Fatal injuries in motorcycle riders according to helmet use. The effect of helmets on the incidence and severity of head and cervical spine injuries in motorcycle and moped accident victims: a prospective analysis based on emergency department and trauma centre data. The association of helmet use with the outcome of motorcycle crash injury when controlling for crash/injury severity. Helmet use and motorcycle fatalities in Taiwan. Case-control study of the effectiveness of different types of helmets for the prevention of head injuries among motorcycle riders in Taipei, Taiwan. The impact of two related prevention strategies on head injury reduction among nonfatally injured motorcycle riders, California, 1991-1993. The role of helmets in reducing head injuries from motorcycle accidents: a political or medical issue? Increased risk of death or disability in unhelmeted Wisconsin motorcyclists. Is helmet use beneficial to motorcyclists?
Helmets have been shown to be effective in preventing head injuries in motorcyclists, but some studies have suggested that helmets may cause injury to parts of the head or neck because they add mass to the head.
                This study examined patterns of fatal injuries in helmeted and unhelmeted motorcyclists.
                Coroner reports, hospital records, and police reports for motorcyclists fatally injured in crashes from July 1, 1988 through October 31, 1989 were examined. All injury diagnoses were abstracted and coded to the 1990 version of The Abbreviated Injury Scale and the International Classification of Diseases, 9th revision.
                Cerebral injury, intracranial hemorrhage, face, skull vault, and cervical spine injuries were more likely to be found in fatally injured unhelmeted motorcyclists than in helmeted motorcyclists.
                These results expand earlier reports showing that helmets provide protection for all types and locations of head injuries, and show that they are not associated with increased neck injury occurrence. The aim of this prospective study was to quantify the anatomic severity of head and cervical spine injuries in hospital admitted victims of motorcycle and moped accidents in relation to helmet use and controlled for non-head injuries (i.e. kinetic impact). Two hundred and twenty-three patients entered the study group, of which 152 were motorcyclists and 71 were moped riders. Our results reveal that helmets do prevent head injury in motorcycle and moped accidents, especially in those crashes involving relatively low kinetic energy transfers. Helmet use does not lead to an increase of the incidence or severity of cervical spine injury. As a result compulsory helmet laws should not be limited to motorcyclists but also focus on all moped riders and probably also bicyclists. This study illustrates that emergency departments can provide important epidemiological information for injury control purposes. However, the epidemiological use of emergency department data and hospital data in general requires cautiousness. Confounding is a common problem which should be dealt with during analysis. Many studies have reported that helmet use by motorcycle riders significantly decreases their risk of head injury, death, and disability in the event of a crash. However, these studies have not controlled for crash severity and thus do not conclusively show the value of helmet use by motorcycle riders. Using data from a statewide trauma registry, the present study examines the association of helmet use with various outcomes of motorcycle crashes, controlling for overall crash severity as measured by a modified Injury Severity Score. The results show that in crashes where the overall degree of injury was comparable, the risk of head injury in hospitalized motorcyclists was nearly twice as high for unhelmeted riders as it was for helmeted riders, thus confirming the protective effects of helmet use. However, there were no significant differences in various measurements of resource utilization, including days in hospital, hospital charges, and need for post-hospital rehabilitation. A higher incidence of extremity injuries among the helmeted riders may account for their failure to demonstrate consistently lower resource utilization, despite lower rates of head injury. Motorcycle deaths accounted for more than half of total traffic fatalities in Taiwan in 2002. This study uses the police-reported crash data from Taiwan between 1999 and 2001 to estimate the effectiveness of helmets, simultaneously taking into account of sample selection bias. Sample selection arises because helmet usage will affect the probability of death or injury, which in turn influences whether a crash is included in the data. The results show that sample selection does not seriously bias the estimate of helmet effectiveness and helmets reduce the probability of death in a crash by 40%, which is higher than what was previously found. Without helmets, the number of motorcyclists killed in 2001 would have jumped by 51%. The estimated proportion of helmeted motorcyclists has increased from 71 to 78% between 1999 and 2001, suggesting that helmet use is rising after the implementation of mandatory helmet law in 1997. Also, helmets significantly reduce the likelihood of head and neck injuries in a crash by 53%, and lead to a 71% reduction in the probability of death caused by head and neck injuries. A total of 1,351 victims of motorcycle accidents, brought to one of 15 hospitals responsible for emergency care in Taipei, Taiwan, between August 1 and October 15, 1990, were enrolled in a case-control study to investigate the effectiveness of different types of helmets for the prevention of head injuries. A total of 562 of those with head injuries were assigned to the case group, while the remaining 789 victims without head injuries were considered as emergency room controls. The case group was subdivided into daytime and evening cases, according to the time of accident. For each daytime case, we took