Motorcycle helmet effect on a per-crash basis in Thailand and the United States

OBJECTIVE: To compare the effectiveness of motorcycle helmets seen in prospective on-the-street motorcycle accident investigations. The data are drawn from two detailed, in-depth studies of motorcycle accidents, in which trained investigators collected extensive accident evidence on-scene immediately after the crash. This article compares helmeted and unhelmeted motorcycle riders on a per-accident basis for fatality rates, the rate of serious (AIS > 2) brain injuries among survivors, or an outcome that involved either of the two. METHODS: Nine hundred motorcycle crashes in Los Angeles and 969 crashes in Thailand were investigated in detail at the accident scenes, including photos of vehicles, skids, damage, and sometimes the rider. Helmets were collected and injury information was obtained from riders and care providers. This evidence was then used to reconstruct collision events to identify speeds, precrash motions, collision contacts, injury causation, and helmet performance. RESULTS: In both studies, approximately 6% of riders were killed and 20-25% were hospitalized. Overall, unhelmeted riders were two to three times as likely to be killed, and three times as likely to suffer either death or survival with AIS > 2 brain injury. Unhelmeted survivors had three to four times as many AIS > 2 brain injuries as helmeted riders on a per-crash basis. Nearly 100% of riders with AIS > 4 somatic injuries died. Such injuries were 30% of Thailand fatalities and 57% of L.A. fatalities, but only about 2-3% of the overall accident population. Among the 97-98% of riders with AIS < 5 somatic injuries, helmet use could prevent about three-fourths of fatalities and brain injuries. CONCLUSIONS: Helmets were extremely effective in preventing brain injury and death in 97% of the accident population in less-than-extreme crashes. Helmet use cannot prevent all fatalities because many of those killed succumb to below-the-neck injuries that a helmet cannot prevent.     

Severity and patterns of injury in helmeted vs. non-helmeted motorcyclists in a rural state

Introduction: Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders. Methods: Retrospective review (2014–2018) of a single level 1 trauma center’s registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student’s t-test or Pearson’s χ² p-value ≤0.05 as significant. State Department of Transportation data registry for state level mortality and collision incidence over the same time period was also obtained. Results: Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS. Conclusions: Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.     

Are motorcycles really “donorcycles”? Examining organ donation rates between unhelmeted and helmeted motorcyclists

Introduction: Motorcycles are colloquially referred to as “donorcycles” among medical staff. However, the actual impact of helmet laws and helmet use on organ donation is unknown. Michigan’s 35-year-old universal helmet law (UHL) was repealed in April 2012 and replaced by a partial-helmet law. We hypothesized that there would be an increase in organ donation rates from unhelmeted motorcyclist fatalities. Methods: Michigan's Gift of Life Michigan organ donation database was queried from April 2008 through May 2015 in conjunction with the Michigan Trauma Quality Improvement Program database from the same time period. All in-hospital motorcycle crash fatalities were examined. Results: A three-fold increase was found in the rate of organ donation for unhelmeted motorcyclists compared to helmeted motorcyclists (p = 0.006). Motorcycle crash fatalities tended to be younger in age after the UHL repeal with an average age of 32.8 years versus 40.8, however, this finding was not statistically significant (p = 0.071). Additionally, there was no significant difference in organ donation rates pre-UHL repeal (2008–2012) versus post-repeal (2012–2015). Conclusions: This is the first study to demonstrate an increased rate of organ donation among unhelmeted motorcyclist fatalities compared to helmeted rider fatalities. There was no significant increase in the rate of organ donation following the Michigan UHL repeal. However, we identified that some motorcycle crash fatalities were from illegally unhelmeted riders in the past, prior to the repeal. Practical Application: Unhelmeted motorcyclists are three times more likely than helmeted riders to become organ donors, possibly due to the well documented increase in severe traumatic brain injuries in this population. From a public health perspective, helmets should be required for all motorcyclists and efforts to advocate in favor of helmet legislation should be supported by trauma systems and health professionals.     

