WHILE MOST STUDIES OF youth-related motorcycle injury focus on death, a new report describes the significant burden of nonfatal traumatic brain injury in this population. An accompanying study shows that while younger motorcycle riders are required by law to wear helmets in 47 of the 50 United States, young cyclists in states that require helmets only for younger riders face a greater risk of traumatic brain injury than do young motorcyclists in states that require all riders, regardless of age, to wear helmets. The first study, released November 15 by Pediatrics, found that in 2006, among 12to 20-year-olds, motorcyclerelated crashes accounted for 5662 discharges from hospitals, representing 3% of injury hospitalizations among youths and 5% of traumatic brain injuries (Weiss H et al. Pediatrics. 2010;126[6]: 1141-1148). One-third of these motorcycle-related hospitalizations involved traumatic brain injury. Among patients with traumatic brain injury, the probability of long-term disability was 24%. Patients with traumatic brain injury were 3.6 times more likely to be discharged to a rehabilitation facility and more than 10 times more likely to die in the hospital than were patients admitted following a motorcyclerelated crash without traumatic brain injury. The authors based their findings on data from the 2006 Kids’ Inpatient Database, which is a sample of inpatient discharges for patients younger than 21 years from 38 states. The other study, by the same authors and also released November 15 by Pediatrics, found that in states with youth-specific laws requiring helmet use, risk of serious traumatic brain injury among the young was 38% higher than found in states with laws requiring all motorcyclists to wear helmets (Weiss H et al. Pediatrics. 2010;126[6]: e1589-e1595). The researchers used data derived from the 2005 to 2007 State Inpatient Databases of the Healthcare Cost and Utilization Project. Lead author Harold Weiss, PhD, MPH, a professor and director of the Injury Prevention Research Unit at the University of Otago’s Dunedin School of Medicine in New Zealand, said his team’s findings echo results from other studies, but move the discussion beyond tallying deaths to considering long-term disability. “The one thing we did that others have not is to look specifically at traumatic brain injury and long-term disability—you do not get long-term disability data from crash data,” said Weiss, who was at the Center for Injury Research and Control at the University of Pittsburgh during the study. For Jeffrey H. Coben, MD, director of West Virginia University’s Injury Control Research Center in Morgantown, the findings relating to state helmet laws are both compelling and disturbing. In the past, every state had laws requiring all motorcyclists to wear helmets, but today only 21 do, and 3 have no helmet regulations. “The bottom line is that injuries associated with motorcycle crashes among youth have continued to increase, and we know that many of the most severe injuries can be prevented with the use of helmets,” said Coben, who was not an author of the studies. The weakening of helmet laws in various states has contributed to the increase in severe brain injuries, he added. “Whenever the law is weakened to apply to only a certain portion of the population, helmet use rates drop down to about 50%, and a significant decrease [in helmet use] is seen among the young riders.” Anne T. McCartt, PhD, senior vice president for research with the Insurance Institute for Highway Safety, said