Injury patterns and outcomes in motorcycle driver crashes in the United States: The effect of helmet use

Injury. 2024 Mar;55(3):111196. doi: 10.1016/j.injury.2023.111196. Epub 2023 Nov 21.


Background: Motorcycle crashes pose a persistent public health problem with disproportionate rates of severe injuries and mortality. This study aims to analyze injury patterns and outcomes with regard to helmet use. We hypothesized that helmet use is associated with fewer head injuries and does not increase the risk of cervical spine injuries.

Methods: The National Trauma Data Bank was queried for all motorcycle driver crashes between 2007-2017. Univariable analysis was used to compare demographics, clinical data, injury patterns using abbreviated injury scale, and outcomes between helmeted motorcycle drivers and non-helmeted motorcycle drivers who were injured in traffic crashes. Independent factors associated with mortality were determined by regression analysis after adjustment for potential confounders.

Results: A total of 315,258 patients were included for analysis, 66 % of these patients were helmeted. The sample was 92.5 % male and the median age was 41 years. Non-helmeted motorcycle drivers were more likely to sustain severe head trauma (head abbreviated injury scale ≥ 3: 28.5 % vs. 13.3 %, p < 0.001), had higher intensive care unit-admission (38 % vs. 30.2 %, p<0.001), mechanical ventilation (20.1 % vs. 13 %, p<0.001) and overall mortality rates (6.2 % vs. 3.9 %, p<0.001). Cervical spine injuries occurred in 10.6 % of non-helmeted motorcycle drivers and in 9.5 % of helmeted motorcycle drivers (p<0.001). Helmet use was identified as an independent factor associated with lower mortality [OR 0.849 (0.809-0.891), p<0.001].

Conclusion: Helmet use is protective for severe head injuries and associated with decreased mortality. Helmet use was not associated with increased rates of cervical spine injuries. On the contrary, fewer injuries were observed in helmeted motorcycle drivers. Public health initiatives should be aimed at enforcement of universal helmet laws within the United States and across the world.

Keywords: Accidents; Cervical spine; Crash; Helmet; Motorcycle.

MeSH terms

  • Accidents, Traffic
  • Adult
  • Craniocerebral Trauma* / epidemiology
  • Craniocerebral Trauma* / prevention & control
  • Female
  • Head Protective Devices
  • Humans
  • Male
  • Motorcycles
  • Neck Injuries*
  • Spinal Injuries* / epidemiology
  • Spinal Injuries* / prevention & control
  • United States / epidemiology