Injury incidence and predictors on a multiday recreational bicycle tour: The Register's Annual Great Bike Ride Across Iowa, 2004 to 2008

A descriptive and comparative analysis of injuries reported in USA Cycling-sanctioned competitive road cycling events

Background

Competition in road cycling events is common, yet little is known about the nature and disposition of injuries sustained in these events. The purpose of this study is to describe injured body regions and the disposition of injuries sustained by cyclists during competitive road cycling events.

Methods

Data regarding body region injured and injury disposition were retrospectively analyzed from a convenience sample of 1053 injury reports (male: n = 650 [61.7%], age = 33.4 ± 13.6 years; female: n = 116 [11.0%], age = 33.3 ± 13.9 years; missing: n = 284 [27.0%]) completed during the 2016 competitive season.

Results

A total of 1808 injuries were reported. Injured body regions included upper extremity (46.5%, n = 841), lower extremity (32.2%, n = 583), head/neck (10.4%, n = 189), torso/back (5.2%, n = 95), face (4%, n = 87), and internal/other (0.7%, n = 13). There were 1.37 ± 0.81 injuries recorded per report. Dispositions following injury were medical attention (34.1%, n = 316), ambulance/EMS (19.3%, n = 179), report only (15% n = 139), referred (13.0% n = 121), released to parent/personal vehicle (12.1% n = 112), refused care (4.1% n = 38), and continued riding (2.5% n = 23). Males (34.0%, n = 212) received medical attention more frequently than females (23.3%), p < 0.05. Females received EMS transport (29.1%, n = 30) more frequently than males (16.8%, n = 105), p < 0.05.

Conclusions

Upper extremity is the most injured body region in this data set. Following injury, racers often receive medical attention and a substantial percentage require transport by EMS.

Clinical relevance

Anticipating the nature of injuries sustained by cyclists may promote positive health outcomes by ensuring medical teams are prepared for the immediate medical needs of cyclists.

'As easy as riding a bike': a systematic review of injuries and illness in road cycling

Objectives

To allow the implementation of effective injury and illness prevention programmes for road cyclists, we wanted to first identify the injury/illness burden to this group of athletes. We, therefore, undertook a systematic review of all reported injuries/illness in road cycling.

Design

Systematic review.

Data sources

Identification of articles was achieved through a comprehensive search of: MEDLINE, Embase, PsycINFO, Web of Science and Cochrane Library from inception until January 2020.

Eligibility criteria for selecting studies

Studies reporting injuries/illness in adults participating in road cycling. Cycling commuter studies were excluded from the analysis.

Method

Two review authors independently screened titles and abstracts for eligibility and trial quality. Initial search criteria returned 52 titles and abstracts to be reviewed, with 12 studies included after reviewing the full text articles.

Results

The most common injuries sustained were abrasions, lacerations and haematomas accounting for 40–60% of the total injuries recorded. Fractures (6–15%) were the second most frequent type of injury. Head injuries (including concussions) accounted for 5–15% of injuries with musculotendinous injuries accounting for 2–17.5%. The upper limb was more frequently affected by injuries than the lower limb, with amateurs appearing to be at higher risk of injury/illness than professionals. Clavicle was the prevalent fracture, with patellofemoral syndrome the number one overuse diagnosis. No meta-analysis of the results was undertaken due to the inconsistent methods of reporting.

Conclusion

This is the first systematic review of road cycling injuries. Injuries most often affected the upper limb, with clavicle being the most prevalent fracture and the most common overuse injury being patellofemoral syndrome.

Drug and Alcohol Related Patient Presentations to Emergency Departments during Sporting Mass-Gathering Events: An Integrative Review

BACKGROUND

Drug and alcohol consumption at sporting mass-gathering events (MGEs) has become part of the spectator culture in some countries. The direct and indirect effects of drug and alcohol intoxication at such MGEs has proven problematic to in-event health services as well as local emergency departments (EDs). With EDs already under significant strain from increasing patient presentations, resulting in access block, it is important to understand the impact of sporting and other MGEs on local health services to better inform future planning and provision of health care delivery.

AIM

The aim of this review was to explore the impact of sporting MGEs on local health services with a particular focus on drug and alcohol related presentations.

