The protective effect of helmet use in motorcycle and bicycle accidents: a propensity score–matched study based on a trauma registry system

Spencer C. H. Kuo, Pao-Jen Kuo, Cheng-Shyuan Rau, Yi-Chun Chen, Hsiao-Yun Hsieh, Ching-Hua Hsieh

Transportation by motorcycle and bicycle has become popular in Taiwan, this study was designed to investigate the protective effect of helmet use during motorcycle and bicycle accidents by using a propensity score-matched study based on trauma registry system data. Data of adult patients hospitalized for motorcycle or bicycle accidents between January 1, 2009 and December 31, 2015 were retrieved from the Trauma Registry System. These included 7735 motorcyclists with helmet use, 863 motorcyclists without helmet use, 76 bicyclists with helmet use, and 647 bicyclists without helmet use. The primary outcome measurement was in-hospital mortality. Secondary outcomes were the hospital length of stay (LOS), intensive care unit (ICU) admission rate, and ICU LOS. Normally distributed continuous data were analyzed by the unpaired Student t-test, and non-normally distributed data were compared using the Mann-Whitney U-test. Two-sided Fisher exact or Pearson chi-square tests were used to compare categorical data. Propensity score matching (1:1 ratio using optimal method with a 0.2 caliper width) was performed using NCSS software, adjusting for the following covariates: sex, age, and comorbidities. Further logistic regression was used to evaluate the effect of helmet use on mortality rates of motorcyclists and bicyclists, respectively. The mortality rate for motorcyclists with helmet use (1.1%) was significantly lower than for motorcyclists without helmet use (4.2%; odds ratio [OR] 0.2; 95% confidence interval [CI]: 0.17-0.37; p < 0.001). Among bicyclists, there was no significant difference in mortality rates between the patients with helmet use (5.3%) and those without helmet use (3.7%; OR 1.4; 95% CI: 0.49-4.27; p = 0.524). After propensity-score matching for covariates, including sex, age, and comorbidities, 856 well-balanced pairs of motorcyclists and 76 pairs of bicyclists were identified for outcome comparison, showing that helmet use among motorcyclists was associated with lower mortality rates (OR 0.2; 95% CI: 0.09-0.44; p < 0.001). In contrast, helmet use among bicyclists was not associated with a decrease in mortality (OR 1.3; 95% CI: 0.30-5.96; p = 0.706). The hospital LOS was also significantly shorter for motorcyclists with helmet use than for those without (9.5 days vs. 12.0 days, respectively, p < 0.001) although for bicyclists, helmet use was not associated with hospital LOS. Fewer motorcyclists with helmet use were admitted to the ICU, regardless of the severity of injury; however, no significant difference of ICU admission rates was found between bicyclists with and without helmets. Motorcycle helmets provide protection to adult motorcyclists involved in traffic accidents and their use is associated with a decrease in mortality rates and the risk of head injuries. However, no such protective effect of helmet use was observed for bicyclists involved in collisions.