Helmet use is associated with safer bicycling behaviors and reduced hospital resource use following injury

Rachel Webman, Linda A. Dultz, Ronald J. Simon, S. Rob Todd, Dekeya Slaughter, Sally Jacko, Omar Bholat, Stephen Wall, Chad Wilson, Deborah A. Levine, Matthew Roe, H. Leonr Pachte, Spiros G. Frangos

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


BACKGROUND: While the efficacy of helmet use in the prevention of head injury is well described, helmet use as it relates to bicyclists' behaviors and hospital resource use following injury is less defined. The objective of this study was to compare the demographics, behaviors, hospital workups, and outcomes of bicyclists based on helmet use. METHODS: This study was a subset analysis of a 2.5-year prospective cohort study of vulnerable roadway users conducted at Bellevue Hospital Center, a NewYork City Level 1 trauma center. All bicyclists with known helmet statuswere included. Demographics, insurance type, traffic law compliance, alcohol use, Glasgow Coma Scale (GCS) score, initial imaging studies, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), admission status, length of stay, disposition, and mortality were assessed. Information was obtained primarily from patients; witnesses and first responders provided additional information. RESULTS: Of 374 patients, 113 (30.2%) were wearing helmets. White bicyclists were more likely to wear helmets; black bicyclists were less likely ( p = 0.037). Patients with private insurance were more likely to wear helmets, those with Medicaid or no insurance were less likely ( p = 0.027). Helmeted bicyclists were more likely to ride with the flow of traffic (97.2%) and within bike lanes (83.7%) (p < 0.001 and p = 0.013, respectively). Nonhelmeted bicyclists were more likely to ride against traffic flow ( p = 0.003). There were no statistically significant differences in mean GCS score, AIS score, and mean ISS for helmeted versus nonhelmeted bicyclists. Nonhelmeted patients were more likely to have head computed tomographic scans ( p = 0.049) and to be admitted ( p = 0.030). CONCLUSION: Helmet use is an indicator of safe riding practices, although most injured bicyclists do not wear them. In this study, helmet use was associated with lower likelihood of head CTs and admission, leading to less hospital resource use. Injured riders failing to wear helmets should be targeted for educational programs.

Original languageEnglish (US)
Pages (from-to)877-881
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Issue number5
StatePublished - Nov 2013
Externally publishedYes


  • Behavior
  • Bicyclist
  • Helmet
  • Injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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