Systematic review and meta-analysis of efficacy of helmet use and helmet laws to reduce mortality and cervical spine injury in adult motorcycle riders: A practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: Motorcycle crash fatalities remain a significant public health concern. Traumatic brain injury is a leading cause of death following motorcycle crash. We aim to provide evidence-based guidelines pertaining to helmet use and helmet laws with respect to important outcomes including mortality, cervical spine injury, and discharge disposition. METHODS: An evidence-based systematic review was performed to answer the following Population, Intervention, Comparator, Outcomes (PICO) questions: PICO 1—Should adult motorcycle riders wear helmets or not wear helmets to improve mortality, brain injury–related mortality, cervical spine injury, and discharge disposition from the hospital? PICO 2—Should motorcycle universal helmet laws (UHLs) or no UHLs be enacted to improve mortality, brain injury–related mortality, cervical spine injury, and discharge disposition from the hospital? An academic medical librarian searched Medline, Cochrane CENTRAL, CINAHL, Embase, Engineering Village, Health and Safety Science Abstracts, Scopus, SPORTDiscus, TRID, the VHL Regional Portal, and Elsevier. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used to assess the quality of the evidence and create recommendations. The working group reached consensus on the final evidence-based recommendations. The study was registered in PROSPERO (CRD42020172705). RESULTS: A total of 28 studies were identified for analysis for PICO 1, and 10 studies were identified for PICO 2. Helmet use was associated with a lower incidence of mortality (odds ratio, 0.48; 95% confidence interval, 0.41–0.56; p < 0.001) and lower incidence of cervical spine injury (odds ratio, 0.66; 95% confidence interval, 0.58–0.76; p < 0.001). Although a meta-analysis for PICO 2 was not possible because of significant methodological heterogeneity, the vast majority of studies demonstrated large improvements in outcomes with a UHL. Overall certainty of evidence was deemed low for PICO 1 and PICO 2 because of risk of bias. CONCLUSION: We strongly recommend that individual motorcycle riders wear helmets and that universal helmet legislation be enacted and enforced to decrease mortality, to decrease the incidence of cervical spine injury, and to improve discharge disposition from the hospital.