The impact of motorcycle helmet use.

Mandatory motorcycle helmet-use legislation is supported by the high morbidity of motorcycle trauma and its cost to society. Opponents argue, however, that the majority of motorcycle trauma morbidity and costs are the result of injuries to body regions other than the head. Previous data do not address this argument because they fail to control for differences in non-head injury severity (i.e., kinetic impact) between helmeted and unhelmeted patients. This study investigates the impact of helmet use on the morbidity and cost of motorcycle trauma, after controlling for non-head injuries. A retrospective review of all patients admitted to Harborview Medical Center with motorcycle trauma from 1/1/85 to 1/1/90 was performed. Non-head injury severity was determined by calculating an ISS that did not include head injury. This non-head ISS was used to control for injury severity below the neck. Four hundred twenty-five patients were identified. Stratified analysis showed that helmet use decreased the need for and duration of mechanical ventilation, the length of ICU stay, the need for rehabilitation, and prevented head injury. Costs of acute care were significantly less in helmeted patients. Regression analysis, controlling for age, gender, and blood alcohol level (as well as non-head injury severity), confirmed that acute costs were 40% less with helmet use.     

Hospital cost is reduced by motorcycle helmet use

BACKGROUND: The purpose of this study was to identify the impact of motorcycle helmet use on patient outcomes and cost of hospitalization, in a state with a mandatory helmet law. METHODS: Patients admitted after motorcycle crashes from July 1996 to October 2000 were reviewed, including demographics, Injury Severity Score, length of stay, injuries, outcome, helmet use, hospital cost data, and insurance information. Statistical analysis was performed comparing helmeted to unhelmeted patients using analysis of variance, Student's test, and regression analysis. RESULTS: We admitted 216 patients: 174 wore helmets and 42 did not. Injury Severity Score correlated with both length of stay and cost of hospitalization. Mortality was not significantly different in either group. Failure to wear a helmet significantly increased incidence of head injuries (Student's test, p < 0.02), but not other injuries. Helmet use decreased mean cost of hospitalization by more than $6,000 per patient. CONCLUSION: Failure to wear a helmet adds to the financial burden created by motorcycle-related injuries. Therefore, individuals who do not wear helmets should pay higher insurance premiums.     

Protective effect of helmet use on cervical injury in motorcycle crashes: A case–control study

Introduction

Helmet use during motorcycle crashes (MCCs) has been shown to reduce traumatic brain injury and mortality. However, preventive effects of its use on cervical spine injury remain controversial. In this study, we evaluated whether helmet use can reduce cervical spine injury during MCCs.

Incidence, severity, and patterns of intrathoracic and intra-abdominal injuries in motorcycle crashes

BACKGROUND: Although severe head injuries have been reduced with helmet use, little has been done to address the severity of trauma to organs of the trunk in motorcycle crashes. We detail the frequency, severity, and pattern of intrathoracic and intra-abdominal injuries that may be helpful in the recognition and medical treatment of such injuries. METHODS: Diagnostic and treatment information from emergency room, hospital, and coroner records from a cohort of motorcyclists injured from 1991 to 1992 were obtained from 28 hospitals and 11 coroners in California. RESULTS: Multiple intrathoracic and intra-abdominal injuries were common, and the number and bilaterality of rib fractures were strongly associated with chances of injuries to the thoracic and abdominal organs. CONCLUSION: Patients with severe injury in one anatomic region of the trunk are very likely to have severe injuries in the same or other anatomic regions. These patients are best treated in trauma centers, where rapid diagnosis and treatment are possible.     

Association of age and severe injury in young motorcycle riders: A cross-sectional study from Karachi,Pakistan

IntroductionThe burden imposed by motorcyclist deaths and injuries is high in low- and middle-income countries. Many injured motorcycle riders in these settings are underage. The aim of this study was to assess the association between age and severe injury in young motorcycle riders.MethodsWe analysed road traffic injury surveillance data from the emergency rooms of five hospitals in Karachi from 2007 to 2015. We used logistic regression to assess the association of motorcycle riders’ age, categorised as underage (13-17 years), early licensing age (18-19 years) and late licensing age (20-24 years), with severe injury, defined as an Injury Severity Score (ISS) ≥ 16.ResultsThe study sample included 45,366 motorcycle riders. There were 10115 (22.3%) motorcycle riders aged 13-17 years, 9899 (21.8%) aged 18-19 years and 25352 (55.9%) aged 20-24 years. Almost all were male (99%). Being aged 13-17 years (adjusted odds ratio 1.25; 95% CI 1.11, 1.42) and 18-19 years (adjusted odds ratio 1.26; 95% CI 1.10, 1.43) were associated with higher odds of severe injury compared with being aged 20-24 years.ConclusionMotorcycle riders who presented to the hospital with injuries after road traffic crashes and were aged 13-17 years and 18-19 years had significantly higher odds of severe injury than those aged 20-24 years.     

