Predictors of recovery in cyclists hospitalised for orthopaedic trauma following an on-road crash

Twelve-month recovery following road trauma: Results from an inception cohort in Vancouver, Canada

BACKGROUND

Injury-related disability following road trauma is a major public health concern. Unfortunately, outcome following road trauma and risk factors for poor recovery are inadequately studied, especially for road trauma survivors with minor injuries that do not require hospitalization.

OBJECTIVES

This manuscript reports 12-month recovery outcomes for a large cohort of road trauma survivors.

METHODS

This was a prospective, observational inception cohort study of 1,480 road trauma survivors recruited between July 2018 and March 2020 from 3 trauma centres in British Columbia, Canada. Participants were aged ≥16 years and arrived in a participating emergency department within 24 h of a motor vehicle collision. Data on baseline health and injury severity were collected from structured interviews and medical records. Outcome measures, including the SF-12, were collected during follow-up interviews at 2, 4, 6 and 12 months. Predictors of recovery outcomes were identified using Cox proportional hazards models and summarized using hazard ratios.

RESULTS

Only 42 % of participants self-reported full recovery and only 66 % reported a return to usual daily activities. Females, older individuals, pedestrians, and those who required hospital admission had a poorer recovery than other groups. Similar patterns were observed for the SF-12 physical component. For the SF-12 mental component, no significant differences were observed between participants admitted to hospital and those discharged home from the ED. Return to work was reported by 77 % of participants who had a paying job at baseline, with no significant differences between sex and age groups.

CONCLUSIONS

In a large cohort of road trauma survivors, under half self-reported full recovery one year after the injury. Poor mental health recovery was observed in both participants admitted to hospital and those discharged home from the ED. This finding may indicate a need for early intervention and continued mental health monitoring for all injured individuals, including for those with less serious injuries.

"No Man's Land": the experiences of persons injured in a road traffic crash wanting to return to work in Queensland, Australia

PURPOSE

This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI.

METHODS

The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants (n = 18) aged 18-65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data.

RESULTS

Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support.

CONCLUSIONS

Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme.IMPLICATIONS FOR REHABILITATIONThis study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme.Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury.Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI.Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work.

Friction burns in cyclists: An under-recognised problem

INTRODUCTION

Cycling-related friction burns, also known as abrasions or "road rash", can occur when cyclists are involved in a fall or a collision. However, less is known about this type of injury as they are often overshadowed by concurrent traumatic and/or orthopaedic injuries. The aims of this project were to describe the nature and severity of friction burns in cyclists admitted to hospitals with specialist burn services in Australia and New Zealand.

METHODS

A review of cycling-related friction burns recorded by the Burns Registry of Australia and New Zealand was undertaken. Summary statistics described demographic, injury event and severity, and in-hospital management data for this cohort of patients.

RESULTS

Between July 2009 and June 2021, 143 cycling-related friction burn admissions were identified (accounting for 0.4% of all burns admissions during the study period). Seventy-six percent of patients with a cycling-related friction burn were male, and the median (interquartile range) of patients was 14 (5-41) years. The greatest proportion of cycling-related friction burns were attributed to non-collision events, namely falls (44% of all cases) and body parts being caught or coming into contact with the bicycle (27% of all cases). Although 89% of patients had a burn affecting less than five percent of their body, 71% of patients underwent a burn wound management procedure in theatre such as debridement and/or skin grafting.

CONCLUSIONS

In summary, friction burns in cyclists admitted to participating services were rare. Despite this, there remains opportunities to better understand these events to inform the development of interventions to reduce burn injury in cyclists.

Exploring the perspectives of key stakeholders in returning to work after minor to serious road traffic injuries: a qualitative study

PURPOSE

This qualitative study conducted in Queensland, Australia aimed to explore various stakeholders' perspectives on (1) the barriers and facilitators of Return to Work (RTW) for injured persons following minor to serious Road Traffic Injuries (RTI) in a fault-based scheme, and to investigate the changes needed to better support RTW following RTI.

METHODS

The study was performed using the Interpretive Description methodological approach. Data were collected during interviews (n = 17), one focus group (n = 4), and an open-ended survey (n = 10) with five categories of stakeholders: treating health providers, workplace representatives, legal representatives, rehabilitation advisors, and insurers. Participants were eligible to participate if they had at least one year of employment history in their respective profession in Queensland, Australia, and were experienced in assisting the RTW of people with RTI. Thematic analysis was used to analyse the data.

