), epidural hematomas (30.1%), subdural hematomas (27.9%), subarachnoid hemorrhages (12.4%), skull fractures (21.4%), and facial fractures (18.5%). Moderate-to-severe loss of consciousness was present in 36.3% of patients. Not wearing a helmet was associated with an odds ratio of 2.20 (95% confidence interval [CI], 1.15–4.22) for presenting with moderate to severe loss of consciousness compared to helmeted patients. Craniotomy or craniectomy was indicated for evacuation of hematoma in 20.0% of cases, and nonhelmeted patients had 3.21-fold higher odds of requiring neurosurgical intervention (95% CI, 1.25–8.27). Furthermore, lack of helmet usage was associated with 2.72-fold higher odds of discharge with functional deficits (95% CI, 1.14–6.49). In total, 30.1% of patients were discharged with severe functional deficits.Conclusions: Helmets demonstrate a protective effect and may be an effective public health intervention to significantly reduce the burden of traumatic brain injury in Cambodia and other developing countries with increasing rates of motorization across the world.

Effects of repealing the motorcycle helmet law in Michigan

BackgroundIn 2012, Michigan repealed its universal helmet law. Our study assessed the clinical impact of this repeal. MethodsOur trauma database was queried retrospectively for 2 motorcycle riding seasons before and 3 seasons after repeal. On-scene death data was obtained from the Medical Examiner. ResultsHelmet use in hospitalized patients decreased after the helmet law repeal. Non-helmeted patients had a significant increased rate of head injury. Non-helmeted patients were more likely to die during hospitalization. While, helmet use and drugs/alcohol status significantly affected the risk for head injury, only drug/alcohol had a significant effect on overall mortality. ConclusionsFollowing helmet law repeal, helmet use has decreased. Helmet status and drug/alcohol use was found to significantly increase risk of head injury. Although overall mortality was only affected by drug/alcohol use, non-helmeted patients did have a higher inpatient mortality. These findings deserve furthermore study and may provide a basis for reinstating the universal helmet law.

The effect of helmets on motorcycle outcomes in a level I trauma center in Connecticut

ABSTRACTObjective: The State of Connecticut has a partial motorcycle helmet law, which has been linked to one of the lowest helmet compliance rates in the Northeast. We examine the clinical and financial impact of low motorcycle helmet use in the State of Connecticut.Methods: A retrospective cohort study comparing the outcomes between helmeted and nonhelmeted motorcycle crash victims over a 12.5-year period, from July 2, 2002, to December 31, 2013. All patients who were admitted to the hospital after a motorcycle crash were included in the study. Patients were stratified into helmeted and nonhelmeted cohorts. Group differences were compared using t-test or Wilcoxon rank test for continuous variables and chi-square test for dichotomous outcomes. Regression models were created to evaluate predictors of helmet use, alcohol and drugs as confounding variables, and factors that influenced hospital costs.Results: The registry included 986 eligible patients. Of this group, 335 (34%) were helmeted and 651 (66%) were nonhelmeted. Overall, nonhelmeted patients had a worse clinical presentation, with lower Glasgow Coma Scale (GCS; P <.01), higher Injury Severity Score (ISS; P <.01), higher incidence of loss of consciousness (LOC; P <.01), longer intensive care unit (ICU; P <.01) admissions, and higher incidence of head (P <.01) or face injuries (P <.01). Nonhelmeted patients were also twice as more likely to die from their injuries (P =.04, odds ratio [OR] = 1.89, 95% confidence interval [CI], 1.02–3.45). Financially, nonhelmeted patients incurred mean hospital costs of $18,458, whereas helmeted patients incurred $14,970 (P =.18). ISS, GCS, and ICU length of stay were significantly correlated with increased hospital costs (P <.01). Not using a helmet was a significant predictor of mortality (P =.04) after adjusting for alcohol/drug use and age.Conclusions: Helmet use is associated with lower injury severity and increased survival after a motorcycle crash. These outcomes remained consistent even after controlling for age and alcohol and drug use. The medical and financial impact of Connecticut's partial helmet law should be carefully evaluated to petition for increased education and enforcement of helmet use.