Motorcycle helmets and spinal cord injury: helmet usage and type

The objective of this study was to assess the role of helmets and helmet type in relation to injury to the cervical spinal cord. It was based on a consecutive series of 110 motorcyclists with neurological damage to the spinal cord admitted alive (referred to as acute survivors) to a specialist spinal cord injuries unit at an Australian hospital. Cases were those with injury to the cervical spinal cord and controls were those with injury to the cord of other segments of the spine. The study showed that there was no significant difference in the odds of cervical spinal cord injury among unhelmeted and helmeted motorcyclist acute survivors. In addition, it confirmed the findings of a recently published Australian fatality study demonstrating no difference in the odds of cervical spinal cord injury among full-face and open-face helmet wearers. These results contrasted with the findings of earlier studies. In consideration of the limitations of existing research on the role of helmets in spinal cord injury, further study is required based on a larger series or a series having a higher proportion of non-wearers and open-face helmet wearers, including both survivors and those killed, and including assessment of cord and non-cord spinal injuries separately, helmet type, head impact, and helmet retention.     

The effects of a mandatory motorcycle helmet law on helmet use and injury patterns among motorcyclist fatalities

BACKGROUND: The National Highway Traffic Safety Administration (NHTSA) has found that motorcycle helmets are 37% effective in preventing death and 65% effective in preventing brain injuries in a crash. Unfortunately, in 1995 Congress lifted federal sanctions against states without helmet laws and since then there have been a number of primary motorcycle helmet laws repealed or weakened. More lives could be saved and serious injuries avoided if there was increased helmet use throughout the United States. METHODS: This study analyzed helmet use and injury patterns among motorcycle riders in the United States involved in fatal crashes from 1995 through 2003 and compared the results between states with and without a primary helmet law. Age, sex, injury severity and helmet use are some of the variables obtained from the Fatality Analysis Reporting System (FARS). RESULTS: In the 20 states and the District of Columbia, which currently have a primary helmet law, 84.0% of fatally injured riders were wearing a helmet. In the 27 states with a secondary helmet law, 36.2% of fatalities used a helmet, and in the remaining three states with no law at all, helmet use dropped to 17.6%. In the two states (Arkansas and Texas) that changed from a primary helmet law to a secondary helmet law in 1997, helmet use decreased from 78.2% in 1996 to 31.7% in 2000. CONCLUSION: If all states were to enact a primary motorcycle helmet law, helmet use would dramatically increase while decreasing the number of motorcyclist head injuries and fatalities. IMPACT ON INDUSTRY: The results of this study will hopefully persuade law makers to enact primary helmet laws in all states throughout the nation. Helmet manufacturers can use this data to design more comfortable helmets while also improving upon the protective qualities of these safety devices.     

Changes in motorcycle-related injuries and deaths after mandatory motorcycle helmet law in a district of Vietnam

Objective: Our study measured the change in head injuries and deaths among motorcycle users in Cu Chi district, a suburban district of Ho Chi Minh City.

Methods: Hospital records for road traffic injuries (RTIs) were collected from the Cu Chi Trauma Centre and motorcycle-related death records were obtained from mortality registries in commune health offices. Head injury severity was categorized using the Abbreviated Injury Score (AIS). Rate ratios (RRs) were used to compare rates pre- and post-law (2005/2006–2009/2010). Cu Chi's population, stratified by year, age, and sex, was used as the denominator.

Results: Of records identifying the transportation mode at the time of injury, motorcyclists accounted for most injuries (3,035, 87%) and deaths (238, 90%). Head injuries accounted for 70% of motorcycle-related hospitalizations. Helmet use was not recorded in any death records and not in 97% of medical records. Males accounted for most injuries (73%) and deaths (88%). The median age was 28 years and 32 years for injuries and deaths, respectively. Compared to the pre-law period, rates of motorcycle injuries (RR = 0.53; 95% confidence interval [CI], 0.49–0.58), head injuries (RR = 0.35; 95% CI, 0.31–0.39), severe head injuries (RR = 0.47; 95% CI, 0.34–0.63), and deaths (RR = 0.69; 95% CI, 0.53–0.89) significantly decreased in the post-law period.

