title: Helmet use is associated with safer bicycling behaviors and reduced hospital resource use following injury.
abstract: 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 New York City Level 1 trauma center. All bicyclists with known helmet status were 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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Departments of Surgery (R.W., L.A.D., R.J.S., S.R.T., D.S., S.J., O.B., C.W., H.L.P., S.G.F.), Emergency Medicine (S.W., D.A.L.), and Pediatrics (D.A.L.), Bellevue Hospital Center, New York University School of Medicine; and Office of Research, Implementation and Safety (M.R.), NYC Department of Transportation, New York, New York.
authors.forename: Rachel
authors.initials: R
authors.lastname: Webman
authors.forename: Linda A
authors.initials: LA
authors.lastname: Dultz
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Simon
authors.forename: S Rob
authors.initials: SR
authors.lastname: Todd
authors.forename: Dekeya
authors.initials: D
authors.lastname: Slaughter
authors.forename: Sally
authors.initials: S
authors.lastname: Jacko
authors.forename: Omar
authors.initials: O
authors.lastname: Bholat
authors.forename: Stephen
authors.initials: S
authors.lastname: Wall
authors.forename: Chad
authors.initials: C
authors.lastname: Wilson
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Levine
authors.forename: Matthew
authors.initials: M
authors.lastname: Roe
authors.forename: H Leon
authors.initials: HL
authors.lastname: Pachter
authors.forename: Spiros G
authors.initials: SG
authors.lastname: Frangos
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000517:prevention & control*; D001642:Bicycling / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000517:prevention & control* / Q000523:psychology; D005500:Follow-Up Studies; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006295:Health Resources / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D011446:Prospective Studies; D012309:Risk-Taking; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology