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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Innocenti M, Pelotti S, Fais P. Bicycle injuries: A systematic review for forensic evaluation. Forensic Sci Int 2024; 359:112027. [PMID: 38677158 DOI: 10.1016/j.forsciint.2024.112027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
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.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Maria Paola Bonasoni
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy.
| | - Mattia Innocenti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Zibung E, von Oelreich E, Eriksson J, Buchli C, Nordenvall C, Oldner A. Long-term opioid use following bicycle trauma: a register-based cohort study. Eur J Trauma Emerg Surg 2023; 49:531-538. [PMID: 36094567 PMCID: PMC9925469 DOI: 10.1007/s00068-022-02103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Evelyne Zibung
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Erik von Oelreich
- Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden ,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Eriksson
- Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden ,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Oldner
- Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden ,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Loyola M, Nelson JD, Clifton G, Levinson D. The relation of visual perception of speed limits and the implementation of cycle lanes - a cross-country comparison. ACCIDENT; ANALYSIS AND PREVENTION 2022; 174:106722. [PMID: 35679797 DOI: 10.1016/j.aap.2022.106722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Speed plays a key role in road safety research. Recent studies have indicated an association between speed limits and driving behaviour. However, less attention has been paid to the role of context in the perception of speed limits, and the way cycle lanes influence this perception. This study examines how respondents in different countries of residence perceive speed limits, and how cycle lanes influence their perception of speed limits. An online survey provided quantitative data for a cross-country comparison from 1591 respondents in Australia, the Netherlands, and the United Kingdom. The findings show that country of residence influences the way speed limits are perceived, and cycle lanes are interpreted distinctly. In locations where cycle lanes are common, they act as indicators of either lower or higher speed limits, while in countries with less familiarity with cycle lanes respondents associate cycle lanes only with lower speed limits. Suggesting a safer and broader understanding of cycle lanes where they are familiar (the Netherlands) and a narrower understanding where cycle lanes are not common (Australia and the United Kingdom), this study provides evidence for policymakers explaining resistance to implementing cycle lanes and implies that implementing lower speed limits and cycle lanes are a road safety measure. Suggestions are identified for future research.
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Affiliation(s)
- Miguel Loyola
- The University of Sydney, Institute of Transport and Logistics Studies, The University of Sydney, Building H04, NSW 2006, Australia.
| | - John D Nelson
- The University of Sydney, Institute of Transport and Logistics Studies, The University of Sydney, Building H04, NSW 2006, Australia
| | - Geoffrey Clifton
- The University of Sydney, Institute of Transport and Logistics Studies, The University of Sydney, Building H04, NSW 2006, Australia
| | - David Levinson
- The University of Sydney, School of Civil Engineering, The University of Sydney, Building J05, NSW 2006, Australia
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Bicycle-related cervical spine injuries. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100119. [PMID: 35585915 PMCID: PMC9108519 DOI: 10.1016/j.xnsj.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
The incidence of bicycle-related cervical spine injuries (CSI) was 1.7/100,000/year. Bicycling was the second most common cause of CSI, only preceded by falls. Occipital condyle fracture was common in bicyclists. Bicyclists with CSI were associated with more multiple trauma and concomitant head injury than non-bicyclists.
Background Bicyclists are vulnerable road users. The aim of this paper was to describe all bicycle-related traumatic cervical spine injuries (CSIs) in the South-East region of Norway (2015–2019), and to investigate whether certain types of CSIs are typical for bicyclists. Methods Retrospective cohort study of prospectively collected registry data of all CSIs in the South-East region of Norway (3.0 million inhabitants), from 2015 to 2019. Patient characteristics, injury types, and treatment were summarized with descriptive statistics. Bayesian multivariable logistic regression was used to identify potential factors associated with occipital condyle fractures (OC-Fx) or odontoid fractures (OFx). Results During the five-year study period, 2,162 patients with CSIs were registered, and 261 (12%) were bicycle-related. The incidence of bicycle-related CSIs was 1.7/100,000 person-years. The median age of the patients with bicycle-related CSIs was 55 (IQR: 22) years, 83% were male, 71% used a helmet, 16% were influenced by ethanol, 12% had a concomitant cervical spinal cord injury (SCI), and 64% sustained multiple traumas. The three most common bicycle-related CSIs were C6/C7 fracture (Fx) (28%), occipital condyle Fx (OC-Fx) (23%) and C5/C6 Fx (19%). Patients with bicycle-related CSIs compared to patients with non-bicycle related CSIs were younger, more often male, had fewer comorbidities, more likely multiple traumas, more often had OC-Fx, and less often sustained an odontoid fracture (OFx). Multivariable logistic regression of potential risk factors for OC-Fx demonstrated a significantly increased risk of OC-Fx for bicyclists compared to non-bicyclists (OR=2.8).The primary treatment for bicycle-related CSIs was external immobilization in 187/261 (71.6%) cases, open surgical fixation in 44/261 (16.8%), and no treatment in 30/261 (11.5%). Conclusion Bicycle crashes are a frequent cause of CSIs in the Norwegian population and should be of concern to the public society. The three most common bicycle-related CSIs were C6/C7 fracture, occipital condyle fracture and C5/C6 fracture.
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van der Zaag PD, Rozema R, Poos HP, Kleinbergen JY, van Minnen B, Reininga IH. Maxillofacial fractures in electric and conventional bicycle related accidents. J Oral Maxillofac Surg 2022; 80:1361-1370. [DOI: 10.1016/j.joms.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/15/2022]
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Abstract
Pedal cycling is advocated for increasing physical activity and promoting health and wellbeing. However, whilst some countries have achieved zero cyclist deaths on their roads, this is not the case for Great Britain (GB). A retrospective cross-sectional analysis was conducted of STATS19 cyclist crash data, a dataset of all police-reported traffic crashes in GB. Information about crash location, casualty, driver and vehicles involved were included as predictors of casualty severity (fatal or severe vs. slight). Sixteen thousand one hundred seventy pedal cycle crashes were reported during 2018. Severe or fatal cyclist crash injury was associated with increasing age of the cyclist (35-39 years, OR 1.38, 95% CI 1.11 to 1.73; 55-59 years, OR 1.73, 95% CI 1.35 to 2.2; 70 years and over, OR 2.87, 95% CI 2.12 to 3.87), higher road speed limits (50 MPH OR 2.10, 95% CI 1.43 to 3.07; 70 MPH OR 4.12, 95% CI 2.12 to 8.03), the involvement of goods vehicles (OR 2.08, 95% CI 1.30 to 3.33) and the months of May and June (OR 1.34 to 1.36, 95% CI 1.06 to 1.73). Urban planning that includes physical separation of pedal cyclists from other road users, raising awareness around the risks from goods vehicles and reducing road speed should be the urgent focus of interventions to increase the benefits and safety of cycling.
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Molina-Soberanes D, Martínez-Ruiz V, Gordo DÁ, Martín-delosReyes LM, Rivera-Izquierdo M, Lardelli-Claret P. Cycling area can be a confounder and effect modifier of the association between helmet use and cyclists' risk of death after a crash. Sci Rep 2022; 12:3157. [PMID: 35210513 PMCID: PMC8873269 DOI: 10.1038/s41598-022-07135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
The effect of helmet use on reducing the risk of death in cyclists appears to be distorted by some variables (potential confounders, effect modifiers, or both). Our aim was to provide evidence for or against the hypothesis that cycling area may act as a confounder and effect modifier of the association between helmet use and risk of death of cyclists involved in road crashes. Data were analysed for 24,605 cyclists involved in road crashes in Spain. A multiple imputation procedure was used to mitigate the effect of missing values. We used multilevel Poisson regression with province as the group level to estimate the crude association between helmet use and risk of death, and also three adjusted analyses: (1) for cycling area only, (2) for the remaining variables which may act as confounders, and (3) for all variables. Incidence–density ratios (IDR) and their 95% confidence intervals were calculated. Crude IDR was 1.10, but stratifying by cycling area disclosed a protective, differential effect of helmet use: IDR = 0.67 in urban areas, IDR = 0.34 on open roads. Adjusting for all variables except cycling area yielded similar results in both strata, albeit with a smaller difference between them. Adjusting for cycling area only yielded a strong association (IDR = 0.42), which was slightly lower in the adjusted analysis for all variables (IDR = 0.45). Cycling area can act as a confounder and also appears to act as an effect modifier (albeit to a lesser extent) of the risk of cyclists’ death after a crash.