Injury outcome among helmeted and non-helmeted motorcycle riders and passengers at a tertiary care hospital in north-western Tanzania

Motorcycle helmets have been reported to reduce the risk of death and head injuries following motorcycle accidents. The aim of this descriptive prospective study was to determine the injury outcome among helmeted and non-helmeted motorcyclists and passengers at a tertiary hospital in north-western Tanzania. A total of 654 patients involved in the motorcycle accident were studied. Of these, 468 (71.6%) were motorcyclists (riders) and the remaining 186 (28.4%) were passengers. The median age of patients at presentation was 26 years. Male outnumbered females by a ratio of 4.5: 1. Helmet use was reported in 312 (47.7%) patients. Non- helmeted patients were young compared with helmeted patients and this was statistically significant (p = 0.021). The rate of helmet use was significantly higher among motorcyclists than among passengers (p = 0.004). History of alcohol consumption prior to the accident was reported in 212 (32.4%) patients. The rate of helmet use was significantly low among alcohol consumers compared with non-alcohol consumers (p = 0.011). Lack of helmet use was significantly associated with abnormal head Computed Tomography scans, admission to the Intensive care unit, severe trauma, and worse traumatic brain injury severity (p < 0.001). Helmet use was significantly associated with shorter period of hospitalization and reduced mortality rate (p < 0.001). Motorcycle helmet use is still low in this part of Tanzania and this poses a great impact on injury outcome among motorcycle injury patients. This observation calls for action to implement more widespread injury prevention and helmet safety education and advocacy.

Helmet use among Alaskan children involved in off-road motorized vehicle crashes

BackgroundOff-road motorized vehicle crashes are a common source of trauma among Alaska children. Injury morbidity is worse in Alaska Native children than non-Native children, but the reasons are unclear.ObjectiveTo evaluate the differences in helmet use between the Native and the non-Native children, and to assess the impact of helmet use on injury patterns and outcomes.DesignThis retrospective cohort study identified patients aged 17 or younger admitted after all-terrain vehicle, snowmobile or motorbike injury between 2001 and 2011 from the Alaska Trauma Registry. Helmeted and non-helmeted patients were compared with respect to demographics, central nervous system (CNS) injury and the overall risk of death or permanent disability. Logistic regression was used to evaluate predictors of helmet use and the effects of ethnicity and helmet use on outcomes.ResultsOf the 921 injured children, 51% were Alaska Native and 49% were non-Native. Helmet use was lower among Native versus non-Native patients on unadjusted comparison (24% vs. 71%) and multivariable logistic regression (OR 0.17, 95% CI 0.11–0.27, p<0.0001). Prevalence of CNS injury was higher among Native children (39.7% vs. 30.4%, p=0.016). However, on logistic regression with adjustment for helmet use, Native ethnicity was not a significant predictor of CNS injury (OR 1.07, 95% CI 0.68–1.68, p=0.78), whereas helmet use was strongly protective against CNS injury (OR 0.28, 95% CI 0.18–0.44, p<0.0001) as well as death or permanent disability (OR 0.26, 95% CI 0.10–0.67, p=0.006).ConclusionsHelmet use is lower among Alaska Native children involved in off-road motorized vehicle crashes. These ethnic disparities in helmet use contribute to higher rates of CNS injury among Native children. Helmet use significantly improves overall outcome. Helmet promotion efforts should be expanded, especially in Native communities.