The impact of helmet use on outcomes after a motorcycle crash

BackgroundHelmet use in a motorcycle collision has been shown to reduce head injury and death. Its protective effect on the cervical spine (C-spine), however, remains unclear. The objective of this study was to explore the relationship between helmet use and C-spine injuries.MethodRetrospective National Trauma Data Bank (NTDB) study. All motorcycle collisions between 2007 and 2014 involving either a driver or passenger were included. Data collected included demographics, vital signs, Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and specific injuries. The primary outcome was the prevalence of C-spine injuries. Secondary outcomes included were overall mortality, ventilation days, intensive care unit length of stay (LOS), total hospital LOS, and in-hospital complications.ResultsA total of 270,525 patients were included. Helmets were worn by 57.6% of motorcyclists. The non-helmeted group was found to have a higher incidence of head injury with head AIS > 2 (27.6% vs 14.8%, p < 0.001). Univariate analysis showed a higher prevalence of C-spine injuries in the non-helmeted group (10.4% vs 9.4%, p < 0.001), with a higher proportion of severe C-spine injuries with AIS > 2 (3.2% vs 2.6%, p < 0.001). Additionally, traumatic brain injury (TBI) was found to be two times higher in the non-helmeted group (20.7% vs 10.9%, p < 0.001). Multiple logistic regression showed helmet use to be an independent protective factor against mortality (OR = 0.832, 95% CI 0.781–0.887, p < 0.001). Although statistically significant in univariate analysis, helmet use was not associated with C-spine injuries after adjusting for relevant covariates. However, helmet use reduced the risk of severe head injuries by almost 50% (OR = 0.488, 95% CI 0.475–0.500, p < 0.001).ConclusionsHelmet use reduces the risk of head injury and death among motorcyclists; however, no association with C-spine injuries could be detected.     

Comparison of severity and pattern of injuries between motorcycle riders and their pillions: A matched study

Introduction

Motorcyclists and their pillion riders are the most vulnerable group of road users in Singapore, accounting for 50% of all road traffic accident fatalities in 2011. This study aims to compare the severity and pattern of injuries between matched pairs of riders and pillions.

Methods

Thirty-two matched pairs who presented to the A&E of an urban hospital from 1 August 2011 to 20 March 2012 were enrolled. Data were obtained from the hospital's trauma registry records, clinical records and accident victims were interviewed individually. Analysis was done using Stata 10 and considered rider-pillion pairs.

Results

Thirty-one pairs agreed to participate. There was no statistically significant difference in the ISS between riders and pillions (p = 0.25). There was no significant difference in the probability of survival, Revised Trauma Score, distribution of injuries, total duration of admission and ICU stay between riders and pillions. When one party of the matched pair sustained a head, face, thoracic, abdominal/pelvic, extremity or external injury, the likelihood that the other party had an injury in the same region was 31%, 14%, 10%, 14%, 56% and 68% respectively. Cohen's kappa values were 0.28, 0.15, 0.05, 0.17, 0.24 and −0.16 for the respective regions.

Discussion

By comparing the severity and pattern of injuries between naturally matched pairs on the same motorcycle, one can account for potential confounding by the type and impact of collision, rider experience, amount of time to availability of medical aid, and other factors that may influence the outcome. Our study shows no statistically significant difference in the ISS and distribution of injuries between riders and pillions of matched pairs. Therefore, future health and insurance policies should provide equal coverage for both riders and pillions. Medical practitioners should approach riders and pillions similarly as there is no significant difference in their injury distribution. When one party of a matched pair presents with a head, extremity or external injury, care should be taken to look for an injury in the same region in the other party.

Conclusion

Our study shows that there is no statistically significant difference in the ISS of riders and pillions. The pattern of injury is also similar. This study provides us useful information in the clinical management of motorcyclists and their pillions.     

The burden of unhelmeted motorcycle injury: A nationwide scoring-based analysis of helmet safety legislation

IntroductionMotorcycle collisions comprise a large portion of motor vehicle injuries and fatalities with over 80,000 injuries and 5,500 fatalities per year in the United States. Unhelmeted riders have poor medical outcomes and generate billions in costs. Despite helmet use having been shown to lower the risk of neurological injury and death, helmet compliance is not universal, and legislation concerning helmet use also varies widely across the United States.MethodsIn this study, we systematically reviewed helmet-related statutes from all US jurisdictions. We evaluated the stringency of these statutes using a legislative scoring system termed the Helmet Safety Score (HSS) ranging from 0–7 points, with higher scores denoting more stringent statutes. Regression modeling was used to predict unhelmeted mortality using our safety scores.ResultsThe mean score across all jurisdictions was 4.73. We found jurisdictions with higher HSS's generally had lower percentages of unhelmeted fatalities in terms of total fatalities as well as per 100,000 people and 100,000 registered motorcycles. In contrast, some lower-scoring jurisdictions had over 100 times more unhelmeted fatalities than higher-scoring jurisdictions. Our HSS significantly predicted unhelmeted motorcycle fatalities per 100,000 people (β = -0.228 per 1-point increase, 95% CI: -0.288 to -0.169, p < .0001) and per 100,000 registered motorcycles (β = -6.17 per 1-point increase, 95% CI: -8.37 to -3.98, p < .0001) in each state. Aspects of our score concerning helmet exemptions for riders and motorcycle-type vehicles independently predicted higher fatalities (p < .0001). Higher safety scores predicted lower unhelmeted fatalities.ConclusionStringent helmet laws may be an effective mechanism for decreasing unhelmeted mortality. Therefore, universal helmet laws may be one such mechanism to decrease motorcycle-related neurological injury and fatality burden. In states with existing helmet laws, elimination of exemptions for certain riders and motorcycle-type vehicles may also decrease fatalities.     

