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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Galteland P, Døving M, Næss I, Sehic A, Utheim TP, Eken T, Skaga NO, Helseth E, Ramm-Pettersen J. The association between head injury and facial fracture treatment: an observational study of hospitalized bicyclists from a level 1 trauma centre. Acta Neurochir (Wien) 2024; 166:132. [PMID: 38472419 PMCID: PMC10933183 DOI: 10.1007/s00701-024-06019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. METHODS Retrospective analysis of data from bicycle-related injuries in the period 2005-2016 extracted from the Oslo University Hospital trauma registry. RESULTS A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1-2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3-6). The mean patient age was 40.2 years (range 3-91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03-3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30-8.60, p = 0.012). CONCLUSION Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit.
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Affiliation(s)
- Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Ingar Næss
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Torsten Eken
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Jon Ramm-Pettersen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
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Stassen HS, Atalik T, Haagsma JA, Wolvius EB, Verdonschot RJCG, Rozeboom AVJ. Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:28-35. [PMID: 37031014 DOI: 10.1016/j.ijom.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 04/10/2023]
Abstract
Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.
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Affiliation(s)
- H S Stassen
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T Atalik
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A Haagsma
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R J C G Verdonschot
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A V J Rozeboom
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
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Galteland P, Næss I, Døving M, Sehic A, Utheim TP, Skaga NO, Eken T, Helseth E, Ramm-Pettersen J. Facial Fractures and Their Relation to Head and Cervical Spine Injuries in Hospitalized Bicyclists. J Craniofac Surg 2023; 34:34-9. [PMID: 36608095 DOI: 10.1097/SCS.0000000000009032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/21/2022] [Indexed: 12/31/2022] Open
Abstract
Bicyclists are vulnerable road users. The authors aimed to characterise facial fractures and their association with head and neck injuries in bicyclists admitted to a Scandinavian Level 1 trauma center with a catchment area of ~3 million inhabitants. Data from bicycle-related injuries in the period 2005 to 2016 were extracted from the Oslo University Hospital trauma registry. Variables included were age; sex; date of injury; abbreviated injury scale (AIS) codes for facial skeletal, head and neck injuries; and surgical procedure codes for treatment of facial fractures. Anatomical injury was classified according to AIS98. A total of 1543 patients with bicycle-related injuries were included. The median age was 40 years (quartiles 53, 25), and 1126 (73%) were men. Overall, 652 fractures were registered in 339 patients. Facial fractures were observed in all age groups; however, the proportion rose with increasing age. Bicyclists who suffered from facial fractures more often had a concomitant head injury (AIS head >1) than bicyclists without facial fractures (74% vs. 47%), and the odds ratio for facial fracture(s) in the orbit, maxilla and zygoma were significantly increased in patients with AIS head >1 compared to patients with AIS head=1. In addition, 17% of patients with facial fractures had a concomitant cervical spine injury versus 12% of patients without facial fractures. This results showed that facial fractures were common among injured bicyclists and associated with both head and cervical spine injury. Thus, a neurological evaluation of these patients are mandatory, and a multidisciplinary team including maxillofacial and neurosurgical competence is required to care for these patients.
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Al Saffar MMA, Verdonschot RJCG, Stassen HS, Wolvius EB, Rozeboom AVJ. The Association of Helmet Use with the Occurrence of Maxillofacial Injuries Following Bicycle or Scooter Accidents: A Retrospective Cohort Study. Craniomaxillofac Trauma Reconstr 2022; 15:21-27. [PMID: 35265273 PMCID: PMC8899353 DOI: 10.1177/1943387521998199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design Retrospective Cohort Study. Objective Yearly, bicycle and scooter accidents in the Netherlands amount to 90 thousand emergency department visits. Maxillofacial injuries are common after cycling or scooter accidents. To prevent these injuries, helmet use might be beneficial. However, the effect of helmet use on maxillofacial injuries remains unclear. The aim of this retrospective study is to assess the effect of helmet use on maxillofacial injuries in patients who had a bicycle or scooter accident. Methods We collected data from the emergency department of the Erasmus Medical Center in the period from October 2017 to October 2019. Patients that were involved in a bicycle or scooter accident and subsequently received a CT scan of the head were included. We compared the incidence of maxillofacial injuries in helmeted cyclists and scooter users to non-helmeted users. Descriptive and analytic statistics were computed. Level of statistical significance was set at p < 0.05. Results Helmet use among scooter users was associated with a significant reduction in maxillofacial fractures (p < 0.001) and soft tissue injuries (p < 0.001). Helmet use among cyclists was not associated with a reduction in maxillofacial fractures (p = 0.17) or soft tissue injuries (p = 0.30). Helmet use was not associated with a reduction in soft tissue injuries of the lower face in both cyclists (p = 0.47) and scooter users (p = 0.24). Conclusions Helmet use should be considered among cyclists and scooter users to prevent maxillofacial injuries. Especially unhelmeted scooter users might benefit from helmet use as this is associated with a lower incidence of maxillofacial injuries.