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Affiliation(s)
- Daniel Molina-Soberanes
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Building A, 8th Floor, CP 18016, Granada, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Building A, 8th Floor, CP 18016, Granada, Spain. .,Centre for Biomedical Research in Network of Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Health Research Institute of Granada (Instituto Biosanitario de Granada, ibs.GRANADA), Granada, Spain.
| | - Daniel Águila Gordo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Building A, 8th Floor, CP 18016, Granada, Spain.,Cardiology Service, University General Hospital, Ciudad Real, Spain
| | - Luis Miguel Martín-delosReyes
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Building A, 8th Floor, CP 18016, Granada, Spain
| | - Mario Rivera-Izquierdo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Building A, 8th Floor, CP 18016, Granada, Spain.,Health Research Institute of Granada (Instituto Biosanitario de Granada, ibs.GRANADA), Granada, Spain
| | - Pablo Lardelli-Claret
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Building A, 8th Floor, CP 18016, Granada, Spain.,Centre for Biomedical Research in Network of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Health Research Institute of Granada (Instituto Biosanitario de Granada, ibs.GRANADA), Granada, Spain
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Hasjim BJ, Grigorian A, Schubl SD, Lekawa M, Kim D, Bernal N, Nahmias J. Helmets Protect Pediatric Bicyclists From Head Injury and Do Not Increase Risk of Cervical Spine Injury. Pediatr Emerg Care 2022; 38:e360-e364. [PMID: 33181791 DOI: 10.1097/pec.0000000000002290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Only 21 states have mandatory helmet laws for pediatric bicyclists. This study sought to determine the incidence of helmeted riders among pediatric bicyclists involved in a collision and hypothesized the risk of a serious head and cervical spine injuries to be higher in nonhelmeted bicyclists (NHBs) compared with helmeted bicyclists (HBs). METHODS The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for pediatric (age <16 years) bicyclists involved in a collision. Helmeted bicyclists were compared with NHBs. A serious injury was defined by an abbreviated injury scale grade of greater than 2. RESULTS From 3693 bicyclists, 3039 (82.3%) were NHBs. Compared with HBs, NHBs were more often Black (21.6% vs 3.8%, P < 0.001), Hispanic (17.5% vs 9.3%, P < 0.001), without insurance (4.6% vs 2.4%, P = 0.012), and had a higher rate of a serious head injury (24.6% vs 9.3%, P < 0.001). Both groups had similar rates of complications and mortality (P > 0.05). The associated risk of a serious head (odds ratio = 3.17, P < 0.001) and spine injury (odds ratio = 0.41, P = 0.012) were higher and lower respectively in NHBs. Associated risks for cervical spine fracture or cord injury were similar (P > 0.05). CONCLUSIONS Pediatric bicyclists involved in a collision infrequently wear helmets, and NHBs was associated with higher risks of serious head injury. However, the associated risk of serious spine injury among NHBs was lower. The associated risks for cervical spine fracture or cervical cord injuries were similar. Nonhelmeted bicyclists were more likely to lack insurance and to be Black or Hispanic. Targeted outreach programs may help decrease the risk of injury, especially in at-risk demographics.
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Affiliation(s)
- Bima J Hasjim
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Areg Grigorian
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Sebastian D Schubl
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Michael Lekawa
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Dennis Kim
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, LA County Harbor-UCLA Medical Center, Torrance, CA
| | - Nicole Bernal
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
| | - Jeffry Nahmias
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine
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The Analysis of the Factors Influencing the Severity of Bicyclist Injury in Bicyclist-Vehicle Crashes. SUSTAINABILITY 2021. [DOI: 10.3390/su14010215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Transportation and technological development have for centuries strongly influenced the shaping of urbanized areas. On one hand, it undoubtedly brings many benefits to their residents. However, also has a negative impact on urban areas and their surroundings. Many transportation and technological solutions lead, for example, to increased levels of pollution, noise, excessive energy use, as well as to traffic accidents in cities. So, it is important to safe urban development and sustainability in all city aspects as well as in the area of road transport safety. Due to the long-term policy of sustainable transport development, cycling is promoted, which contributes to the increase in the number of this group of users of the transport network in road traffic for short-distance transport. On the one hand, cycling has a positive effect on bicyclists’ health and environmental conditions, however, a big problem is an increase in the number of serious injuries and fatalities among bicyclists involved in road incidents with motor vehicles. This study aims to identify factors that influence the occurrence and severity of bicyclist injury in bicyclist-vehicle crashes. It has been observed that the factors increasing the risk of serious injuries and deaths of bicyclists are: vehicle driver gender and age, driving under the influence of alcohol, exceeding the speed limit by the vehicle driver, bicyclist age, cycling under the influence of alcohol, speed of the bicyclist before the incident, vehicle type (truck), incident place (road), time of the day, incident type. The obtained results can be used for activities aimed at improving the bicyclists’ safety level in road traffic in the area of analysis.
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Grivna M, AlKatheeri A, AlAhbabi M, AlKaabi S, Alyafei M, Abu-Zidan FM. Risks for bicycle-related injuries in Al Ain city, United Arab Emirates: An observational study. Medicine (Baltimore) 2021; 100:e27639. [PMID: 34871233 PMCID: PMC8568463 DOI: 10.1097/md.0000000000027639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/12/2021] [Indexed: 01/05/2023] Open
Abstract
Traffic-related injuries are a serious health problem. Traffic safety is a priority reflected in the United Nations Sustainable Development Goals. Data on current hazards for bicycle-related injuries from the United Arab Emirates are lacking. The aim of our observational study was to assess the behavior of bicyclists on the roads in Al Ain City, United Arab Emirates and compare our current results with a previous study from 2004.We adapted and tested a structured data collection form. Different sectors of Al Ain were randomly selected to cover the whole city during different times. Bicyclists were observed without direct contact.Out of 1129 bicyclists, 97.6% were males and 13.2% children. 39.4% were cycling on main roads with high-density traffic, 33.1% were cycling against the traffic, 39.3% were cycling at night, and 96.8% of them were not using lights. Only 2.1% of the bicyclists used helmets. A higher proportion of female than male cyclists used helmets (25.9% vs 1.5%; P < .001, Fisher exact test). There was an increase in cycling with the traffic (P < .001) and in use of helmets (P < .025) compared with the previous study.Unsafe practices of bicyclists and low use of helmets despite legislation persist in Al Ain. There is a need to raise bicycle safety awareness and improve enforcement of bicycle helmet legislation. This should be directed toward expatriate workers, children, parents, and maids. Environmental changes, namely building separate bicycle lanes, can increase safety for cycling.
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Affiliation(s)
- Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmed AlKatheeri
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohammed AlAhbabi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Saeed AlKaabi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohammed Alyafei
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Electric Scooter-Related Injuries: A New Epidemic in Orthopedics. J Clin Med 2021; 10:jcm10153283. [PMID: 34362067 PMCID: PMC8348701 DOI: 10.3390/jcm10153283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The use of electric scooters has increased considerably as they are an accessible means of transportation. The number of injuries from falls and collisions has risen significantly. Therefore, the aim of the study was to describe demographics injury patterns of electric scooter accidents produced over one year. Methods: A prospective observational study of electric scooter- related injuries presented in the emergency room from May 2019 until May 2020. The inclusion criteria was based on the direct cause of injury produced while an electric scooter was in use. Demographic data, the use of a helmet or the lack thereof, accident mechanism, injury time, type of injury produced, and the treatment applied were collected. Results: Over the study period, 397 patients were identified with a total of 422 injuries. The mean age was 30.8 years, with 12.6% of patients being minors. The patients mainly presented in evening hours and in summertime at the emergency department. Of the total injuries seen, 46.9% were fractures. Some 25% of the total cases required surgery. Only 19% of the riders wore a helmet at the time of the accident. Most of the fractures were to the upper limbs (62.6%). There was a greater incidence of radius fractures. Conclusion: Injuries incurred while using electric scooters are an emerging phenomenon, despite existing regulations. In this study, most injuries occurred in young men and were due to falls from the vehicle. Nearly half of those injuries were fractures to the upper limbs. Surprisingly, 50% of the fractures required surgery.
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Beppu S, Hitosugi M, Ueda T, Koh M, Nishiyama K. Factors influencing the length of emergency room stay and hospital stay in non-fatal bicycle accidents: A retrospective analysis. Chin J Traumatol 2021; 24:148-152. [PMID: 33781635 PMCID: PMC8173571 DOI: 10.1016/j.cjtee.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Lengthy hospitalization places a burden on patients and healthcare resources. However, the factors affecting the length of hospital stay (LHoS) and length of emergency room stay (LERS) in non-fatal bicycle accidents are currently unclear. We investigated these factors to inform efforts to minimize hospitalization. METHODS We performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016. We measured LHoS, LERS, mechanism of injury, head injury prevalence, polytrauma, operations performed, injury severity score (ISS), abbreviated injury scale (AIS) score, maximum AIS score, and trauma and injury severity score probability of survival. We conducted multiple regression analysis to determine predictors of LHoS and LERS. RESULTS Within the study period, 82 victims met the inclusion and exclusion criteria and were included. Mean age was (46.0 ± 24.7) years. Overall mean LHoS was (16.8 ± 25.2) days, mean LERS was (10.6 ± 14.7) days, median ISS was 9 (interquartile range (IQR): 3-16), median maximum AIS was 3 (IQR: 1-4), and median trauma and injury severity score probability of survival was 98.0% (IQR: 95.5%-99.6%). Age, maximum AIS, ISS, and prevalence of surgery were significantly greater in long LHoS and LERS group compared with short LHoS and LERS group (p < 0.05). Performance of surgery independently explained LHoS (p = 0.0003) and ISS independently explained LERS (p = 0.0009). CONCLUSION Surgery was associated with long hospital stays and ISS was associated with long emergency room stays. To improve the quality life of the bicyclists, preventive measures for reducing injury severity or avoiding injuries needing operation are required.
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Affiliation(s)
- Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan; Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan.