Conclusions: Rates of head injuries and deaths among motorcycle riders decreased significantly after implementation of the mandatory helmet law in Vietnam. To further examine the impact of the motorcycle helmet law, including compliance and helmet quality, further emphasis should be placed on gathering helmet use data from injured motorcyclists.     

Severity of e-scooter rider injuries associated with trip characteristics

Introduction: E-scooter rider injuries have been growing, but little is known about how trip and incident characteristics contribute to their severity. Method: We enrolled 105 adults injured while riding e-scooters who presented to an emergency department in Washington, DC, during 2019. Enrolled participants completed an interview during the emergency department visit, and their charts were abstracted to document their injuries and treatment. Logistic regression examined the association of incident location and circumstances with the likelihood of sustaining an injury on the Abbreviated Injury Scale (AIS) ≥ 2, while controlling for rider characteristics. Results: The most common locations of e-scooter injuries in our study sample occurred on the sidewalk (58%) or road (23%). Accounting for other trip and rider attributes, e-scooter riders injured on the road were about twice as likely as those injured elsewhere to sustain AIS ≥ 2 injuries (RR, 1.96; 95% CI, 1.23–2.36) and those who rode at least weekly more often sustained AIS ≥ 2 injuries compared with less frequent riders (RR, 1.86; 95% CI, 1.11–2.32). Conclusions: Greater injury severity for riders injured on the road may reflect higher travel speeds. Practical applications: Injury severity associated with riding in the road is one factor that jurisdictions can consider when setting policy on where e-scooters should be encouraged to ride, but the risk of any crash or fall associated with facilities should also be examined. Although injuries are of lower severity on sidewalks, sharing sidewalks with slower moving pedestrians could potentially lead to more conflicts.     

Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand

Background: In Thailand, road traffic injuries are the leading cause of death for youth ages 15–19 years, with 80% of the injuries and deaths from motorcycle accidents. Objectives: To determine the prevalence of child and young adolescent motorcyclists in Hat Yai municipality and their risk behaviors. Method: A cross-sectional study was conducted between June 2011 and March 2012 in which 2,471 students, ages 8 to 18 years, were recruited from 9 primary and secondary schools in Hat Yai municipality. The questionnaire included questions on being a motorcycle rider or passenger, risky behaviors, and helmet use while riding. Results: Of the total, 1,573 (63.7%) were riders and 898 (36.3%) were pillion passengers. The majority of the riders younger than 15 years rode their motorcycle mainly only in narrow streets for a short trip. Only 30% of the riders wore a helmet every time they rode a motorcycle. About 10% of the participants riding or a passenger on a motorcycle had consumed alcohol at least once before riding their motorcycle. Multiple logistic regression analysis found that motorcycle injuries were significantly associated with speeds greater than 60 km/h, not wearing a helmet while riding, and alcohol consumption before riding (odds ratios 1.63, 1.59, and 3.09, respectively). Conclusion: Nearly two thirds of young adolescents in Hat Yai municipality were motorcycle riders. These young adolescents were at risk of traffic injuries because more than 50% of them had ridden at high speed or not worn a helmet while riding, and some of them had consumed alcohol before riding.     

Exploring motorcyclist injury severity resulting from various crash configurations at T-junctions in the United Kingdom--an application of the ordered probit models