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Affiliation(s)
- M. M. A. Al Saffar
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands,M. M. A. Al Saffar, Department of Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015GD Rotterdam, The Netherlands.
| | - R. J. C. G. Verdonschot
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H. S. Stassen
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E. B. Wolvius
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A. V. J. Rozeboom
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Puolakkainen T, Murros OJ, Abio A, Thorén H, Virtanen K, Snäll J. Associated Injuries Are Common Among Patients With Bicycle-Related Craniofacial Fractures. J Oral Maxillofac Surg 2021; 79:1319-1326. [PMID: 33607009 DOI: 10.1016/j.joms.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ample evidence exists on the relationship between bicycle injuries and craniofacial fractures. However, as the mechanism behind these injuries is often multifactorial, the presence of associated injuries (AIs) in this study population requires further examination. We hypothesized that patients with craniofacial fracture injured in bicycle accidents are at high risk of sustaining severe AIs, especially those of the head and neck region. PATIENTS AND METHODS The investigators performed a retrospective study on all patients with bicycle-related craniofacial fracture admitted to a tertiary trauma centre during 2013 to 2018. The predictor variable was defined as any type of craniofacial fracture. The outcome variable was defined as any kind of AI. Other study variables included demographic and injury-related parameters. Variables were analyzed using bivariate and Firth's logistic regression analyses. RESULTS A total of 407 patients were included in the analysis. Our results revealed that AIs were present in 150 (36.9%) patients; there were multiple AIs in 47 cases. Traumatic brain injuries followed by upper limb injuries were the most frequent AIs. Severe head and neck injuries were present in 20.1% of all patients with craniofacial fracture. AIs were observed in 57.4% of patients with combined midfacial fractures (P < .001). Helmet use had a protective effect against traumatic brain injuries (P < .001). CONCLUSIONS Our results suggest that AIs are relatively common in this specific patient population. Close co-operation in multidisciplinary trauma centers allowing comprehensive evaluation and treatment can be recommended for patients with bicycle-related craniofacial fracture.
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Affiliation(s)
- Tero Puolakkainen
- Resident, Post-Doctoral Student, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland.
| | - Olli-Jussi Murros
- Resident, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Anne Abio
- Doctoral Student, Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland; and Doctoral Student, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Hanna Thorén
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland; Professor, and Department of Oral and Maxillofacial Diseases, Turku University Hospital, Finland, Turku, Finland
| | - Kaisa Virtanen
- Chief Physician, Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Johanna Snäll
- Department Head, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland
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Baschera D, Lawless A, Roeters R, Frysch CWS, Zellweger R. Severity and predictors of head injury due to bicycle accidents in Western Australia. Acta Neurochir (Wien) 2021; 163:49-56. [PMID: 33113011 DOI: 10.1007/s00701-020-04626-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Head and face injuries are the second most frequently reported injuries among bicyclists. Recently, helmet usage has increased, and in some countries, helmet laws have been introduced. However, subsequent changes in the incidence and severity of traumatic brain injury (TBI) are unknown, and data on neurosurgical interventions are lacking. Therefore, we analyzed a cohort of bicyclists with TBI, in a state with an enforced helmet law, and compared our results with the available literature. METHODS Patient data of bicycle accidents that occurred between January 2008 and January 2015 were extracted from the state trauma registry, and the corresponding patient files and CT scans were comprehensively reviewed. RESULTS Of the 1019 patients admitted due to bicycle accidents, 187 patients suffered from TBI. Most cases were mild; however, 72 involved intracranial hemorrhages. Of the TBI patients, 113 were wearing helmets. CT scans were performed on 168 TBI patients, 120 of whom had a Rotterdam CT score of 1, with no difference between helmeted and non-helmeted patients. Open head injury (p < 0.05) and epidural hematomas were significantly less frequent among helmet wearers (p = 0.03). Ten patients required surgery; helmet use and neurosurgical involvement were not significantly correlated. CONCLUSIONS Patients who wore helmets were significantly less likely to suffer from epidural hematomas and open head injuries. While TBI severity was not significantly different between helmeted and non-helmeted bicyclists, the overall occurrence of TBI and moderate to severe TBI among all admissions was lower than that seen in comparable studies from countries without helmet laws.