RESULTS

Seven themes were extracted reflecting the barriers and facilitators of RTW along with stakeholders' recommendations to address these barriers. These themes were: (1) knowledge is power; (2) stakeholder expertise; (3) early and appropriate treatment matters; (4) insurers could do better; (5) necessity of employers' support; (6) fix the disjointed system; (7) importance of individual factors pre- and post- injury. The main barriers identified were stakeholders' insufficient communication and knowledge on RTW process following RTI.

CONCLUSIONS

Individual and system barriers identified in this study suggest that RTW after RTI occurs in a complex system requiring the commitment of all stakeholders. This is particularly important for managing knowledge-related barriers by provision of high quality and easily accessible information about the RTW process, disability schemes, and the nature of RTI.

Long-term opioid use following bicycle trauma: a register-based cohort study

PURPOSE

Chronic opioid use is a significant public health burden. Orthopaedic trauma is one of the main indications for opioid prescription. We aimed to assess the risk for long-term opioid use in a healthy patient cohort.

METHODS

In this matched cohort study, bicycle trauma patients from a Swedish Level-I-Trauma Centre in 2006-2015 were matched with comparators on age, sex, and municipality. Information about dispensed opioids 6 months prior until 18 months following the trauma, data on injuries, comorbidity, and socioeconomic factors were received from national registers. Among bicycle trauma patients, the associations between two exposures (educational level and injury to the lower extremities) and the risk of long-term opioid use (> 3 months after the trauma) were assessed in multivariable logistic regression models.

RESULTS

Of 907 bicycle trauma patients, 419 (46%) received opioid prescriptions, whereof 74 (8%) became long-term users. In the first quarter after trauma, the mean opioid use was significantly higher in the trauma patients than in the comparators (253.2 mg vs 35.1 mg, p < 0.001) and fell thereafter to the same level as in the comparators. Severe injury to the lower extremities was associated with an increased risk of long-term opioid use [OR 4.88 (95% CI 2.34-10.15)], whereas high educational level had a protecting effect [OR 0.42 (95% CI 0.20-0.88)].

CONCLUSION

The risk of long-term opioid use after a bicycle trauma was low. However, opioids should be prescribed with caution, especially in those with injury to lower extremities or low educational level.

An investigation of cyclist passing distances in the Australian Capital Territory

In Australia, cycling hospitalisations are increasing and the cycling participation rate is stagnating. In an effort to improve cyclist safety, many Australian jurisdictions have mandated a minimum passing distance that vehicles much provide when overtaking a cyclist on a public road, including the Australian Capital Territory (ACT). However, it is not currently clear how vehicle-cyclist passing distances are affected by various parameters such as the road environment, the vehicles involved, or the speed limit. This naturalistic bicycle riding study examined data from passing distance measurement devices that were installed on the bicycles of volunteer cyclists who ride in the ACT, to explore how passing distances and compliance with the minimum passing distance were affected by several parameters. Over a four-week period, 23 volunteer cyclist participants undertook 465 journeys and travelled 6531 km over a total period of 271 h. There were 10,959 passing events identified on roads zoned greater than 60 km/h (high speed roads) of which 1349 (12.3 %) were non-compliant. On roads zoned 60 km/h or less (low speed roads) there were 5517 passing events of which 153 (2.8 %) were non-compliant. Regression analyses showed that differences in passing distance and non-compliance with the minimum passing distance were associated with road classification, bike lane presence, and speed limit. The results were mixed but, in general, passing distances were greater on roads with a lower (hierarchy) classification and on motorways as well as on roads with higher speed limits. An exception to this was roads with a speed limit of 50 km/h where passing distances were closer in comparison to roads with a speed limit of 60 km/h. Bike lanes were generally associated with an increase in passing distance except on 'trunk' classified roads, where a bike lane resulted in closer passing events. This suggests that on trunk roads, which are assumed to carry large amounts of traffic, bike lanes may be insufficient to offer protection to cyclists and additional measures may be required.

Health and return to work in the first two years following road traffic injury: a comparison of outcomes between compensation claimants in Victoria and New South Wales, Australia

BACKGROUND

People who sustain road traffic injuries often have poor health outcomes. While outcomes are often worse in people with a compensation claim, especially in fault-based schemes versus no-fault schemes, few studies have directly compared outcomes across scheme types.

OBJECTIVE

To compare health and work outcomes between people who had no compensation claim, a fault-based claim, or "no-fault" transport or workers compensation claim after hospitalisation for a road traffic injury.