OBJECTIVES: The fact that motorcycle users tend to be more vulnerable to injuries than those using other motorized vehicles may act synergistically with the complexity of conflicting movements between vehicles and motorcycles to increase injury severity in a junction-type accident. A junction-type collision tends to be more severe than a non-junction case due to the fact that some of the injurious crashes such as angle-collision commonly occur. Existing studies have applied several statistical modeling techniques to examine influential factors on the occurrences of different crashes among motorized vehicles but surprisingly very little has empirically explored whether a particular crash type, resulting from a junction-type accident, is more injurious to motorcyclists. This article attempts to investigate whether a particular collision is more deadly to motorcyclists conditioned on crash occurrence at T-junctions in the U.K., while controlling for environment, vehicle, and demographic factors. METHODS: The statistical modeling technique employed is the ordered probit models using the data extracted from the STATS19 accident injury database (1999-2004). RESULTS: The modeling found determinants of injury severity among motorcyclists at T-junctions in the U.K. For example, an approach-turn/head-on collision is much more injurious to motorcyclists; and, those riding in early morning (i.e., 0000-0659) are more likely to be severely injured. CONCLUSIONS: This study offers a guideline for future research, as well as insight into potential prevention strategies that might help moderate motorcyclist injuries.     

Motorcycle helmet visor–related facial injury and its potential mechanism of injury: Evidence-based case study

Objectives: We encountered an unusual facial laceration wound in relation to motorcycle helmet visor use during our clinical practice. We aimed to assess the prevalence of this unusual facial injury among motorcyclists who sustained facial injuries in selected hospitals and to determine the possible mechanism involved.

Methods: We used our prospective cross-sectional substudy involving injured motorcyclists presenting at major trauma hospitals in Southern Klang Valley, Malaysia, between March 2010 and March 2011. of 391 subjects with facial injuries, 2 male motorcyclists sustained this laceration. The wounds were assessed and we believed that each was associated with the helmet visor. One of the visors was collected and the edge was inspected using scanning electron microscopy (SEM).

Results: The prevalence of this unusual injury was 0.51% (95% confidence interval, 0.002–0.012) among motorcyclists who sustained facial injuries. Both cases were involved in a head-on collision with their colliding partners and their helmets were intact throughout the crash. The visor in case 1 was intact, but the visor in case 2 was broken. SEM analysis showed that the visor in case 1 had a potential cutting surface.

We postulated that with helmet rotation in the forward and downward position and with some degree of visor bending or with a dislodged visor, the sharp-edged visor could potentially severely lacerate the face.

Conclusion: This injury affects facial aesthetics and early referral to the facial surgery team is advocated. Documentation of the mechanism of injury, the patient’s helmet and visor is obligatory, so that this information can be delivered to the regional road safety authority for preventive measures.     

Overview of motorcycling in the United States: a national telephone survey

Objectives

Motorcycle registrations have risen in recent years. Although motorcyclist crash fatalities in 2009 were 16% lower than in 2008, they were double the number of deaths in 1997. The present study examined current motorcyclists’ travel patterns and views of motorcycle helmets and other safety topics.

Methods

Motorcycle drivers were interviewed in a national telephone survey conducted in 2009. A weighted sample of 1,606 motorcyclists resulted from adjusting for the oversampling of those younger than 40 and those in the three states without a motorcycle helmet use law (Illinois, Iowa, New Hampshire). All analyses were based on the weighted sample, which was intended to result in a nationally representative sample of motorcyclists.

Results

About one-quarter of respondents said they did not always wear helmets. Of these respondents, 57% said a law requiring helmet use would persuade them to do so, and 27% said nothing would. Ninety-four percent of respondents in states with universal helmet laws said they always ride helmeted, compared with about half of respondents in other states. About half of all respondents favored these laws. About three-quarters said they believe helmets keep riders safer, including two-thirds of respondents who oppose universal laws and almost half of drivers who rarely/never wear helmets. Drivers ages 18–29 and drivers of sport/unclad sport, sport touring, and super sport motorcycles were more likely to always wear helmets, support universal helmet laws, and believe helmets keep riders safer. About half of respondents said antilock braking systems (ABS) enhance safety and that they would get ABS on their next motorcycle. Less than one-quarter thought an airbag would protect a motorcyclist in a crash, and even fewer would consider getting one on their next motorcycle. Forty-three percent of motorcyclists said they had crashed at least once; 62% of the most recent crashes involved no vehicles besides the motorcycle. Respondents reported riding their motorcycles about 5,400 miles, on average, during the past year. Drivers ages 18–29 reported riding fewer miles, on average, than older drivers and more often rode at night and to/from work or school. Drivers of touring and sport touring motorcycles traveled more miles and took more long trips.

