title: Helmet use among motorcycle and moped riders injured in Hawaii: Final medical dispositions from a linked database.
abstract: BACKGROUND
  Reports regarding helmets in motorcycle crashes have been limited by the lack of data across the spectrum of injury outcomes, generally excluding low-severity injuries that do not require further medical treatment. We hypothesized that the protective effect of helmets may be underestimated in studies that focused only on patients who arrive at a trauma center and that it may differ depending on whether the crash involved a motorcycle or moped.
  
  
  METHODS
  The emergency medical service reports of 2,553 crash patients treated from 2007 to 2009 were linked to police crash reports, hospital billing data, death certificates, and the Fatal Analysis Reporting System for a more complete description of the crashes throughout the state.
  
  
  RESULTS
  The number of unhelmeted riders (n = 1,674) was nearly double those who were helmeted (n = 879). Multivariate logistic regression models estimated 45% greater odds of a hospital admission (vs. no hospital treatment or a discharge from the emergency department setting) among unhelmeted riders, compared with helmeted riders. Unhelmeted riders also had an adjusted odds of a fatal injury that was more than double that of helmeted riders (odds ratio, 2.71; 95% confidence interval, 1.68-4.46). Stratified analyses showed that these protective associations between helmet use and medical disposition were apparent only among motorcyclists.
  
  
  CONCLUSIONS
  The magnitude of the protective associations between helmets and medical outcomes was generally greater than that reported by other studies. Motorcyclists seem to benefit from helmet use more than moped riders. This data could be used to promote helmet use through education and public policy.
  
  
  METHODS
  Prognostic/epidemiologic study, level III.
authors.affiliation: From the Injury Prevention and Control Program (D.J.G., L.R.), Hawaii Department of Health; and Department of Surgery (C.L.L., L.L.W., S.S.), University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Galanis
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Ly
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wong
authors.forename: Susan
authors.initials: S
authors.lastname: Steinemann
authors.forename: Linda
authors.initials: L
authors.lastname: Rosen