METHODS

Participants aged >=18 years admitted to hospital in New South Wales or Victoria for >24 hours were recruited in two separate prospective cohort studies (N=1,034). People who died or sustained minor or very severe injuries were excluded. Groups included Compulsory Third Party (fault-based, n=128), no-fault Transport Accident Commission (TAC; n=454) and workers compensation claimants (n=73), or no claim (n=226). Outcomes at six, 12- and 24-months post-injury included health [SF-12 Mental Component Score (MCS) and Physical Component Score (PCS)], and return to work for people working pre-injury. Multivariable mixed effects linear and logistic regressions, adjusting for demographic and injury covariates, examined differences in health and work outcomes between claimant groups, with fixed effects of time and random effects of participant ID.

RESULTS

Health status was better in people with a no-fault TAC claim (MCS: m=50.62, 95%CI:49.62,51.62; PCS: m=40.49, 95%CI:39.46,41.52) or no claim (MCS: m=49.99, 95%CI:49.62,51.62; PCS: m=44.36, 95%CI:43.00,45.72), than people with a workers compensation (MCS: m=45.73, 95%CI:43.46,48.00; PCS: m=38.94, 95%CI:36.59,41.30) or fault-based CTP claim (MCS: m=41.34, 95%CI:39.54,43.13; PCS: m=35.64, 95%CI:33.78,37.49). Relative to fault-based CTP claimants, the odds of returning to work were higher for people with no claim (AOR=6.84, 95%CI:1.73,27.05) but did not differ for no-fault TAC (AOR=1.21, 95%CI:0.36,4.05) or workers compensation claimants (AOR=0.83,95%CI: 0.17,3.99). While people with a fault-based CTP claim had poorer mental and physical health and return to work after injury, they showed greater improvements in mental health, and similar levels of improvement in physical health and work participation over time to the other groups.

CONCLUSION

The patterns of health and work across scheme types provide important insights against which we can contrast the effects of future scheme designs on client outcomes.

Getting back on the bike: Participation in cycling after a hospitalisation crash

This study firstly aimed to describe bicyclists' return to cycling after a hospitalisation crash. Secondly, it aimed to determine factors associated with reduced cycling post-crash. A study of 83 cyclists hospitalised due to an on-road crash was undertaken in Perth, Western Australia. Participants completed a questionnaire shortly following the crash and were followed up approximately 12 months after the crash. Injury information was obtained from the WA State Trauma Registry. A binary logistic regression model was used to examine factors associated with 'reduced cycling exposure' at follow-up. Sixty percent of participants had 'reduced cycling exposure' and 40% had 'no reduction in cycling exposure' at follow up. Twenty-two percent of participants had not cycled at all since the crash. Despite 46% reporting fear of crashing/ lack of confidence as a reason for 'reduced cycling exposure', only 7% of all participants had received any counselling. After controlling for confounding factors, those who participated in group riding before the crash (OR: 0.24, 95% CI: 0.08-0.66, p = 0.006) and those who had a 'complete functional recovery' (OR: 0.15, 95% CI: 0.04-0.64, p = 0.011), had lower odds of 'reduced cycling exposure' at follow-up. In addition, those who were not employed full time at baseline had higher odds of 'reduced cycling exposure' at follow up (OR: 3.72, 95% CI: 1.22-11.33, p = 0.021). Provision of psychological services following a bicycle crash may be an important intervention for improving levels of fear and confidence surrounding cycling and assisting cyclists in returning to their pre-crash level of participation. In addition, interventions promoting return to cycling, should be targeted towards non-group riders who cycle for either commuting or recreational purposes.

Return to Work Pathways Following Injury in Road Traffic Crashes: A Retrospective Cohort Study

OBJECTIVES

To determine: 1) different return to work (RTW) pathways among road traffic crash (RTC) survivors; 2) RTW differences between RTC and workers' compensation schemes, and; 3) factors associated with relapse and attempting graduated RTW.

METHODS

Administrative income support data from RTC survivors with compensated work absence in Victoria, Australia were arranged as daily income payments, pattern recognition determined RTW pathways. Multivariable logistic regression showed odds of relapse or attempting graduated RTW by covariate.

RESULTS

Most had successful RTWs without relapse (66.7% full, 7.2% graduated), 22% relapsed at least once, and 17% attempted gradual RTW. Sex, injury type, length of hospital stay, road user group, and compensation scheme were associated with relapse and graduated RTW attempt likelihood.

CONCLUSIONS

Results help identify people likely to benefit from RTW interventions, such as programs that incentivise graduated RTW.

Twelve-month health outcomes for bicyclists and car occupants after a non-catastrophic traffic crash injury

OBJECTIVE

In this inception cohort study, we investigated differences in health outcomes for bicyclists (cyclists) and car occupants (car driver and passengers) at 12months after a non-catastrophic traffic injury. We also aimed to determine the independent predictors of key health outcomes among cyclists.