Child and adolescent traumatic brain injury: correlates of injury severity

A record review focused on children and adolescents, with a history of traumatic brain injury, who were consecutively admitted to a brain injury clinic in which all new patients are psychiatrically evaluated. Significant correlates of severity of injury in the cognitive, education and communication domains of functioning included Performance IQ but not Verbal IQ nor standardized ratings of language or learning disability. Current organic personality syndrome OPS but not attention deficit hyperactivity disorder or oppositional defiant disorder conduct disorder diagnostic status was signifi cantly related to severity. In conclusion, the findings in this referred sample are similar to prospective studies indicating that Performance IQ appears sensitive in reflecting brain damage. The finding linking OPS to severity of injury is not surprising. This is because OPS is a diagnosis which is dependent on the clinician s judgment of the likelihood that the organic factor is etiologically related to a defined behavioural syndrome. The diagnosis therefore requires a clinical judgment that the threshold of severity of a presumed organic etiological factor has been reached.     

The impact of a repealed motorcycle helmet law in Miami-Dade County

OBJECTIVE: To study the impact of helmet nonuse in motorcycle crashes after the repeal of a mandatory helmet law in the state of Florida. METHODS: We prospectively studied all patients evaluated at the University of Miami/Jackson Memorial Medical Center from July 1, 2000, through December 31, 2000, involved in motorcycle crashes, and compared them with those seen during the same time period the year before the helmet law change. RESULTS: In 1999, before the repeal of the helmet law, there were 52 cases evaluated at our center compared with 94 after the law change. Helmet usage decreased from 1999 (83%) to 2000 (56%). The number of brain injuries (Abbreviated Injury Scale score > or = 2) during this same time period increased from 18 to 35, and the number of fatalities from 2 to 8. CONCLUSION: The repeal of a motorcycle helmet law significantly increased the number and severity of brain injuries admitted to our trauma center.     

Injury patterns in motorcycle accidents

A retrospective study of 260 cases of motorcycle accidents which occurred over a 4 1/2 year period is reported. Approximately 8% died of their injuries. The vulnerability of the tibia to open fractures is noted, and the frequent association of these open injuries with severe contamination and devitalization of tissues resulting in a high complication rate. Severely comminuted intraarticular fractures of the distal tibia and radius were numerous, and one is tempted to name the injury the "motorcycle radius." Traumatic amputations were few and all involved the lower extremity. Fractures of the cervical and thoracic spine numbered only one each, but in each instance severe neurologic sequelae ensued. A plea is made for more accident prevention measures including protective equipment and driver education specific for the motorcyclist.     

Serious leg injuries in motorcycle despatch riders. An unacceptable occupational hazard?

In the 3 years up to the end of 1988, 18 of the 46 patients admitted with lower limb fractures following a motorcycle accident were despatch riders. Ten of the despatch riders were injured in the final year of the study. The nature of the injuries sustained, the reasons for their apparent frequent incidence and possible preventive measures are discussed.     

Factors associated with seatbelt, helmet, and child safety seat use in a spanish high-risk injury area

BACKGROUND: Focus of motor vehicle crashes death prevention is actually placed on preinjury period. The purpose of this study was to estimate predictors of using seatbelts, helmet and children safety seats. METHODS: Data from a cross-sectional survey was analyzed. The behaviors were explored as dichotomous variables. Multivariate logistic regression models are proposed to predict them. RESULTS: The educational level and community size measured by number of inhabitants were directly associated with all the behaviors studied. Females were more likely than males to use seatbelts and less likely to ride a motorcycle. Seatbelt and helmet use increased with age. Those exposed to both traffic in the city and on the road were more likely to use seatbelt and helmet than those only exposed in the city. Other variables included in any of the models were: being married or living with a partner, health-related variables as smoking habit, wealth-related variables as home ownership, and an ecological measure of wealth that is the average family income of the community. CONCLUSIONS: Protective device use is associated with sociodemographic, health, and wealth-related variables, and type of exposure to traffic. There are also ecological variables associated with the behaviors studied. These findings should be helpful for planning safer habits promotion programs. Further research, from the discourse analysis of people with different risk profile, should be performed to improve the understanding of the use of protective devices.