Riding at Risk: The Lifesaving Role of Helmets for Motorcycle Pillion Riders.

Introduction: Road traffic accidents are a significant cause of mortality and morbidity worldwide, with traumatic brain injury (TBI) being a common consequence. Pillion riders on motorized two-wheelers (MTWs) represent a vulnerable group, often with inadequate protective measures. Objective: To assess the pattern and severity of brain injury in pillion riders of MTWs, evaluate the mechanism and type of injury, highlight the importance of helmet use, and study associated injuries and outcomes. Materials and Methods: This cross-sectional observational study was conducted at a tertiary care center from August 2022 to January 2024, including 120 pillion riders presenting with TBI. Data regarding demographics, injury characteristics, helmet use, clinical findings, radiological parameters, management, and outcomes were collected and analyzed. Results: The mean age of patients was 38.59 ± 15.35 years, with males comprising 59.2%. Motorcycles were the predominant vehicle (90%), and cross-saddle was the common seating position (70%). Only 6.7% of pillion riders used helmets. Skull fractures were observed in 68.3%, subarachnoid hemorrhage in 59.2%, subdural hemorrhage in 50%, and contusions in 69.2% of cases. Based on the Glasgow Coma Scale, 47.5% had mild, 16.7% had moderate, and 35.8% had severe TBI. The mortality rate was 35.8%, with craniocerebral injury being the cause of all deaths. None of the helmet users succumbed to injuries. Conclusion: Pillion riders sustain serious TBIs comparable to or more severe than riders. The mortality rate is substantial, particularly among those not wearing helmets. Mandatory helmet use for pillion riders could significantly reduce mortality and injury severity. Further comparative studies between riders and pillion riders are warranted to better understand injury patterns and develop targeted preventive strategies.