Association of State Helmet Laws with Helmet Use and Injury Outcomes in Motorcycle Crashes

Abstract

BACKGROUND: Helmet laws vary by state. North Carolina (NC) requires all motorcyclists to be helmeted, whereas South Carolina (SC) requires helmets only for drivers younger than 21 years of age. We examined helmet use data and outcomes among motorcycle crash (MCC) patients evaluated at a Level I trauma center with a catchment area spanning the 2 states. STUDY DESIGN: A retrospective cohort study was conducted of all adult MCC victims evaluated by the trauma department at an American College of Surgeons-verified Level 1 trauma center between July 2012 and July 2022. Helmet usage was compared by state, and outcomes were compared by helmet status. RESULTS: A total of 2,196 patients were evaluated following MCC; 86.3% were helmeted. Patients injured from NC were more likely to be helmeted when compared with SC (94 vs 52%, respectively, p < 0.001). Helmeted patients had a lower Injury Severity Score (13.6 vs 16.0, p = 0.001). Helmeted patients were more likely to be discharged from the emergency department (13% vs 10%) and were less likely to be admitted to the ICU (25% vs 39%, p < 0.001). In-hospital mortality for helmeted patients was 4% vs 7% in unhelmeted patients (p = 0.05). CONCLUSIONS: Patients from NC were more likely to be helmeted when compared with SC. Unhelmeted patients had more severe injuries, were more likely to be admitted, and require ICU-level care.