Helmet use is associated with safer bicycling behaviors and reduced hospital resource use following injury

While the efficacy of helmet use in the prevention of head injury is well described, helmet use as it relates to bicyclists' behaviors and hospital resource use following injury is less defined. The objective of this study was to compare the demographics, behaviors, hospital workups, and outcomes of bicyclists based on helmet use. This study was a subset analysis of a 2.5-year prospective cohort study of vulnerable roadway users conducted at Bellevue Hospital Center, a New York City Level 1 trauma center. All bicyclists with known helmet status were included. Demographics, insurance type, traffic law compliance, alcohol use, Glasgow Coma Scale (GCS) score, initial imaging studies, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), admission status, length of stay, disposition, and mortality were assessed. Information was obtained primarily from patients; witnesses and first responders provided additional information. Of 374 patients, 113 (30.2%) were wearing helmets. White bicyclists were more likely to wear helmets; black bicyclists were less likely (p = 0.037). Patients with private insurance were more likely to wear helmets, those with Medicaid or no insurance were less likely (p = 0.027). Helmeted bicyclists were more likely to ride with the flow of traffic (97.2%) and within bike lanes (83.7%) (p < 0.001 and p = 0.013, respectively). Nonhelmeted bicyclists were more likely to ride against traffic flow (p = 0.003). There were no statistically significant differences in mean GCS score, AIS score, and mean ISS for helmeted versus nonhelmeted bicyclists. Nonhelmeted patients were more likely to have head computed tomographic scans (p = 0.049) and to be admitted (p = 0.030). Helmet use is an indicator of safe riding practices, although most injured bicyclists do not wear them. In this study, helmet use was associated with lower likelihood of head CTs and admission, leading to less hospital resource use. Injured riders failing to wear helmets should be targeted for educational programs. Epidemiologic study, level III.

Helmeted vs Nonhelmeted

This article reports on a retrospective review of the outcomes from 2-wheeled vehicle accidents and the impact of helmet use or non-use. The authors focus on the state of Florida, which rescinded its mandatory motorcycle helmet law in 2000. In the 10 years since this change, helmet use has dropped dramatically, and motorcycle fatalities have increased rapidly. In this study, the authors analyzed all 2-wheeled vehicle accidents evaluated at a level 1 trauma center over a 5-year period (2005-2010), comparing all outcomes, costs, and insurance status for helmeted and nonhelmeted riders (n = 1,439). Outcomes were compared for baseline population statistics, Glasgow Outcome Scale score, cost of hospitalization, discharge outcome, and health insurance status. In the 1,331 patients with full data, 995 (74.8%) were involved in motorcycle accidents, 249 (18.7%) were involved in bicycle accidents, and 87 (6.5%) were involved in scooter/moped accidents. Overall, 749 riders were nonhelmeted and 582 were helmeted. In the motorcycle group, there were 522 helmeted and 473 nonhelmeted riders. For the population of bicycle riders, there were 204 male and 45 female riders. For all vehicle types, hospital charges were skewed to the right, with a few expensive stays raising the overall average. For motorcycle riders, the average and median charges were significantly higher in nonhelmeted patients. For bicycle and scooter patients, no statistical significance was found; however, overall maximum charges were greatest in the nonhelmeted patients. In regard to insurance status, overall, riders wearing helmets were significantly more likely to have insurance than nonhelmeted riders. The authors conclude that, for the largest population (motorcycle riders), the results clearly demonstrate that helmets are effective in decreasing mortalities and improving outcomes at discharge. Also, as expected from the mortality and outcomes data, helmets significantly reduce the hospital charges for motorcycle riders involved in accidents. In estimating the cost savings for motorcycle helmet use, the authors found an average cost savings per helmeted patient of $23,603. The authors conclude that the age and insurance exemption of the law should be revoked and a universal helmet law be reinstated in the state of Florida. Motorcycle helmets significantly reduce overall morbidity and mortality, improve discharge outcome, and are cost-effective in healthcare savings.