METHODS

Of the 2019 participants at baseline, 299 were cyclists and 927 were car occupants; 229 cyclists and 489 car occupants were followed up 12months after the injury. A telephone-administered questionnaire was used to obtain information on socio-economic, pre-injury health and injury-related characteristics. The survey also included tools on health outcomes: quality of life (SF-36 and EQ-5D-3L scales), pain severity, general psychological distress, trauma-related distress and pain catastrophizing.

RESULTS

After adjusting for all potential confounders, general psychological distress scores and trauma-related distress scores were 2.05 and 0.60 units lower for cyclists than car occupants (P=0.01 and P<0.0001, respectively) at 12-month follow-up. Cyclists showed greater improvement than car occupants over 12months in mean pain severity ratings and SF-12 physical component summary (PCS) score (both P<0.0001) but had lower mean pain severity and similar PCS scores at baseline. However, cyclists showed less improvement in SF-12 mental component summary (MCS) scores (P=0.03) than car occupants but had higher mean MCS scores at baseline. Pre-injury and baseline quality-of-life scores and pain catastrophizing as well as injury involving the head or face were significant predictors of overall psychological functioning, general psychological distress and trauma-related distress in cyclists at 12months.

CONCLUSIONS

Cyclists demonstrated better recovery than car occupants at 12months after sustaining a traffic crash injury. Prognostic indicators of long-term physical functioning and psychological well-being in cyclists were related to pre-injury and baseline quality of life and pain factors and injury location.

A systematic review of the association between fault or blame-related attributions and procedures after transport injury and health and work-related outcomes

Attributions of fault are often associated with worse injury outcomes; however, the consistency and magnitude of these impacts is not known. This review examined the prognostic role of fault on health, mental health, pain and work outcomes after transport injury. A systematic search of five electronic databases (Medline, Embase, CINAHL, PsycINFO, Cochrane Library) yielded 16,324 records published between 2000 and January 2018. Eligibility criteria were: adult transport injury survivors; prospective design; multivariable analysis; fault-related factor analysed; pain, mental health, general health or work-related outcome. Citations (n = 10,558, excluding duplicates) and full text articles (n = 555) were screened manually (Reviewer 1), and using concurrent machine learning and text mining (Reviewer 2; using Abstrackr, WordStat and QDA miner). Data from 55 papers that met all inclusion criteria were extracted, papers were evaluated for risk of bias using the QUIPS tool, and overall level of evidence was assessed using the GRADE tool. There were six main fault-related factors classified as: fault or responsibility, fault-based compensation, lawyer involvement or litigation, blame or guilt, road user or position in vehicle, and impact direction. Overall there were inconsistent associations between fault and transport injury outcomes, and 60% of papers had high risk of bias. There was moderate evidence that fault-based compensation claims were associated with poorer health-related outcomes, and that lawyer involvement was associated with poorer work outcomes beyond 12 months post-injury. However, the evidence of negative associations between fault-based compensation claims and work-related outcomes was limited. Lawyer involvement and fault-based compensation claims were associated with adverse mental health outcomes six months post-injury, but not beyond 12 months. The most consistent associations between fault and negative outcomes were not for fault attributions, per se, but were related to fault-related procedures (e.g., lawyer engagement, fault-based compensation claims).

The road to recovery for vulnerable road users hospitalised for orthopaedic injury following an on-road crash

BACKGROUND

Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma.

METHODS

A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time.

RESULTS

6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian.

CONCLUSION

Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.

Pain, Anxiety, and Depression in the First Two Years Following Transport-Related Major Trauma: A Population-Based, Prospective Registry Cohort Study

Objectives

This study aimed to characterize the population prevalence of pain and mental health problems postinjury and to identify risk factors that could improve service delivery to optimize recovery of at-risk patients.

Methods

This population-based registry cohort study included 5,350 adult survivors of transport-related major trauma injuries from the Victorian State Trauma Registry. Outcome profiles were generated separately for pain and mental health outcomes using the “pain or discomfort” and “anxiety or depression” items of the EuroQol Five Dimensions Three-Level questionnaire at six, 12, and 24 months postinjury. Profiles were “resilient” (no problems at every follow-up), “recovered” (problems at six- and/or 12-month follow-up that later resolved), “worsening” (problems at 12 and/or 24 months after no problems at six and/or 12 months), and “persistent” (problems at every follow-up).

