Effect of Motorcycle Helmets on Craniofacial Trauma and Associated Injuries

Purpose: To identify relationships between helmet use, injury patterns, and outcomes of motorcycle accidents (MCA). Data on mortality, blood alcohol concentration (BAC), extracranial injuries, injury severity score (ISS), operative intervention(s), ICU length of stay (LOS), ventilator duration, hospital LOS, payer distribution, total cost of care and demographics were analyzed. Methods: A retrospective cohort analysis utilizing data from the Trauma Registry, Department of Transportation, and medical records of patients presenting to a single level one trauma center with craniofacial injuries secondary to MCA from 1999 to 2008. Results: 486 patients were identified: 329 were unhelmeted (68%), and 157 were helmeted (32%). Seventy-one percent of men and 34% of women were unhelmeted (p<0.001). Unhelmeted motorcyclists were more likely to die in the field (67% vs. 33%, 95% CI 57-77%), and had higher risk of death during hospitalization (RR=1.89, p<0.05), particularly with concomitant traumatic brain injury or cranial vault fracture (RR=2.1, p<0.05). Unhelmeted patients had a higher mean BAC (0.08 vs. 0.038; p<0.0001) and were more likely to operate a motorcycle over the legal limit (42.0% vs. 19.1%; p<0.0001). Soft tissue injuries of the head and neck were more common among unhelmeted operators (80.2% vs. 67.8%, p<0.01), who required more craniofacial operative interventions (211 vs. 68 procedures, p<0.00). No significant differences were noted in other variables. Conclusions: Our analysis of helmet use, injury patterns, and outcomes after MCA demonstrates that unhelmeted motorcyclists had worse outcomes. Helmeted motorcyclists were significantly more likely to survive MCA and suffer less severe craniofacial trauma.