Objective. To study the impact of helmet use on outcomes after recreational vehicle accidents. Methods. This is an observational cohort of adult and pediatric patients who sustained a TBI while riding a recreational vehicle. Recreational vehicles included bicycles, motorcycles, and all-terrain vehicles (ATVs), as well as a category for other vehicles such as skateboards and scooters. Results. Lack of helmet use was significantly associated with having a more severe traumatic brain injury and being admitted to the hospital. Similarly, 25% of those who did wearing a helmet were admitted to the ICU versus 36% of those who did not ( ). The hospital length of stay was significantly greater for patients who did not use helmets. Conclusion. Lack of helmet use is significantly correlated with abnormal neuroimaging and admission to the hospital and ICU; these data support a call for action to implement more widespread injury prevention and helmet safety education and advocacy. 1. Introduction In recent years, the use of recreational vehicles (RVs), such as on- and off-road motorcycles and all-terrain vehicles (ATVs), has increased significantly in popularity. Nearly one in five Americans (19.2%) aged sixteen and older participated one or more times in off-highway recreation within the past year. The use of these vehicles is especially popular in the under-thirty age group [1]. Unfortunately, RV use puts a person at risk of sustaining a traumatic brain injury (TBI), which is a leading cause of injury-related death and disability in the US [2]. Incidence of these injuries as a result of RV use may be on the rise. While the overall rate of motor vehicle-related TBI deaths decreased between 1993 and 2007, the rate of motorcycle-related TBI deaths actually increased significantly during those years [2]. In fact, although motorcycles account for only 2% of vehicle registrations in the US, motorcycle accidents are responsible for 10% of traffic-related deaths [3]. Bicycle riding is also a common activity particularly among children. In USA, approximately 70% of children aged from 5 to 14 ride bicycles. Head and brain injuries during a crash are the worst danger associated with bicycle riding. According to the US Centers for Disease Control, head injury is the most common cause of death and serious disability from bicycle crashes. In addition to being a leading cause of death, TBIs can dramatically diminish quality of life for patients who survive. In one study, employment rate prior to sustaining a moderate or severe TBI was 80%; at three months after injury,
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