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      Fact and Fiction Regarding Motorcycle Helmet Use, Associated Injuries, and Related Costs in the United States

      1 , 1 , 2 , 3 , , 2

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      Cureus

      Cureus

      helmet, motorcycle crash, traumatic head injury

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          Abstract

          Background

          Despite evidence that helmet use decreases motorcycle-associated injuries and mortality, the use of motorcycle helmets is not universal. As trauma surgeons are frequently the primary providers responsible for motorcycle crash victims, we sought to gain a better understanding of trauma surgeons’ perspectives on helmet use with motorcycles.

          Methods

          Members of the American Association for the Surgery of Trauma (AAST) were asked to participate in a survey that centered on attitudes, knowledge, and beliefs regarding motorcycle helmet use, associated injuries, and related costs. Demographic data were analyzed. In addition, we performed a literature search to attempt to clarify the current data on this subject.

          Results

          A total of 127 surgeons participated. The majority were male (64%, n=81), in academic practice (67%, n=85), and worked at a Level I trauma center (80%, n=102). Of those that owned a motorcycle, 100% wear a helmet when riding. Seven percent (n=9) of respondents believe helmet use increases cervical spine injury, although the majority (78%, n=99) disagree. In regards to head injuries and helmet use, most (93%, n=118) believe that helmets decrease the severity of head injury, improve outcomes (98%, n=124), and impact long-term disability (93%, n=118). Ninety percent (n=114) of surgeons believe that state legislation mandating motorcycle helmet use increases helmet utilization, and 82% (n=104) believe that the decision to wear a helmet should not be a personal decision. The majority (83%, n=106) of trauma surgeons agreed that helmet use would likely lead to a major reduction in motorcycle-related health care costs.

          Conclusions

          North American trauma surgeons wear helmets when they ride motorcycles and believe that these devices are highly protective, leading to a reduction in brain injury and the subsequent health care costs.

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          Most cited references 21

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          Helmets for preventing injury in motorcycle riders.

          Motorcycle crash victims form a high proportion of those killed or injured in road traffic crashes. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes. To assess the effects of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes. We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2007), MEDLINE (up to April 2007), EMBASE (up to April week 16, 2007), CINAHL (January 1982 to February 2003), TRANSPORT (up to issue 12, 2006) (TRANSPORT combines the following databases: Transportation Research Information Services (TRIS) International Transport Research Documentation (ITRD) formerly International Road Research Documentation (IRRD), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Websites of traffic and road safety research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles. We considered studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. We included any studies that compared an intervention and control group. Therefore the following study designs were included: randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded. Two authors independently screened reference lists for eligible articles. Two authors independently assessed articles for inclusion criteria. Data were abstracted by two independent authors using a standard abstraction form. Sixty-one observational studies were selected of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for death and head injury outcomes. Motorcycle helmets were found to reduce the risk of death and head injury in motorcyclists who crashed. From four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction. 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.
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            Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005.

            To estimate the costs of motor vehicle-related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit costs were multiplied by incidence to yield total costs. Injury incidence and costs are presented by age, sex, and road user type. Motor vehicle-related fatal and nonfatal injury costs exceeded $99 billion. Costs associated with motor vehicle occupant fatal and nonfatal injuries accounted for 71 percent ($70 billion) of all motor vehicle-related costs, followed by costs associated with motorcyclists ($12 billion), pedestrians ($10 billion), and pedalcyclists ($5 billion). The substantial economic and societal costs associated with these injuries and deaths reinforce the need to implement evidence-based, cost-effective strategies. Evidence-based strategies that target increasing seat belt use, increasing child safety seat use, increasing motorcyclist and pedalcyclist helmet use, and decreasing alcohol-impaired driving are available.
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              Non-helmeted motorcyclists: a burden to society? A study using the National Trauma Data Bank.

              Helmet laws remain controversial. Opponents believe negative findings are a result of biased statistical analyses that fail to account for the impact of alcohol and drugs. In this study, we evaluated the effect that helmet use had upon injury severity, outcome controlling for alcohol or drug use, resource utilization, and financial burden using the National Trauma Data Bank (NTDB). Two groups of patients, helmeted and non-helmeted motorcyclists, were identified using the NTDB over an 8-year period. Group differences were compared using nonparametric Wilcoxon tests for continuous variables and Fisher's exact test for dichotomous outcomes. To evaluate the effect that alcohol or drug use had on mortality, logistic regression models were created. A total of 9,769 patients were identified by the NTDB of which 6756 (69.2%) were helmeted and 3013 (30.8%) were non-helmeted. Helmet use was associated with lower injury severity, mortality, and resource utilization. Non-helmeted motorcyclists accrued greater hospital charges and were significantly less likely to have health insurance. When controlling for alcohol or drug use, mortality continued to be significantly associated with non-helmet use. Non-helmeted motorcyclists have worse outcomes than their helmeted counterparts independent of the use of alcohol or drugs. Furthermore, they monopolize more hospital resources, incur higher hospital charges, and as non-helmeted motorcyclists frequently do not have insurance, reimbursement in this group of patients is poor. Thus, the burden of caring for these patients is transmitted to society as a whole.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                19 November 2018
                November 2018
                : 10
                : 11
                Affiliations
                [1 ] Surgery, University of Texas Health Science Center, San Antonio, USA
                [2 ] Surgery, Staten Island University Hospital, Staten Island, USA
                [3 ] Surgery, Hackensack Meridian Health, Hackensack, USA
                Author notes
                Article
                10.7759/cureus.3610
                6343861
                Copyright © 2018, Hofmann et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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                helmet, motorcycle crash, traumatic head injury

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