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Tadahiro Ueda
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan
| | - Mirae Koh
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan
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Feler J, Maung AA, O'Connor R, Davis KA, Gerrard J. Sex-based differences in helmet performance in bicycle trauma. J Epidemiol Community Health 2021; 75:994-1000. [PMID: 33827896 DOI: 10.1136/jech-2020-215544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the existence of sex-based differences in the protective effects of helmets against common injuries in bicycle trauma. METHODS In a retrospective cohort study, we identified patients 18 years or older in the 2017 National Trauma Database presenting after bicycle crash. Sex-disaggregated and sex-combined multivariable logistic regression models were calculated for short-term outcomes that included age, involvement with motor vehicle collision, anticoagulant use, bleeding disorder and helmet use. The sex-combined model included an interaction term for sex and helmet use. The resulting exponentiated model parameter yields an adjusted OR ratio of the effects of helmet use for females compared with males. RESULTS In total, 18 604 patients of average age 48.1 were identified, and 18% were female. Helmet use was greater in females than males (48.0% vs 34.2%, p<0.001). Compared with helmeted males, helmeted females had greater rates of serious head injury (37.7% vs 29.9%, p<0.001) despite less injury overall. In sex-disaggregated models, helmet use reduced odds of intracranial haemorrhage and death in males (p<0.001) but not females. In sex-combined models, helmets conferred to females significantly less odds reduction for severe head injury (p=0.002), intracranial bleeding (p<0.001), skull fractures (p=0.001), cranial surgery (p=0.006) and death (p=0.017). There was no difference for cervical spine fracture. CONCLUSIONS Bicycle helmets may offer less protection to females compared with males. The cause of this sex or gender-based difference is uncertain, but there may be intrinsic incompatibility between available helmets and female anatomy and/or sex disparity in helmet testing standards.
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Affiliation(s)
- Joshua Feler
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adrian A Maung
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rick O'Connor
- Yale New Haven Health System, New Haven, Connecticut, USA
| | - Kimberly A Davis
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason Gerrard
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
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Cicchino JB, Kulie PE, McCarthy ML. Severity of e-scooter rider injuries associated with trip characteristics. JOURNAL OF SAFETY RESEARCH 2021; 76:256-261. [PMID: 33653557 DOI: 10.1016/j.jsr.2020.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/23/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION E-scooter rider injuries have been growing, but little is known about how trip and incident characteristics contribute to their severity. METHOD We enrolled 105 adults injured while riding e-scooters who presented to an emergency department in Washington, DC, during 2019. Enrolled participants completed an interview during the emergency department visit, and their charts were abstracted to document their injuries and treatment. Logistic regression examined the association of incident location and circumstances with the likelihood of sustaining an injury on the Abbreviated Injury Scale (AIS) ≥ 2, while controlling for rider characteristics. RESULTS The most common locations of e-scooter injuries in our study sample occurred on the sidewalk (58%) or road (23%). Accounting for other trip and rider attributes, e-scooter riders injured on the road were about twice as likely as those injured elsewhere to sustain AIS ≥ 2 injuries (RR, 1.96; 95% CI, 1.23-2.36) and those who rode at least weekly more often sustained AIS ≥ 2 injuries compared with less frequent riders (RR, 1.86; 95% CI, 1.11-2.32). CONCLUSIONS Greater injury severity for riders injured on the road may reflect higher travel speeds. Practical applications: Injury severity associated with riding in the road is one factor that jurisdictions can consider when setting policy on where e-scooters should be encouraged to ride, but the risk of any crash or fall associated with facilities should also be examined. Although injuries are of lower severity on sidewalks, sharing sidewalks with slower moving pedestrians could potentially lead to more conflicts.
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Affiliation(s)
| | - Paige E Kulie
- Department of Emergency Medicine, George Washington University Medical Center, Washington, DC, United States
| | - Melissa L McCarthy
- George Washington University Milken Institute School of Public Health, Washington, DC, United States
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Næss I, Galteland P, Skaga NO, Eken T, Helseth E, Ramm-Pettersen J. The number of patients hospitalized with bicycle injuries is increasing - A cry for better road safety. ACCIDENT; ANALYSIS AND PREVENTION 2020; 148:105836. [PMID: 33171415 DOI: 10.1016/j.aap.2020.105836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 05/27/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Norwegian authorities encourage people to commute by bicycle to improve public health, decrease rush-hour traffic jams and reduce pollution. However, increasing the number of bicyclists, especially in the rush-hour traffic, may increase the number of serious bicycle injuries. OBJECTIVE To explore trends in hospitalized bicycle injuries at a Norwegian level I trauma centre during the last decade. METHODS Data was extracted from the prospectively registered institutional trauma registry. We identified patients admitted after bicycle injuries between 2005 and 2016. RESULTS A total of 1543 patients were identified. Median age was 40 years (range 3-91) and 73 % were males. The majority of weekday injuries occurred in the morning and during the afternoon rush-hour, peaking at 8 am. and 4 pm. The annual number of admitted bicycle injuries increased from 79 to 184 during the study period. Also, an increase in the share of bicyclists using helmets was observed. The median Injury Severity Score (ISS) of 10 remained unchanged. 63 % had serious trauma (ISS ≥ 9), while 34 % suffered severe trauma (ISS ≥ 16). The absolute number of both serious and severe trauma increased annually. 36 % had head and neck injuries, while 16 % had chest injuries graded with Abbreviated Injury Scale ≥3. Loss of consciousness with Glasgow Coma Scale score <9 was seen in 7%. Median length of hospitalization was 3 days, and 39 % had surgery in one or more body regions. The 30-day mortality was 2.3 %. CONCLUSIONS The number of admitted bicycle injuries to our trauma centre is increasing. Rush-hour injuries dominate during weekdays. Bicycle injuries can be devastating and deserve more public attention to promote road safety.
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Affiliation(s)
- Ingar Næss
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway.
| | - Nils Oddvar Skaga
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
| | - Torsten Eken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - Jon Ramm-Pettersen
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway.
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Tsutsumi Y, Ito D, Nakamura M, Koshinuma S, Yamamoto G, Hitosugi M. Maxillofacial Injuries in Cyclists: A Biomechanical Approach for the Analysis of Mechanisms of Mandible Fractures. J Oral Maxillofac Surg 2020; 79:871-879. [PMID: 33306963 DOI: 10.1016/j.joms.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The investigators characterized the occurrence of maxillofacial injuries in cyclists and biomechanically analyzed the mechanisms of mandible fractures. METHODS We retrospectively analyzed injury data and performed biomechanical analyses with finite element models. Hospital records from 2011 through 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries while riding a bicycle. Patients with maxillofacial fractures were compared to those without. Logistic regression analysis was performed to identify which variables were independently associated with the occurrence of maxillofacial fractures. To reconstruct the injury scenario (one in which a person falls from a bicycle and contacts the road surface with their face), computer simulations using The Total Human Model for Safety model were performed. RESULTS The hospital records of 94 patients (62 men, 32 women; 26.1 ± 17.3 years of age) who sustained oral and maxillofacial injuries while riding a bicycle were reviewed. Twenty patients (21.3%) sustained maxillofacial fractures; mandible fractures were most common (16 patients). Patients with maxillofacial fractures were significantly older and had higher severity injuries; however, logistic regression analysis showed that only age was an independent predictor of the occurrence of maxillofacial fracture (odds ratio, 1.03; P = .025). In simulations, higher von Mises stresses were found in the mandible when the cyclist fell with the neck extended and the body horizontal, and consequently, the center of mandibular body strikes the road surface. Contact forces were approximately 8 kN. High tensile stresses occurred laterally and high compressive stresses occurred medially in the mandibular ramus, which indicated that the mandibular ramus deformed in the transverse plane. CONCLUSION Biomechanical analyses show that mandible fractures can occur when a cyclist falls from a bicycle and their lower face strikes the road's surface.
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Affiliation(s)
- Yasuhiko Tsutsumi
- Clinical Instructor, Department of Oral Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Daisuke Ito
- Associate Professor, Faculty of Societal Safety Sciences, Kansai University, Osaka, Japan
| | - Mami Nakamura
- Associate Professor, Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Shinya Koshinuma
- Associate Professor, Department of Oral Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Gaku Yamamoto
- Professor and Chair, Department of Oral Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Hitosugi
- Professor and Chair, Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan.
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Strotmeyer SJ, Behr C, Fabio A, Gaines BA. Bike helmets prevent pediatric head injury in serious bicycle crashes with motor vehicles. Inj Epidemiol 2020; 7:24. [PMID: 32532330 PMCID: PMC7291179 DOI: 10.1186/s40621-020-00249-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Approximately 75% of all bicycle-related mortality is secondary to head injuries, 85% of which could have been prevented by wearing a bicycle helmet. Younger children appear to be at greater risk than adults, yet helmet use is low despite this risk and legislation and ordinances requiring helmet use among younger riders. We sought to determine whether bicycle helmets are associated with the incidence and severity of head injury among pediatric bicyclists involved in a bicycle crash involving a motor vehicle. METHODS We performed a retrospective review of patients age ≤ 18 years hospitalized at a level I pediatric trauma center between January 1, 2008, and December 31, 2018. Data were abstracted from the institutional trauma registry and electronic medical record. International Classification of Diseases 9th and 10th editions and external causes of injury codes were used to identify MV related bicycle crashes and determine the abbreviated injury severity (AIS) for head injury severity. Injury narratives were reviewed to determine helmet use. We calculated the incidence of head injury from bicycle vs. MV crashes utilizing descriptive statistics. We analyzed the risk and severity of injury utilizing univariate and multivariate logistic regression. RESULTS Overall, 226 bicyclists were treated for injuries from being struck by a MV. The median age was 11 (interquartile range (IQR): 8 to 13) years. Helmeted bicyclists (n = 26, 27%) were younger (9.4 years versus 10.8 years, p = 0.04), and were less likely (OR 0.21, 95% CI 0.09 to 0.49) to be diagnosed with a head injury compared to unhelmeted bicyclists (n = 199). Of those with a head injury, helmeted bicyclists were less likely (OR 0.57, 95% CI 0.11-2.82) to sustain severe or higher injury using AIS. When adjusting for demographics (age, sex, race) and injury severity, helmet use predicted a reduction in head injury (OR 6.02, 95% CI 2.4-15.2). CONCLUSIONS Bicycle helmet use was associated with reduced odds of head injury and severity of injury.. These results support the use of strategies to increase the uptake of bicycle helmets wearing as part of a comprehensive youth bicycling injury prevention program.
