Helmet use in patients with severe traumatic brain injury: associations with Rotterdam CT score components, skull fractures, and cervical fractures.

BACKGROUND

Helmet use is widely accepted to reduce head injury severity by absorbing impact forces, but the specific effect on the presence of radiologically detected intracranial injuries remains unclear.

OBJECTIVE

To examine the relationship between helmet use and Rotterdam CT score components, craniocervical fractures, and short-term mortality in cyclists and motorcyclists with severe TBI.

METHOD: This is a secondary analysis of data from the BRAIN-PROTECT dataset, a prospective observational study of 2,589 subjects with severe traumatic brain injury in the Netherlands. Logistic regression analysis was used, with helmet use as the independent variable, and Rotterdam score components, craniocervical fractures, and 30-day mortality as outcome measures.

RESULTS

Among 499 severe TBI patients analyzed (median age 43 years), helmet use significantly reduced epidural mass (OR 0.25, 95% CI 0.10-0.60, p = 0.008) and skull fractures (OR 0.37, 95% CI 0.25-0.56, p = 0.004). However, helmeted patients had higher odds of cervical fractures (OR 2.94, 95% CI 1.74-4.98, p = 0.004), which persisted after adjusting for age and motor GCS component.

CONCLUSION

Among patients with severe TBI, those wearing helmets showed epidural mass lesions and skull fractures less frequently, but more often had cervical fractures than those not wearing helmets.