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Motorcycle Passengers at Greatest Risk for TBIs

Motorcycle Passengers at Greatest Risk for TBIs

Indiana University’s School of Medicine (IUSoM) researchers discovered recently that it is the passengers on motorcycles who are more likely to forgo using protective helmets, making them more likely to experience traumatic brain injuries (TBIs) than drivers of motorcycles. Surprisingly, passengers had more TBI injuries than drivers even when they did wear helmets.

The report, one of the first to investigate the benefits of helmet usage, was published November 15, 2017, in JAMA Surgery online. IUSoM Department of Surgery researchers used data from 2007 through 2010 in the National Trauma Data Bank and examined outcomes for over 85,000 motorcycle trauma patients. Researchers divided the patients into two groups: motorcycle passengers and motorcycle drivers. Consistently the passengers were more likely than the drivers to be non-compliant with helmet usage and to suffer TBIs.

Study Details

Approximately two-thirds of motorcycle drivers who underwent trauma were wearing helmets, compared to 57.5 percent of the passengers. The study found that a TBI was the most frequent injury when either a passenger or driver was not wearing a helmet. However, passengers had more un-helmeted TBIs, with 40 percent of passengers suffering a traumatic brain injury compared to 36 percent of the drivers.

Surprisingly, even when helmets were worn, passengers were still more likely to experience TBIs: 36 percent of helmeted passengers suffered a TBI, compared to 31 percent of the helmeted drivers. One of the study’s investigators, Dr. Tyler Evans of IUSoM, stated in an email, “We believe that in certain accidents, the passenger is more likely to be ejected from the motorcycle. This is likely to increase the risk for serious head injury despite helmet use, given that being ejected from the motorcycle at a high rate of speed may be too severe of an impact for the helmet to be as protective.”

It has been speculated that drivers might experience fewer TBIs because they are gripping the steering column as well as being protected by a windshield. Drivers can also see what is coming and have the opportunity to grip the motorcycle more tightly when they anticipate a crash. Additionally, passengers often sit higher than the driver and have less to grip in an emergency. Sitting on top of the rear wheel can create instability for the passenger, making them more likely to be ejected from the motorcycle.

While alcohol played a role in some crashes, it was still the case that passengers had a higher rate of TBIs even after the data were corrected for alcohol and drug usage, gender, and age.


More than 8 million motorcycles are on U.S. highways, and preventing serious crash injuries is a public health priority for the National Highway Traffic Safety Administration (NHTSA). The NHTSA has discovered that, when motorcycle usage was compared to passenger vehicle usage, the proportion of deaths in motorcycle crashes has increased over the years. One possible reason is the dropping of mandatory helmet usage requirements by many states and the federal government starting in 1975.

A University of Washington, Seattle, researcher who was not part of the study, Jacob Sunshine, noted in an email that, “The primary take-away from this study is that motorcycle helmets significantly reduce head and neck injuries in both drivers and passengers.”

Indiana’s helmet law requires only those younger than 18 years of age to wear a protective helmet.

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