METHOD

A well-established integrative literature review methodology was undertaken. Six electronic databases and the Prehospital and Disaster Medicine (PDM) journal were searched to identify primary articles related to the aim of the review. Articles were included if published in English, from January 2008 through July 2019, and focused on a sporting MGE, mass-gathering health, EDs, as well as drug and alcohol related presentations.

RESULTS

Seven papers met the criteria for inclusion with eight individual sporting MGEs reported. The patient presentation rate (PPR) to in-event health services ranged from 0.18/1,000 at a rugby game to 41.9/1,000 at a recreational bicycle ride. The transport to hospital rate (TTHR) ranged from 0.02/1,000 to 19/1,000 at the same events. Drug and alcohol related presentations from sporting MGEs contributed up to 10% of ED presentations. Alcohol was a contributing factor in up to 25% of cases of ambulance transfers.

CONCLUSIONS

Drug and alcohol intoxication has varying levels of impact on PPR, TTHR, and ED presentation numbers depending on the type of sporting MGE. More research is needed to understand if drug and alcohol intoxication alone influences PPR, TTHR, and ED presentations or if it is multifactorial. Inconsistent data collection and reporting methods make it challenging to compare different sporting MGEs and propose generalizations. It is imperative that future studies adopt more consistent methods and report drug and alcohol data to better inform resource allocation and care provision.

Cyclists' fractures in the elderly

Cyclists' fractures were as common in the elderly as in the young. In cyclists' fractures in the elderly, the ratio of women and the frequency of upper extremity fractures were significantly lower, compared with the young group.

PURPOSE

Bicycles are useful for both men and women of any age as a means of transportation. In the present aging society, it is common for elderly people to ride bicycles in their daily lives. There have been no reports describing the characteristics of elderly cyclists' fractures. We conducted this study to elucidate these characteristics.

METHODS

Data of cyclists' fractures, excluding head or facial injuries, treated in an urban hospital were retrospectively collected. We documented the mechanism of injury, gender, age, and location of each fracture. We compared the gender, age, and location between cyclists' fractures and non-cyclists' fractures treated in the same period in the same hospital.

RESULTS

Fifty percent of cyclists' fractures occurred in cyclists over 60 years old (23% in their 60s, 19% in their 70s, and 7% in their 80s). The proportion of women was significantly higher among cyclists' fractures than among non-cyclists' fractures in patients under 60 years old (p = 0.0001), but was significantly lower in patients over 60 years old (p = 0.002). We found a significant relationship between the fracture location of three categories (upper extremities, lower extremities, and trunk) and CF/NCF (p = 0.04). The proportion of upper extremity fractures in cyclists compared with non-cyclists was similar under 60 years, but significantly lower in patients over 60 years (p = 0.049).

CONCLUSIONS

Our study showed that cyclists' fractures were not uncommon in the elderly. In the elderly group, the ratio of women and the frequency of upper extremity fractures were significantly lower, compared with the young group.

The Injury and Illness Profile of Male and Female Participants in a 94.7 km Cycle Race: A Cross-Sectional Study

OBJECTIVE

To describe the incidence and patterns of injury and illness of male and female participants during a 94.7 km distance cycling event.

DESIGN

Descriptive study.

SETTING

Momentum 94.7 Cycle Challenge 2014.

PARTICIPANTS

All 23 055 race starters (males = 17 520, females = 5236, not specified = 299).

MAIN OUTCOME MEASURES

The incidence and type of all medical complaints and difference between sexes.

RESULTS

Incidence (per 1000 race starters) of all medical complaints was 38.69 (males = 36.52, females = 38.39), adverse medical events 11.88 (males = 10.73, females = 16.42) and serious adverse events 1.3 (males = 0.86, females = 2.67). The incidence of nontraumatic medical complaints was 32.49 (males = 33.39, females = 31.32) and of traumatic injuries was 3.99 (males = 3.14, females = 7.07). Females compared to males had a higher risk of sustaining traumatic injuries (P < 0.001), central nervous system, (P = 0.0062) and eye complaints (P = 0.0107). Most complaints (80.6%) were reported for the musculoskeletal system. Males 10-15 years (P = 0.0013) and females 23-39 years (P = 0.0336), and older than 50 years (P = 0.0002) had a higher than expected risk for traumatic injuries.