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Affiliation(s)
- Stephen J. Strotmeyer
- Department of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224 USA
| | - Christopher Behr
- Department of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224 USA
| | - Anthony Fabio
- University of Pittsburgh School of Public Health, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15213 USA
| | - Barbara A. Gaines
- Department of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224 USA
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Cheong HS, Tham KY, Chiu LQ. Injury patterns in elderly cyclists and motorcyclists presenting to a tertiary trauma centre in Singapore. Singapore Med J 2020; 62:482-485. [PMID: 32211913 DOI: 10.11622/smedj.2020038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION With Singapore's ageing population, there are increasing numbers of elderly cyclists and motorcyclists. Compared to younger riders, this cohort sustains more injuries and has poorer outcomes. This study aimed to describe and compare patient demographics, injury patterns and outcomes among elderly cyclists and motorcyclists at a Level 1 trauma centre. METHODS Data of all cyclists, motorcyclists and pillion riders aged 65 years and above who presented to the emergency department after accidents from 1 January 2013 to 31 December 2017 was extracted from the hospital's trauma registry and reviewed. RESULTS Cyclists and motorcyclists formed 42.0% and 58.0%, respectively, of 157 recruited patients. At the time of the accident, 40.8% of the patients were employed. The mean age of the patients was 71.6 ± 5.8 years. Extremities and pelvic girdle injuries (61.1%) were the most frequent, followed by chest injuries (48.4%), and head and neck injuries (40.1%). Among severe injuries (defined as Abbreviated Injury Scale score ≥ 3), chest injuries (39.5%) were the most common, followed by head and neck injuries (36.3%). The overall mortality rate was 9.6%, with cyclists at nearly three times the risk compared to motorcyclists. More cyclists than motorcyclists (18.2% vs. 11.0%) required intensive care. There were no significant differences in the length of hospital stay between cyclists and motorcyclists. CONCLUSION Elderly riders have unique injury patterns and consume significant healthcare resources. Trauma systems need to acknowledge this changing injury epidemiology and equip trauma centres with the necessary resources targeted at elderly patients. Future work should focus on strategies to minimise extremity and chest injuries.
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Affiliation(s)
- Hui Shyuan Cheong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kum Ying Tham
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
| | - Li Qi Chiu
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
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Stier R, Jehn P, Johannsen H, Müller C, Gellrich NC, Spalthoff S. Reality or wishful thinking: do bicycle helmets prevent facial injuries? Int J Oral Maxillofac Surg 2019; 48:1235-1240. [DOI: 10.1016/j.ijom.2019.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
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Molina-Soberanes D, Martínez-Ruiz V, Lardelli-Claret P, Pulido-Manzanero J, Martín-delosReyes LM, Moreno-Roldán E, Jiménez-Mejías E. Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study. BMJ Open 2019; 9:e028039. [PMID: 31444182 PMCID: PMC6707684 DOI: 10.1136/bmjopen-2018-028039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash. DESIGN Cohort study. SETTING Spain. PARTICIPANTS 65 977 cyclists injured in road crashes recorded between 1993 and 2013 in the Spanish Register of Road Crashes with Victims. MAIN OUTCOME Death within the first 24 hours after the crash. METHODS A multiple imputation procedure was used to mitigate the effect of missing values. Differences between regions were assumed and managed with multilevel analysis at the cyclist and province levels. Incidence density ratios (IDR) with 95% CI were calculated with a multivariate Poisson model. RESULTS Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists ('over 74' category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling.There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41). CONCLUSIONS We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.
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Affiliation(s)
- Daniel Molina-Soberanes
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Pablo Lardelli-Claret
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - José Pulido-Manzanero
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- Department of Public Health & Maternal and Child Health, Complutense University of Madrid, Madrid, Spain
| | - Luis Miguel Martín-delosReyes
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Elena Moreno-Roldán
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
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Kim T, Jung KY, Kim K, Yoon H, Hwang SY, Shin TG, Sim MS, Jo IJ, Cha WC. Protective effects of helmets on bicycle-related injuries in elderly individuals. Inj Prev 2018; 25:407-413. [PMID: 30291153 DOI: 10.1136/injuryprev-2018-042942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/25/2018] [Accepted: 09/01/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The increasing frequency of bicycle-related injuries is due to the growing elderly population and their increasing physical activity. This study aimed to compare the protective effects of helmets on bicycle-related injuries in elderly individuals compared with those in younger adults. METHODS Data from the Korean emergency department-based Injury In-depth Surveillance database from eight emergency departments during 2011-2016 were retrospectively analysed. The subjects sustained injuries while riding bicycles. Cases with unknown clinical outcomes were excluded. Covariates included mechanism, place and time of injury. The primary outcome was traumatic brain injury (TBI) incidence, and the secondary outcomes were in-hospital mortality and severe trauma. The effects of helmets on these outcomes were analysed and differences in effects were determined using logistic regression analysis. Subsequently, the differences in the effects of helmets use between age groups were examined by using interaction analysis RESULTS: Of 7181 adults, 1253 were aged >65 years. The injury incidents showed a bimodal pattern with peaks around ages 20 and 50 years. Meanwhile, the helmet-wearing rate showed a unimodal pattern with its peak at age 35-40 years; it decreased consistently with age. By multivariate analysis, helmet-wearing was associated with a reduced TBI incidence (OR 0.76; 95% CI 0.57 to 0.99) and severe trauma (OR 0.78; 95% CI 0.65 to 0.93). The effects of helmets increased in elderly individuals (TBI (p=0.022) and severe trauma (p=0.024)). CONCLUSION The protective effects of helmets on bicycle-related injuries are greater for elderly individuals, thus reducing TBI incidence.
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Affiliation(s)
- Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Yul Jung
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Høye A. Bicycle helmets - To wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries. ACCIDENT; ANALYSIS AND PREVENTION 2018; 117:85-97. [PMID: 29677686 DOI: 10.1016/j.aap.2018.03.026] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/08/2018] [Accepted: 03/25/2018] [Indexed: 05/23/2023]
Abstract
A meta-analysis has been conducted of the effects of bicycle helmets on serious head injury and other injuries among crash involved cyclists. 179 effect estimates from 55 studies from 1989-2017 are included in the meta-analysis. The use of bicycle helmets was found to reduce head injury by 48%, serious head injury by 60%, traumatic brain injury by 53%, face injury by 23%, and the total number of killed or seriously injured cyclists by 34%. Bicycle helmets were not found to have any statistically significant effect on cervical spine injury. There is no indication that the results from bicycle helmet studies are affected by a lack of control for confounding variables, time trend bias or publication bias. The results do not indicate that bicycle helmet effects are different between adult cyclists and children. Bicycle helmet effects may be somewhat larger when bicycle helmet wearing is mandatory than otherwise; however, helmet wearing rates were not found to be related to bicycle helmet effectiveness. It is also likely that bicycle helmets have larger effects among drunk cyclists than among sober cyclists, and larger effects in single bicycle crashes than in collisions with motor vehicles. In summary, the results suggest that wearing a helmet while cycling is highly recommendable, especially in situations with an increased risk of single bicycle crashes, such as on slippery or icy roads.
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Affiliation(s)
- Alena Høye
- Institute of Transport Economics, Gaustadalleen 21, 0349, Oslo, Norway.
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Yu HY, Dennison C. A laboratory study on effects of cycling helmet fit on biomechanical measures associated with head and neck injury and dynamic helmet retention. J Biomech Eng 2018; 141:2694851. [PMID: 30098148 DOI: 10.1115/1.4040944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Indexed: 11/08/2022]
Abstract
There is a scant biomechanical literature that tests, in a laboratory setting, whether or not determinants of helmet fit affect biomechanical parameters associated with injury. Using conventional cycling helmets and repeatable models of the human head and neck, integrated into a guided drop impact experiment at speeds up to 6m/s, this study tests the hypothesis that fit affects head kinematics, neck kinetics, and the extent to which the helmet moves relative to the underlying head (an indicator of helmet positional stability). While there were a small subset of cases where head kinematics were statistically significantly altered by fit, when viewed as a whole our measures of head kinematics suggest that fit does not systematically alter kinematics of the head secondary to impact. Similarly, when viewed as a whole our data suggests that fit does not systematically alter resultant neck compression and resultant moment and associated biomechanical measures. Our data suggests that backward fit helmets exhibit the worst dynamic stability, in particular when the torso is impacted before the helmeted head is impacted, suggesting that the typical certification method of dynamical loading of a helmet to quantify retention may not be representative of highly plausible cycling incident scenarios where impact forces are first applied to the torso leading to loading of the neck prior to the head. Further study is warranted so that factors of fit that affect injury outcome are uncovered in both laboratory and real world settings.
