A study of bicycle accidents

Thoracoabdominal Injuries

Trauma to the thorax and abdomen can occur during participation in sports. This chapter reviews some of the more common presentations of such injuries and how such injuries should be best managed. Thoracic injuries reviewed include internal injuries such as pneumothorax, pulmonary contusion, hemothorax, commotio cordis, and cardiac contusion. Chest wall injuries are also reviewed such as rib fractures, costochondritis, and slipping rib syndrome plus sternal and scapular fractures. Abdominal injuries reviewed are focused on internal organ trauma to the spleen and liver, kidney, pancreas, and bowel. There is attention to the effect of Epstein-Barr virus and infectious mononucleosis, seen very frequently in high school and collegiate athletes. Finally, groin pain and athletic pubalgia are described.

In addition to anatomy and clinical presentation, imaging modalities that characterize such trauma are reviewed for each diagnosis. Prevention of thoracoabdominal injuries and return-to-play decisions are described at the chapter conclusion.

Bicycle-Related Injuries: a Local Scene

To determine the profile of bicycle injury and possible risk factors for severe injuries, we studied patients with bicycle-related accidents attending the Accident and Emergency Department of North District Hospital between 1 May 1999 to 31 October 1999. Of the 424 patients, 52 (12.3%) were admitted and one (0.24%) died. Comparing to those not admitted, significantly more of the admitted cases suffered from major injuries, rode on rainy days and involved in collision with motor vehicles. A total of 160 patients (37.8%) had documented head injuries. However the extremely low utilisation rates of helmet at the time of injury implied that action should be taken in this direction to reduce bicycle-related morbidity and mortality.

Characteristics of bicycle crashes in an adolescent population in Flanders (Belgium)

INTRODUCTION

In regions where transportation is mainly motorized, air pollution and traffic congestion are rife. Active transportation such as cycling might be a solution but safety is a major concern. An efficient science based safety policy is needed. The aim of this paper is to analyze in depth the bicycle crash causes and characteristics in an adolescent population (14-18 yr).

METHODS

By using questionnaires for self-reported bicycle crashes, bicycle crash data were collected from insurance companies (January 2014-June 2015) and from schools (November 2013-March 2014). Six bicycle crash causes were predefined and possible differences between schools and insurance companies were analyzed.

RESULTS

Eighty-six school and 78 insurance registered crashes were analyzed. "Distraction of the cyclist" and "third party crossing a bicycle path failing to see the cyclist" are the main causes of bicycle crashes (both 29%). Bad (maintained) infrastructure accounted for 21% of the crash causes. Bicycle crashes reported at insurance companies needed significantly more medical attention and led to high absenteeism (57% at least one day of absenteeism). Only 21% of the bicycle crashes reported at insurance companies were also reported in the official police database.

CONCLUSION

The human factor was the main cause accounting for 79% of the crashes. Bicycle crashes involving a car accounted for 42% and single bicycle crashes accounted for 31% of the total number of crashes. From the bicycle crashes registered at insurance companies 21% was also registered in official police statistics. A combination of information, education and changing the bicycle specific environment might reduce the consequences of human errors more efficiently.

Comparative Analysis of Traumatic Deaths in Nigeria

Introduction:

The number of deaths due to trauma from road traffic accidents (RTAs), and from the use of firearms either for homicide or armed robbery, ethnic conflicts, and other events, such as flooding, explosions from petroleum products, and religious violence, is on the rise in Nigeria. This preliminary study is a comparative analysis of the frequency of deaths caused by RTAs and the deaths caused by the use of firearms during armed robbery. The study sought to identify the number of traumatic deaths caused by RTAs or armed robbery as well as the number of victims who sustained injuries in the process of RTA or armed robberies.

Methods:

An indigenous, non-governmental organization (NGO) network was used to abstract data for the frequency of RTAs associated with death or injuries and for deaths caused by armed robberies and was supplemented with data obtained from the Nigerian police.

Results:

For RTAs, the victims included drivers, passengers, and pedestrians. In 3,032 cases of RTAs, the total number of deaths was 1,239 (29.1%): one Nigerian dies for every three to four crashes. The total number of deaths due to RTAs was significantly higher than was the number of deaths due to the use of firearms in commission of robbery.

Police reports relative to the use of firearms during armed robberies indicate that of a total of the 652 victims who were killed, 348 (68.1%) were the armed robbers, 134 (26.2%) were bystanders, and 29 (5.7%) were policemen.

