Cervical spine injuries and helmet laws: A population-based study

BACKGROUND: To assess the incidence of cervical spine (C-spine) injuries in patients admitted after motorcycle crash in states with mandatory helmet laws (MHL) compared with states without helmet laws or selective helmet laws. METHODS: The Nationwide Inpatient Sample from the Healthcare and Utilization Project for the year 2008 was analyzed. International Classification of Diseases and Health Related Problems, Ninth Edition codes were used to identify patients with a diagnosis of motorcycle crash and C-spine injuries. National estimates were generated based on weighted analysis of the data. Outcome variables investigated were as follows: length of stay (LOS), in-hospital mortality, hospital teaching status, and discharge disposition. States were then stratified into states with MHL or selective helmet laws. RESULTS: A total of 30,117 discharges were identified. Of these, 2,041 (6.7%) patients had a C-spine injury. Patients in MHL states had a lower incidence of C-spine injuries (5.6 vs. 6.4%; p < 0.003) and less in-hospital mortality (1.8 vs. 2.6%; p < 0.0001). Patients older than 55 years were less likely to be discharged home (57.5% vs. 72.5%; p < 0.0001), more likely to die in-hospital (3.0% vs. 2.1%; p < 0.0001), and more likely to have a hospital LOS more than 21 days (7.7% vs. 6.2%; p < 0.0001). CONCLUSION: Patients admitted to the hospital in states with MHLs have decreased rate of C-spine injuries than those patients admitted in states with more flexible helmet laws. Patients older than 55 years are more likely to die in the hospital, have a prolonged LOS, and require services after discharge.