Motorcycle injuries as an emerging public health problem in Mwanza city, Tanzania: A call for urgent intervention

Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and are a common cause of road traffic injuries. The aim of this study was to establish the prevalence, injury pattern and treatment outcome of motorcycle injuries among patients presenting to Bugando Medical Centre in Mwanza, Tanzania, between March 2009 and February 2010. Data was collected using a pre-tested, coded questionnaire. A total of 384 motorcycle injury patients were studied constituting 37.2% of all road traffic injuries. Over two-thirds (69.5%) of the patients were males (Male: Female ratio = 2.3:1). The mean age of the patients was 25.7 years (range: 4-87 years). The majority of patients were businessmen and students accounting for 68.8% and 42.2%, respectively. Motorcyclists accounted for the majority of motorcycle injury patients (212, 55.2%), followed by passengers (130. 33.9%) and pedestrians (42, 10.9%). Helmet use was recorded in 87 patients (22.7%). Most patients (352; 91.7%) sustained blunt injuries. Musculoskeletal (extremities) and head injuries were the most common body region injured affecting 234 (60.9%) and 212 (55.2%) patients, respectively. The majority of patients (244; 63.5%) were treated surgically. Wound debridement was the most common (86.9%) procedure performed. The overall mean length of hospital stay (LOS) was 19.23 days (range= 1-120 days). The LOS for non-survivors was 5.6 days (range= 1- 25 days). Patients with major trauma (ISS > 16), severe head injury (GCS 3-8) and those with long bone fractures stayed longer in the hospital and this was significant (P-value <0.001). Mortality rate was 16.7% (64 deaths). Age of the patient, non-helmeted patients, major trauma (ISS > 16), admission systolic blood pressure <90mmHg, severe head injury (GCS <9), need for intensive care unit admission and need for ventilatory support significantly influenced mortality (P-value < 0.001). Motorcycle injuries constitute a major but neglected emerging public health problem in Mwanza City and continue to be one of the most common cause or agent of road traffic injuries. The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws.

Motorcycle Collisions Involving White-Tailed Deer in Central and Northern Wisconsin: A Rural Trauma Center Experience

Risk of deer motorcycle collisions (DMC) continues to increase in Midwestern and East Coast States and is a growing regional public health issue. We conducted a retrospective chart review of all motorcycle collisions involving animals over a 9-year period from October 1993 to October 2002. Data collected included Injury Severity Score (ISS), injury type, outcome, use of helmets/alcohol, time of year/day. Fifty-five DMC were identified, 49 drivers, and 6 passengers. ISS for helmeted patients was 6.02+/-4.6 and 17.6+/-14.9 for non-helmeted patients. There were 7 human fatalities (all without helmets). Of the 55 patients, 16% of those injured were intoxicated, without helmets, and had average ISS higher than those non-intoxicated. Head, chest and orthopedic extremity trauma accounted for >70% of injuries seen within the entire population. Incidence peaked in June/July, and 55% of the collisions occurred between the hours of 1800 and 2200. DMC are a significant public health issue in mid-western states. Education about helmet and alcohol use and safety on rural roads may be the best prevention. Continued research focusing on prevention is necessary.

48. Age, Sex, Ethanol Levels, and Helmet Use Among Injured Motorcyclists

Introduction: Previous studies of motorcycle injuries show that helmet use is associated with a decrease in head trauma. Understanding patterns of helmet use is important in selecting and assessing injury prevention strategies.Methods: All 470 motorcyclists presenting to either of two regional Level I trauma centers from 7/93 through 12/95 comprise this case series. Thirty-three patients were excluded due to unknown helmet use or outcome, and 50 due to age under 18 years (for whom helmet use was required by state law).Results: Of 386 patients, 42% wore helmets, and 58% did not, with no difference in the mean ages of the groups. 13% of patients were women (n = 50), and 10% were passengers (n = 38). Women were 25 times more likely than men to be passengers (95% CI: 11 to 50), and passengers were 5 times more likely than drivers to not wear a helmet (95% CI: 2 to 16). Helmet use was not related to sex, even when the data were controlled for driver vs. passenger. Of 265 patients assayed for ethanol, 30% had &gt;100 mg/dL, 7% had &lt;100 mg/dL, and 63% had none. Non-helmeted patients were 3.6 more likely than helmeted ones to have detectable ethanol (95% CI: 2.0 to 6.5), but there was no association with sex or age. The mean ethanol level was 80 mg/dL in non-helmet users, and 24 mg/dL in helmet users (p &lt;0.001). 39% of non-helmeted patients were legally intoxicated (ethanol &gt; 100 mg/dL), compared to 11% of helmeted ones.

