OUTCOM ES OF UNHELMETED MOTORCYCLISTS: IS IT REALLY THAT BAD? Lars S. Nelson MD, Chad Smith, MD, Tobi Safcsak RN, and Rodrigo F. Alban, MD From the Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida Background: The potential consequences from lack of helmet use are continuously debated. Several states have repealed the universal helmet law despite evidence that it decreases the risk of mortality, traumatic brain injury and hospital expenses. Retractors of the law argue individual rights and freedom without significant effect on outcomes. However, focus on specific detrimental effects in regards to helmet use needs to be better established. Objective: The purpose of this study was to evaluate the impact of helmet use on patient outcomes after motorcycle, bicycle, and all terrain vehicles (ATV) related injuries at a level 1 trauma center in a state that has repealed the universal helmet law. Methods: A retrospective review was performed on the Orlando Regional Medical Center trauma registry from January 2009 through August 2010. All patients admitted after motorcycle, bicycle, or ATV related injuries were included for analysis. Data analyzed included age, gender, race, heart rate, systolic blood pressure, GCS, ventilator days, ICU days, abbreviated injury severity score (AIS) head, injury severity score (ISS), hospital length of stay, mortality and billing charges. Statistical analysis was performed comparing unhelmeted to helmeted patients using a Chi Square test for categorical variables and Student’s t-test for continuous variables. Results: A total of 1,074 patients with blunt injuries were admitted during the study period, of which 149 were involved in a motorcycle, bicycle, or ATV crash and therefore included for analysis. Of those, 109 were unhelmeted (73.1%) and 40 helmeted (26.9%). Unhelmeted patients were younger than helmeted patients: 36.6 vs. 41.9 years respectively, P<0.05. Admission vital signs did not differ amongst unhelmeted and helmeted patients: initial SBP of 138.3 vs. 143.8 and initial HR of 94.2 vs. 96.2, P=NS. Admission GCS was 10.8 for helmeted and 11.6 for unhelmeted, P=NS. Severity scores, including AIS head (3.16 vs. 3.20, P=NS) and ISS scores were also similar (unhelmeted ISS of 17.1 vs. helmeted ISS of 18.3, P=NS). Analysis of outcomes revealed no significant difference amongst groups, including mortality, ICU length of stay and hospital length of stay, nevertheless costs were higher for those patients not wearing a helmet. Table: Mortality (%) ICU LOS Hospital LOS Charges* Unhelmeted 10.1 3.6 12.3 $136,604 Helmeted 10 3.5 9.6 $105,309 P=0.05 Conclusion: In a state that has repealed the universal helmet safety law, the majority of trauma patients involved in motorcycle, bicycle or ATV accidents present unhelmeted. These patients are younger and incur higher hospital charges than their helmeted counterparts. Nevertheless, admission vital signs, injury severity and outcomes were not significantly different. Further studies including larger number of patients are warranted.
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