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Døving M, Galteland P, Eken T, Sehic A, Utheim TP, Skaga NO, Helseth E, Ramm-Pettersen J. Dentoalveolar injuries, bicycling accidents and helmet use in patients referred to a Norwegian Trauma Centre: A 12-year prospective study. Dent Traumatol 2020; 37:240-246. [PMID: 33220164 DOI: 10.1111/edt.12627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Despite its many benefits, bicycling carries the risk of accidents. Although numerous studies have reported the effect of helmet use on traumatic brain injury, it remains unclear if, and to what extent, helmet use reduces the risk of facial injuries. This is particularly true in regard to injuries of the lower face. In addition, there is limited evidence of the effect of helmet use on dentoalveolar injuries. Thus, the aim of this study was to determine the frequency and distribution of dentoalveolar injuries in bicycling accidents and to explore the influence of helmet use. MATERIAL AND METHODS A total of 1543 bicyclists were included from the trauma registry of a Norwegian tertiary trauma center over a 12-year period. Data were collected prospectively, including patient characteristics, type of injury, and helmet use. The prevalence of dentoalveolar injuries was assessed in conjunction with helmet use and facial fractures. RESULTS Twenty-five percent of the patients had maxillofacial injuries, and 18% of those with facial fractures exhibited concomitant dentoalveolar injuries. The most common type of dentoalveolar injury was tooth fracture (39%). The most frequent location of facial fractures with combined dentoalveolar injuries was the maxilla, which had fractured in 32 patients. Women had a higher risk of sustaining dentoalveolar injuries compared to men (odds ratio 1.50, 95% confidence interval 1.02-2.22). There were 1257 patients (81%) who had reliable registration of helmet use; 54% of these wore a helmet, while 46% did not. Helmet users had an increased risk of dentoalveolar injuries compared to non-helmeted bicyclists (adjusted odds ratio 1.54, 95% confidence interval 1.02-2.31). CONCLUSIONS Dentoalveolar injuries are fairly common in trauma patients admitted to a trauma center following bicycling accidents. Bicycling helmets are associated with an increased risk of dentoalveolar injuries.
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Affiliation(s)
- Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Torsten Eken
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Jon Ramm-Pettersen
- Department of Neurosurgery, Oslo University Hospital Ullevål, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hwang MJ, Dodson TB, Dillon JK. Communities With Bikeshare Programs Might Have a Lower Risk of Bicycle-Related Maxillofacial Injuries: Results From an Early Adopter of Bikeshare Programs. J Oral Maxillofac Surg 2020; 78:610.e1-610.e9. [DOI: 10.1016/j.joms.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
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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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Benjamin T, Hills NK, Knott PD, Murr AH, Seth R. Association Between Conventional Bicycle Helmet Use and Facial Injuries After Bicycle Crashes. JAMA Otolaryngol Head Neck Surg 2020; 145:140-145. [PMID: 30543361 DOI: 10.1001/jamaoto.2018.3351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Bicycling is an increasingly common activity in the United States that is often associated with fall injuries to the head and face. Although helmets lessen head injury, their role in reducing facial injuries is less clear; therefore, it is important to understand the protective capacity for the face in current helmet design. Objective To estimate the conventional bicycle helmet's association with the rate of facial injury after bicycle crashes. Design, Setting, and Participants This retrospective cohort study accessed records from January 1, 2010, to December 31, 2014, from the National Trauma Databank, which collects data from emergency departments in US hospitals. Each record pertained to 1 emergency department admission for a bicycle crash. The National Trauma Databank registry data are collected