The Current Injury Situation of Bicyclists???A Medical and Technical Crash Analysis

Bicycle injuries: A systematic review for forensic evaluation

Bicycles are employed as means of transportation across various age groups, from young students to the elderly, for work, education, health, and leisure trips. Despite not achieving high speeds, bicyclists remain vulnerable to severe and even fatal injuries when they are involved in traffic accidents. Although the rising awareness of ecological issues and traffic law enforcement mean that cyclists are increasingly susceptible to road traffic crashes and injuries. Injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence. The aim of this study is to provide a systematic review of the literature on injuries sustained in cyclists involved in road accidents describing and analysing elements useful for forensic assessment. The literature search was performed using PubMed, Scopus, and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving bicycles. A total of 128 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the bicycle accident was examined and discussed. This review highlights that injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence and the energy levels involved in the crash. The assessment of injuries offers valuable insights that integrated with circumstantial and engineering data perform the reconstruction of accident dynamics.

Value of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries

OBJECTIVE

To characterise patients presenting to EDs for a bicycle-related injury, identify contributing factors to the injuries and describe the data gaps.

METHODS

A retrospective study of bicycle-related injury presentations over the 5 year period 2010-2014 to two major metropolitan EDs. Data collected from the emergency presentation database consisted of patient demographics, presenting complaint, discharge diagnosis and details about the circumstances and mechanism of the accident.

RESULTS

Bicycle injuries (n = 4144) increased from 20.0 to 25.2 per 1000 injury presentations over 5 years. Patients were 80% male across all age groups and 35% of presentations occurred at the weekend. Fractures accounted for one-third (34%) of all injuries, while injuries to the upper extremities and head resulted in 36% and 19% of cases, respectively. Admission rate was 17%. The number of falls exceeded collisions (1611 vs 937), and in the 13.3% of the fall cases where documentation was present for which how the fall occurred, over half were attributed to bike handling errors. Information related to type of bicycle, accident location, type of activity, protective clothing worn (including helmets) and visibility aids was not recorded for over 95% of the cases.

CONCLUSION

Bicycle injuries carry a considerable burden to the ED and the incidence of presentations appears to be rising. The current triage data, designed to provide a rapid assessment for medical urgency, are limited to describing broad demographics, trends and causes.

Fit, stability and comfort assessment of custom-fitted bicycle helmet inner liner designs, based on 3D anthropometric data

Research has demonstrated that a better-fitted bicycle helmet offers improved protection to the rider during an impact. Nowadays, bicycle helmets in the market that range in size from small/medium to medium/large might not fit the diverse range of human head shapes and dimensions. 3D scanning was used to create 3D head shape databases of 20 participants who volunteered for the study. We developed new custom-fitted helmet inner liners, based on the 3D head shape of two sub-groups of participants, to map their head sizes and contours closely to the conventional Medium (M) and Large (L) sizes as described in from AS/NZS 2512.1: 2009. The new custom-fitted helmet was compared with the helmet available in the market place in a dynamics stability test and from participants' subjective feedback. A significant reduction in the angle of helmet rotation on the headform in the lateral direction was recorded for the custom-fitted helmet. A Wilcoxon signed-rank test was conducted to evaluate participants' feedback on the helmets according to different area definitions. The overall fit and comfort and the top region of the new helmet were significantly improved. However, no difference was found at the significant level of 0.05 for the front and rear region of the new helmet.

SOFIE, a bicycle that supports older cyclists?

