Research at University Medical Center Brackenridge indicates area cyclists are 3.6 times more likely to suffer a head or brain injury if they have been drinking alcohol. The findings are the first statistically significant results of a year-long study entitled Alcohol, Bicycle Helmets and Head Injury in Austin underway in the Emergency Departments of the Seton Family of Hospitals .

The 200-patient study also concluded most of the alcohol-related bike crashes occurred near the Austin downtown area where both traffic and bike speeds are lower and that drinking significantly reduced the likelihood that a helmet would be used.

"Information about bike use and alcohol was the first reliable information to emerge," adds Pat Crocker, DO, one of the study's investigators and medical chief of Dell Children's Medical Center ED. "We found that bicycle riders who had been drinking or using drugs - far away more alcohol than drugs - were four times more likely to have a head injury. While riding the bike after consuming alcohol, only one out of 40 patients was wearing a helmet, so it appears that one of the first things that happens is that riders don't bother with helmets."

"Riding a bike requires more attention than driving a car and you don't have that metal armor, the car's body, around you," adds T.J. Milling, MD, co-investigator and director of clinical research of Emergency Departments at UMC Brackenridge and Dell Children's . "Of course, if you drive drunk, you're just as likely to kill someone else. Riding a bicycle drunk, the brain you damage is your own."

They also found that cost of care was significantly higher for those who had been cycling while drinking and not wearing a helmet. Of the 200 patients included, 78 experienced head injuries of some kind.

"In severe injuries, if the lungs and chest are crushed by a car, a helmet isn't going to help you. But a lot of accidents happen at low speeds. Safety training, especially if you re riding downtown where there are lots of cars and pedestrians, a safety class is recommended," says Dr. Crocker.

Drs. Crocker and Milling are preparing their findings for submission to a trauma journal for publication. In the meantime, the study continues.

Other Study Design Goals

"We initiated this study following community discussion about bike safety and bike lanes. Although some published data has shown there is a benefit to wearing helmets, a number of the studies didn't include adequate numbers of patients to reach statistical significance. There also was no unique community-based information available," says Dr. Crocker. "Our goal was to make this study different from previous studies by combining a number of issues around bicycle use and not have it be just about helmet safety. We also wanted to assure it included enough patients to become significant."

The study has been extended for another year to confirm another finding: That cyclists without helmets are twice as likely to have a significant head injury.

"We looked at experience of the rider, street conditions, weather conditions, type of street, location in city and use of drugs or alcohol. In all truthfulness, I suspect data will show that wearing a helmet improves safety, but we won't know for sure until the study reaches statistical significance," adds Dr. Crocker.

The researchers also plan to report data comparing the cost of care for cyclists, including those who wear helmets and those who do not along with cost of care for riders who used alcohol and those who did not. In all, three or four potential reports may result from the study.

"We believe this study will confirm the gestalt of ED physicians that people who wear helmets aren't as several injured and the helmet can mean the difference between life and death," says Dr. Milling.

"In looking at some of the cross data, we found those most likely to be injured, have higher hospital charges and worse lifetime outcomes were not wearing helmets. It doesn't take many such cases to become very expensive to society. We followed injured patients through one year of cost of care, which is high. Especially if you look at the two or three people severely injured, whose ongoing medical costs will be astronomical over the next 20 years."

"I would offer that a visit to the emergency department and cost of hospital care for significant head injury is just the tip of iceberg," continues Dr. Crocker. Most head injuries affect people for the rest of their lives. Some are disabled permanently, most have quality of life impaired, they may be unable to work and a few will require constant care for the rest of their lives. I've seen estimates that cost of care for head injury is about $2 million over the life of the patient. But the key issue is a person's life is ruined."

Current law does not mandate the use of a helmet by cyclists over age 18. The Travis County Medical Society supports mandatory bicycle helmet use for riders of all ages.

Ongoing Research at Seton Family of Hospitals

The amount of medical research at the UMC Brackenridge has recently increased dramatically, with more than 200 active studies covering a wide range of topics including aneurysms, stroke, snakebites and IV insertion during STARFlight transport.

"We are making a targeted effort to increase the amount and quality of clinical research taking place at UMC Brackenridge," said Thomas P. Erlinger, MD, director of clinical research, Seton Family of Hospitals. "Several studies, like this one, have direct relevance to our patient population and the greater community. That is our goal. To encourage relevant and high-quality research that can impact people's lives."