Bledsoe Gregory H, Schexnayder Stephen M, Carey Martin J, Dobbins William N, Gibson William D, Hindman Jason W, Collins Terry, Wallace Bonny H, Cone John B, Ferrer Thomas J
Department of Emergency Medicine, University of Arkansas for Medical Sciences, Littler Rock 72205, USA.
J Trauma. 2002 Dec;53(6):1078-86; discussion 1086-7. doi: 10.1097/00005373-200212000-00009.
On July 1, 1997, Arkansas became the first state in 14 years to repeal their adult helmet law. We examined the clinical and financial impact of this repeal.
A 6-year retrospective review was conducted of the University of Arkansas for Medical Sciences trauma registry including the 3 years before and the 3 years after the repeal of the helmet law. A head and neck Abbreviated Injury Scale (AIS) score >or= 3 was considered severe. All patients admitted to the hospital or who died in the emergency department were included in the study. The database of the Arkansas Highway and Transportation Department was also used to determine the number of crashes and fatalities occurring statewide (1995-1999).
Although total and fatal crashes in Arkansas were not significantly different (1995-1996 vs. 1998-1999), nonhelmeted deaths at the scene of a crash significantly increased from 19 of 48 (39.6%) (1995-1996) to 40 of 53 (75.5%) (1998-1999) (p < 0.0001). Before repeal, 25% of nonfatal crash admissions were nonhelmeted (18 of 73). This significantly increased to 54% (52 of 96, p< 0.001) after repeal. Overall, patients who were nonhelmeted had significantly higher AIS scores for head and neck, significantly more severe head injuries (AIS score >or= 3), 47% (33 of 70) versus 20% (20 of 99), and significantly longer length of intensive care unit stay. Financially, patients without helmets had significantly higher unreimbursed charges compared with their helmeted counterparts, resulting in a total of 982,560 dollars of additional potentially lost revenue over the length of the study.
Repeal of the mandatory helmet law was associated with an increase in the nonhelmeted crash scene fatality rate. After the repeal, there was a disproportionately higher admission rate for nonhelmeted motorcycle crash survivors. These patients had an increased use of hospital resources and poorer reimbursement of charges compared with their helmeted counterparts. This resulted in significantly higher unreimbursed charges. States considering repeal of their mandatory adult helmet laws should consider the potential negative financial impact on their health care system and the increased morbidity associated with nonhelmeted motorcycle riders involved in a crash.
1997年7月1日，阿肯色州成为14年来首个废除其成人头盔法的州。我们研究了这一废除举措的临床和经济影响。
对阿肯色大学医学科学创伤登记处进行了一项为期6年的回顾性研究，涵盖头盔法废除前3年和废除后3年的数据。头部和颈部简明损伤定级（AIS）评分≥3分被视为重伤。所有入院患者或在急诊科死亡的患者均纳入研究。阿肯色州公路与运输部的数据库也被用于确定全州范围内发生的撞车事故及死亡人数（1995 - 1999年）。
尽管阿肯色州的撞车事故总数和致命事故数量没有显著差异（1995 - 1996年与1998 - 1999年相比），但撞车现场未戴头盔死亡人数从48例中的19例（39.6%）（1995 - 1996年）显著增加到53例中的40例（75.5%）（1998 - 1999年）（p < 0.0001）。在废除头盔法之前，非致命撞车事故入院患者中有25%未戴头盔（73例中的18例）。废除后这一比例显著增至54%（96例中的52例，p < 0.001）。总体而言，未戴头盔的患者头部和颈部的AIS评分显著更高，重伤（AIS评分≥3分）情况显著更多，分别为47%（70例中的33例）和20%（99例中的20例），且重症监护病房住院时间显著更长。在经济方面，未戴头盔的患者与戴头盔的患者相比，未报销费用显著更高，在研究期间总共导致了982,560美元的潜在收入损失。
废除强制性头盔法与未戴头盔的撞车现场死亡率上升有关。废除后，未戴头盔的摩托车撞车事故幸存者的入院率不成比例地更高。与戴头盔的患者相比，这些患者对医院资源的使用增加，费用报销情况更差。这导致未报销费用显著更高。考虑废除其强制性成人头盔法的州应考虑这对其医疗保健系统可能产生的负面经济影响，以及与未戴头盔的摩托车骑行者撞车相关的发病率增加问题。
