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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states have repealed the universal helmet law despite evidence that it decreases the risk of mortality,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has repealed the universal helmet law.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.
                         Mortality (%)            ICU LOS             Hospital LOS            Charges*
   Unhelmeted                  10.1                  3.6                   12.3               $136,604
     Helmeted                   10                   3.5                    9.6               $105,309
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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