Older cyclists remain at high risk of sustaining an injury after a fall with their bicycle. A growing awareness for the need and possibilities to support safety of older cyclists has been leading to bicycle design ideas. However, the effectiveness and acceptance of such designs has not been studied yet. This study aims to analyse the effect of 3 support systems: an automatic adjustable saddle height, optimised frame and wheel geometry and drive-off assistance. The support systems are integrated on the SOFIE bicycle, a prototype bicycle designed to support older cyclists during (dis-)mounting and at lower cycling speeds. Nine older cyclists (65-80 years) were asked to cycle on a 'normal' and on the 'SOFIE' bicycle. They cycled on a parking lot to avoid interaction with traffic. The following tasks were analysed: cycling at comfortable and low speed avoiding an obstacle and (dis-)mounting the bicycle. Bicycle and cyclist motions were recorded with 10 Inertial Measurement Units and by 2 video cameras. FUSION software (LABVIEW) was used to assess kinematic parameters. First, a subjective analysis of the different cycling tasks was made, supported by video analysis. Second, differences in cyclist and bicycle kinematic parameters between the normal and SOFIE bicycle were studied for the various cycling tasks. The SOFIE bicycle was experienced as a 'supportive' and comfortable bicycle and objectively performed 'safer' on various cycling tasks. For example: The optimised frame geometry with low step-in enabled a faster (dis-)mounting time and less sternum roll angle and angular acceleration. The adjustable saddle height enabled the participants to keep both feet on the ground till they started cycling with the 'drive-off' support. The latter reduces steering activity: maximum steer angle and angular acceleration. During sudden obstacle avoidance, less upper body and thigh accelerations are recorded. In conclusion, the SOFIE bicycle was able to support older cyclists during various cycling tasks and may reduce fall risk.

Road accidents involving bicycles: configurations and injuries

This study analyzed the most common types of accident involving bicycles and compared the frequency of injuries. The data source was the database of German In-Depth Accident Study (GIDAS). Cases consist of bicycles and their riders involved in accidents between 2000 and 2010. In most collisions, the bicycle impacted with a car. The percentage of injured bicyclists was higher in collisions with a heavy vehicle and decreased when the bicycle impacted with lighter vehicles. A high percentage of injured bicyclists in single accidents was observed; the most severe injury was more frequently to head and extremities. Accidents involving a car and a bicycle with the right of way in a bicycle path represented about 20% of involved and injured bicyclists. The ten most frequent configurations represented about 60% of involved and injured bicyclists. These results contribute to understand the dangerous scenarios for bicyclists and to suggest preventive actions.

Road Traffic Related Injury Severity in Truck Drivers: A Prospective Medical and Technical Analysis of 582 Truck Crashes

BACKGROUND

While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTA) involving trucks, little is known about RTA injury risk for truck drivers.

OBJECTIVES

The aim of this study was to analyze the injury severity in truck drivers following RTAs.

PATIENTS AND METHODS

Our local accident research unit prospectively documented 43000 RTAs involving 582 trucks between 2000 and 2011. Injury severity, including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration.

RESULTS

Thirteen percent (77/582) of truck drivers were injured. Extremities were found to be at highest risk of injury with the lower extremities (36x) being injured most severely (10x: AIS 2 and 3). Death occurred only after collisions with other trucks, and severity of injuries increased with an increased speed limit. The maximum abbreviated injury scale was higher in the crash opponents (56x MAIS ≥ 3) compared to the truck drivers (8x MAIS ≥ 3). Overall, 82% of the crash opponents were injured.

CONCLUSIONS

The safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.

Injury severity of pedestrians, bicyclists and motorcyclists resulting from crashes with reversing cars

OBJECTIVE

Pedestrians, bicyclists and motorcyclists can suffer serious injury in road traffic crashes. To date, no studies examine the injury severity within this vulnerable cohort following collisions with reversing cars.

MATERIAL AND METHODS

Our institution prospectively maintains a database including medical and technical information regarding traffic accidents in our area, including urban and suburban regions. In a retrospective review of this database, the authors describe the injury severity of pedestrians, bicyclists and motorcyclists following traffic crashes involving reversing cars. Injury severity was described using the abbreviated injury scale (AIS) as well as the maximum abbreviated injury scale (MAIS).

RESULTS

This study included 234 crashes occurring between 1999 and 2012. The lower extremity was injured most often while also suffering more severe injuries with a median AIS of 1 compared to 0 in all other documented body regions. The upper extremity was injured second most often. AIS ranging from 4 to 6 were infrequent. AIS 3 however, was documented for the legs in 4.3% of patients. MAIS 0, 1, 2, 3, 5 and 9 were found in 1, 164, 46, 14, 1, and 8 patients in the study cohort, respectively. Pedestrians and motorcyclists were seriously injured in 9.1% and 9.6% of cases, respectively. In contrast, no bicyclists suffered serious injuries. As to the zone of impact, most collisions occurred at the rear center of the vehicle (35%) followed by rear left (26%), rear right (20%), side rear (11%), side center (4%) and side front (3%). 204 (87.2%) collisions occurred during the day, 19 (8.1%) at night and 11 (4.7%) at twilight. Speed was similar in crashes involving pedestrians, bicyclists and motorcyclists, being as high as 7.0±3.6, 7.0±4.0 and 7.9±4.2km/h respectively.

