From the emergency room door to the trauma center to the rehabilitation unit, the authors report, care for unhelmeted crash victims cost substantially more and kept patients in the hospital longer than care for patients who wore helmets.
At the same time, those injured while riding without a helmet were somewhat less likely to be covered by insurance that could pay for their care, according to the paper in the September issue of the Journal of Trauma. The results also confirm earlier findings that riders without helmets were younger, suffered more head and neck injuries, and had a higher overall injury severity score.
The study analyzed data for 216 motorcycle crash victims brought to the U-M Health System's Trauma Burn Center between 1996 and 2000. Forty-two of them, or 19 percent, were not wearing a helmet when they crashed -- despite Michigan's mandatory helmet law. The detailed analysis was made possible by a unique medical records database that captures diagnoses and charges for U-M patients.
On average, helmet use led to average hospital costs that were about 20 percent, or $6,000, less than costs for those who didn't wear helmets. For patients who were treated on an inpatient rehabilitation floor at the U-M after leaving the trauma unit, average costs for unhelmeted riders were nearly twice those of helmeted riders.
"This adds further evidence to the argument that we need helmet laws for every rider in every state, not to infringe on personal freedom, but to improve safety and reduce costs for everyone," says Mary Margaret Brandt, M.D. an assistant professor in the U-M Medical School's Department of Surgery and a trauma surgeon at the Trauma Burn Center. "Until that happens, it shows that those who ride without helmets should pay higher insurance premiums, as smokers and other high-risk groups do."
The U-M researchers' approach differs from that of previous studies that tallied health care costs for every victim of motorcycle crashes in a given state -- including those who died at the scene or before they reached the hospital, and therefore lowered the overall average cost of care.
In 2000, 2,862 motorcyclists died and approximately 58,000 were injured in highway crashes in the United States, according to the National Highway Traffic Safety Administration. Unhelmeted riders are 40 percent more likely to suffer a fatal head injury and 15 percent more likely to sustain a nonfatal injury than those who wear helmets, NHTSA reports.
Despite the evidence supporting helmet use as a means of reducing injuries, deaths, health care costs and disability, three U.S. states have no helmet law, and another 27 have laws that only require helmets for certain riders, mainly minors.
Since the U.S. Congress lifted federal sanctions in 1995, five states have weakened their helmet laws. And in the past year, there have been campaigns to weaken or repeal the helmet laws of 10 states, including Michigan. The state's latest repeal attempt passed the state House in May.
The U-M study found that 81 percent of the patients admitted to the U-M Trauma Burn Center from motorcycle crashes in the study period had worn a helmet, even though Michigan state police surveys from 1997 to 1999 found that 96 percent of people involved in motorcycle crashes wore helmets.
The average age of the helmeted riders was 37 years, compared with 32 years for unhelmeted riders. Ninety-two percent of all the patients studied were male. The injury severity score for each patient was calculated, and it correlated with the length of the patient's stay in the Trauma Burn Center and with the cost of the patient's hospitalization. The injury severity score for head and neck injuries was significantly higher for patients who had not worn helmets.
Patients who had worn helmets during their crash had average hospital costs of $31,158, as opposed to $37,317 for those who hadn't worn a helmet. Ninety-two percent of the helmeted riders were insured, while only 86 percent of unhelmeted riders were.
The researchers tracked 23 patients from the larger group who were admitted to the hospital-based rehabilitation unit run by the U-M Physical Medicine and Rehabilitation Department. Average costs for unhelmeted riders ran $43,053, compared with $23,201 for helmeted riders.
Brandt notes that the UMHS Data Warehouse, which has tracked all cost data for U-M inpatients since mid-1996, made the current research possible. She speculates that outpatient costs for unhelmeted patients, which cannot be accurately be tracked because many patients return to their home town after treatment at the U-M Trauma Burn Center, may be even higher.
"These differences in costs create a financial burden, incurred by the patient, which weighs on the health care system and society," she says. "The price for personal freedom is not isolated to the individual motorcyclist, but is paid by the entire community."
Besides Brandt, the paper's authors include Karla S. Ahrns, RN, a nurse in the Trauma Burn Center; and current and former U-M surgeons Cynthia A. Corpron, M.D., Glen Franklin, M.D. and Wendy L. Wahl, M.D.
For more information on motorcycle helmet issues, visit:
National Highway Traffic Safety Administration: www.nhtsa.dot.gov
Insurance Institute for Highway Safety: www.hwysafety.org/safety_facts/state_laws/helmet_use.htm