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Affiliation(s)
- Henry Y Yu
- Biomedical Instrumentation Lab, Department of Mechanical Engineering, University of Alberta, Edmonton AB Canada T6G 1H9
| | - Christopher Dennison
- Biomedical Instrumentation Lab, Department of Mechanical Engineering, University of Alberta, Edmonton AB Canada T6G 1H9
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Eley R, Vallmuur K, Catchpoole J. Value of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries. Emerg Med Australas 2018; 31:234-240. [PMID: 30008185 DOI: 10.1111/1742-6723.13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 05/08/2018] [Accepted: 05/30/2018] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Rob Eley
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kirsten Vallmuur
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Jesani Catchpoole
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Asgarzadeh M, Fischer D, Verma SK, Courtney TK, Christiani DC. The impact of weather, road surface, time-of-day, and light conditions on severity of bicycle-motor vehicle crash injuries. Am J Ind Med 2018; 61:556-565. [PMID: 29635849 DOI: 10.1002/ajim.22849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study examined whether environmental variables including weather, road surface, time-of-day, and light conditions were associated with the severity of injuries resulting from bicycle-motor vehicle crashes. METHODS Using log-binomial regressions, we analyzed 113 470 police reports collected between 2000 and 2014 in four U.S. states with environmental and injury severity information. "Severe" injuries included fatal and incapacitating injuries, and "non-severe" included non-incapacitating, possible or no-injuries. RESULTS Light condition was significantly associated with the injury severity to the bicyclist with more severe injuries at dawn (RR = 1.62 [95%CI 1.35-1.94]) and during darkness (both lighted and unlighted roads: 1.32 [1.24-1.40], respectively, 1.57 [1.41-1.76]) as compared to daylight. In these conditions of low visibility, risk was further increased during early morning hours before 7 am (1.61 [1.22-2.13]). CONCLUSIONS Crashes in low light conditions and during early morning hours are more likely to result in higher injury severity.
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Affiliation(s)
- Morteza Asgarzadeh
- Harvard T.H. Chan School of Public Health; Department of Environmental Health; Boston Massachusetts
- Liberty Mutual Research Institute of Safety; Center for Injury Epidemiology; Hopkinton Massachusetts
| | - Dorothee Fischer
- Harvard T.H. Chan School of Public Health; Department of Environmental Health; Boston Massachusetts
- Liberty Mutual Research Institute of Safety; Center for Injury Epidemiology; Hopkinton Massachusetts
| | - Santosh K. Verma
- Liberty Mutual Research Institute of Safety; Center for Injury Epidemiology; Hopkinton Massachusetts
| | - Theodore K. Courtney
- Liberty Mutual Research Institute of Safety; Center for Injury Epidemiology; Hopkinton Massachusetts
| | - David C. Christiani
- Harvard T.H. Chan School of Public Health; Department of Environmental Health; Boston Massachusetts
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Abstract
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.
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Affiliation(s)
- Noora K Airaksinen
- Faculty of Heath Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland.
| | - Ilona S Nurmi-Lüthje
- Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014 Helsinki, Finland
| | - J Matti Kataja
- National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland
| | - Heikki P J Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS, Kuopio, Finland
| | - Peter M J Lüthje
- Department of Orthopaedics and Traumatology, North Kymi Hospital, FI-45750 Kouvola, Finland
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Sousa CAMD, Bahia CA, Constantino P. Analysis of factors associated with traffic accidents of cyclists attended in Brazilian state capitals. CIENCIA & SAUDE COLETIVA 2018; 21:3683-3690. [PMID: 27925109 DOI: 10.1590/1413-812320152112.24152016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/07/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Brazil has the sixth largest bicycles fleet in the world and bicycle is the most used individual transport vehicle in the country. Few studies address the issue of cyclists' accidents and factors that contribute to or prevent this event. Methodology: VIVA is a cross-sectional survey and is part of the Violence and Accidents Surveillance System, Brazilian Ministry of Health. We used complex sampling and subsequent data review through multivariate logistic regression and calculation of the respective odds ratios. Results: Odds ratios showed greater likelihood of cyclists' accidents in males, people with less schooling and living in urban and periurban areas. People who were not using the bike to go to work were more likely to suffer an accident. Discussion: The profile found in this study corroborates findings of other studies. They claim that the coexistence of cyclists and other means of transportation in the same urban space increases the likelihood of accidents. Conclusion: The construction of bicycle-exclusive spaces and educational campaigns are required.
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Affiliation(s)
- Carlos Augusto Moreira de Sousa
- Departamento de Ensino sobre Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | - Camila Alves Bahia
- Coordenação de Vigilância Epidemiológica, Secretaria Municipal de Saúde do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Patrícia Constantino
- Departamento de Ensino sobre Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública, Fiocruz. Av. Brasil 4036/700, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
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Ikpeze TC, Glaun G, McCalla D, Elfar JC. Geriatric Cyclists: Assessing Risks, Safety, and Benefits. Geriatr Orthop Surg Rehabil 2018; 9:2151458517748742. [PMID: 29383267 PMCID: PMC5784561 DOI: 10.1177/2151458517748742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/31/2017] [Accepted: 11/19/2017] [Indexed: 12/15/2022] Open
Abstract
Nearly 1 in every 3 Americans ride bicycles each year, but only 20% of the reported 100 million cyclists ride on a weekly basis. Bicycling is a common form of transportation and recreation and has gained popularity among the elderly patients. In recent years, the number of elderly cyclists has increased steadily and studies have cited ease of use, need for exercise, and enjoyment as important contributing factors. The benefits of physical activity on health is well-documented, and elderly individuals are encouraged to remain active to reduce the progression of age-related weakness and loss of muscle mass. Safety concerns, however, have been a prevalent public health issue. According to the Center for Disease Control and Prevention, elderly and teenage cyclists account for the highest number of head injuries and fatalities among all cyclists. Safety measures that include wearing protective gear such as helmets and choosing the appropriate bicycle have been recommended to minimize the risk of sustaining injuries while riding. Despite these concerns, bicycling has remained a popular and exciting activity for the elderly patients.
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Affiliation(s)
- Tochukwu C Ikpeze
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Daren McCalla
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - John C Elfar
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Park JC, Chang IB, Ahn JH, Kim JH, Oh JK, Song JH. Epidemiology and Risk Factors for Bicycle-Related Severe Head Injury: A Single Center Experience. Korean J Neurotrauma 2017; 13:90-95. [PMID: 29201840 PMCID: PMC5702764 DOI: 10.13004/kjnt.2017.13.2.90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Head injury is the main cause of death and severe disability in bicycle-related injuries. The purpose of this study was to compare the demographic characteristics and injury mechanisms of bicycle-related head injuries according to the severity and outcome and determine the main risk factors and common types of accompanying injuries. METHODS A total of 205 patients who were admitted to the neurosurgery department of our hospital for bicycle-related head injuries between 2007 and 2016 were analyzed. We categorized the patients into two groups according to severity and outcome of head injury, and then identified the differences in age, sex, and cause of injury between the two groups. RESULTS Collisions with a motor vehicle increased the risk of severe head injury (p=0.011), resulted in poor outcomes (Glasgow Outcome Scale [GOS] ≤3; p=0.022), and caused more accompanying chest/abdominal (p<0.001) and pelvic/lower extremity injuries (p=0.001) than other mechanisms. Older age and high grade of head injury severity resulted in poor outcomes (p=0.028 and p<0.001, respectively), and caused more accompanying chest/abdominal injuries (p<0.032 and p<0.001, respectively) compared with younger age and low grade of head injury severity. CONCLUSION In bicycle-related head injuries, collision with motor vehicle is one of the most important risk factor for high grade of head injury severity and outcome. In addition, bicycle-related head injuries are often accompanied by injuries of other parts of the body.
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Affiliation(s)
- Jun Chul Park
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Yu HY, Knowles BM, Dennison CR. A Test Bed to Examine Helmet Fit and Retention and Biomechanical Measures of Head and Neck Injury in Simulated Impact. J Vis Exp 2017. [PMID: 28994780 DOI: 10.3791/56288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Conventional wisdom and the language in international helmet testing and certification standards suggest that appropriate helmet fit and retention during an impact are important factors in protecting the helmet wearer from impact-induced injury. This manuscript aims to investigate impact-induced injury mechanisms in different helmet fit scenarios through analysis of simulated helmeted impacts with an anthropometric test device (ATD), an array of headform acceleration transducers and neck force/moment transducers, a dual high speed camera system, and helmet-fit force sensors developed in our research group based on Bragg gratings in optical fiber. To simulate impacts, an instrumented headform and flexible neck fall along a linear guide rail onto an anvil. The test bed allows simulation of head impact at speeds up to 8.3 m/s, onto impact surfaces that are both flat and angled. The headform is fit with a crash helmet and several fit scenarios can be simulated by making context specific adjustments to the helmet position index and/or helmet size. To quantify helmet retention, the movement of the helmet on the head is quantified using post-hoc image analysis. To quantify head and neck injury potential, biomechanical measures based on headform acceleration and neck force/moment are measured. These biomechanical measures, through comparison with established human tolerance curves, can estimate the risk of severe life threatening and/or mild diffuse brain injury and osteoligamentous neck injury. To our knowledge, the presented test-bed is the first developed specifically to assess biomechanical effects on head and neck injury relative to helmet fit and retention.
