"Universal helmet laws reduce traumatic brain injury among children and adolescents," said Kathryn Anderson, MD, a resident at the University of Arizona College of Medicine in Tucson. "And, unfortunately, there is a trend toward repealing these laws."
Helmet laws have long been controversial. In 1967, the federal government started withholding some highway safety funds from states that did not require everyone on a motorcycle to wear a helmet. But in 1976, that policy was rescinded.
Currently, 19 states have universal laws, 28 states have laws only for younger riders, and three states have no motorcycle helmet laws.
There has been an increase in the number of passenger vehicles and motorcycles registered in the United States. Although fatalities involving passenger vehicles are decreasing, fatalities involving motorcycle riders are increasing, said Dr Anderson.
Dr Anderson, who presented the study results here at the American College of Surgeons 2014 Clinical Congress, explained that her team wanted to know if universal laws were more or less effective in protecting young people than laws requiring helmets only for certain age groups.
The researchers looked at the Nationwide Inpatient Sample database, which documents about 20% of all admissions and discharges in American hospitals.
They identified 587 motorcycle riders — passengers or drivers — who were younger than 21 years and had been hospitalized in 2011 with a traumatic brain injury resulting from a motorcycle accident.
They analyzed this cohort according to state law — whether a helmet was required for all riders, for riders younger than 21 years, or for riders younger than 18 years.
The incidence of traumatic brain injury was significantly lower in states requiring a helmet for all riders than in those requiring a helmet for only younger riders.
Table. Incidents per 1000 Motorcycle Accidents
Overall, young riders were 2.5 times less likely to sustain a traumatic head injury in a motorcycle accident in states requiring helmets for all riders, the researchers report.
This work could have an important impact. "Studies like this are, I think, crucial," said study discussant Christopher Newton, MD, from the University of California Benioff Children's Hospital in Oakland.
"The pen is mightier than the scalpel. Legislation will save far more lives than we will," he said.
Legislation will save far more lives than we will.
Dr Anderson explained that changes to motorcycles and helmets would likely confound a comparison between current data and those from the 1960s. In particular, motorcycles are getting bigger, she said.
After the presentation, an audience member pointed out that an association between traumatic brain injury and universal helmet laws does not prove causation. "I don't think we can reach such a conclusion with the data you presented," he said.
He pointed out that if broader laws resulted in fewer traumatic brain injuries, then states requiring helmets for riders younger than 21 should have fewer such injuries than states requiring them for riders younger than 18 — the opposite of what Dr Anderson reported.
"I agree," said Dr Anderson. "I'm a little unsure why states with broader coverage — that is, up to 21 — had a higher rate of traumatic brain injury, except to say that I don't think there's a huge difference between the states that require up to 18 and those that require up to 21."
Enforcement could be an issue, she said.
"It's easier to enforce if you have a universal law," Dr Newton pointed out. "It's pretty hard for law enforcement to see the difference between a 16-year-old and a 19-year-old. That's a primary issue."
Dr Anderson explained that the effectiveness of enforcement among states is difficult to track, because laws are written differently in different states. For example, some states require insurance for medical liability. "I highly doubt that a police officer is going to pull you over and say, 'Can I see your insurance coverage'," she said. "It's hard to tease that out, and we weren't able to look at that specifically."
Dr Anderson and Dr Newton have disclosed no relevant financial relationships.
American College of Surgeons (ACS) 2014 Clinical Congress. Presented October 28, 2014.
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