CONCLUSIONS

This is the first study that analyzes injury severity among these vulnerable road users following collisions with reversing vehicles. The majority of collisions occur at low impact speed during the day. Most injuries resulting from these collisions are not serious, however pedestrians are at greatest risk of severe injury to any body region. The lower extremities suffer the most serious and frequent injuries within this cohort.

Effectiveness of Bicycle Safety Helmets in Preventing Facial Injuries in Road Accidents

BACKGROUND

The effectiveness of bicycle safety helmets in preventing head injuries is well- documented. Recent studies differ regarding the effectiveness of bicycle helmets in preventing facial injuries, especially those of the mid-face and the mandible.

OBJECTIVES

The present study was conducted to determine the protective effect of a bicycle helmet in preventing mid-face and mandibular fractures.

PATIENTS AND METHODS

Data from an accident research unit were analyzed to collect technical collision details (relative collision speed, type of collision, collision partner, and use of a helmet) and clinical data (type of fracture).

RESULTS

Between 1999 and 2011, 5,350 bicycle crashes were included in the study. Of these, 175 (3.3%) had fractures of the mid-face or mandible. In total, 228 mid-face or mandibular fractures were identified. A significant correlation was found between age and relative collision speed, and the incidence of a fracture. While no significant correlation was found between the use of a helmet and the incidence of mid-facial fractures, the use of a helmet was correlated with a significantly increased incidence of mandibular fractures.

CONCLUSIONS

Higher age of cyclists and increasing speed of the accident opponent significantly increase the likelihood of sustaining facial fractures. The use of bicycle helmets does not significantly reduce the incidence of mid-facial fractures, while being correlated with an even increased incidence of mandibular fractures.

Cyclists' clothing and reduced risk of injury in crashes

INTRODUCTION

A majority of cyclists' hospital presentations involve relatively minor soft tissue injuries. This study investigated the role of clothing in reducing the risk of cyclists' injuries in crashes.

METHODS

Adult cyclists were recruited and interviewed through hospital emergency departments in the Australian Capital Territory. This paper focuses on 202 who had crashed in transport related areas. Eligible participants were interviewed and their self-reported injuries corroborated with medical records. The association between clothing worn and injury was examined using logistic regression while controlling for potential confounders of injury.

RESULTS

A high proportion of participants were wearing helmets (89%) and full cover footwear (93%). Fewer wore long sleeved tops (43%), long pants (33%), full cover gloves (14%) or conspicuity aids (34%). The primary cause of injury for the majority of participants (76%) was impact with the ground. Increased likelihood of arm injuries (Adj. OR=2.06, 95%CI: 1.02-4.18, p=0.05) and leg injuries (Adj. OR=3.37, 95%CI: 1.42-7.96, p=0.01) were associated with wearing short rather than long sleeves and pants. Open footwear was associated with increased risk of foot or ankle injuries (Adj. OR=6.21, 95%CI: 1.58-23.56, p=0.01) compared to enclosed shoes. Bare hands were associated with increased likelihood of cuts, lacerations or abrasion injuries (Adj. OR=4.62, 95%CI: 1.23-17.43, p=0.02) compared to wearing full cover gloves. There were no significant differences by fabric types such as Lycra/synthetic, natural fiber or leather.

CONCLUSIONS

Clothing that fully covers a cyclist's body substantially reduced the risk of injuries in a crash. Coverage of skin was more important than fabric type. Further work is necessary to determine if targeted campaigns can improve cyclists' clothing choices and whether impact protection can further reduce injury risk.

Vertebral fractures in motor vehicle accidents - a medical and technical analysis of 33,015 injured front-seat occupants

Spinal injuries pose a considerable risk to life and quality of life. In spite of improvements in active and passive safety of motor vehicles, car accidents are regarded as a major cause for vertebral fractures. The purpose of this study was to evaluate the current incidence of vertebral fractures among front-seat occupants in motor vehicle accidents, and to identify specific risk factors for sustaining vertebral fractures in motor vehicle accidents. Data from an accident research unit were accessed to collect collision details, preclinical data, and clinical data. We included all data on front-seat occupants. Hospital records were retrieved, and radiological images were evaluated. We analysed 33,015 front-seat occupants involved in motor vehicle accidents over a 24-year period. We identified 126 subjects (0.38%) with cervical spine fractures, 78 (0.24%) with thoracic fractures, and 99 (0.30%) with lumbar fractures. The mean relative collision speeds were 48, 39, and 40 kph in subjects with cervical, thoracic, and lumbar spine fractures, respectively, while it was 17.3 kph in the whole cohort. Contrary to the overall cohort, these patients typically sustained multiple hits rather than simple front collisions. Occupants with vertebral fractures frequently showed numerous concomitant injuries; for example, additional vertebral fractures. The incidence of vertebral fractures corresponded with collision speed. Safety belts were highly effective in the prevention of vertebral fractures. Apart from high speed, complex injury mechanisms as multiple collisions or rollovers were associated with vertebral fractures. Additional preventive measures should focus on these collision mechanisms.

Mechanisms of motor vehicle crashes related to burns--an analysis of the German In depth Accident Study (GIDAS) database

BACKGROUND

Patients of motor vehicle crashes (MVCs) suffering burns are challenging for the rescue team and the admitting hospital. These patients often face worse outcomes than crash patients with trauma only. Our analysis of the German In-depth Accident Study (GIDAS) database researches the detailed crash mechanisms to identify potential prevention measures.

METHODS

We analyzed the 2011 GIDAS database comprising 14,072 MVC patients and compared individuals with (Burns) and without (NoBurns) burns. Only complete data sets were included. Patients with burns obviously resulting of air bag deployment only were not included in the Burns group. Data acquisition by an on call team of medical and technical researchers starts at the crash scene immediately after the crash and comprises technical data as well as medical information until discharge from the hospital. Statistical analysis was done by Mann-Whitney-U-test. Level of significance was p < 0.05.

RESULTS

14,072 MVC patients with complete data sets were included in the analysis. 99 individuals suffered burns (0.7%; group "Burns"). Demographic data and injury severity showed no statistical significant difference between the two groups of Burns and NoBurns. Injury severity was measured using the Injury Severity Score (ISS). Direct frontal impact (Burns: 48.5% vs. NoBurns: 33%; p < 0.05) and high-energy impacts as represented by delta-v (m/s) (Burns: 33.5 ± 21.4 vs. NoBurns: 25.2 ± 15.9; p < 0.05) were significantly different between groups as was mortality (Burns: 12.5% vs. NoBurns: 2.1%; p < 0.05). Type of patients' motor vehicles and type of crash opponent showed no differences.

CONCLUSIONS

Our results show, that frontal and high-energy impacts are associated with a frequency of burns. This may serve automobile construction companies to improve the burn safety to prevent flames spreading from the motor compartment to the passenger compartment. Communities may impose speed limits in local crash hot spots.

Fatal falls from bicycles: a case report

Though rare occurrences, fatal falls from bicycles are generally linked to the absence of a protective helmet and/or a collision with another vehicle. The case presented here is exceptional due to its circumstances and the consequences of the accident: a fall with no obstacle at a low speed that brought about multiple traumas and the death of a cyclist wearing a protective helmet. Comparing this against a review of cyclist accidentology literature, this case is unique. The increased use of autopsy in terms of forensic accidentology is to be encouraged so as not to misunderstand the possibility of such lesion-based consequences following a simple fall from a bicycle.

Bicyclist-bicyclist crashes--a medical and technical crash analysis

BACKGROUND

The purpose of this study was to analyze the actual injury situation of bicyclists focusing on accidents involving more than one bicyclist. A medical and technical analysis was performed as a basis for preventive measures.

METHODS

Technical and medical data were collected at the scene, shortly after the accident. Technical analysis included speed at crash, type of collision, impact angle, environment, lane used, and relative velocity. Medical analysis included injury patterns and severity (Abbreviated Injury Scale [AIS], Injury Severity Score [ISS]).

RESULTS

Five hundred seventy-eight injured bicyclists in 289 accidents from 1999 to 2008 were included into the study. Sixty-one percent were male (n = 350) and 39 percent were female (n = 228). Sixty-seven percent ranged between 18 and 64 years of age, 12 percent each between 13 and 17 years of age and older than 65 years, 8 percent between 6 and 12 years, and 1 percent between 2 and 5 years. Ninety-two percent of crashes took place in urban areas and 8 percent in rural areas. Ninety-seven percent of crashes occurred in dry conditions and 3 percent in wet conditions. Eighty-three percent of all accidents occurred during the daytime, 10 percent at night, and 7 percent at dawn. The helmet use rate was only 7.5 percent for all involved bicyclists. The mean Abbreviated Injury Scale (AIS) score was 1.31.

CONCLUSION

The prevalence of bicycle-to-bicycle crashes is high. Most of these accidents occur in urban areas. Bicyclists should be considered as minimally or unprotected road users, with an unsatisfactorily low rate of helmet use. Though the average level and patterns of injuries is moderate, most of the severe injuries involved the head and extremities. However, there was no significant correlation between frequent helmet use and sustained injuries to the head of major AIS.

Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality

Alcohol is one of the most important personal risk factors for serious and fatal injuries, contributing to approximately one third of all deaths from accidents. It is also described that alcohol intoxication leads to a higher mortality in the clinical course. In this study, we hypothesized that alcohol intoxication leads to different accident kinematics, a higher ISS (Injury Severity Score), and higher preclinical mortality compared to sober patients. A technical and medical investigation of alcohol intoxicated road users was performed on the scene of the crash and at the primary admitting hospital. Alcohol testing was performed with either breath alcohol tests or measurement of blood alcohol concentration (BAC) in a standard laboratory test. Between 1999 and 2010, 37,635 road traffic accidents were evaluated by the Accident Research Unit. Overall 20,741 patients were injured, 2.3% of the patients were killed. Among the injured patients, 2.2% with negative BAC were killed, compared to 4.6% fatal injuries in patients with a positive BAC (p < 0.0001). Of the patients with a positive BAC, 8.0% were severely injured, compared to 3.6% in the BAC negative group (p < 0.0001). Regarding the relative speed at impact (Δv for motorized drivers, vehicle collision speed for pedestrians and bikers), there was a significant higher difference for BAC positive patients (30 ± 20) compared to the BAC negative patients (25 ± 19, p < 0.0001). Alcohol intoxication in trauma patients leads to higher preclinical mortality, higher impact speed difference, and higher injury severity. The subgroup analysis for different alcohol concentrations shows no difference in ISS, MAIS, and relative speed, but a correlation of increasing age of patients with higher alcohol concentrations.

Risk factors for severe injury in cyclists involved in traffic crashes in Victoria, Australia

This study examines the impact of cyclist, road and crash characteristics on the injury severity of cyclists involved in traffic crashes reported to the police in Victoria, Australia between 2004 and 2008. Logistic regression analysis was carried out to identify predictors of severe injury (serious injury and fatality) in cyclist crashes reported to the police. There were 6432 cyclist crashes reported to the police in Victoria between 2004 and 2008 with 2181 (33.9%) resulting in severe injury of the cyclist involved. The multivariate analysis found that factors that increase the risk of severe injury in cyclists involved in traffic crashes were age (50 years and older), not wearing a helmet, riding in the dark on unlit roads, riding on roads zoned 70 km/h or above, on curved sections of the road, in rural locations and being involved in head-on collisions as well as off path crashes, which include losing control of vehicle, and on path crashes which include striking the door of a parked vehicle. While this study did not test effectiveness of preventative measures, policy makers should consider implementation of programs that address these risk factors including helmet programs and environmental modifications such as speed reduction on roads that are frequented by cyclists.

Knee injuries in severe trauma patients: a trauma registry study in 3.458 patients

Background

Purpose of the presented study is to answer the following questions: Are knee injuries associated with trauma mechanisms or concomitant injuries? Do injuries of the knee region aggravate treatment costs or prolong hospital stay in polytraumatized patients?

Methods

A retrospective analysis including 29.779 severely injured patients (Injury Severity Score [greater than or equal to] 16) from the Trauma Registry of the German Society for Trauma Surgery database (1993-2008) was conducted. Patients were subdivided into two groups; the "Knee" group (n=3.458, 11.6% of all patients) including all multiple trauma patients with knee injuries, and the "Non Knee" group (n=26.321) including the remaining patients. Patients with knee injuries were slightly younger, less often male gender and had a significantly increased ISS.

Results

Patients in the Knee group suffered significantly more traffic accidents compared to the Non Knee group (82% vs. 52%, p<0.001). These injuries were more often caused by car or motorbike accidents. Severe thoracic and limb injuries (AIS[greater than or equal to]3) were more frequently found in the Knee group (p<0.001) while head injury was distributed equally. The overall hospital stay, ICU stay, and treatment costs were significantly higher for the Knee group (38.1 vs. 25.5 days, 15.2 vs. 11.4 days, 40,116 vs. 25,336 Euro, respectively; all p<0.001).

Conclusions

Traffic accidents are associated with an increased incidence of knee injuries than falls or attempted suicides. Furthermore, severe injuries of the limbs and chest are more common in polytraumatized patients with knee injuries. At last, treatment of these patients is prolonged and consequently more expensive.

A prospective cohort study on minor accidents involving commuter cyclists in Belgium

The purpose of this study is to gain insight into bicycle accidents. Bicycle accident data and weekly exposure data were prospectively collected for one year to calculate the incidence rate (IR) of bicycle accidents. An accident was included if it occurred during utilitarian cycling, resulting in an acute injury with corporal damage. If an accident occurred, a detailed questionnaire was filled out to collect detailed information about its circumstances and consequences. A sample of 1087 regular (≥2 cycling trips to work a week) adult (40±10 years) cyclists was analyzed. Over the 1-year follow-up period, 20,107 weeks were covered, accumulating 1,474,978 cycled kilometers. Sixty-two participants were involved in 70 bicycle accidents, of which 68 were classified as 'minor'. The overall IR for the 70 accidents was 0.324 per 1000 trips (95% CI 0.248-0.400), 0.896 per 1000 h (95% CI 0.686-1.106) and 0.047 per 1000 km (95% CI 0.036-0.059) of exposure. Brussels-capital region is the region with the highest IR (0.086; 95% CI 0.054-0.118), with a significantly (P<0.05) higher IR compared to Flanders (0.037; 95% CI 0.025-0.050). Injuries were mainly caused by 'slipping' (35%) or 'collision with a car' (19%). The accidents caused abrasions (42%) and bruises (27%) to the lower (45%) and upper limbs (41%). Police, hospital emergency department or insurance companies were involved in only 7%, 10% and 30% of the cases, respectively. It is noteworthy that 37% of the participants indicated that they could have avoided the accident. In order to decrease the number of accidents, measures should be taken to keep cycling surfaces clean and decrease the number of obstacles on bicycle infrastructure. Roads and intersections need to be built so that the collisions between cars and bicycles are decreased to a minimum. Car drivers and cyclists should pay more attention towards each other. Underreporting of minor bicycle accidents in Belgium is confirmed, and is higher than expected. Reliable accident statistics, taking into account exposure, are needed to decide which road safety measures are the most effective. The 'safety in numbers' principle is also applicable for minor bicycle accidents.

The injury epidemiology of cyclists based on a road trauma registry

Background

Bicycle use has increased in some of France's major cities, mainly as a means of transport. Bicycle crashes need to be studied, preferably by type of cycling. Here we conduct a descriptive analysis.

Method

A road trauma registry has been in use in France since 1996, in a large county around Lyon (the Rhône, population 1.6 million). It covers outpatients, inpatients and fatalities. All injuries are coded using the Abbreviated Injury Scale (AIS). Proxies were used to identify three types of cycling: learning = children (0-10 years old); sports cycling = teenagers and adults injured outside towns; cycling as means of transport = teenagers and adults injured in towns. The study is based on 13,684 cyclist casualties (1996-2008).

Results

The percentage of cyclists injured in a collision with a motor vehicle was 8% among children, 17% among teenagers and adults injured outside towns, and 31% among those injured in towns. The percentage of serious casualties (MAIS 3+) was 4.5% among children, 10.9% among adults injured outside towns and 7.2% among those injured in towns. Collisions with motor-vehicles lead to more internal injuries than bicycle-only crashes.

Conclusion

The description indicates that cyclist type is associated with different crash and injury patterns. In particular, cyclists injured in towns (where cycling is increasing) are generally less severely injured than those injured outside towns for both types of crash (bicycle-only crashes and collisions with a motor vehicle). This is probably due to lower speeds in towns, for both cyclists and motor vehicles.