Conclusions

Motorcyclists’ travel patterns and views vary widely, but there are distinct patterns by driver age and motorcycle type. Drivers who believe helmets keep riders safer are more likely to always wear them, but this belief appears insufficient to motivate some drivers to wear them. However, universal helmet laws appear effective in increasing helmet use. Many drivers are receptive to purchasing ABS on their next motorcycle.

Impact on industry

States should be encouraged to enact universal helmet laws, and motorcycle manufacturers should be encouraged to offer ABS.     

Validation of the abrasion resistance test protocols and performance criteria of EN13595: The probability of soft tissue injury to motorcycle riders by abrasion resistance of their clothing

IntroductionMotorcyclists represent an increasing proportion of road users globally and are increasingly represented in crash statistics. Soft tissue injuries are the most common type of injuries to crashed motorcyclists. These injuries can be prevented through the use of protective clothing designed for motorcycle use. However, the quality of such clothing is not controlled in many countries around the world. A European Standard was developed to assess the performance of clothing but as this is not mandatory, clothing certified to this Standard is difficult to obtain. Given the importance of this Standard, and that it has been validated only once, further validation work is required.MethodsIn-depth crash investigation data were used to investigate the relationship between the abrasion resistance performance of clothing and real-world injury outcome. Clothing was collected from riders who crashed on public roads in Sydney and Newcastle, Australia. This clothing was tested according to the EU Standard and the time to hole was recorded. Hospital medical records were reviewed and the association between a rider suffering a soft tissue injury and the time-to-hole for the garment was examined.ResultsThe probability of soft tissue injury for Level 1 Standard garments was between 40–60%, but more than 60% of garments tested failed to meet the minimum requirement.ConclusionsThe findings of this study provide qualified support for the Standard, with a marginal association between time-to-hole and injury being found.Practical ImplicationsThis work supports the need for improved safety performance and an increased number of high performing garments being available to motorcyclists.     

A multinomial logit model of motorcycle crash severity at Australian intersections

Introduction: Motorcyclists are exposed to more fatalities and severe injuries per mile of travel as compared to other vehicle drivers. Moreover, crashes that take place at intersections are more likely to result in serious or fatal injuries as compared to those that occur at non-intersections. Therefore, the purpose of this study is to evaluate the contributing factors to motorcycle crash severity at intersections. Method: A data set of 7,714 motorcycle crashes at intersections in the State of Victoria, Australia was analyzed over the period of 2006–2018. The multinomial logit model was used for evaluating the motorcycle crashes. The severity of motorcycle crashes was divided into three categories: minor injury, serious injury and fatal injury. The risk factors consisted of four major categories: motorcyclist characteristics, environmental characteristics, intersection characteristics and crash characteristics. Results: The results of the model demonstrated that certain factors increased the probability of fatal injuries. These factors were: motorcyclists aged over 59 years, weekend crashes, midnight/early morning crashes, morning rush hours crashes, multiple vehicles involved in the crash, t-intersections, crashes in towns, crashes in rural areas, stop or give-way intersections, roundabouts, and uncontrolled intersections. By contrast, factors such as female motorcyclists, snowy or stormy or foggy weather, rainy weather, evening rush hours crashes, and unpaved roads reduced the probability of fatal injuries. Practical Applications: The results from our study demonstrated that certain treatment measures for t-intersections may reduce the probability of fatal injuries. An effective way for improving the safety of stop or give-way intersections and uncontrolled intersections could be to convert them to all-way stop controls. Further, it is recommended to educate the older riders that with ageing, there are physiological changes that occur within the body which can increase both crash likelihood and injury severity.     

