INTRODUCTION: Motorcycle helmet laws remain controversial. Advocacy groups have intensified efforts to repeal helmet laws, stating that most outcome studies are relatively small and regional, making data interpretation difficult. We conducted a large national study using the National Trauma Data Bank (NTDB) for patients injured in motorcycle crashes (MCC) with attention to injury patterns, helmet use, resource utilization, and outcome.
METHODS: The NTDB (7.0) identified MCC patients (2002-2006). Data collected included demographics, injury severity (ISS, abbreviated injury scores (AIS)), resource utilization (lengths of stay, insurance status), and hospital outcome.
RESULTS: 1.8 million patients were entered into the NTDB. 97,019 patients had MCC; 58,255 had helmet use documented, forming the study cohort. 87% were male. Mean age, admission GCS score, and ISS was 36 years, 13.7, and 13.1, respectively. Patients with helmets (45,479; 78% of total) were compared to those without (12,776):

	GCS	ISS	Head AIS	Spine AIS	ICU days	Self pay	Mortality
Helmet	13.9	12.8	0.4	0.2	2.3	27%	4%
No helmet	13.0	14.1	0.8	0.2	2.8	41%	7%
p value	.0001	.0001	.0001	.81	.0001	.0001	.0001

Controlling for age, ISS, SBP, and GCS, the odds of hospital mortality increased 40% for unhelmeted patients. By reducing ICU stay, helmet use would save approximately $22.4 million.
CONCLUSIONS: Unhelmeted MCC patients suffer more severe brain injuries, consume more resources, and have the worst payor mix. Society bears a large financial burden due to the high number of uninsured unhelmeted patients. This large national database study demonstrates a survival advantage for helmeted patients. All states should have universal motorcycle helmet laws that are aggressively enforced.