and recorded by incident, which is equivalent to an injury-related hospital admission. All injuries involving patients aged 18 to 65 years for whom data on helmet use and injury were available were included. Statistical analysis was conducted from July 19 to October 17, 2016. Exposures Helmeted and nonhelmeted bicycle crashes. Main Outcomes and Measures Head and facial injuries among helmeted and nonhelmeted bicycle crashes. Results A total of 85 187 facial injuries met inclusion criteria (patient age 18-65 years, availability of helmet use status, and type of injury). Demographic information on bicycle riders was frequently unavailable. Among all injuries, fractures to the head (11.6% [9854]) and face (11.3% [9589]) occurred at similar rates. Helmets reduced head fractures by 52% (from 14.0% [7623] to 7.3% [2231]) and head soft-tissue injuries by 30% (from 15.0% [8151] to 10.9% [3358]), but had lower rates in protecting against facial injuries. While reducing facial injuries overall, the amount of protection with helmet use varied with facial location of the injury. Reduction in facial fractures was 35% (95% CI, 31%-39%) for upper face, 28% (95% CI, 23%-32%) for mid face, and 21% (95% CI, 15%-26%) for the lower face. Helmets were less protective against facial soft-tissue injuries, with a reduction of 33% (95% CI, 30%-36%) in the upper face, 21% (95% CI, 16%-26%) in the mid face, and 2% (95% CI, 0%-6%) in the lower face. Conclusions and Relevance Although bicycle helmets provide some protection against facial injuries after bicycle crashes, the level of protection depends on the proximity of the injury to the helmeted head. The lower face is particularly vulnerable to injury despite helmet use.
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Affiliation(s)
- Tania Benjamin
- School of Medicine, University of California, San Francisco
| | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - P Daniel Knott
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Andrew H Murr
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Rahul Seth
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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Rice S, Iaccarino MA, Bhatnagar S, Robidoux G, Zafonte R, Kotler DH. Reporting of Concussion-Like Symptoms After Cycling Crashes: A Survey of Competitive and Recreational Cyclists. J Athl Train 2019; 55:11-16. [PMID: 31855078 DOI: 10.4085/1062-6050-91-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Cycling crashes are common among recreational and competitive riders and may result in head and bodily trauma. Information is limited regarding the signs and symptoms of head injury (HI) after cycling crashes, medical treatment, and recovery. OBJECTIVES To evaluate concussion-like symptom reporting after cycling crashes with or without HI in recreational and competitive cyclists and to assess crash characteristics and follow-up medical care. DESIGN Cross-sectional study. SETTING Voluntary online survey. PATIENTS OR OTHER PARTICIPANTS A convenience sample of 780 cyclists residing in the United States: 528 males, 249 females, 2 gender queer/nonbinary, and 1 transgender female. MAIN OUTCOME MEASURE(S) Survey-based, self-reported signs and symptoms of HI, including the third edition of the Sport Concussion Assessment Tool (SCAT3) symptom checklist, loss of consciousness, posttraumatic amnesia, and helmet damage. RESULTS Of the participants, 403 reported crashes in the previous 2 years. Cyclists who self-reported no significant injury after their crash were excluded, leaving 77 HI reporters (HI group) and 260 trauma controls (TC group). The HI group more frequently reported experiencing 17 of the 22 symptoms on the SCAT3 symptom checklist. The HI group described a 4-fold higher incidence of loss of consciousness (HI = 13/77 [16.9%] versus TC = 11/2600 [4.2%]) and memory loss immediately after the crash (HI = 44/77 [57.1%] versus TC = 37/260 [14.2%]). The HI group reported major, noncosmetic helmet damage 2.5 times more frequently than the TC group (HI = 49/77 [63.6%] versus TC = 67/260 [25.8%]). CONCLUSIONS The findings suggest that a standardized concussion assessment is needed for cyclists who experience major trauma.
