Systematic review and meta-analysis of efficacy of helmet use and helmet laws to reduce mortality and cervical spine injury in adult motorcycle riders: A practice management guideline from the Eastern Association for the Surgery of Trauma

Authors

Asanthi M. Ratnasekera, From the Division of Trauma and Surgical Critical Care, Department of Surgery (A.M.R.), Christianacare Health, Newark, Delaware; Department of Surgery (S.S.S.), Crozer Health, Upland, Pennsylvania; Legacy Research Institute/Devers Eye Institute (S.K.G.), Legacy Health Systems, Portland, Oregon; Department of Surgery (C.B.), Natividad Medical Center, Salinas, California; Department of Surgery (A.G.-S.), Cooper University Hospital, Camden, New Jersey; Division of Trauma and Acute Care Surgery (N.L.), Scripps Memorial Hospital, La Jolla, California; Scripps Clinic/Scripps Clinic Medical Group (N.L.); Midwestern University (H.A.A.), Chicago, Illinois; Department of Surgery (R.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (H.M.), Jazan University, Saudi Arabia; Division of Trauma (S.H.), Wellspan York Hospital, York, Pennsylvania; Division of Surgery (S.C.), King Saud Medical City, Riyadh, Saudi Arabia; Division of Trauma Surgery, Acute Care Surgery, and Surgical Critical Care (H.S.-L.), Creighton University School of Medicine, Phoenix, Arizona; Louis Calder Memorial Library, Department of Learning, Research, and Clinical Information Services, (J.M.R.) University of Miami Miller School of Medicine Miami, Florida; Division of Acute Care Surgery (A.L.T.), Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Surgery (S.K.), The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Surgery (E.J.K.), University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma and Acute Care Surgery, Department of Surgery (P.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Division of General Surgery, Trauma and Surgical Critical Care, Department of Surgery (L.K.), Yale School of Medicine, New Haven, Connecticut; and Trauma Surgery Services (R.R.), Legacy Emanuel Medical Center, Portland, Oregon.
Sirivan S. Seng
Stuart K. Gardiner
Caroline Butler
Anna Goldenberg-Sandau
Ning Lu
Hiba Abdel Aziz
Rachel D. Appelbaum
Hassan Mashbari
Shabnam Hafiz
Sharfuddin Chowdhury
Hahn Soe-Lin
John M. Reynolds
Amanda L. Teichman
Susan Kartiko
Elinore J. Kaufman
Patrick Murphy
Lisa Kodadek
Rishi Rattan

Document Type

Journal Article

Publication Date

6-4-2025

Journal

The journal of trauma and acute care surgery

DOI

10.1097/TA.0000000000004607

Keywords

Helmets; helmet laws; motorcycle collisions; universal helmet laws

Abstract

BACKGROUND: Motorcycle crash fatalities remain a significant public health concern. Traumatic brain injury is a leading cause of death following motorcycle crash. We aim to provide evidence-based guidelines pertaining to helmet use and helmet laws with respect to important outcomes including mortality, cervical spine injury, and discharge disposition. METHODS: An evidence-based systematic review was performed to answer the following Population, Intervention, Comparator, Outcomes (PICO) questions: PICO 1-Should adult motorcycle riders wear helmets or not wear helmets to improve mortality, brain injury-related mortality, cervical spine injury, and discharge disposition from the hospital? PICO 2-Should motorcycle universal helmet laws (UHLs) or no UHLs be enacted to improve mortality, brain injury-related mortality, cervical spine injury, and discharge disposition from the hospital? An academic medical librarian searched Medline, Cochrane CENTRAL, CINAHL, Embase, Engineering Village, Health and Safety Science Abstracts, Scopus, SPORTDiscus, TRID, the VHL Regional Portal, and Elsevier. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used to assess the quality of the evidence and create recommendations. The working group reached consensus on the final evidence-based recommendations. The study was registered in PROSPERO (CRD42020172705). RESULTS: A total of 28 studies were identified for analysis for PICO 1, and 10 studies were identified for PICO 2. Helmet use was associated with a lower incidence of mortality (odds ratio, 0.48; 95% confidence interval, 0.41-0.56; p < 0.001) and lower incidence of cervical spine injury (odds ratio, 0.66; 95% confidence interval, 0.58-0.76; p < 0.001). Although a meta-analysis for PICO 2 was not possible because of significant methodological heterogeneity, the vast majority of studies demonstrated large improvements in outcomes with a UHL. Overall certainty of evidence was deemed low for PICO 1 and PICO 2 because of risk of bias. CONCLUSION: We strongly recommend that individual motorcycle riders wear helmets and that universal helmet legislation be enacted and enforced to decrease mortality, to decrease the incidence of cervical spine injury, and to improve discharge disposition from the hospital. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level II.

APA Citation

Ratnasekera, Asanthi M.; Seng, Sirivan S.; Gardiner, Stuart K.; Butler, Caroline; Goldenberg-Sandau, Anna; Lu, Ning; Abdel Aziz, Hiba; Appelbaum, Rachel D.; Mashbari, Hassan; Hafiz, Shabnam; Chowdhury, Sharfuddin; Soe-Lin, Hahn; Reynolds, John M.; Teichman, Amanda L.; Kartiko, Susan; Kaufman, Elinore J.; Murphy, Patrick; Kodadek, Lisa; and Rattan, Rishi, "Systematic review and meta-analysis of efficacy of helmet use and helmet laws to reduce mortality and cervical spine injury in adult motorcycle riders: A practice management guideline from the Eastern Association for the Surgery of Trauma" (2025). GW Authored Works. Paper 7463.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7463

Department

Surgery