T. Soleimani1, T. A. Evans1, S. I. Fernandez1, L. Spera1, R. Sood1, B. L. Zarzaur1, S. S. Tholpady1 1Indiana University School Of Medicine,Division Of Plastic Surgery,Indianapolis, IN, USA
Introduction
Numerous studies demonstrate the utility of safety equipment (helmets) in prevention of serious traumatic injury related to accidents involving motorcycles. Few studies have focused on whether the pattern of injury is different and if the protective benefit is the same in passengers when compared to riders. This study was designed to evaluate these differences in usage of helmets and subsequent patterns of injury between the riders and passengers of motorcycles.
Methods
Using 2007-2010 National Trauma Databank (NTDB), motorcycle trauma patients were identified by ICD-9 codes (Ecodes: E810-E819). The injured patients were divided into two groups: motorcycle riders or passengers (fourth digit 2 and 3 respectively). Demographics, helmet use, injury severity, and outcomes including mortality, major complications, and length of hospital stay (LOS) were compared and contrasted. Major complications were defined as acute renal failure, ARDS, cardiorespiratory arrest, coma, pneumonia, sepsis, cerebrovascular accident, and surgical site infection.
Results
A total of 79,818 riders and 5,896 passengers were identified. Riders were more likely to be older (mean: 40.4 vs. 38.8 years), male (91.9% vs. 17.1%), obese (2.4% vs. 1.9%), and non-white (17.8% vs. 13.6%). They were also more likely to be under influence of drugs (51.2% vs. 47.5%). They were significantly more likely to wear helmet (66.2% vs. 57.5%). For riders, older age, white race, and female gender were associated with higher rates of wearing helmet. For passengers, the rate of helmet use was not associated with age and had reverse association with white race and female gender.
The mean Glasgow coma scale (GCS) was similar between riders and passengers (mean: 13.2 vs. 13.1) however the Injury Severity Score (ISS) was slightly higher for the riders (mean: 12.9 vs. 13.7). The rate of major complications was significantly higher among the riders (8.1% vs 6.1%) even after adjusting for potential confounders. There were no significant differences in rates of mortality (4.6% vs 4.1%) and LOS between the riders and passengers. The unadjusted ICU admission rate was slightly higher for the riders (34.2% vs 32.7%). However, after adjusting for other potential confounders, the riders and passengers had no significant difference in rate of ICU admission.
Conclusions
This is one of the first studies to study demographics and outcomes of motorcycle passengers when compared to riders. There is a very small protective effect in being a passenger when major complications are considered, but mortality, LOS, and ICU admissions were all similar. Interestingly, while the outcomes are similar, the demographics of helmet use were different. Being young, white, and female all were associated with being an unhelmeted passenger; these trends should be prospectively followed and intervened upon as changes in this population’s behavior would yield significant life and quality of life dividends.