Use your head

According to the Centers for Disease Control and Prevention’s publication Motorcycle Safety, motorcycle deaths have increased each year between 1997 and 2008, for an overall increase of 150 percent.* Contrary to popular belief, young people are not the only ones who die as a result of motorcycle crashes; more than half the people killed in motorcycle crashes were age 40 or older during that time frame. In 2008, half of all crashes took place on rural roads and almost 40 percent involved alcohol. Forty-one percent of the motorcyclists and 51 percent of the passengers who died were riding without a helmet.

Figure 1: Hospital discharge status

Figure 1: Hospital discharge status

Helmets are designed to maintain the rider’s visibility and hearing, while reducing the risk of death by 37 percent and the risk of head injury by 69 percent. In 2008, helmet use led to nearly $3 billion dollars in health care savings. According to Motorcycle Safety, the single most effective way for states to save lives and save money is through a universal helmet use law.

Currently, states fall into one of three general groupings with respect to motorcycle helmet use laws. The first group of states has a universal helmet law that requires all motorcycle riders and passengers of all ages to wear a helmet whenever riding. The second group has a partial helmet law that only requires specific groups of people, such as children and teens below a certain age, to wear helmets. The third group of states has no helmet use legislation.

The debate rages on from state to state with respect to motorcycle helmet laws. Does a law interfere with an individual’s personal freedom? The simple answer is yes, but no differently than impaired driving laws, cell phone use laws, seatbelt use laws, and quarantine laws for infectious diseases. The purpose of these laws is to provide for the nation’s well-being.

Figure 2: Motorcyclist/passenger mortality by helmet use

Figure 2: Motorcyclist/passenger mortality by helmet use

The most recent state to repeal a universal helmet use law was Michigan—although there is still a helmet requirement for children and adolescents in place. The law now states that anyone under the age of 19 is required to wear a helmet. The state where I reside and practice, Illinois, has the distinction of being one of only three states with no helmet use law of any sort. Working year after year and seeing the consequences of unsafe acts that result in lifelong impairment, when in all likelihood a 40-ounce, properly engineered, plastic head covering may have mitigated the severity of brain injury in a motorcycle crash, is disheartening.

To examine the occurrence of motorcyclists’ helmet use in the National Trauma Data Bank® (NTDB) research dataset for 2010, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Searched codes included external cause of injury E codes 810 (motor vehicle crash with train), 811 (motor vehicle crash with re-entrant motor vehicle), 812 (motor vehicle crash with another motor vehicle), 813 (motor vehicle crash with other vehicle); 814 (motor vehicle crash with pedestrian), 815 (motor vehicle crash with collision on highway), 816 (motor vehicle crash due to loss of control), and 819 (motor vehicle crash, unspecified nature). These records were searched by the E code postdecimal value of .2 for driver of a motorcycle (motorcyclist) or .3 for passenger of a motorcycle, and were also searched for a valid protective device field value of either 1 (none) or 7 (helmet). A total of 32,040 records for motorcyclists and motorcycle passengers were uncovered, of which 28,767 records had a protective device field of helmet or no helmet.

In all, 24,653 of these records contained a hospital discharge status, including 18,843 patients discharged to home, 3,233 to acute care/rehab, and 1,748 sent to skilled nursing facilities; 829 died. These patients were 87 percent male, on average 41 years of age, had an average hospital length of stay of 6.8 days, and an intensive care unit length of stay of 6.5 days. They had an average injury severity score of 13.3, were on the ventilator for an average of 7.5 days, and helmet use was 38 percent. A total of 16,736 motorcyclists/motorcycle passengers were tested for alcohol, with 33 percent testing positive. Mortality was more than 81 percent greater in the nonhelmeted group (see Figures 1 and 2).

The average adult head weighs about eight pounds and is supported by seven vertebrae of which the top two, the atlas and the axis, allow for movement. The bony skull is on average six millimeters thick. The brain, which is the consistency of gelatin and is contained within a bony structure and supported on a bony spine, similar to an inverted taffy apple, was not engineered to absorb the type of impact that comes from hitting the concrete at 30 miles per hour. As physicians, we must tell our patients, “Please use your head and wear a helmet—if not for yourself then for the people who care about you, so they can continue to care about you instead of having to care for you when you sustain a significant brain injury.”

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The NTDB Annual Report 2011 is available on the ACS website as a PDF file and as a PowerPoint presentation at In addition, information regarding how to obtain NTDB data for more detailed study is available on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at

Statistical support for this article has been provided by Chrystal Price, data analyst, NTDB.

*U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. Motorcycle Safety, How to Save Lives and Save Money. Available at: Accessed May 15, 2012.

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