CONCLUSIONS

Medical complaints ratio reported was 1:26 (males = 1:28, females = 1:26) in all starters during the cycling event. Cyclists that did not finish the race (adverse events) were 1:84 (males = 1:93, females = 1:61). Serious adverse events that required hospitalization were 1:769 (males = 1:1163, females = 1:374). The majority of admissions were for traumatic injuries, followed by cardiovascular complaints. Results from this study indicated that a wide spectrum of medical complaints can be expected during such an event with a higher risk for females to sustain traumatic injuries and to encounter central nervous system and eye complaints. Information regarding the pattern and type of medical encounters can prove useful during planning and management of similar future events.

Injuries and Illnesses Occurring on a Recreational Bicycle Tour: The Great Ohio Bicycle Adventure

OBJECTIVE

Recreational multiday cycling events have grown popular in the United States; however, little has been published regarding the injuries and illnesses that occur during these events. The objective of this study was to describe injuries and illnesses that occur in the Great Ohio Bicycle Adventure (GOBA) and to examine associated risk factors.

METHODS

Injury and illness data collected from an on-site medical clinic during the 2013 and 2014 GOBA tours were merged with rider registration data for analysis. Diagnoses were classified as acute injury, overuse injury, or medical illness. The odds ratios of sustaining at least 1 injury/illness, as well as sustaining an acute injury, were assessed adjusting for riders' demographics.

RESULTS

A total of 4005 (2172 in 2013 and 1833 in 2014) cyclists participated in GOBA, with an an age of 50.7±17.6 (2-86) years (mean±SD [range]), of whom 59.8% were male. During the tours, 143 (3.6%) riders reported at least 1 injury/illness, which resulted in 220 clinical diagnoses, including 114 (51.8%) acute injuries, 27 (12.3 %) overuse injuries, and 79 (35.9%) medical illnesses. The lower extremities were the most commonly injured body site (n=71, 50.4%). "Superficial/Abrasions/Contusions" was the most common injury/illness type (n=68, 30.9%). Riders who had no previous tour experience or who were at least 50 years old had a greater risk of injury/illness than their counterparts.

CONCLUSIONS

The prevalence of injury and illness is relatively low in multiday recreational cycling events. Our findings provide important data for planning and preparing for medical coverage at mass recreational cycling events.

Health Service Impact from Mass Gatherings: A Systematic Literature Review

Background

During a mass gathering, some participants may receive health care for injuries or illnesses that occur during the event. In-event first responders provide initial assessment and management at the event. However, when further definitive care is required, municipal ambulance services provide additional assessment, treatment, and transport of participants to acute care settings, such as hospitals. The impact on both ambulance services and hospitals from mass-gathering events is the focus of this literature review.

Aim

This literature review aimed to develop an understanding of the impact of mass gatherings on local health services, specifically pertaining to in-event and external health services.

Method

This research used a systematic literature review methodology. Electronic databases were searched to find articles related to the aim of the review. Articles focused on mass-gathering health, provision of in-event health services, ambulance service transportation, and hospital utilization.

Results

Twenty-four studies were identified for inclusion in this review. These studies were all case-study-based and retrospective in design. The majority of studies (n=23) provided details of in-event first responder services. There was variation noted in reporting of the number and type of in-event health professional services at mass gatherings. All articles reported that patients were transported to hospital by the ambulance service. Only nine articles reported on patients presenting to hospital. However, details pertaining to the impact on ambulance and hospital services were not reported.

Conclusions

There is minimal research focusing on the impact of mass gatherings on in-event and external health services, such as ambulance services and hospitals. A recommendation for future mass-gathering research and evaluation is to link patient-level data from in-event mass gatherings to external health services. This type of study design would provide information regarding the impact on health services from a mass gathering to more accurately inform future health planning for mass gatherings across the health care continuum.

RanseJ, HuttonA, KeeneT, LensonS, LutherM, BostN, JohnstonANB, CrillyJ, CannonM, JonesN, HayesC, BurkeB. Health service impact from mass gatherings: a systematic literature review. Prehosp Disaster Med. 2017;32(1):71–77.

