Wearing a full-face helmet during a motorcycle crash dramatically reduced the risk of craniofacial fractures and traumatic brain injury, a prospective, observational study has shown.
Among 151 motorcycle crash victims, those wearing full-face helmets were significantly less likely than those wearing other helmet types to have a facial fracture (7.2% vs. 26.8%; P = .0221) or skull fracture (1.2% vs. 10.6%; P = .0015).
This represents a relative risk reduction of 73% and 89%, respectively.
The incidence of traumatic brain injury was cut almost in half, from 24% to 13%, with a full-face helmet, but the difference did not reach statistical significance (relative risk reduction, 45%; P = .091), Dr. Brian L. Brewer reported at the annual meeting of the Eastern Association for the Surgery of Trauma (EAST).
"Similar studies need to be performed to document the beneficial effect of full-face helmets in decreasing the incidence of skull fractures and facial fractures and, possibly, traumatic brain injury and mortality," said Dr. Brewer, whose research earned the 2013 Cox-Templeton Injury Prevention Paper Award from the EAST Foundation.
Currently, about 20 states require that all motorcyclists wear a helmet. Two states have no such law on the books, and several other states require only that certain individuals wear helmets while riding a motorcycle.
"Surprisingly, legislation in this arena is relatively anemic, given the significant financial implications for health care cost," he said, noting that 4,000 lives and an estimated $32.4 million could be saved each year with a universal helmet law.
On the opposite side of the yellow line, motorcyclists argue that helmets aren’t "cool," limit their field of vision, and increase the risk of cervical spine fractures. Others such as Michigan Gov. Rick Snyder, who last year repealed a 35-year-old law requiring helmets for all Michigan motorcycle drivers, consider it a matter of individual liberty.
The U.S. Department of Transportation has developed 218 minimal performance standards for DOT-certified helmets, but they pertain to weight, thickness, chin straps, and limitations on harmful decorations – not helmet design, explained Dr. Brewer of Sinai Hospital in Baltimore.
To explore whether full-face helmets could offer a greater degree of protection from craniofacial trauma than modular, half, and bucket helmets, the researchers prospectively enrolled 135 men and 16 women with an average age of 38.4 years (range, 19-74 years) who were involved in a motorcycle crash from 2011 to 2012.
The average Glasgow Coma Scale score was 14 in the full-face group and 13 in the other helmet group. Injury Severity Scores were 11.87 and 14.64, respectively. "Other helmet" types were 39 half-helmets and 28 modular helmets.
In all, there were cervical spine fractures in 8.5% of patients wearing full-face helmets, compared with 11.9% of those wearing other helmet types (relative risk reduction, 20%; P = .78), Dr. Brewer said. Mortality was also similar, at 4.8% and 7.9% (RRR, 36%; P = 0.36).
He acknowledged that data from this and other studies may do little to convince unwilling motorcyclists to don a helmet, particularly older riders – who surprisingly were found to be less likely to wear the safer, full-face helmets.
"We will use this and further studies to prove to the Department of Transportation that there should be a minimum standard in helmets," Dr. Brewer said in an interview. Then, "once we can affect the legislature, then we can go out to the public and say, ‘Listen, this is the law, and this is what you have to do.’ "
Dr. Brewer and his coauthors reported no conflicts of interest.