Elizabeth Orsay

A prospective study of the impact of helmet usage on motorcycle trauma

STUDY OBJECTIVE To determine the effect of the use of a motorcycle helmet on reducing the mortality, morbidity, and health care costs resulting from motorcycle crashes. DESIGN A prospective, multicenter study of all eligible motorcycle crash victims. SETTING The emergency departments of eight medical centers across the state of Illinois, including representatives from urban, rural, teaching, and community facilities. TYPE OF PARTICIPANTS All motorcycle crash victims presenting less than 24 hours after injury for whom helmet information was known. Data were collected from April 1 through October 31, 1988. MEASUREMENTS AND MAIN RESULTS Fifty-eight of 398 patients (14.6%) were helmeted, and 340 (85.4%) were not. The nonhelmeted patients had higher Injury Severity Scores (11.9 vs 7.02), sustained head/neck injuries more frequently (41.7 vs 24.1%), and had lower Glasgow Coma Scores (13.73 vs 14.51). Twenty-five of the 26 fatalities were nonhelmeted patients. By logistic regression, the lack of helmet use was found to be a major risk factor for increased severity of injury. A 23% increase in health care costs was demonstrated for nonhelmeted patients (average charges

Motorcycle Trauma in the State of Illinois: Analysis of the Illinois Department of Public Health Trauma Registry

7,208 vs

The Impaired Driver: Hospital and Police Detection of Alcohol and Other Drugs of Abuse in Motor Vehicle Crashes

5,852). CONCLUSION Helmet use may reduce the overall severity of injury and the incidence of head injuries resulting from motorcycle crashes. A trend toward higher health care costs was demonstrated in the nonhelmeted patients.

Prospective study of the effect of safety belts in motor vehicle crashes.

STUDY OBJECTIVE To assess the current morbidity and mortality of motorcycle trauma in the state of Illinois and, specifically, to assess the incidence and cost of head injury to motorcycle crash patients according to their helmet use. DESIGN Retrospective, cross-sectional examination of the Illinois Department of Public Health Trauma Registry, for which data are available from July 1, 1991, through December 31, 1992. Data are collected from all hospitals designated as Level I or Level II trauma centers in Illinois. PARTICIPANTS All patients involved in motorcycle crashes and subsequently taken to a Level I or Level II trauma center in Illinois and entered into the trauma registry during the period studied. RESULTS Head injury, spinal injury, helmet use, demographic data, hospital charges, days in ICU, and source of payment were selected as outcome measures. During the 18-month study period, 1,231 motorcycle trauma patients were entered into the trauma registry. Eighteen percent were helmeted and 56.0% were nonhelmeted. In 26.0% the helmet status at the time of the crash was unknown. Thirty percent of the helmeted patients sustained head injury and 4% sustained spinal or vertebral injury, compared with 51% and 8%, respectively, for nonhelmeted patients. Nonhelmeted patients were significantly more likely to sustain severe (Abbreviated Injury Score [AIS], 3 or more) or critical (AIS, 5 or more) head injury. Patients with these serious head injuries incurred almost three times the hospital charges and used a disproportionately larger share of ICU days than those with mild or no head injuries. There was a trend toward greater use of public funds or self-pay status (no insurance) for payment of hospital charges in nonhelmeted patients. CONCLUSION Motorcycle helmet nonuse was associated with an increased incidence of serious head injury. Motorcycle trauma patients with severe or critical head injuries used a significantly greater proportion of ICU days and hospital charges than those with mild or no head injuries.