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Affiliation(s)
- Henry Y Yu
- Department of Mechanical Engineering, University of Alberta
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Uhrenholt L, Boel LWT, Thomsen AH. Fatal Cervical Spine Injury Following a Bicycle Crash. SCANDINAVIAN JOURNAL OF FORENSIC SCIENCE 2017. [DOI: 10.1515/sjfs-2017-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Spinal injury following direct loading of the head and neck is a rare sequel of bicycle crashes. Fatal head injuries following bicycle crashes have been described in great detail and safety measures such as bicycle helmets have been developed accordingly. Less frequently, however, potentially severe cervical spine injuries have been described. We present the case of a middle-aged female who sustained an ultimately fatal cervical spine injury following a collision with a car whilst biking wearing a helmet. We discuss the literature regarding the protective effects of bicycle helmets, the relevance to cervical spine injury and legislation on mandatory use of helmets for injury prevention.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine , Aarhus University , 8200 Aarhus , Denmark
- Paraclinical Imaging Studies Group (PIMAS) , Aarhus University , 8200 Aarhus , Denmark
| | - Lene Warner Thorup Boel
- Department of Forensic Medicine , Aarhus University , 8200 Aarhus , Denmark
- Paraclinical Imaging Studies Group (PIMAS) , Aarhus University , 8200 Aarhus , Denmark
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Gaither TW, Sanford TA, Awad MA, Osterberg EC, Murphy GP, Lawrence BA, Miller TR, Breyer BN. Estimated total costs from non-fatal and fatal bicycle crashes in the USA: 1997–2013. Inj Prev 2017; 24:135-141. [DOI: 10.1136/injuryprev-2016-042281] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/27/2017] [Accepted: 03/29/2017] [Indexed: 11/03/2022]
Abstract
IntroductionEmergency department visits and hospital admissions resulting from adult bicycle trauma have increased dramatically. Annual medical costs and work losses of these incidents last were estimated for 2005 and quality-of-life losses for 2000.MethodsWe estimated costs associated with adult bicycle injuries in the USA using 1997–2013 non-fatal incidence data from the National Electronic Injury Surveillance System with cost estimates from the Consumer Product Safety Commission's Injury Cost Model, and 1999–2013 fatal incidence data from the National Vital Statistics System costed by similar methods.ResultsApproximately 3.8 million non-fatal adult bicycle injuries were reported during the study period and 9839 deaths. In 2010 dollars, estimated adult bicycle injury costs totalled $24.4 billion in 2013. Estimated injury costs per mile bicycled fell from $2.85 in 2001 to $2.35 in 2009. From 1999 to 2013, total estimated costs were $209 billion due to non-fatal bicycle injuries and $28 billion due to fatal injuries. Inflation-free annual costs in the study period increased by 137% for non-fatal injuries and 23% for fatal injuries. The share of non-fatal costs associated with injuries to riders age 45 and older increased by 1.6% (95% CI 1.4% to 1.9%) annually. The proportion of costs due to incidents that occurred on a street or highway steadily increased by 0.8% (95% CI 0.4% to 1.3%) annually.ConclusionsInflation-free costs per case associated with non-fatal bicycle injuries are increasing. The growth in costs is especially associated with rising ridership, riders 45 and older, and street/highway crashes.
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Lin ZB, Ji YH, Xiao QY, Luo LB, Li LP, Choi B. Risk factors of bicycle traffic injury among middle school students in chaoshan rural areas of china. Int J Equity Health 2017; 16:28. [PMID: 28122573 PMCID: PMC5267448 DOI: 10.1186/s12939-016-0512-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/28/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bicycle injuries are a leading cause of accidental death among children in the world, and bicycle-related injuries are also very common in China, thus to find out bicycle injury risk factors is imperative. This study aims to identify the cyclist-, bicycle- and road-related risk factors of bicycle injury, to develop health education programs as an intervention and to provide a scientific basis for establishing policies against bicycle injury. METHODS We selected two middle schools randomly among seven schools in Chaoshan rural areas,where the main means of transportation for students from home to school was bicycle. The subjects were middle school students from 7th to 9th grades from Gucuo Middle School and Hefeng Middle School. Cyclists were surveyed through questionnaires about bicycle injury in the past 12 months. RESULTS Multivariable logistic analysis showed that compared with a combination-type road、 motor lane and a non-intact road were both risk factors of bicycle injuries. This was followed by riding with fatigue, non-motor lane and inattentive riding. CONCLUSION Bicycle injuries are frequent in China. Three risk factors on bicycle traffic injury among middle school students in Chaoshan rural areas of China were identified. This study provides important data to develop intervention strategies for China and other developing countries.
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Affiliation(s)
- Zhen-bin Lin
- Shantou University Medical College, Shantou, China
| | - Yan-hu Ji
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Qing-yu Xiao
- Shantou University Medical College, Shantou, China
| | - Li-bo Luo
- Shantou University Medical College, Shantou, China
| | - Li-ping Li
- Shantou University Medical College, Shantou, China
| | - Bernard Choi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Embree TE, Romanow NTR, Djerboua MS, Morgunov NJ, Bourdeaux JJ, Hagel BE. Risk Factors for Bicycling Injuries in Children and Adolescents: A Systematic Review. Pediatrics 2016; 138:peds.2016-0282. [PMID: 27940760 DOI: 10.1542/peds.2016-0282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Child and adolescent bicycling is beneficial, but injuries occur and can be severe and costly. OBJECTIVE To systematically review the individual and environmental factors associated with bicycling injury risk in children and adolescents. DATA SOURCES Fourteen electronic databases were searched. STUDY SELECTION Two authors independently assessed potentially relevant articles for eligibility. The inclusion criteria were as follows: bicyclists younger than 20 years old; examined individual and environmental characteristics of bicycling crashes; compared injured and uninjured bicyclists or bicyclists with different types or severity of injury; study designs with a predetermined comparison group; and published in English from January 1990 to May 2015. The exclusion criteria were outcomes related to helmet use, helmet legislation, or mountain biking, and comparisons of census-based injury rates. DATA EXTRACTION Data on study design, setting, population, injury definitions, injury risk factors, and results were extracted. Risk of bias was assessed by using the Newcastle-Ottawa Scales. RESULTS Fourteen articles were included. Lower socioeconomic status, riding on the road, riding in rural compared with urban areas, and riding on the sidewalk were associated with bicycling injury. Bicycling safety education did not protect children against future injury. Injuries related to a motor vehicle collision were more severe than other bicycling injuries. LIMITATIONS Study heterogeneity prevented meta-analyses. Study quality was affected by inadequate definitions of study groups and self-reported data. CONCLUSIONS Lower socioeconomic status and riding location were associated with bicycling injury and severity increased with motor vehicle collisions. The bicycling environment is a promising avenue for prevention.
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Affiliation(s)
| | | | | | | | - Jacqueline J Bourdeaux
- Postgraduate Medical Education, Faculty of Medicine, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brent E Hagel
- Departments of Paediatrics and .,Cumming School of Medicine.,Community Health Sciences.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, and.,O'Brien Institute for Public Health.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; and
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Uhrenholt L. Serious bicycle crash injury in chiropractic practice - a case report of delayed diagnosis. Chiropr Man Therap 2016; 24:40. [PMID: 27822361 PMCID: PMC5088667 DOI: 10.1186/s12998-016-0121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/16/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bicyclists are vulnerable road users and are at risk of serious spinal injury if involved in traffic crashes. In Denmark approximately 25 bicyclists are killed each year and some 20.000 bicycle related casualties are registered in the National Patient Registry each year. In addition to these figures, a large number of casualties remain unregistered despite injury. Many of the casualties will consult chiropractors in primary practice with or without preceding evaluation in the established emergency care facilities. Therefore, chiropractors are expected to be able to proficiently evaluate these patients clinically and radiologically in order to ensure the best possible patient care. CASE PRESENTATION This report involves a middle-aged female who consulted several physicians following a collision with a motor vehicle while riding a bike. Despite clinical symptoms and consequent examinations she suffered from inadequate diagnostic evaluation until a radiological examination was performed 18 days following the injurious crash identifying unstable cervical spine fractures. CONCLUSIONS The presented case is an example of the serious spinal injuries bicyclists may suffer when involved in high-energy traffic crashes despite wearing a bicycle helmet. The case report highlights the need for relevant clinical (including radiological) decision strategies when dealing with trauma patients in chiropractic practice. This involves the direct access to radiological procedures with no unnecessary delay when indicated as in most trauma cases. Furthermore, clearly defined and easy accessible referral schemes from primary care settings to emergency departments must be available to the chiropractic physician. Chiropractors are clinically competent to examine and diagnose, including radiologically evaluate, patients who have been injured in traffic crashes. Hence, chiropractors may contribute to the diagnosis, management and rehabilitation of spinal injured patients following many types of crashes and accident, including bicycle crashes.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Nortvig & Uhrenholt Kiropraktisk Klinik, Jens Baggesens Vej 88A, 8200 Aarhus N, Denmark
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Zeuwts L, Vansteenkiste P, Cardon G, Lenoir M. Development of cycling skills in 7- to 12-year-old children. TRAFFIC INJURY PREVENTION 2016; 17:736-742. [PMID: 26889690 DOI: 10.1080/15389588.2016.1143553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Cycling is a complex skill consisting of motor skills such as pedalling, braking, and steering. Because the ability to perform cycling skills is based on the age-related development of the child, experience and age-related reference values are of interest in light of customized testing and training. METHODS One hundred thirty-eight children from the second (7-8 years), fourth (9-10 years), and sixth (11-12 years) grades performed a practical bicycle test consisting of 13 test items with specific points of interest. Moreover, age at onset of cycling, cycling to and from school, independent mobility, and minutes cycling per week were estimated using a parental questionnaire. RESULTS It is found that cycling skills are strongly related to age with 11- to 12-year-old children outperforming 7- to 8-year-old children for 11 test items and 9- to 10-year-old children for 8 test items. CONCLUSIONS Next to age, age at onset of cycling also contributed to cycling skills. Therefore, our results suggest that cycling skills are associated with physical and mental maturation. Subsequently, age-related reference values are provided to customize testing and training.
