Head Injury Mechanisms in Helmet-Protected Motorcyclists: Prospective Multicenter Study :

In the present study, the incidence of severe brain injury was 600 percent higher for patients riding without a helmet and the incidence of all brain injuries was nearly twice as high in the nonhelmeted riders. All surviving patients with severe brain injury sustained residual long-term disability. The incidence of injury and death was much higher for motorcyclists than for occupants of automobiles involved in accidents. Riding a motorcycle is dangerous and riding without a helmet is fool-hardy. Helmets also protect the face, as facial fractures were twice as common in the nonhelmeted riders. There were no significant differences between nonhelmeted and helmeted motorcyclists in terms of overall injury as measured by an injury severity score of 16 or greater. Orthopedic injuries, in this study, were so common that orthopedic surgeons performed more major operations than all other surgical specialists combined. Depth of orthopedic coverage is essential to treat significant numbers of injured motorcyclists. Neurosurgeons are key members of a trauma care team. Helmet laws would help us utilize our limited neurosurgical capacity more effectively by reducing the incidence of brain injury. Medical professionals must educate the public regarding the societal and personal cost of unhelmeted motorcycle riding. Legislation mandating helmet usage for motorcycle riders must be sought.

This study examined the prevalence of non-standard helmet use among motorcycle riders following introduction of a mandatory helmet use law and the prevalence of head injuries among a sample of non-standard helmet users involved in motorcycle crashes. Motorcycle rider observations were conducted at 29 statewide locations in the 2 years following the introduction of the mandatory helmet use law in January, 1992. Medical records of motorcyclists who were injured in 1992 for whom a crash report was available and for whom medical care was administered in one of 28 hospitals were reviewed. Chi-squares and analysis of variance were used to describe differences between groups. Prevalence of non-standard helmet use averaged 10.2%, with a range across observation sites from 0 to 48.0%. Non-standard helmet use varied by type of roadway, day of week, and time of day. Injuries to the head were more frequent and of greater severity among those wearing non-standard helmets than both those wearing no helmet and those wearing standard helmets. Non-standard helmets appear to offer little head protection during a crash. Future study is needed to understand the dynamics leading to head injury when different types of helmets are worn.

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.