Conclusions:

The enormity of the problems of traumatic deaths from RTAs and armed robberies in a developing country has been highlighted.

Bicycle-related injuries among young children related to age at debut of cycling

This study focuses on bicycle-related injuries among young children and the effect of being an inexperienced beginner related to age at debut of cycling. The study was based on a random stratified population sample of 1200 children aged 4-15 years in Bergen, Norway. Data about age at debut of cycling, cycling habits and any previous bicycle-related injuries were collected. A child was defined as a beginner within the first 12 months of active cycling. Relation between the first bicycle-related injury and age at debut was analysed by the Kaplan-Meier method. The risk of getting injured during the first 12 months of active cycling were significant lower for children aged 7 or 8 years at the debut of cycling compared to younger children (hazard ratio = 0.78, P < 0.001). Children cycling more than 1h per week were at greater risk of getting injured during the first 12 months than those who cycled less (hazard ratio = 1.95, P = 0.014). This study shows that the risk of getting injured during the first 12 months of active cycling is reduced if bicycling debut is delayed until 7 or 8 years instead of at 4 or 5 years.

Bicycle-related head injury: a study of 86 cases

Within the framework of a bicycle helmet research program, we have set up a database of bicycle accident victims, containing both accident and clinical data. The database consists of a consecutive series of 86 victims of bicycle accidents who underwent a neurosurgical intervention in our hospital between 1990 and 2000. Data were obtained from police files, medical records, computed tomography head scans and a patient questionnaire. In only three victims, the wearing of a helmet was documented. In this study, the head injuries are analysed and the relation between the different types of head injuries and outcome is assessed. Forty-four accidents were collisions with a motor vehicle and 42 accidents were falls. Most impacts occurred at the side (57%) or at the front (27%) of the head. The most frequent injuries were skull fractures (86%) and cerebral contusions (73%). Age was negatively correlated with outcome (P = 0.0002 ) and positively correlated with the number (P = 0.00002) and volume (P = 0.00005) of contusions and the presence of subdural haematomas (P = 0.000001). The injuries with the strongest negative effect on outcome were: subarachnoid haemorrhage (P = 0.000001), multiple (P = 0.000005) or large ( P 0.0007) contusions, subdural haematoma (P = 0.001) and brain swelling (P = 0.002). A significant coexistence of these four injuries was found. We hypothesise that in many patients the contusions may have been the primary injuries of this complex and should therefore be considered as a main injury determining outcome in this study. We believe that such findings may support a rational approach to optimising pedal cyclist head protection.

Injuries in a 1-day recreational cycling tour: Bike New York

STUDY OBJECTIVE

To describe injuries during a 1-day urban cycling tour.

METHODS

During the May 1996 "Bike New York" tour, we monitored EMS calls to identify injuries in a cohort of helmeted cyclists shielded from traffic. We collected demographic information from entry records, injury data from ambulance call reports, and follow-up on transported patients from telephone interviews with emergency physicians. Data were summarized using proportions, relative risks (RRs), 95% confidence intervals (CIs), and chi2 RESULTS: Approximately 28,000 cyclists participated, of which 23,502 (84%) were officially registered. Sixty-eight percent of registered bicyclists were male, and 92% were between 18 and 55 years old. Of the 140 EMS calls made during the tour, 136 (97%) involved participants; this yielded an injury incidence of 5 per 1,000 riders, or 12 to 13 per 100,000 person-miles. Injury was more common among younger cyclists (RR=1.4 for age </=35 years versus age >35 years; 95% CI, 1.0 to 2.0; P <.05), and possibly women (RR=1.3; 95% CI,.9 to 1.8; P =.11). Injuries were mostly minor, but there were 7 concussions and 6 clavicle fractures; none of the 140 injuries was fatal. Thirty-eight calls resulted in ED transport, and 5 of these patients were admitted. Although EMS units were evenly distributed along the route, most EMS calls occurred in only 3 of the 7 zones (P <.001).

CONCLUSION

Injuries during the largest 1-day US cycling tour were uncommon. More data are needed to determine the relative importance of injury risk factors. Data collection during mass events may help guide distribution of EMS personnel.