four pictures of passing motorcycles at the same time and place during the week after each accident. Of the 254 daytime cases, we successfully took pictures for 224 (88%) and identified 1,094 motorcycle riders in the pictures as street controls. Logistic regression analyses were used to determine the roles of the following variables in predicting risk of head injury: age, sex, riding position, weather, place of accident, helmet type, and motorcycle type, and status of helmet wearing. The relative risk of head injury among motorcycle riders was significantly reduced by wearing a full-face helmet, but not by wearing a full- or a partial-coverage helmet. Although the traumatic injury death rate in the United States decreased during the last 20 years, the percent of all injury deaths attributable to brain injuries has remained steady. Head injuries are a leading cause of injury among motorcycle riders in crashes, and the helmet is an effective measure to reduce these injuries. To reduce the burden and cost of motorcycle injuries, many states have increased helmet use by introducing mandatory helmet legislation. This report presents evidence on the effects of the motorcycle helmet and helmet use legislation--two interrelated prevention strategies which decrease traumatic brain injury among motorcycle riders. Nonfatally injured motorcyclists were included if they crashed between January 1, 1991 and December 31, 1993 and were treated in one of 18 hospitals in 10 California counties. Medical records for all injured motorcyclists admitted to these 18 hospitals and those treated in the emergency department and released in eight of these hospitals were individually reviewed. Complete lists of injury diagnoses for each rider were coded according to the 1990 Abbreviated Injury Severity Scale by trained clinical staff. Before the universal helmet law was introduced (when only a third of injured riders wore helmets) 38.2% of riders sustained head injuries. When helmet use increased to over 85% of injured riders following the law, less than 25% of riders sustained head injuries. Both the severity and the number of head injuries per individual rider decreased after the mandatory helmet use law led to increased helmet use. Riders wearing helmets suffered fewer skull fractures, fewer intracranial injuries, had less frequent and shorter periods of loss of consciousness, more favorable GCS scores, and shorter hospital stays. Mandatory motorcycle helmet use laws are an effective mechanism to increase helmet use among riders and thus prevent head and brain injuries resulting from motorcycle crashes. The cases of 311 motorcycle accident victims who were seen at a major trauma center over 17 months were reviewed. The types and severity of injuries were standardized according to the Injury Severity Score (ISS) for motor vehicle accidents. Victims were categorized into groups: helmet or no helmet and major, minor or no head injury. Major injury was defined as a 3 on the Abbreviated Injury Scale for "head" (loss of consciousness for at least 15 minutes with or without skull fracture and with or without neurological deficit). THE FOLLOWING CONCLUSIONS ARE DRAWN: (1) The death rate for those with and without helmets was not significantly different, (2) the victims of fatal accidents had identical total ISS scores regardless of the presence of helmets, (3) the chance of sustaining a severe head injury was significantly higher in the no helmet group and (4) the incidence of long-term neurological defect was three times greater in the no helmet group. The purpose of this study is to investigate the relationships among motorcycle rider helmet, alcohol use and the full spectrum of health outcomes following crashes.
                Data from the National Highway Traffic Safety Administration-sponsored Crash Outcome Data Evaluation System (CODES) for Wisconsin, 2002, were used to study 2462 motorcycle crash victims. Logistic regression models were used to assess the relationship of helmet and alcohol use with outcomes.
                Compared to helmeted motorcycle riders, unhelmeted riders were more likely to require inpatient hospitalization (Relative Risk Ratio [RRR] = 1.4; 95% confidence interval [CI]:1.1-1.8) or die (RR = 1.9, 95% CI:1.0-3.7) but equally likely to be treated in emergency departments. Injury patterns differed by helmet use. Unhelmeted riders were more likely to suffer injuries of the head (odds ratio [OR] = 2.3, 95% CI:1.5-3.3) or face (OR = 3.0, 95% CI:2.1-4.2) than helmeted riders. No difference was observed in other injuries, including spine/neck injuries. Reported alcohol use was more prevalent among patients who were inpatients or died, and was associated with higher likelihood of not wearing a helmet (OR = 7.0, 95% CI:4.8-12.9).
                Motorcycle riders who are inpatients or die in a crash are less likely to be helmeted and more likely to sustain head or face injuries. Alcohol use is associated with unhelmeted riding and increased risk of poor outcomes. These findings support policy and educational efforts promoting helmet use, which seek to decrease these tragedies. This study included 83 motorcyclists, helmeted and nonhelmeted, involved in crashes. All these patients were flown to a major trauma center in the Northeast (Hartford Hospital, Connecticut) directly from the scene by a helicopter ambulance service (LifeStar). The study showed that the majority of these patients were male and under the age of 30 years. Twenty-seven had blood alcohol levels above the legal limit. Sixty-nine percent were nonhelmeted and, statistically, a significant number in this category had a Glasgow Coma Scale (GCS) score of 8 or under. Cervical spine injuries were discovered in only six patients. Nine of the ten patients declared dead on arrival (DOA) were nonhelmeted. We conclude that helmets provide protection and certainly do not increase the incidence of cervical spine injuries.
Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.