Examination of factors associated with use rates after transition from a universal to partial motorcycle helmet use law

Objectives: Motorcycle riders account for a disproportionately high number of traffic injuries and fatalities compared to occupants of other vehicle types. Though research has demonstrated the benefits of helmet use in preventing serious and fatal injuries in the event of a crash, helmet use has remained relatively stable in the United States, where the most recent national estimates show a 64% use rate. Use rates have been markedly lower among those states that do not have a universal helmet law for all riders. In 2012, the state of Michigan repealed its longstanding mandatory helmet use law. In order to gain insights as to the effects of this legislative change, a study was conducted to examine short-term changes in helmet use and identify factors associated with use rates.

Methods: A statewide direct observation survey was conducted 1 year after the transition from a universal helmet law to a partial helmet law. A random parameters logistic regression model was estimated to identify motorcyclist, roadway, and environmental characteristics associated with helmet use. This modeling framework accounts for both intravehicle correlation (between riders and passengers on the same motorcycle) as well as unobserved heterogeneity across riders due to important unobserved factors.

Results: Helmet use was shown to vary across demographic segments of the motorcyclist population. Use rates were higher among Caucasian riders, as well as among those age 60 and above. No significant difference was observed between male and female riders. Use was also found to vary geographically, temporally, and with respect to various environmental characteristics. Geographically, helmet use rates tended to be correlated with historical restraint use trends, which may be reflective of riding environment and general differences in the riding population. To this end, rates were also highly variable based upon the type of motorcycle and whether the motorcyclist was wearing high-visibility gear.

Conclusions: The study results demonstrate the short-term reduction in helmet use following transition from a universal to partial motorcycle helmet law. The reduction in use is somewhat less pronounced than has been experienced in other states, which may be reflective of general differences among Michigan motorcyclists because the state has also generally exhibited higher use rates of seat belts and other forms of occupant protection. The study results also highlight potential target areas for subsequent education and public awareness initiatives aimed at increasing helmet use.     

Influence of seat geometry and seating posture on NIC(max) long-term AIS 1 neck injury predictability

OBJECTIVE: Validated injury criteria are essential when developing restraints for AIS 1 neck injuries, which should protect occupants in a variety of crash situations. Such criteria have been proposed and attempts have been made to validate or disprove these. However, no criterion has yet been fully validated. The objective of this study is to evaluate the influence of seat geometry and seating posture on the NIC(max) long-term AIS 1 neck injury predictability by making parameter analyses on reconstructed real-life rear-end crashes with known injury outcomes. METHODS: Mathematical models of the BioRID II and three car seats were used to reconstruct 79 rear-end crashes involving 110 occupants with known injury outcomes. Correlations between the NIC(max) values and the duration of AIS 1 neck injuries were evaluated for variations in seat geometry and seating posture. Sensitivities, specificities, positive predictive values, and negative predictive values were also calculated to evaluate the NIC(max) predictability. RESULTS: Correlations between the NIC(max) values and the duration of AIS 1 neck injuries were found and these relations were used to establish injury risk curves for variations in seat geometry and seating posture. Sensitivities, specificities, positive predictive values, and negative predictive values showed that the NIC(max) predicts long-term AIS 1 neck injuries also for variations in seat geometry and seating postures. CONCLUSION: The NIC(max) can be used to predict long-term AIS 1 neck injuries.     

Parameters influencing AIS 1 neck injury outcome in frontal impacts

In order to gain more knowledge of the neck injury scenario in frontal impacts, a statistical study of parameters influencing incidences of AIS 1 neck injuries was performed. The data set consisted of 616 occupants in Volvo cars. Information regarding the crash, the safety systems, occupant characteristics (including prior neck problems), behavior and sitting posture at the time of impact, and neck symptoms (including duration) was collected and analyzed. Occupant characteristics (mainly gender, weight, and age), kinematics (head impacts) and behavior at the time of impact were identified as the most prominent parameter areas with regard to AIS 1 neck injury outcome. Specifically, women had a significantly higher AIS 1 neck injury rate as compared to men, occupants under the age of 50 had a significantly higher AIS 1 neck injury rate as compared to those above 50 and occupants weighing less than 65 kg have a significantly higher AIS 1 neck injury rate than heavier occupants. Drivers stating that they impacted their head against a frontal interior structure had a significantly higher AIS 1 neck injury rate than those without head impact. Also, occupants who stated they had tensed their neck muscles at the time of impact, had a significantly higher AIS 1 neck injury rate as compared to occupants who did not. Occupant activities, such as tightly gripping the steering wheel or straightening their arms showed a significantly increased AIS 1 neck injury rate, indicating that occupant behavior at time of impact could be influential with respect to AIS 1 neck injury outcome. Also, occupants reporting prior neck problems had a higher rate of persistent symptoms (>1 year) but no difference with respect to passing symptoms (<3 months) as compared to those without prior neck problems. Additionally, there was no distinct pattern for the duration of neck symptoms.     

