Helmet use patterns in urban trauma centers in New York City: A retrospective review of patients from 2013 to 2022

Background: There has been a recent rise in micromobility device use, which can be attributed to the increase in delivery services, faster 2-wheeled vehicles, and COVID. However, the rate of helmet use is largely unknown. We aim to document the trends and identify risk factors for helmet use over the last decade in urban trauma centers in New York City to find opportunities for intervention. Methods: A bi-institutional retrospective review of patients from January 1, 2013, to January 1, 2023, in a level I and II urban trauma center who were in motorcycle or motorized vehicle collisions was performed. Standard American College of Surgeons Trauma Quality Improvement Program metrics were recorded, including age, demographics, and helmet status. Results: A total of 1,219 trauma activations were reviewed. Helmet use dropped from 97.1% in 2013 to 46.8% in 2022. Motorcycle use dropped to 26.3% in 2022, whereas micromobility devices increased to 59.7%. Multivariate analysis revealed that older patients (adjusted odds ratio: 1.02), patients in Queens (adjusted odds ratio: 1.39), and motorcyclists (adjusted odds ratio: 4.19) were factors independently associated with the use of a helmet. Overall, electric bike riders have the lowest rate of helmet use (35.5%), and motorcyclists have the highest rate (77.9%). Conclusion: Over the last decade, there has been a drastic decrease in helmet use and motorcycle ridership, and increased electric bike and micromobility device use. Younger patients, patients in Manhattan, and the African American and Hispanic populations have a lower propensity for helmet use. Given these data, there is an opportunity for community outreach to vulnerable populations and increase helmet use awareness.