It is Time to put the Lid on Traumatic Brain Injuries in Scooter Crashes

Abstract

Introduction: Rider education that stresses helmet usage has not reached the scooter population. The impression that scooters are a safe, low-speed means of transport often results in poor helmet compliance. However, severe head injuries are common in scooter crashes. We chose to evaluate whether helmet use in the scooter rider population is associated with a reduction of traumatic brain injury (TBI), skull, and c-spine injuries. Materials and methods:A retrospective analysis of our Level I trauma center registry was performed identifying all patients treated for scooter crash-related injuries from 2003 to 2015. Helmet data were collected from Emergency Medical Services, police, and hospital records. Statistical analysis was performed using χ 2 , Mann-Whitney U-test, and z-test for proportions.Results: Of 1,006 scooter crash patients, 13.3% of patients wore helmets at the time of their crash. Their mean age was 34.2 ± 16 years with an 80% male population. The Glasgow Coma Scale (GCS) in the unhelmeted group was nominally lower (13.11 ± 3.7) when compared with the helmeted group (13.92 ± 2.8). There were more TBIs (61.6%) in unhelmeted patients vs helmeted patients (36.6%; p < 0.0001). Of all helmeted patients, none presented with epidural hematomas, and helmeted patients suffered significantly fewer subdural hemorrhages, subarachnoid hemorrhages, and skull fractures when compared with unhelmeted patients (p = 0.008, p = 0.005, p < 0.0001 respectively). Mortality was 4.0% in the unhelmeted group and 1.5% in the helmeted group (p = 0.215), but this difference did not reach statistical significance. Conclusion:Helmet use significantly lowers the risk of TBI in scooter crashes. Additional multicenter trials are needed to study a possible survival benefit associated with helmet use. Educational and community outreach programs are needed urgently to improve helmet use compliance among scooter riders in order to reduce the TBI incidence.