An epidemiological study of bicycle-related injuries

The objectives of this study were to describe bicycle-related injuries in relation to injury patterns, age, gender and medical treatment in a defined Swedish population and to identify factors contributing to injury. The study group comprised all patients living in the county of Västmanland, Sweden, visiting a physician or dentist because of bicycle-related injury during one year (November 1989-October 1990). Cyclists were mostly injured on pavements, pedestrian malls and cycle tracks. Twenty percent of the events occurred on public roads in urban areas; most frequently, the injured were in the age range 0-24. The most common bicycle injury event involved no other party. The events were often caused by environmental factors, in combination with behaviour such as excessive speed, lack of attention, breach of traffic regulations or a co-ordination problem. Head injuries, including oral injuries, were the most common, in particular among children and adolescents. One in four children in the age range 0-9 sustained an oral injury.

Evaluation of elite British cyclists: the role of the squad medical

OBJECTIVE

To describe and report results from the procedures and protocols used by the British Cycling Federation during the squad medicals of its elite cyclists.

METHODS

Screening of over 500 elite riders has been done by doctors, dentists, physiotherapists, opticians, and dietitians since 1990. A questionnaire provided additional information on musculoskeletal problems.

RESULTS

523 riders have been examined and 92 (17.5%) have been referred for further assessment or treatment. Most of these riders were sent either to their own general practitioner or to the British Olympic Medical Centre. The questionnaire was completed by 81% of riders. Low back pain was the most common problem that riders encountered (60%), and knee pain the second most common (33%). Four riders failed the eye examination, and a further 11 were classed as borderline. Twenty one per cent of riders undergoing dental examination needed further dental treatment.

CONCLUSIONS

The squad medical is an important and useful strategy for evaluating elite British cyclists. It shows that a structured system can help early diagnosis and treatment to provide injury-free cyclists at the start of a competitive season. The results from the questionnaire confirm previously unsubstantiated opinions about the incidence of musculoskeletal injuries in cyclists.

Head injuries in helmeted child bicyclists

OBJECTIVE

To determine the characteristics and the severity of head and facial injuries to helmeted child bicyclists, and whether the helmet contributed to the injury, and to study factors related to bicycle accidents.

DESIGN

Retrospective review of two case series. Children sustaining head injury while not wearing helmets were studied as a form of reference group.

SETTING

Large paediatric teaching hospital.

SUBJECTS

34 helmeted child bicyclists and 155 non-helmeted bicyclists, aged 5-14 years.

MAIN OUTCOME MEASURES

Number of injuries, type of injuries, injury severity score, deaths, and accident circumstances.

RESULTS

79% of the head injuries of the helmeted child group were mild and two thirds of these had facial injuries. Children in the helmet group were in a greater proportion of bike-car collisions than the no helmet group and at least 15% of the helmets were lost on impact. There were no injuries secondary to the helmet.

CONCLUSIONS

Most of the head injuries sustained by the helmeted children were of mild severity and there was no evidence to suggest that the helmet contributed to injury. Nevertheless, consideration should be given to designing a facial protector for the bicycle helmet and to improvement of the fastening device.

Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature

In this study, we review the incidence and aetiology of 3858 metacarpal fractures in a series of 235,427 patients across the life-span. We found men aged 10-29 to have the highest incidence rates for metacarpal fracture (2.5 per cent). Accidental fall was the dominant cause of these fractures in the age group 9 years or less (38.7 per cent) and in the groups 50 years and older. Our data clearly show transport accidents and in particular bicycle accidents to be major determinants in all age groups. We conclude that recognition of the high frequency of metacarpal fractures among men aged 10-29 years should be given and public expenditure should be invested in the development and recommendation of proper safety gear.

Paediatric bicycle injuries

Bicycle injuries are an important cause of trauma. Approximately 75% of such accidents occur in children and involve difficult decisions in the areas of education, engineering and legislation. A prospective 3-year study was undertaken to understand the range of injuries and in particular to concentrate on severe injuries. In all, 251 children were admitted to Westmead Hospital after receiving bicycle injuries. Most injuries were minor but there were 37 serious injuries and six deaths. Head injuries predominated, especially in the seriously injured. The rate of wearing helmets was low, with less than 10% of all admissions wearing a helmet. None of the seriously or fatally injured wore a helmet. Helmet-wearing remains the single most important preventative measure to be instituted if the serious morbidity and mortality rates associated with bicycle injuries are to decrease.

