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Choice of motorcycle helmet makes a difference: A prospective observational study

Brewer, Brian L. MD; Diehl, Albert H. III MD; Johnson, Laura S. MD; Salomone, Jeffrey P. MD; Wilson, Kenneth L. MD; Atallah, Hany Y. MD; Feliciano, David V. MD; Rozycki, Grace S. MD, MBA

Journal of Trauma and Acute Care Surgery: July 2013 - Volume 75 - Issue 1 - p 88–91
doi: 10.1097/TA.0b013e3182988b59
EAST 2013 Plenary Papers

BACKGROUND Although many states mandate that motorcyclists wear helmets, their laws do not indicate which type of helmet should be used. In addition, there are no prospective studies in the literature evaluating patterns of injuries as they relate to helmet type. The hypothesis in this study was that full-face helmets (FFHs) reduce craniofacial injuries associated with motorcycle collisions when compared with other helmet types.

METHODS A prospective observational study was conducted at a Level I trauma center to evaluate the efficacy of helmet types relative to craniofacial injuries. Data included patient demographics, helmet types, injuries, and outcomes. The incidences of facial fractures, skull fractures, and traumatic brain injuries (TBIs) were compared in patients wearing FFHs versus other helmet types (OH) during motorcycle crashes.

RESULTS From 2011 to 2012, 151 patients of motorcycle crashes (135 males, 16 female; mean age, 38.4 years; range, 19–74 years) whose helmet types were identified by health care providers were entered into the study. The distribution of helmets was 84 FFH and 67 OH (39 half and 28 modular). Facial fractures were present in 7% of the patients wearing FFH (95% confidence interval, 0.015–0.125) versus 27% (95% confidence interval, 0.164–0.376) of those wearing OH (p = 0.004). In addition skull fractures were present in 1% of the patients wearing FFH versus 8% in those wearing OH (p < 0.05). While there was a trend for patients wearing FFH to have a lower incidence of TBI (13% vs. 25% in those wearing OH), this was not statistically significant (p = 0.053). There were no differences in Injury Severity Score (ISS), length of stay, or mortality between the two groups.

CONCLUSION Victims of motorcycle crashes who are wearing FFH have a significant reduction in facial and skull fractures when compared with those wearing OH. Further studies will be needed to assess whether FFH will significantly decrease the incidence of TBI.

LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.

From the Department of Surgery (B.L.B.), Sinai Hospital, Baltimore, Maryland; Department of Surgery (A.H.D., H.Y.A., G.S.R.), Emory University School of Medicine, Morehouse School of Medicine (K.L.W.); and Department of Surgery (D.V.F.), Atlanta Medical Center/Mercer University School of Medicine, Atlanta, Georgia; Department of Surgery (L.S.J.), Washington Hospital Center, Washington, District of Columbia; Department of Surgery (J.P.S.), Maricopa Medical Center, University of Arizona-Pheonix, Pheonix, Arizona.

Submitted: December 22, 2012, Revised: March 5, 2013, Accepted: March 11, 2013.

This study was presented at the 26th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 15–19, 2013, in Scottsdale, Arizona. The authors received the 2013 Cox-Templeton Injury Prevention Paper award for this work.

Address for reprints: Brian L. Brewer, MD, 2435 West Belvedere Avenue, Baltimore, MD 21215 email:

© 2013 Lippincott Williams & Wilkins, Inc.