Lastfogel J, Soleimani T, Flores R, Cohen A, Wooden WA, Munshi I, Tholpady SS. Helmet Use and Injury Patterns in Motorcycle-Related Trauma. JAMA Surg. 2016;151(1):88-90. doi:10.1001/jamasurg.2015.3225
Wearing a motorcycle helmet has been shown to decrease the number of injuries and the mortality rate associated with motorcycle-related trauma.1 Once almost universal, many states have regressed to partial or no helmet laws.2 This changing legislation has provided opportunities for study that clearly indicate the reduction in mortality benefit of helmet use. Although beneficial, helmet use could possibly lead to changes in injury patterns that have been previously undescribed. Using data from the National Trauma Database, we performed a comparative analysis to evaluate the injury patterns, surgical indications, and costs of hospital admission for helmeted and unhelmeted riders.
The 2007-2010 National Trauma Database was used to identify patients with motorcycle-related trauma via International Classification of Diseases, Ninth Revision (ICD-9) codes (E-codes E810-E819, fourth digit 2 or 3). A total of 85 689 patients were identified; those who died were not excluded. The ICD-9 codes were used to identify patients who underwent surgery. Independent variables included helmeted vs unhelmeted rider, ethnicity, sex, alcohol abuse, and tobacco use. The Abbreviated Injury Scale score was used to evaluate patterns of injury in 4 areas: head and neck, trunk, spine, and extremities. The outcome variables were the total length of stay, the number of days in the intensive care unit, and the number of days on a ventilator. Statistical evaluation was performed using SAS version 9.3 (SAS Institute). The National Trauma Database contains deidentified data and does not require institutional review board approval.
Alcohol abuse and tobacco use are both independently correlated with a decrease in helmet use. Those with private insurance had the highest percentage of helmet use, with self-pay patients being the highest percentage of unhelmeted riders (Table 1).
The Abbreviated Injury Scale scores of subgroups of patients were used to evaluate patterns of injury for helmeted and unhelmeted riders. As expected, the incidence of head injury was higher among the unhelmeted riders (63.81%) than among the helmeted riders (38.95%). In comparison, helmeted riders had higher rates of thoracic injury (47.76%) and extremity injury (80.18%) than did unhelmeted riders (42.05% and 70.46%, respectively) (Table 1).
Differences in total length of stay, number of days in the intensive care unit, and number of days on a ventilator were small. Unhelmeted riders in both categories had slightly longer lengths of stay and increased numbers of days in the intensive care unit (Table 2).
The ICD-9 procedure codes were used to capture the number of patients requiring surgical therapy in various categories. Orthopedic procedures were the most common surgical indication, with helmeted riders undergoing more orthopedic procedures than unhelmeted riders (35.7% vs 30.0%). A greater percentage of unhelmeted riders required surgery in most of the other categories evaluated (Table 2).
In the present study, alcoholism and tobacco use were both independently associated with a decrease in helmet use. This correlation has been shown in previous studies.3,4 Unhelmeted riders were more likely to either self-pay or be covered under government insurance. These trends may reflect a tendency to engage in high-risk behavior while either ignoring or dismissing the potential consequences of these actions.
The data on the Abbreviated Injury Scale scores indicated that helmeted riders had a higher number of injuries to the spine, trunk, and extremities and had significantly more orthopedic procedures. One possible explanation for this is that helmeted riders are surviving higher-force impacts than unhelmeted riders and are thus presenting with more extensive injuries. Helmet use itself may be a factor in contributing to high-impact collisions because a helmeted rider’s increased sense of security may result in a proclivity for higher speeds.
Owing to their significantly higher rate of head injury, unhelmeted patients are expected to have a markedly increased length of stay; however, the higher rates of other injuries among the helmeted group resulted in only slightly longer lengths of stay for unhelmeted patients. Nevertheless, the current trends toward bundled reimbursements and patient-guided satisfaction metrics imply increased costs for even small differences in time of care. Given the change in injury patterns from the head to the rest of the body as a result of helmet use, updated recommendations for the use of supplemental protective gear could be beneficial to both the individual and the health care system.
Corresponding Author: Sunil S. Tholpady, MD, PhD, Department of Surgery, Division of Plastic Surgery, Indiana University, 705 Riley Hospital Dr, RI 2514, Indianapolis, IN 46202 (firstname.lastname@example.org).
Published Online: October 21, 2015. doi:10.1001/jamasurg.2015.3225.
Author Contributions: Drs Tholpady and Lastfogel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Lastfogel, Soleimani, Flores, Cohen, Wooden, Tholpady.
Acquisition, analysis, or interpretation of data: Lastfogel, Soleimani, Wooden, Munshi, Tholpady.
Drafting of the manuscript: Lastfogel, Wooden, Tholpady.
Critical revision of the manuscript for important intellectual content: Soleimani, Flores, Cohen, Munshi, Tholpady.
Statistical analysis: Lastfogel, Soleimani, Tholpady.
Administrative, technical, or material support: Munshi, Tholpady.
Study supervision: Flores, Wooden, Tholpady.
Conflict of Interest Disclosures: None reported.
Previous Presentation: This paper was presented at the 39th Annual Meeting of the Association of VA Surgeons; May 4, 2015; Miami Beach, Florida.