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Affiliation(s)
- Linus Zeuwts
- a Ghent University , Department of Movement and Sports Sciences , Ghent , Belgium
| | - Pieter Vansteenkiste
- a Ghent University , Department of Movement and Sports Sciences , Ghent , Belgium
| | - Greet Cardon
- a Ghent University , Department of Movement and Sports Sciences , Ghent , Belgium
| | - Matthieu Lenoir
- a Ghent University , Department of Movement and Sports Sciences , Ghent , Belgium
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Rowson S, Bland ML, Campolettano ET, Press JN, Rowson B, Smith JA, Sproule DW, Tyson AM, Duma SM. Biomechanical Perspectives on Concussion in Sport. Sports Med Arthrosc Rev 2016; 24:100-7. [PMID: 27482775 PMCID: PMC4975525 DOI: 10.1097/jsa.0000000000000121] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concussions can occur in any sport. Often, clinical and biomechanical research efforts are disconnected. This review paper analyzes current concussion issues in sports from a biomechanical perspective and is geared toward Sports Med professionals. Overarching themes of this review include the biomechanics of the brain during head impact, role of protective equipment, potential population-based differences in concussion tolerance, potential intervention strategies to reduce the incidence of injury, and common biomechanical misconceptions.
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Affiliation(s)
- Steven Rowson
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
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Olivier J, Creighton P. Bicycle injuries and helmet use: a systematic review and meta-analysis. Int J Epidemiol 2016; 46:278-292. [DOI: 10.1093/ije/dyw153] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 11/13/2022] Open
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Stier R, Otte D, Müller C, Petri M, Gaulke R, Krettek C, Brand S. Effectiveness of Bicycle Safety Helmets in Preventing Facial Injuries in Road Accidents. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e30011. [PMID: 27800459 PMCID: PMC5079115 DOI: 10.5812/atr.30011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 03/16/2016] [Accepted: 04/13/2016] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Rebecca Stier
- Department of Cranio Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
- Corresponding author: Rebecca Stier, Department of Cranio Maxillofacial Surgery, Hannover Medical School (MHH), Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany. Tel: +49-5115324748, Fax: +49-5115324740, E-mail:
| | - Dietmar Otte
- Department for Accident Research, Hannover Medical School, Hannover, Germany
| | | | | | - Ralph Gaulke
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Stephan Brand
- Trauma Department, Hannover Medical School, Hannover, Germany
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Plumert JM, Kearney JK, Cremer JF. Children's Road Crossing: A Window Into Perceptual-Motor Development. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2016; 16:255-258. [PMID: 19180252 DOI: 10.1111/j.1467-8721.2007.00515.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most research on perceptual-motor development has focused on changes occurring during infancy and toddlerhood. In this paper, we describe our work on the development of perceptual-motor development during late childhood and early adolescence in the context of an important applied problem: bicycling across traffic-filled roads. Specifically, we have examined the gaps between cars that children and adults accept when bicycling across intersections, using an immersive, interactive bicycling simulator. This work highlights both methodological advances in using immersive, interactive virtual environments to study perceptual-motor functioning as well as theoretical advances in understanding the problem of moving the self in relation to other moving objects. We conclude with ideas for future research and practical implications of this work.
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Gopinath B, Jagnoor J, Craig A, Kifley A, Dinh M, Ivers R, Boufous S, Cameron ID. Describing and comparing the characteristics of injured bicyclists and other injured road users: a prospective cohort study. BMC Public Health 2016; 16:324. [PMID: 27074801 PMCID: PMC4831149 DOI: 10.1186/s12889-016-2988-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to establish the frequency and characteristics (e.g. socioeconomic, pre-injury, and crash-related parameters) of injured bicyclists and other injured road users. Methods 748 participants aged ≥17 years who had sustained a minor or non-catastrophic injury in a land-transport crash, were interviewed after presenting to a metro hospital emergency department in New South Wales, Australia. A telephone-administered questionnaire obtained information on socio-economic, pre-injury health, and crash-related characteristics. These factors were then compared between injured bicyclists and other road users (car driver/passengers, motorcyclists/pillion and pedestrians/skateboarders). Cycling injury severity was characterized by three metrics (sustaining multiple injuries; hospital admission for ≥12 h; and sustaining a head/neck and/or facial injury). Results In this cohort of people with injuries, 238 (32 %) were bicyclists. Frequency of cycling injuries were significantly different between age-groups among men (p = 0.0002), and were more common in men aged 45–59. Bicyclists were more likely to be aged 45–59, married, have university/tertiary qualifications and have a professional occupation compared to other road users (all p <0.0001). Bicyclists compared to participants involved in other types of land transport crashes were more likely to self-report excellent general health (p = 0.01), and were less likely to report a great/overwhelming perceived danger of death or 15.0 % versus 23–41 %; p <0.0001). Frequency of upper extremity and lower extremity injuries in bicyclists were 81.9 % and 60.5 %, respectively. Explanatory variables significantly associated with injury severity metrics were age, education level, paid work status and perceived danger of death/disability in the crash. Conclusions Minor cycling injuries were a relatively common cause of mild-moderate injury presentations to metro emergency departments. A wide spectrum of socio-demographic-, pre-injury-, and crash-related characteristics were related to cycling injuries.
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Affiliation(s)
- Bamini Gopinath
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia.
| | - Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia
| | - Michael Dinh
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Soufiane Boufous
- Transport and Road Safety Research, The University of NSW, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia
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Bicycle helmets are highly protective against traumatic brain injury within a dense urban setting. Injury 2015; 46:2483-90. [PMID: 26254573 DOI: 10.1016/j.injury.2015.07.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 06/16/2015] [Accepted: 07/19/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND New York City (NYC) has made significant roadway infrastructure improvements, initiated a bicycle share program, and enacted Vision Zero, an action plan to reduce traffic deaths and serious injuries. The objective of this study was to examine whether bicycle helmets offer a protective advantage against traumatic brain injury (TBI) within a contemporary dense urban setting with a commitment to road safety. METHODS A prospective observational study of injured bicyclists presenting to a Level I trauma centre was performed. All bicyclists arriving within 24 h of injury were included. Data were collected between February, 2012 and August, 2014 and included demographics, imaging studies (e.g. computed tomography (CT)), injury patterns, and outcomes including Glasgow Coma Scale (GCS) and Injury Severity Score. RESULTS Of 699 patients, 273 (39.1%) were wearing helmets at the time of injury. Helmeted bicyclists were more likely to have a GCS of 15 (96.3% [95% Confidence Interval (CI), 93.3-98.2] vs. 87.6 [95% CI, 84.1-90.6]) at presentation. Helmeted bicyclists underwent fewer head CTs (40.3% [95% CI, 34.4-46.4] vs. 52.8% [95% CI, 48.0-57.6]) and were less likely to sustain intracranial injury (6.3% [95% CI, 2.6-12.5] vs. 19.7% [14.7-25.6]), including skull fracture (0.9% [95% CI, 0.0-4.9] vs. 15.3% [95% CI, 10.8-20.7]) and subdural hematoma (0.0% [95% CI, 0.0-3.2] vs. 8.1% [95% CI, 4.9-12.5]). Helmeted bicyclists were significantly less likely to sustain significant TBI, i.e. Head AIS ≥3 (2.6% [95% CI: 0.7-4.5] vs.10.6% [7.6-12.5]). Four patients underwent craniotomy while three died; all were un-helmeted. A multivariable logistic regression model showed that helmeted bicyclists were 72% less likely to sustain TBI compared with un-helmeted bicyclists (Adjusted Odds Ratio 0.28, 95% CI 0.12-0.61). CONCLUSIONS Despite substantial road safety measures in NYC, the protective impact of simple bicycle helmets in the event of a crash remains significant. A re-assessment of helmet laws for urban bicyclists is advisable to most effectively translate Vision Zero from a political action plan to public safety reality.
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Teschke K, Koehoorn M, Shen H, Dennis J. Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share. BMJ Open 2015; 5:e008052. [PMID: 26525719 PMCID: PMC4636599 DOI: 10.1136/bmjopen-2015-008052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The purpose of this study was to calculate exposure-based bicycling hospitalisation rates in Canadian jurisdictions with different helmet legislation and bicycling mode shares, and to examine whether the rates were related to these differences. METHODS Administrative data on hospital stays for bicycling injuries to 10 body region groups and national survey data on bicycling trips were used to calculate hospitalisation rates. Rates were calculated for 44 sex, age and jurisdiction strata for all injury causes and 22 age and jurisdiction strata for traffic-related injury causes. Inferential analyses examined associations between hospitalisation rates and sex, age group, helmet legislation and bicycling mode share. RESULTS In Canada, over the study period 2006-2011, there was an average of 3690 hospitalisations per year and an estimated 593 million annual trips by bicycle among people 12 years of age and older, for a cycling hospitalisation rate of 622 per 100 million trips (95% CI 611 to 633). Hospitalisation rates varied substantially across the jurisdiction, age and sex strata, but only two characteristics explained this variability. For all injury causes, sex was associated with hospitalisation rates; females had rates consistently lower than males. For traffic-related injury causes, higher cycling mode share was consistently associated with lower hospitalisation rates. Helmet legislation was not associated with hospitalisation rates for brain, head, scalp, skull, face or neck injuries. CONCLUSIONS These results suggest that transportation and health policymakers who aim to reduce bicycling injury rates in the population should focus on factors related to increased cycling mode share and female cycling choices. Bicycling routes designed to be physically separated from traffic or along quiet streets fit both these criteria and are associated with lower relative risks of injury.
