title: Cervical spine injuries and helmet laws: a population-based study.
abstract: 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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  III.
authors.affiliation: Department of Surgery, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. haisar.dao_campi@tufts.edu
authors.forename: Haisar
authors.initials: H
authors.lastname: Dao
authors.forename: Justin
authors.initials: J
authors.lastname: Lee
authors.forename: Reza
authors.initials: R
authors.lastname: Kermani
authors.forename: Christian
authors.initials: C
authors.lastname: Minshall
authors.forename: Evert A
authors.initials: EA
authors.lastname: Eriksson
authors.forename: Ronald
authors.initials: R
authors.lastname: Gross
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Doben
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009049:Motorcycles / Q000331:legislation & jurisprudence*; D011159:Population Surveillance; D012307:Risk Factors; D013124:Spinal Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology