Bicycle accidents

Fatal cycling injuries

Cycling accidents are responsible for significant morbidity and mortality, especially in boys under the age of 16. While most cycling injuries result from simple falls from the bicycle, the majority of fatalities are caused by head injuries resulting from accidents involving motor vehicles. It is estimated that up to 85% of all cycling fatalities caused by head injuries could be prevented by the use of an appropriate cycling helmet. Although the majority of adult cyclists wear helmets the reverse is true for children, who comprise the greatest proportion of all cyclists. Intensive educational programmes increase the number of cycling helmets that are sold, but have a lesser effect on the number used while cycling. Legislation, compassionately enforced on minors, i.e. with an understanding attitude towards their developmental stage, is the only proven technique that substantially improves rates of helmet use by young cyclists. Such legislation reduces their morbidity and mortality from head injuries. This article reviews the epidemiological factors associated with traumatic cycling injuries and the nature of these injuries. Special attention is paid to head injuries and the evidence that these are largely preventable with the use of appropriate 3-layered cycling helmets, the features of which are detailed. Factors promoting or discouraging helmet use by children are reviewed. These include the following factors: age, since helmet use is highest in mature cyclists and lowest in children because of negative peer pressure; parental example, including an attitude of safety consciousness and parental concern; higher levels of education; access to discounted helmets; public campaigns to promote helmet use; and, most importantly, appropriate legislation. But it is clear that appropriate legislation making helmet use compulsory for all cyclists is the only effective method for increasing helmet use, especially by young cyclist. Such legislation would reduce a mortality rate among young cyclists that has been equated to the mortality caused by some childhood infections in the pre-vaccination era. Some argue that physicians have a particular responsibility for promoting effective legislation for mandatory helmet use so that young children can be 'vaccinated' against the risk of the modern childhood epidemic; fatal head injury while cycling.

Bicycle accidents in childhood

The results of a 10 year study of bicycle fatalities and an eight year study of serious non-fatalities are reported for urban Brisbane (population 1,000,000). There were 845 serious non-fatal bicycle accidents and 46 fatalities during the study. Boys were involved in 86% of accidents. Boys have an accident rate of 134.21 per 100,000 population at risk and a fatality rate of 5.06 per 100,000 at risk. Serious bicycle accidents have increased by 50% in this decade; but considering fatal cases alone, no secular trend was evident over the 10 year period of the study. This suggests that an increase in the overall rate of bicycle accidents has been in part compensated by less serious injuries. In 70% of fatalities children had head injuries, and 87% of fatalities followed a collision between a cyclist and a motor vehicle or a train. Bicycle accidents on the roads most commonly occur to boys aged between 12 and 14 years on a straight road at "mid-block" between 3 and 5 pm in clear weather conditions and in daylight. It is concluded that injuries and fatalities after bicycle accidents can be reduced by protecting children's heads, separating child cyclists from other road traffic, or educating and training both cyclists and other road users in safe behaviour. The compulsory use of helmets and the restriction of access to the roads by child cyclists to reduce injuries are, however, still controversial in many areas.