How To Compare Costs And Outcomes Of Traumatic Brain Injury From Cycling

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1 Comparative Costs and Outcomes of Traumatic Brain Injury from Biking Accidents With or Without Helmet Use Jehane Dagher MD, BScPT, ABPMR, FRCPC Physical Medicine& Rehabilitation Montreal General Hospital

2 Costs of Traumatic Brain Injury from Biking Accidents With or Without Helmet Use & Outcomes of Traumatic Brain Injury from Biking Accidents With or Without Helmet Use 2 articles in press Journal of Brain Injury

3 Co-authors Jehane H. Dagher MD, BScPT, FRCPC, FABPMR, 1,2 Camille Costa MD, 2 Julie Lamoureux DMD, M.Sc., 3 Elaine de Guise PhD, 1,3 Mitra Feyz MSc Ps. 1 Physical Medicine & Rehabilitation Traumatic Brain Injury Program 1.4,5 McGill University Health Centre - Montreal General Hospital 2 Institut de Readaptation de Montreal - University of Montreal 3 Social & Preventive Medicine Department University of Montreal

4 Plan Problem Objectives Methodology Results Discussion Conclusion Crédit: Annonce allemande :"Initiative ProHelm

5 Literature on TBI from cycling 80% of cyclists deaths involve head injuries Cochrane review states that all cycling related TBIs could be decreased by 63 to 88% if everyone wore a helmet

6 Montreal Reality Lack of legislation on bicycle helmets in Montreal Cyclists in Quebec more in 2010 compared to 2005 Recent bike sharing programme launch (2009) Bike helmets wearers in Quebec 46% all cyclists 12% on BIXI

7 Objectives To determine whether there is a difference in patients with TBI who wear or not bicycle helmets in: Health outcomes & Societal financial burden

8 Methodology

9 Methodology Retrospective observational study All 143 patients with TBI from cycling Between April 1 st 2007 and March 31 st 2011 Admitted to Montreal General Hospital McGill University Health Care tertiary care teaching hospital

10 Methodology Independent variables Socio-demographic Helmet use Clinical & medical information Dependent variables Dependent variables Length of stay (LOS)in days (Total & ICU) Extended Glasgow Outcome Scale (GOS-E) Injury Severity Scale (ISS) Marshall Classification Discharge destination Death

11 Costs Direct medical costs Indirect societal costs Loss of productivity Death

12 Results

13 Results Average age 44 years old 75% no helmet 72% men Mechanism of trauma 48% Cyclist vs motor vehicle 36% Cyclist s fall

14 Results Severity of TBI 74% mild TBI 12% moderate TBI 14% severe TBI Marshall classification I or II 85% Discharge destination 52% Home 18% Outpatient rehab 18% Inpatient rehab

15 Helmet 25% No Helmet 75% Total Age(mean) Education(n=114) No education 0% 5% 3.5% Elementary 18% 24% 23% High school 14% 24% 22% College 11% 20% 17% University 57% 27% 34% Employment(n=121) Full time 53% 43% 45% Part time 0% 7% 5% Unemployed 3% 30% 23% Retired 30% 11% 16% Student 13% 10% 11%

16 Helmet No Helmet Total TBI severity Mild 84% 71% 74% Moderate 6% 14% 12% Severe 9% 16% 14% Marshall Classification I 47% 24% 30% II 47% 58% 56% III 0 % 9% 7% IV 6% 7% 7% Evacuated mass lesion 0% 1% 1% Mechanism of Injury MVC 32% 52% 48% Fall 48% 32% 36% vs object 16% 15% 15% vs cyclist 3% 1% 2%

17 Helmet No Helmet Total LOS (mean) Total ICU #Neurosurgical interventions 0 94% 78% 82% 1 6% 13% 11% 2 0% 8% 6% 3 0% 1% 1% Discharge Destination Home 66% 48% 52% Outpatient Rehab 13% 20% 18% Inpatient Rehab 19% 18% 18% Long term Care 0% 1% 1% Acute care transfer 0% 5% 4% Death 3% 8% 7%

18 Neurosurgical Interventions

19 Comparisons -Helmet vs No Helmet

20 Outcomes of TBI bikers with & without helmet

21 Medical Costs 2 x more

22 Societal Costs

23 Comparison Discussion Non-helmet TBI patients had 2.8 times worse CT scan of head More neurosurgical interventions 6 x more ICU stays Double medical costs Higher morbidity 7of the 9 deaths were not wearing a helmet

24 Discussion Helmeted cyclists are underrepresented in our study (25% vs 46% in the community) Helmeted cyclists were better protected from sustaining TBIs in the first place and therefore did not need to be hospitalized for their bike injuries

25 Costs Discussion Differences in costs appear to be during the acute hospitalization, specifically due to 6x longer stay in ICU and more neurosurgical interventions for the cyclists not wearing helmets Trend towards more costs associated with loss of productivity in non helmted TBI s

26 Conclusion Cycling is the # 1 cause of TBI in sports due to its broad appeal TBIs can cause severe long-term disability with repercussions not only on patients ability to be a productive member of society but also on their relatives and their own quality of life

27 Conclusion We believe that helmet wearing is protective against complications and death related to TBIs in cyclists and should be promoted Our recommendation is that promotion efforts target the young, single men, less educated and the unemployed Educate the public on importance of helmet use

28 Helmets save lives!