Cycling crashes in children, adolescents, and adults--a comparative analysis

OBJECTIVE

To compare rates, circumstances, and outcomes of cyclist crashes between children (aged 0-9 years), adolescents (aged 10-19 years), and adults (aged 20 years and over) in Victoria, Australia.

METHODS

A retrospective analysis of cyclist crashes in police records and the Victorian Admitted Episodes Dataset during the period 2004-2008.

RESULTS

Adolescent cyclists had the highest rates, per 100 000 people, of police-reported (32.6, 95% confidence interval [CI]: 30.7-34.5) and hospitalized cyclist crashes (71.6, 95% CI: 68.7-74.4). Police-reported helmet use at the time of the crash was lowest among children (57.1%, 95% CI: 49.5-64.8) compared to 60.2 percent (95% CI: 57.3-63.1) in adolescents and 77.7 percent (95% CI: 76.5-78.8) in adults. This was reflected in the hospital data, which indicated that more than one third of cyclist hospitalizations among children (37.4%) resulted in head injuries compared to around 1 in 4 hospitalized cyclist crashes in adolescents (26.8%) and adults (23.7%). Cyclists emerging off a footpath into the path of a vehicle as well as cyclists struck by vehicles emerging form a driveway were the most frequent types of police-reported crashes involving children (73.9%) and adolescents (48.1%). In contrast, most adult cyclist crashes occurred on the roadway, mainly at intersections.

CONCLUSIONS

Programs to improve the safety knowledge and behavior of children and adolescent cyclists, particularly focusing on helmet use, should be part of a comprehensive approach that encompasses legislative and environmental changes, including appropriate cyclist facilities and reduced speed limit in residential areas.

Critical factors in fatal collisions of adult cyclists with automobiles

This article evaluates, by means of multivariate regression, critical factors influencing the collisions of motor vehicles with adult (over 17 years) cyclists that result in fatal injury of cyclists. The analysis is based on the database of the Traffic Police of Czech Republic from the time period 1995-2007. The results suggest that the most consequential categories of factors under study are: inappropriate driving speed of automobile; the head-on crash; and night-time traffic in places without streetlights. The cyclists' faults are of most serious consequence on crossroads when cyclists deny the right of way. Males are more likely to suffer a fatal injury due to a collision with a car than females. The most vulnerable age group are cyclists above 65 years. A fatal injury of a cyclist is more often driver's fault than cyclist's (598 vs. 370). In order to reduce the fatal risk, it is recommended to separate the road traffic of motor vehicles from bicyclists in critical road-sections; or, at least, to reduce speed limits there.

Injuries to pedal cyclists on New Zealand roads, 1988-2007

BACKGROUND

The risk of injury is one of the major barriers to engaging in cycling. We investigated exposure-based rates and profiles of traffic injuries sustained by pedal cyclists that resulted in death or hospital inpatient treatment in New Zealand, one of the most car dependent countries.

METHODS

Pedal cyclist traffic injuries were identified from the Mortality Collection and the National Minimum Dataset. Total time spent cycling was used as the measure of exposure and computed from National Household Travel Surveys. Analyses were undertaken for the periods 1988-91, 1996-99 and 2003-07 in relation to other major road users and by age, gender and body region affected. A modified Barell matrix was used to characterise the profiles of pedal cyclist injuries by body region affected and nature of injury.

RESULTS

Cyclists had the second highest rate of traffic injuries compared to other major road user categories and the rate increased from 1996-99 to 2003-07. During 2003-07, 31 injuries occurred per million hours spent cycling. Non-collision crashes (40%) and collisions with a car, pick-up truck or van (26%) accounted for two thirds of the cycling injuries. Children and adolescents aged under 15 years were at the highest risk, particularly of non-collision crashes. The rate of traumatic brain injuries fell from 1988-91 to 1996-99; however, injuries to other body parts increased steadily. Traumatic brain injuries were most common in collision cases whereas upper extremity fractures were most common in other crashes.

CONCLUSIONS

The burden of fatal and hospitalised injuries among pedal cyclists is considerable and has been increasing over the last decade. This underscores the development of road safety and injury prevention programmes for cyclists alongside the cycling promotion strategies.