Results

Most participants had persistent (pain/discomfort, N = 2,171, 39.7%; anxiety/depression, N = 1,428, 26.2%) and resilient profiles (pain/discomfort, N = 1,220, 22.3%; anxiety/depression, N = 2,055, 37.7%), followed by recovered (pain/discomfort, N = 1,116, 20.4%; anxiety/depression, N = 1,025, 18.8%) and worsening profiles (pain/discomfort, N = 956, 17.5%; anxiety/depression, N = 948, 17.4%). Adjusted multinomial logistic regressions showed increased risk of problems (persistent, worsening, or resolved) vs no problems (resilient) in relation to female sex, middle age, neighborhood disadvantage, pre-injury unemployment, pre-injury disability, and spinal cord injury. People living in rural areas, motorcyclists, pedal cyclists, and people with head, chest, and abdominal injuries had lower risk of problems.

Discussion

Targeted interventions delivered to people with the risk factors identified may help to attenuate the severity and impact of pain and mental health problems after transport injury.

A population-based study of treated mental health and persistent pain conditions after transport injury

BACKGROUND

Persistent pain and mental health conditions often co-occur after injury, cause enormous disability, reduce social and economic participation, and increase long-term healthcare costs. This study aimed to characterise the incidence, profile and healthcare cost implications for people who have a treated mental health condition, persistent pain, or both conditions, after compensable transport injury.

METHODS

The study comprised a population cohort of people who sustained a transport injury (n = 74,217) between 2008 to 2013 and had an accepted claim in the no-fault transport compensation system in Victoria, Australia. Data included demographic and injury characteristics, and payments for treatment and income replacement from the Compensation Research Database. Treated conditions were identified from 3 to 24-months postinjury using payment-based criteria developed with clinical and compensation system experts. Criteria included medications for pain, anxiety, depression or psychosis, and services from physiotherapists, psychologists, psychiatrists, and pain specialists. The data were analysed with Cox Proportional Hazards regression to examine rates of treated conditions, and general linear regression to estimate 24 month healthcare costs.

RESULTS

Overall, the incidence of treated mental health conditions (n = 2459, 3.3%) and persistent pain (n = 4708, 6.3%) was low, but rates were higher in those who were female, middle aged (35-64 years), living in metropolitan areas or neighbourhoods with high socioeconomic disadvantage, and for people who had a more severe injury. Healthcare costs totalled more than $A707 M, and people with one or both conditions (7.7%) had healthcare costs up to 7-fold higher (adjusting for demographic and injury characteristics) in the first 24 months postinjury than those with neither condition.

CONCLUSIONS

The incidence of treated mental health and persistent pain conditions was low, but the total healthcare costs for people with treated conditions were markedly higher than for people without either treated condition. While linkage with other public records of treatment was not possible, the true incidence of treated conditions is likely to be even higher than that found in this study. The present findings can be used to prioritise the implementation of timely access to treatment to prevent or attenuate the severity of pain and mental health conditions after transport injury.

Cycling injuries and alcohol

BACKGROUND

Most of the cycling accidents that occur in Finland do not end up in the official traffic accident statistics. Thus, there is minimal information on these accidents and their consequences, particularly in cases in which alcohol was involved. The focus of the present study is on cycling accidents and injuries involving alcohol in particular.

METHODS

Data on patients visiting the emergency department at North Kymi Hospital because of a cycling accident was prospectively collected for two years, from June 1, 2004 to May 31, 2006. Blood alcohol concentration (BAC) was measured on admission with a breath analyser. The severity of the cycling injuries was classified according to the Abbreviated Injury Scale (AIS).

RESULTS

A total of 217 cycling accidents occurred. One third of the injured cyclists were involved with alcohol at the time of visiting the hospital. Of these, 85% were males. A blood alcohol concentration of ≥ 1.2 g/L was measured in nearly 90% of all alcohol-related cases. A positive BAC result was more common among males than females (p < 0.001), and head injuries were more common among cyclists where alcohol was involved (AI) (60%) than among sober cyclists (29%) (p < 0.001). Two thirds (64%) of the cyclists with AI were not wearing a bicycle helmet. The figure for serious injuries (MAIS ≥ 3) was similar in both groups. Intoxication with an alcohol level of more than 1.5 g/L and the age of 15 to 24 years were found to be risk factors for head injuries. The mean cost of treatment was higher among sober cyclists than among cyclists with AI (€2143 vs. €1629), whereas in respect of the cost of work absence, the situation was the opposite (€1348 vs. €1770, respectively).

CONCLUSIONS

Cyclists involved with alcohol were, in most cases, heavily intoxicated and were not wearing a bicycle helmet. Head injuries were more common among these cyclists than among sober cyclists. As cycling continues to increase, it is important to monitor cycling accidents, improve the accident statistics and heighten awareness of the risks of head injuries when cycling under the influence of alcohol.