A case-control study of the effectiveness of bicycle safety helmets

Bicycling accidents cause many serious injuries and, in the United States, about 1300 deaths per year, mainly from head injuries. Safety helmets are widely recommended for cyclists, but convincing evidence of their effectiveness is lacking. Over one year we conducted a case-control study in which the case patients were 235 persons with head injuries received while bicycling, who sought emergency care at one of five hospitals. One control group consisted of 433 persons who received emergency care at the same hospitals for bicycling injuries not involving the head. A second control group consisted of 558 members of a large health maintenance organization who had had bicycling accidents during the previous year. Seven percent of the case patients were wearing helmets at the time of their head injuries, as compared with 24 percent of the emergency room controls and 23 percent of the second control group. Of the 99 cyclists with serious brain injury only 4 percent wore helmets. In regression analyses to control for age, sex, income, education, cycling experience, and the severity of the accident, we found that riders with helmets had an 85 percent reduction in their risk of head injury (odds ratio, 0.15; 95 percent confidence interval, 0.07 to 0.29) and an 88 percent reduction in their risk of brain injury (odds ratio, 0.12; 95 percent confidence interval, 0.04 to 0.40). We conclude that bicycle safety helmets are highly effective in preventing head injury. Helmets are particularly important for children, since they suffer the majority of serious head injuries from bicycling accidents.

Nervous system sports-related injuries

With the evolution of sports medicine as a subspecialty comes a redirection of attention to the medical and athletic communities to the prompt recognition and timely treatment of many potentially serious conditions. Nervous system complications of sports injuries have gone largely unaddressed in the literature. It is the goal of this communication to review the wide range of nervous system injuries due to sports activities, discuss the mechanisms of such injuries, and focus attention on their prevention and management. The role of the neurologist and neurosurgeon as a sports medicine team member will be discussed, as will their roles in planning and development of programs and equipment at the secondary school, collegiate, and professional levels.

Incidence, severity, and outcomes of brain injuries involving bicycles

We performed a population-based study of bicycle-related brain injuries in San Diego, California, residents during 1981. Incidence rates among males were three times higher than for females and were highest at ages 10-14 years for males. Only one-third of bicycle-related brain injuries involved collision with a motor vehicle, and this proportion was independent of age or gender. Brain injuries from motor-vehicle collisions were more severe than those resulting from other causes. Over half the brain-injured bicyclists aged 15 and older who were blood alcohol tested were legally intoxicated.

Head injuries in pedal cyclists: how much will protection help?

One hundred consecutive head injuries in cyclists were studied to record the mechanism of accident and the site of impact in order to assess the benefit of a protective helmet. Eleven patients were admitted for injuries sustained, 6 of them with the head as their principal site of injury. Five required only 24 hours' observation, but 1 died after 72 hours from severe primary brain injury. A protective helmet would have covered the sites of impact in five of these six cases and this could have reduced the severity of the injury. A helmet would also reduce the large number of minor injuries seen in the accident department. This small study shows that the wearing of helmets by cyclists would reduce the numbers of head injuries and thus expenditure by the National Health Service. The use of properly designed and tested helmets should be encouraged.

How I Manage Abdominal Injuries

In brief: Abdominal injuries make up only about 10% of sports injuries, but they can sideline athletes for long periods or be life threatening. Any athlete who sustains a severe blow to the abdomen should be judged to have a serious injury until examination proves otherwise. In sports, abdominal injuries occur most often in cycling, horseback riding, and skiing, and they involve children more often than adults. Organs injured most often are the spleen, kidneys, and liver. Two typical case histories are offered, followed by a brief review of abdominal anatomy. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver and related organs.

BMX bicycles: accident comparison with other models

A comparison has been made between BMX bicycle accidents and those occurring when children ride other types of bicycle. The injuries sustained are compared to see if the clinical impressions that BMX are more dangerous, and produce more facial injuries, are correct. This was found not to be true as half the children involved rode BMX bicycles, and the injuries sustained were similar to those occurring to non BMX riders. BMX riders had a lower proportion of serious injuries than riders of racing cycles. There were a large number of head injuries needing admission to hospital, but BMX riders had fewer head injuries than the other groups. The use of protective headgear was minimal. Facial injuries were evenly distributed between BMX and non BMX groups. The major cause of accidents to BMX riders was performing stunts but, overall, poor cycling technique associated with minimal cycling experience were the factors common to 50% of accidents.