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Affiliation(s)
- Kay Teschke
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui Shen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Dennis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Sanford T, McCulloch CE, Callcut RA, Carroll PR, Breyer BN. Bicycle Trauma Injuries and Hospital Admissions in the United States, 1998-2013. JAMA 2015; 314:947-9. [PMID: 26325564 PMCID: PMC4896174 DOI: 10.1001/jama.2015.8295] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas Sanford
- Department of Urology, University of California, San Francisco
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Peter R Carroll
- Department of Urology, University of California, San Francisco
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46
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Biegler P, Johnson M. In defence of mandatory bicycle helmet legislation: response to Hooper and Spicer. JOURNAL OF MEDICAL ETHICS 2015; 41:713-717. [PMID: 23760577 DOI: 10.1136/medethics-2013-101476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023]
Abstract
We invoke a triple rationale to rebut Hooper and Spicer's argument against mandatory helmet laws. First, we use the laws of physics and empirical studies to show how bicycle helmets afford substantial protection to the user. We show that Hooper and Spicer erroneously downplay helmet utility and that, as a result, their attack on the utilitarian argument for mandatory helmet laws is weakened. Next, we refute their claim that helmet legislation comprises unjustified paternalism. We show the healthcare costs of bareheaded riding to pose significant third party harms. It follows, we argue, that a utilitarian case for helmet laws can be sustained by appeal to Mill's Harm Principle. Finally, we reject Hooper and Spicer's claim that helmet laws unjustly penalise cyclists for their own health-affecting behaviour. Rather, we show their argument to suffer by disanalogy with medical cases where injustice may be more evident, for example, denial of bypass surgery to smokers. We conclude that mandatory helmet laws offer substantial utility and are entirely defensible within the framework of a liberal democracy.
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Affiliation(s)
- Paul Biegler
- Monash University-Centre for Human Bioethics, Melbourne, Victoria, Australia
| | - Marilyn Johnson
- Department of Civil Engineering, Monash University-Institute of Transport Studies, Melbourne, Victoria, Australia
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Scholten AC, Polinder S, Panneman MJM, van Beeck EF, Haagsma JA. Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands. ACCIDENT; ANALYSIS AND PREVENTION 2015; 81:51-60. [PMID: 25939135 DOI: 10.1016/j.aap.2015.04.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/10/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
The main cause of death and serious disability in bicycle accidents is traumatic brain injury (TBI). The aim of this population-based study was to assess the incidence and costs of bicycle-related TBI across various age groups, and in comparison to all bicycle-related injuries, to identify main risk groups for the development of preventive strategies. Data from the National Injury Surveillance System and National Medical Registration were used for all patients with bicycle-related injuries and TBI who visited a Dutch emergency department (ED) between 1998 and 2012. Demographics and national, weighted estimates of injury mechanism, injury severity and costs were analysed per age group. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model. Between 1998 and 2012, the incidence of ED treatments due to bicycle-related TBI strongly increased with 54%, to 43 per 100,000 persons in 2012. However, the incidence of all bicycle-related injuries remained stable, from 444 in 1998 to 456/100,000 in 2012. Incidence of hospital admission increased in both TBI (92%) and all injuries from cycling (71%). Highest increase in incidence of both ED treatments and hospital admissions was seen in adults aged 55+. The injury rate of TBI per kilometre travelled increased (44%) except in children, but decreased (-4%) for all injuries, showing a strong decrease in children (-36%) but an increase in men aged 25+, and women aged 15+. Total costs of bicycle-related TBI were €74.5 million annually. Although bicycle-related TBI accounted for 9% of the incidence of all ED treatments due to cycling, it accounted for 18% of the total costs due to all bicycle-related injuries (€410.7 million). Children and adolescents (aged 0-24) had highest incidence of ED treatments due to bicycle-related injuries. Men in the working population (aged 15-64) had highest indirect costs following injuries from cycling, including TBI. Older cyclists (aged 55+) were identified as main risk group for TBI, as they had highest ED attendance, injury rate, injury severity, admission to hospital or intensive care unit, and costs. Incidence of ED treatments due to cycling are high and often involve TBI, imposing a high burden on individuals and society. Older cyclists aged 55+ were identified as main risk group for TBI to be targeted in preventive strategies, due to their high risk for (serious) injuries and ever-increasing share of ED visits and hospital admissions.
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Affiliation(s)
| | - Suzanne Polinder
- Erasmus MC, Department of Public Health, Rotterdam, the Netherlands
| | | | - Ed F van Beeck
- Erasmus MC, Department of Public Health, Rotterdam, the Netherlands
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Trégouët P. Helmets or not? Use science correctly. JOURNAL OF MEDICAL ETHICS 2015; 41:718-719. [PMID: 23760575 DOI: 10.1136/medethics-2013-101521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023]
Abstract
In a recent article, Hooper and Spicer make several arguments against legislation that would mandate the use of bicycle helmets. While they present reasonable objections to the utilitarian as well as the justice defence of such legislation, their review of the empirical evidence contains inaccuracies, omissions and a bias in the selection of empirical data. While there are legitimate reasons to argue against mandating helmet legislation, these arguments should still be based on clinically and scientifically sound evidence.
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Liu HT, Rau CS, Liang CC, Wu SC, Hsu SY, Hsieh HY, Hsieh CH. Bicycle-related hospitalizations at a Taiwanese level I Trauma Center. BMC Public Health 2015; 15:722. [PMID: 26219341 PMCID: PMC4517401 DOI: 10.1186/s12889-015-2075-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate differences in injury severity and mortality between patients who met with bicycle or motorcycle accidents and were hospitalized at a Level I trauma center in Taiwan. METHODS We performed a retrospective analysis of bicycle-related injuries that have been reported in the Trauma Registry System in order to identify and compare 699 bicyclists to 7,300 motorcyclists who were hospitalized for treatment between January 1, 2009 and December 31, 2013. Statistical analyses of the injury severity, associated complications, and length of stay in the hospital and intensive care unit (ICU) were performed to compare the risk of injury of bicyclists to that of motorcyclists with the corresponding unadjusted odds ratios and 95 % confidence intervals (CIs). Adjusted odds ratios (AORs) and 95 % CIs for mortality were calculated by controlling for confounding variables that included age, and an Injury Severity Score (ISS) was calculated. RESULTS More of the cyclists were under 19 years of age or over 70 than were the motorcyclists. In contrast, fewer bicyclists than motorcyclists wore helmets, arrived at the emergency department between 11 p.m. and 7 a.m., and had a positive blood alcohol concentration test. The bicyclists sustained significantly higher rates of injuries to the extremities, while motorcyclists sustained significantly higher rates of injuries to the head and neck, face, and thorax. Compared to motorcyclists, the bicyclists had significantly lower ISSs and New Injury Severity Scores, shorter length hospital stays, and a smaller proportion of admittance into the ICU. However, the bicyclists had higher AORs for in-hospital mortality (AOR: 1.2, 95 % CI: 1.16-1.20). In terms of critical injury severity (ISS ≥ 25), the bicyclists had 4.4 times (95 % CI: 1.95-9.82) the odds of mortality than motorcyclists with the same ISSs. CONCLUSIONS Data analysis indicated that the bicyclists had unique injury characteristics including bodily injury patterns and lower ISSs, but had higher in-hospital mortality compared to motorcycle riders. In this study, given that only 9 % of bicyclists reported wearing helmets and considering the high mortality associated with head injury, it is possible that some bicycle riders underestimated the gravity of cycling accidents.
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Affiliation(s)
- Hang-Tsung Liu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Chi-Cheng Liang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Hsiao-Yun Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Ching-Hua Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
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Kaushik R, Krisch IM, Schroeder DR, Flick R, Nemergut ME. Pediatric bicycle-related head injuries: a population-based study in a county without a helmet law. Inj Epidemiol 2015; 2:16. [PMID: 27747748 PMCID: PMC5005552 DOI: 10.1186/s40621-015-0048-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head injuries are the leading cause of death among cyclists, 85 % of which can be prevented by wearing a bicycle helmet. This study aims to estimate the incidence of pediatric bicycle-related injuries in Olmsted County and assess differences in injuries between those wearing helmets vs. not. METHODS Olmsted County, Minnesota residents 5 to 18 years of age with a diagnostic code consistent with an injury associated with the use of a bicycle between January 1, 2002, and December 31, 2011, were identified. Incidence rates were calculated and standardized to the age and sex distribution of the 2000 US white population. Type of injuries, the percentage requiring head CT or X-ray, and hospitalization were compared using a chi-square test. Pediatric intensive care unit (PICU) admission, permanent neurologic injury, seizure, need for mechanical ventilation, and mortality were compared using Fisher's exact test. RESULTS A total of 1189 bicycle injuries were identified. The overall age-adjusted incidence rate of all injuries was 278 (95 % CI, 249 to 306) per 100,000 person-years for females and 589 (95 % CI, 549 to 629) for males. The corresponding rates for head injuries were 104 (95 % CI, 87 to 121) for females and 255 (95 % CI, 229 to 281) for males. Of patients with head injuries, 17.4 % were documented to have been wearing a helmet, 44.8 % were documented as not wearing a helmet, and 37.8 % had no helmet use documentation. Patients with a head injury who were documented as not wearing a helmet were significantly more likely to undergo imaging of the head (32.1 percent vs. 11.5 %; p < 0.001) and to experience a brain injury (28.1 vs. 13.8 %; p = 0.008). CONCLUSIONS Children and adolescents continue to ride bicycles without wearing helmets, resulting in severe head and facial injuries and mortality.
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Affiliation(s)
- Ruchi Kaushik
- Mayo Clinic Children's Center, 200 First Street SW, Mayo 16E, Rochester, MN, 55905, USA.
| | - Isabelle M Krisch
- Mayo Clinic Children's Center, 200 First Street SW, Mayo 16E, Rochester, MN, 55905, USA
| | - Darrell R Schroeder
- Mayo Clinic Children's Center, 200 First Street SW, Mayo 16E, Rochester, MN, 55905, USA
| | - Randall Flick
- Mayo Clinic Children's Center, 200 First Street SW, Mayo 16E, Rochester, MN, 55905, USA
| | - Michael E Nemergut
- Mayo Clinic Children's Center, 200 First Street SW, Mayo 16E, Rochester, MN, 55905, USA
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