FREQUENCY AND RISK FACTORS OF CLAVICLE FRACTURES IN PROFESSIONAL CYCLISTS

Objective:

To evaluate the prevalence of clavicle fractures in professional and amateur cyclists and evaluate the factors associated with its occurrence.

Method:

One hundred and forty professional and amateur athletes were interviewed through a questionnaire regarding age and time practicing bicycling, among others.

Results:

Among the 140 evaluated cyclists, there were 19 (13.5%) clavicle fractures associated with this sports modality.

Conclusion:

There was a positive association between time practicing bicycling and frequency of clavicle fractures, as well as between hours of weekly training and clavicle fractures. Level of Evidence IV, Case-Series.

Outcome of proximal femoral fractures caused by cycling in the young and mid-aged

BACKGROUND

Cycling is gaining more popularity both as a sport, on and off-road and also as a means of commute. Cycling accidents harbour significant injury risks including fractures. Proximal femoral fractures are uncommonly associated with cycling in the young adult population. The purpose of this study is to describe this unique pattern of injury as well as the outcome of proximal femoral fractures caused by cycling in the young to mid age population.

STUDY DESIGN

retrospective cohort study. 23 fractures in 22 patients were available for analysis. 11 were femoral neck fractures, with six displaced ones, and the rest trochanteric fractures. 21 patients were male patients, and the average age was 42 (range 27-60). All patients but two were operated within 24 h from admission. Radiographic analysis included reduction quality, fracture classification and arthritic changes. Clinical outcome was measured using SF-12 and Oxford hip scores.

RESULTS

All fractures healed. Two patients with displaced femoral neck fractures developed avascular necrosis requiring arthroplasty. One patient developed an AVN 2 years after a stable trochanteric fracture but did not require an arthroplasty as of yet. Eight patients required hardware removal due to symptoms. 77% of patients had resumed cycling at the pre-injury level. Mean SF-12 score was 47.1 ± 11.7 for the physical component and 53.7 ± 6.3 for the mental component. Mean oxford hip score as was 40.1 ± 12.2. Radiographic analysis revealed good to acceptable reduction quality. Fracture type, age, cycling type and reduction were not significantly associated with outcome.

CONCLUSION

Proximal femoral fractures caused by cycling in young to mid-aged adults are an emerging pattern of injury. Overall favourable result can be expected in the majority of cases, with displaced femoral neck fractures having a risk for AVN. Further delineation of the exact cause for this phenomenon is required with possible intervention for injury prevention.

An Analysis of Patient Presentations at a 2-Day Mass-participation Cycling Event: The Ride to Conquer Cancer Case Series, 2010-2012

Objective

To analyze the unique factors involved in providing medical support for a long-distance, cross-border, cycling event, and to describe patient presentations and event characteristics for the British Columbia (BC) Ride to Conquer Cancer from 2010 through 2012.

Methods

This study was a 3-year, descriptive case series report. Medical encounters were documented, prospectively, from 2010-2012 using an online registry. Data for event-related variables also were reported.

Results

Providing medical support for participants during the 2-day ride was complicated by communication challenges, weather conditions, and cross-border issues. The total number of participants for the ride increased from 2,252 in 2010 to 2,879 in 2011, and 3,011 in 2012. Patient presentation rates (PPRs) of 125.66, 155.26, and 198.93 (per 1,000 participants) were documented from 2010 through 2012. Over the course of three years, and not included in the PPR, an additional 3,840 encounters for “self-treatment” were documented.

Conclusions

The Ride to Conquer Cancer Series has shown that medical coverage at multi-day, cross-national cycling events must be planned carefully to face a unique set of circumstances, including legislative issues, long-distance communication capabilities, and highly mobile participants. This combination of factors leads to potentially higher PPRs than have been reported for noncycling events. This study also illuminates the additional workload “self-treatment” visits place on the medical team.

LundA, TurrisSA, WangP, MuiJ, LewisK, GutmanSJ. An analysis of patient presentations at a 2-day mass-participation cycling event: The Ride to Conquer Cancer Case Series, 2010-2012. Prehosp Disaster Med. 2014;29(4):1-8.