Cervical spine injuries and helmet laws: A population-based study
ABSTRACT To assess the incidence of cervical spine (C-spine) injuries in patients admitted after motorcycle crash in states with mandatory helmet laws (MHL) compared with states without helmet laws or selective helmet laws.
The Nationwide Inpatient Sample from the Healthcare and Utilization Project for the year 2008 was analyzed. International Classification of Diseases and Health Related Problems, Ninth Edition codes were used to identify patients with a diagnosis of motorcycle crash and C-spine injuries. National estimates were generated based on weighted analysis of the data. Outcome variables investigated were as follows: length of stay (LOS), in-hospital mortality, hospital teaching status, and discharge disposition. States were then stratified into states with MHL or selective helmet laws.
A total of 30,117 discharges were identified. Of these, 2,041 (6.7%) patients had a C-spine injury. Patients in MHL states had a lower incidence of C-spine injuries (5.6 vs. 6.4%; p = 0.003) and less in-hospital mortality (1.8 vs. 2.6%; p = 0.0001). Patients older than 55 years were less likely to be discharged home (57.5% vs. 72.5%; p = 0.0001), more likely to die in-hospital (3.0% vs. 2.1%; p = 0.0001), and more likely to have a hospital LOS more than 21 days (7.7% vs. 6.2%; p = 0.0001).
Patients admitted to the hospital in states with MHLs have decreased rate of C-spine injuries than those patients admitted in states with more flexible helmet laws. Patients older than 55 years are more likely to die in the hospital, have a prolonged LOS, and require services after discharge.
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ABSTRACT: Objective. To study the impact of helmet use on outcomes after recreational vehicle accidents. Methods. This is an observational cohort of adult and pediatric patients who sustained a TBI while riding a recreational vehicle. Recreational vehicles included bicycles, motorcycles, and all-terrain vehicles (ATVs), as well as a category for other vehicles such as skateboards and scooters. Results. Lack of helmet use was significantly associated with having a more severe traumatic brain injury and being admitted to the hospital. Similarly, 25% of those who did wearing a helmet were admitted to the ICU versus 36% of those who did not (P = 0.0489). The hospital length of stay was significantly greater for patients who did not use helmets. Conclusion. Lack of helmet use is significantly correlated with abnormal neuroimaging and admission to the hospital and ICU; these data support a call for action to implement more widespread injury prevention and helmet safety education and advocacy.09/2013; 2013:450195. DOI:10.1155/2013/450195This article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: Geriatric acetabular, pelvis, and subtrochanteric femur fractures are poorly understood and rapidly growing clinical problems. The purpose of this study was to describe the epidemiologic trends of these injuries as compared with traditional fragility fractures about the hip. From 1993 to 2010, the Nationwide Inpatient Sample (NIS) recorded more than 600 million Medicare-paid hospital discharges. This retrospective study used the NIS to compare patients with acetabular fractures (n=87,771), pelvic fractures (n=522,831), and subtrochanteric fractures (n=170,872) with patients with traditional hip fractures (intertrochanteric and femoral neck, n=3,495,742) with regard to annual trends over an 18-year period in incidence, length of hospital stay, hospital mortality, transfers from acute care institutions, and hospital charges. Traditional hip fractures peaked in 1996 and declined by 25.7% by 2010. During the same 18-year period, geriatric acetabular fractures increased by 67%, subtrochanteric femur fractures increased by 42%, and pelvic fractures increased by 24%. Hospital charges, when controlling for inflation, increased roughly 50% for all fracture types. Furthermore, transfers from outside acute care hospitals for definitive management stayed elevated for acetabular fractures as compared with traditional hip fractures, suggesting a greater need for tertiary care of acetabular fractures. Geriatric acetabular fractures are rapidly increasing, whereas traditional hip fractures continue to decline. Patients with these injuries are more likely to be transferred from their hospital of presentation to another acute care institution, possibly increasing costs and complications. This is likely related to their complexity and the lack of consensus regarding optimal management. [Orthopedics. 2014; 37(3):151-157.].Orthopedics 03/2014; 37(3):151-7. DOI:10.3928/01477447-20140225-50 · 1.05 Impact Factor
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ABSTRACT: Helmet use in two wheeled vehicle accidents is widely reported to decrease the rates of death and traumatic brain injury. Previous reports suggest that there exists a trade off with helmet use consisting of an increased risk of cervical spine injuries. Recently a review of a national trauma database demonstrated the opposite with reduction in cervical spinal cord injuries in motorcycle crashes (MCC). To better ascertain the risks of cervical spine injury with non-helmet use in all two wheeled vehicles we analyzed the University of Florida level one trauma center experience. We reviewed the Traumatic injury database over a five-year period (Jan 1, 2005 to July 1, 2010) for all patients involved in two wheeled vehicle accidents. Patients were stratified according to vehicle type (motorcycle, scooter, and bicycle), helmet use, and the presence or absence of a cervical spine injury. Outcomes were compared for injury severity, cervical spine injury, cervical spinal cord injury, and presence of cervical spine injuries requiring surgery. Population means were compared using paired t-test. 1331 patients were identified, 995 motorcycles, 87 low power scooters, 249 bicycles. Helmet use was variable between each group. One hundred and thirty five total cervical spine injuries were identified. No evidence was found that suggests an increased risk of cervical spine injury or increased severity of cervical spine injury with helmet use. This fact in combination with our previous findings suggest that the law's age and insurance exemption should be revoked and a universal helmet law be reinstated in the state of Florida. Key Words: helmet, two-wheeled vehicles, motorcycle, scooter, bicycle, Florida, cervical spine injury.Journal of neurotrauma 03/2014; DOI:10.1089/neu.2013.3253 · 4.25 Impact Factor