Motorcycle Trauma in the State of Illinois: Analysis of the Illinois Department of Public Health Trauma Registry

Study objective: To assess the current morbidity and mortality of motorcycle trauma in the state of Illinois and, specifically, to assess the incidence and cost of head injury to motorcycle crash patients according to their helmet use. Design: Retrospective, cross-sectional examination of the Illinois Department of Public Health Trauma Registry, for which data are available from July 1, 1991, through December 31, 1992. Data are collected from all hospitals designated as Level I or Level II trauma centers in Illinois. Participants: All patients involved in motorcycle crashes and subsequently taken to a Level I or Level II trauma center in Illinois and entered into the trauma registry during the period studied. Results: Head injury, spinal injury, helmet use, demographic data, hospital charges, days in ICU, and source of payment were selected as outcome measures. During the 18-month study period, 1,231 motorcycle trauma patients were entered into the trauma registry. Eighteen percent were helmeted and 56.0% were nonhelmeted. In 26.0% the helmet status at the time of the crash was unknown. Thirty percent of the helmeted patients sustained head injury and 4% sustained spinal or vertebral injury, compared with 51% and 8%, respectively, for nonhelmeted patients. Nonhelmeted patients were significantly more likely to sustain severe (Abbreviated Injury Score [AIS], 3 or more) or critical (AIS, 5 or more) head injury. Patients with these serious head injuries incurred almost three times the hospital charges and used a disproportionately larger share of ICU days than those with mild or no head injuries. There was a trend toward greater use of public funds or self-pay status (no insurance) for payment of hospital charges in nonhelmeted patients. Conclusion: Motorcycle helmet nonuse was associated with an increased incidence of serious head injury. Motorcycle trauma patients with severe or critical head injuries used a significantly greater proportion of ICU days and hospital charges than those with mild or no head injuries. [Orsay E, Holden JA, Williams J, Lumpkin, JR: Motorcycle trauma in the state of Illinois: Analysis of the Illinois Department of Public Health Trauma Registry. Ann Emerg Med October 1995;26:455-460.]

A prospective study of the impact of helmet usage on motorcycle trauma

To determine the effect of the use of a motorcycle helmet on reducing the mortality, morbidity, and health care costs resulting from motorcycle crashes. A prospective, multicenter study of all eligible motorcycle crash victims. The emergency departments of eight medical centers across the state of Illinois, including representatives from urban, rural, teaching, and community facilities. All motorcycle crash victims presenting less than 24 hours after injury for whom helmet information was known. Data were collected from April 1 through October 31, 1988. Fifty-eight of 398 patients (14.6%) were helmeted, and 340 (85.4%) were not. The nonhelmeted patients had higher Injury Severity Scores (11.9 vs 7.02), sustained head/neck injuries more frequently (41.7 vs 24.1%), and had lower Glasgow Coma Scores (13.73 vs 14.51). Twenty-five of the 26 fatalities were nonhelmeted patients. By logistic regression, the lack of helmet use was found to be a major risk factor for increased severity of injury. A 23% increase in health care costs was demonstrated for nonhelmeted patients (average charges $7,208 vs $5,852). Helmet use may reduce the overall severity of injury and the incidence of head injuries resulting from motorcycle crashes. A trend toward higher health care costs was demonstrated in the nonhelmeted patients.