Motorcycle Helmets and Spinal Injuries: Dispelling the Myth

STUDY OBJECTIVES To determine the incidence of drugs of abuse and alcohol use in admitted drivers involved in motor vehicle crashes (MVCs) and to determine the rate of police detection of alcohol and drug use in these motorists. DESIGN Retrospective chart review of hospitalized drivers involved in MVCs and review of corresponding police reports. SETTING Two Level I trauma centers in a large metropolitan region. PARTICIPANTS All MVC drivers/motorcycle operators admitted to the trauma service from January 1, 1990, to December 31, 1990. MEASUREMENTS AND MAIN RESULTS The records of 634 injured motorists were reviewed; 200 (32% of the 625 patients with serum alcohol levels) were legally drunk (serum alcohol of 100 mg/dL or more), and 132 (22.6% of the 585 urine drug screens) had positive urine drug screens. Cocaine was the most prevalent drug of abuse, present in 51 patients (8.7%). Two hundred eighty-five patients (45.0%) were considered impaired (alcohol of 100 mg/dL or more and/or positive drug screen), representing almost half of all motorists admitted. The impaired motorists were younger, more often male, less likely to use a seat belt or helmet, and had higher Injury Severity Scores than their unimpaired counterparts. Police reports were available for 446 patients, 139 (31.2%) of whom were legally drunk and 67 (15%) of whom had positive drug screens, yielding an overall impairment rate of 46.2%. Only 34 (16.5%) patients were cited for driving under the influence. CONCLUSION An exceedingly high rate of impairment existed in this population of seriously injured motorists in a metropolitan region, the majority of whom were not charged by the police. Although alcohol is the most prevalent source of driver impairment, other drugs of abuse are also important contributors to this problem.

Primary Mesenteric Venous Thrombosis: An Unusual Cause of Abdominal Pain in a Young, Healthy Woman

Trauma resulting from motor vehicle crashes (MVCs) is the leading cause of death in persons 1 to 38 years old. The following prospective study was undertaken to assess the effect of safety belts on the types of injuries sustained in MVCs. A total of 1,364 patients from four Chicago-area hospitals were evaluated prospectively during a six-month period. Safety belts reduced the incidence of head, facial, thoracic, abdominal, and extremity injuries sustained in MVCs. Spinal injuries comprised the only group in which safety belt wearers sustained injuries more frequently than safety belt nonwearers. Further research on the different safety belt designs and effects of air bags is needed to reduce the incidence of cervical and lumbar strain in restrained patients.

Managed Care and Emergency Medical Services: Patient Knowledge Versus Patient Expectations

STUDY OBJECTIVE To determine the relationship between spinal injuries and helmet use in motorcycle trauma. DESIGN Retrospective case series. SETTING Twenty-eight hospitals in four midwestern states--Illinois, Iowa, Nebraska and Wisconsin--representing urban, suburban, and rural settings. PATIENTS AND OTHER PARTICIPANTS Consecutive sample of motorcyclists treated at the participating centers. INTERVENTIONS None. MAIN OUTCOME MEASURES The major variables evaluated were helmet use, ethanol use, and significant head or spinal injuries. RESULTS 1,153 cases were analyzed. Helmet use was not significantly associated with spinal injuries (odds ratio, 1.12; 95% confidence intervals, 0.79, 1.58) whereas head injury was markedly decreased with helmet use (odds ratio, 0.35; 95% confidence intervals, 0.23, 0.53). Ethanol use was a significant variable in both head (odds ratio, 3.89) and spinal (odds ratio, 2.41) injuries. CONCLUSION In contrast to a significant protective relationship identified for head injuries, helmet use was not associated with an increased or decreased occurrence rate of spinal injuries in motorcycle trauma.

Analysis of Hispanic motor vehicle trauma victims in Illinois, 1991-1992

A 24-year-old woman presented to the emergency department with acute abdominal pain and a physical examination consistent with acute pelvic inflammatory disease. She was treated and released only to return several hours later with worsening of her condition and unstable vital signs. Laparotomy revealed acute mesenteric venous thrombosis with patent mesenteric arteries. This is an unusual case of mesenteric thrombosis in a young, healthy woman.

A novel curriculum for teaching research methodology

Abstract [Orsay EM, Stewart KJ: Managed care and emergency medical services: Patient knowledge versus patient expectations. Ann Emerg Med July 1999;34:95-97.]