Bicycle injury events among older adults in Northern Sweden: a 10-year population based study

Bicycles are a common mode of transportation and injured bicyclists cause a substantial burden on the medical sector. In Sweden, about half of fatally injured bicyclists are 65 years or older. This study analyzes the injury mechanisms, injuries, and consequences among bicyclists 65 years or older and compare with younger bicyclists (< or =64) and older adults as passenger car drivers, to give a basis for an injury preventive discussion for this age group. Umeå University Hospital's primary catchments area had 142,000 inhabitants in 2006. Nearly all injured road users in the well-defined geographic area are treated at this hospital and a 10-year data set (N=456) of injured bicyclists aged 65+ from the hospital's continuous injury registration (1997-2006) was analyzed. The results show that the annual injury incidence was 2.4 and 2.2 per 1000 men and women, respectively, aged 65 or older. For men the incidence rate was constant in the three age groups 65-74, 75-84 and 85+, while it decreased strongly for women. The incidence rate for old adults as passenger car drivers and younger bicyclists was 1.0 and 4.6, respectively. Most frequent injury mechanisms were falls when getting on or off a bicycle (20%) and by potholes or irregularities on the ground, edge of a sidewalk, or similar (13%). Only 6% were hit by cars, trucks, or buses. Half of the injured suffered fractures or dislocations, and 10% suffered concussion or more serious intracranial injuries. Getting on or off the bicycle caused most fractures (especially a high fraction of the hip and femur fractures) and resulted in 27% of all inpatient days in hospital. Three individuals died. One-third of the injured were treated as inpatients for a total of 1413 days (on average 9 days), with 69% of the days being caused by fractures. The cost for out- and inpatient acute treatment was approximately USD 4700 (SEK 33,000) per injured. The results merit an interest for this target group; bicycle injuries among older adults are costly both for the individual and the medical sector. Injury mitigation strategies focused on the needs of this group are probably as well motivated as those focused on older car drivers.

The use of conspicuity aids by cyclists and risk of crashes involving other road users: a protocol for a population based case-control study

Background

Regular cycling has been shown to improve health and has a role in tackling the threats posed by obesity and inactivity. Cycle collisions, particularly those involving motorised vehicles, can lead to significant mortality and morbidity and are currently a barrier to wider uptake of cycling. There is evidence that the conspicuity of cyclists is a factor in many injury collisions. Low-cost, easy to use retro-reflective and fluorescent clothing and accessories ('conspicuity aids') are available. Their effectiveness in reducing cycling collisions is unknown. The study is designed to investigate the relationship between the use of conspicuity aids and risk of collision or evasion crashes for utility and commuter cyclists in the UK.

Methods/Design

A matched case-control study is proposed. Cases are adult commuter and utility cyclists involved in a crash resulting from a collision or attempted evasion of a collision with another road user recruited at a UK emergency department. Controls are commuter and utility cyclists matched by journey purpose, time and day of travel and geographical area recruited at public and private cycle parking sites. Data on the use of conspicuity aids, crash circumstances, demographics, cycling experience, safety equipment use, journey characteristics and route will be collected using self-completed questionnaires and maps. Conditional logistic regression will be used to calculate adjusted odds ratios and 95% confidence intervals of the risk of a crash when using any item of fluorescent or reflective clothing or equipment.

Discussion

This study will provide information on the effectiveness of conspicuity aids in reducing the risk of injury to cyclists resulting from crashes involving other road users.

[Injury prevention as the physician's challenge]

In Germany, more than 9 million individuals yearly sustain injuries and more than 30,000 fatal injuries. Based on estimations, preventive measures could avoid more than one half of all accidents and could influence the other half of the accidents such that the injuries caused are minor. The aim of an initiative of the Study Group on Injury Prevention of the German Trauma Society (DGU) is a complete inventory of all prevention programs from different expert groups in Germany. A synopsis of the gathered knowledge should serve as a basis for further interdisciplinary preventive measures. The consistent interdisciplinary orientation of this program is a special characteristic including trauma surgery, orthopedics, pediatric surgery, pediatrics, sociology, legal medicine, psychology, sports medicine, geriatrics, anesthesiology, and others. Special attention was also directed to the age groups of children/adolescents and the elderly.