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We read with interest the recent valuable contribution to road safety and injury prevention literature by Pincus etal (1). There is considerable evidence that appropriate helmet use alleviate the burden of motor cyclists’ injuries greatly. Previous studies also demonstrates that unhelmeted motorcyclists experience more severe injuries (including traumatic brain injuries), resulting in higher health care costs and an increased likelihood of requiring care beyond the hospital (2, 3). Therefore, it is appropriate and more sensible that we calculate and compare the helmeted motor cyclist injury cost to our health care system with unhelmeted motor cyclist. There is definitive evidence that helmets reduce mortality, traumatic brain injury, and hospital expenditures (3).
The main limitation of Pincus et al., study (1) is that the authors failed to separate the cost according to protective device use of injured motor cyclist, despite a recent systematic review and meta-analysis shows that motorcycle helmet use reduces morbidity and contributes to significant health care cost savings (2) . According to previous related study the mean total hospital charge for helmeted motor cyclist was $4184.26 compared to $7383.31 for unhelmeted motor cyclist. If their cost data separated to address comparatively unhelmeted motorcyclists cost, it would have been contributed appropriately to answer the decade long debate on traffic safety value of appropriate helmet use (1, 2, 4).
Analysis of motorcycle related trauma data shows that motorcyclists are more than 3.5 times as likely to die or become injured when compared to other motor vehicle drivers (5), and main cause of fatalities was a head injury, whereas lower limb injuries account for most hospital admissions (5). Use of protective devices, namely helmets, has been shown to prevent injury, disability and death by reducing serious head injuries (6, 7). Therefore, “all operators and riders of motorcycles are required by Ontario provincial law to wear a helmet when on a motorcycle or motor-assisted bicycle”.
Worldwide, un-helmeted motorcyclists are at high risk for serious injury and death in the event of a crash, while placing excessive economic burden on societies through costly medical interventions and long-term disability (8). A Cochrane systematic review concluded that helmets reduce the risk of head injury by approximately 69 percent and death by some 42 percent among motorcyclists (9).
REFERENCES:
(1). Pincus D, Wasserstein D, Nathens AB, Bai YQ, Redelmeier DA, Wodchis WP. Direct medical costs of motorcycle crashes in Ontario. CMAJ. 2017;20;189(46):E1410-E1415. doi: 10.1503/cmaj.170337.
(2). Heldt KA, Renner CH, Boarini DJ, Swegle JR. Costs associated with helmet use in motorcycle crashes: the cost of not wearing a helmet. Traffic Inj Prev. 2012;13(2):144-9. doi: 10.1080/15389588.2011.637252.
(3). Crompton JG, Bone C, Oyetunji T, Pollack KM, Bolorunduro O, Villegas C, Stevens K, Cornwell EE, Efron DT, Haut ER, Haider AH. Motorcycle helmets associated with lower risk of cervical spine injury: debunking the myth. J Am Coll Surg. 2011 Mar;212(3):295-300. doi: 10.1016/j.jamcollsurg.2010.09.032. Epub 2011 Jan 12.
(4). Kim CY, Wiznia DH, Averbukh L, Dai F, Leslie MP. The Economic Impact of Helmet Use on Motorcycle Accidents: A Systematic Review and Meta-analysis of the Literature from the Past 20 Years. Traffic Inj Prev. 2015;16(7):732-8. doi: 10.1080/15389588.2015.1005207. Epub 2015 Apr 28. Review.
(5).Monk JP, Buckley R, Dyer D. Motorcycle-related trauma in Alberta: a sad and expensive story. Can J Surg. 2009 Dec;52(6):E235-E40.
(6). Ameratunga S, Jackson R, Norton R. Death and injury on raods (editorial). BMJ. 2006 Jul 6;333(53):doi:10.1136/bmj.333.7558.53.
(7). Peden M, Scurfield R, Sleet D, Mohan D, Hyder A, Jarawan E. World report on road traffic injury prevention. Geneva: World Health Organization2004.
(8). Eastridge BJ, Shafi S, Minei JP, Culica D, McConnel C, Gentilello L. Economic impact of motorcycle helmets: from impact to discharge. J Trauma. 2006 May;60(5):978-83.
(9). Liu B, Ivers R, Norton R, Blows S, Lo SK. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev. 2008;2:CD004333.