Motorcycle fuel tanks and pelvic fractures: A motorcycle fuel tank syndrome

Objective: Pelvic injuries are a serious and commonly occurring injury to motorcycle riders involved in crashes, yet there has been limited research investigating the mechanisms involved in these injuries. This study aimed to investigate the mechanisms involved in pelvic injuries to crashed motorcyclists.

Method: This study involved in-depth crash investigation and 2 convenience-based data sets were used. These data sets investigated motorcycle crashes in the Sydney, Newcastle, and Adelaide regions. Participants included motorcycle riders who had crashed either on a public road or private property within the study areas. The mechanism of injury and the type of injuries were investigated.

Results: The most frequent cause of pelvic injuries in crashed motorcyclists was due to contact with the motorcycle fuel tank during the crash (85%). For riders who had come into contact with the fuel tank, the injury types were able to be grouped into 3 categories based on the complexity of the injury. The complexity of the injury appeared to increase with impact speed but this was a nonsignificant trend. The pelvic injuries that did not occur from contact with the fuel tank in this sample differed in asymmetry of loading and did not commonly involve injury to the bladder. They were commonly one-sided injuries but this differed based on the point of loading; however, a larger sample of these injuries needs to be investigated.

Conclusion: Overall improvements in road safety have not been replicated in the amelioration of pelvic injuries in motorcyclists and improvements in the design of crashworthy motorcycle fuel tanks appear to be required.     

Fatal motorcycle crashes in wide urban area of Zagreb,Croatia—A 10-year review

Objective: The objective of our study was to determine the prevalence of alcohol and drug intoxication among fatally injured motorcyclists in a wide urban area of Zagreb, Croatia.

Methods: We conducted a single-center observational retrospective study over a 10-year period (2007–2016) in 3 counties covering an area including 1.2 million residents. We reviewed the records on fatally injured motorcyclists, collecting information relating to sex, age, cause of death, time of death in relation to the time of the crash, and the circumstances of the crash (time of day, day of the week, season). Blood alcohol concentration (BAC) and toxicology analysis results were collected and analyzed.

Results: We identified 163 deaths (95.7% males, 4.3% females). Overall, 64.2% of the victims were 20 to 39 years old. The majority (50.9%) of those fatally injured were responsible for causing the traffic crash; the rest were determined not to be responsible or the responsibility could not be determined. The most frequent causes of death were multiple injuries (55.8%) and isolated head trauma (23.3%). The rider’s BAC was above the legal limit for driving (>0.50?g/kg) in 53.8% of cases, with a mean BAC of 1.91?g/kg. There was no difference in riding a motorcycle with a BAC above the legal limit between groups defined as younger (≤39 years of age) and older (≥40 years of age). The number of people with an illegal BAC was significantly higher during weekends than during the work week. The BAC of riders who were responsible for the crash was significantly higher than that of those who were not responsible or whose responsibility could not be determined. Use of illegal drugs or nontherapeutic use of legal drugs was not common and was detected in 10.4% of fatally injured riders.

Conclusions: Alcohol intoxication has a major role in motorcycle crash–related mortality. A significant difference in BAC between fatally injured riders responsible for the accident and those who were not responsible implies that measures directed toward prevention of drinking and driving behavior could lower the number of fatal motorcycle crashes. Weekend measures, especially during spring and summer, could have particularly significant effects.