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Affiliation(s)
- Sarah Rice
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Boston, MA
| | - Saurabha Bhatnagar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Boston, MA.,US Department of Veterans Affairs, Washington, DC
| | | | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Boston, MA
| | - Dana H Kotler
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Spaulding Rehabilitation Hospital, Boston, MA.,Newton-Wellesley Hospital, Newton, MA
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Hwang MJ, Dillon JK, Dodson TB. Helmets Decrease Risk of Bicyclist-Related Maxillofacial Injuries But Not Severity. J Oral Maxillofac Surg 2019; 77:2055-2063. [DOI: 10.1016/j.joms.2019.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022]
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15
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Baschera D, Jäger D, Preda R, Z'Graggen WJ, Raabe A, Exadaktylos AK, Hasler RM. Comparison of the Incidence and Severity of Traumatic Brain Injury Caused by Electrical Bicycle and Bicycle Accidents-A Retrospective Cohort Study From a Swiss Level I Trauma Center. World Neurosurg 2019; 126:e1023-e1034. [PMID: 30857998 DOI: 10.1016/j.wneu.2019.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Electrical bicycles (E-bikes) allow people of all ages to ride at high speeds but have an inherent risk of traumatic brain injury (TBI). Their sales have increased tremendously in recent years. METHODS We performed a retrospective cohort study to compare the incidence and severity of TBI in E-bikers and conventional bicyclists. We included patients at a Swiss level 1 trauma center admitted from 2010 to 2015. The primary outcome was the association between TBI and the bicycle type. The secondary outcome was the association between helmet use and TBI severity. RESULTS Of 557 patients injured riding an E-bike (n = 73) or a bicycle (n = 484), 60% sustained a TBI, most of which were mild (Glasgow coma scale [GCS] score, 13-15; E-bike, 78%; bicycle, 88%). TBI was more often moderate (GCS score, 9-12) or severe (GCS score, 3-8) in E-bikers than in bicyclists (P = 0.04). Intracranial hemorrhage, traumatic subarachnoid hemorrhage, and subdural hematoma occurred significantly more often in E-bikers than in bicyclists (P < 0.05). Neurosurgical intervention was necessary for 5 E-bikers (7%) and 25 (5%) bicyclists (P = 0.15). Wearing a helmet correlated with a lower risk of neurosurgical intervention in bicyclists (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.06-0.73; P = 0.01) and a lower risk of calvarial fractures in both bicyclists (OR, 0.16; 95% CI, 0.06-0.42; P < 0.01) and E-bikers (OR, 0.21; 95% CI, 0.05-0.84; P = 0.03). CONCLUSIONS E-bikers had a significantly greater risk of moderate to severe TBI compared with bicyclists. Helmet use was associated with decreased odds of severe TBI in bicyclists and a tendency toward a more favorable outcome for E-bikers.
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Affiliation(s)
- Dominik Baschera
- Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Damian Jäger
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Raluca Preda
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Rebecca M Hasler
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
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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. Accid Anal Prev 2018; 117:85-97. [PMID: 29677686 DOI: 10.1016/j.aap.2018.03.026] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fitzpatrick DG, Goh M, Howlett DC, Williams M. Bicycle helmets are protective against facial injuries, including facial fractures: a meta-analysis. Int J Oral Maxillofac Surg 2018; 47:1121-1125. [PMID: 29622478 DOI: 10.1016/j.ijom.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/10/2018] [Accepted: 03/06/2018] [Indexed: 11/19/2022]
Abstract
Cycling is a popular activity. However there are risks associated with cycling, including facial injury. Helmets are often worn to prevent head injury. Evidence for their protection against facial injury is limited. This meta-analysis investigated the effect of bicycle helmets on the incidence of facial injury. The PubMed/MEDLINE, Google Scholar, and Cochrane Library databases were searched. Studies included were observational and involved adult participants. Paediatric studies, studies on helmet legislation, and those combining facial injuries with other injury types were excluded. The studies were evaluated by two reviewers. Risk of bias was assessed using the RevMan bias assessment tool. Odds ratios (OR) were extracted for facial injuries and facial fractures. Two meta-analyses were performed using these categories. Nine of the 102 studies identified were included. Helmets were protective against facial injury (OR 0.69, 95% confidence interval 0.63-0.75, P<0.0001). Five studies reported facial fracture rates; helmets were protective against these also (OR 0.79 95% confidence interval 0.70-0.90, P=0.0003). There are no randomized controlled trials on this topic and the number of studies available is small. Bicycle helmets offer protection against facial injuries and this should be considered by cyclists when deciding whether or not to use one.
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Affiliation(s)
- D G Fitzpatrick
- Department of Maxillo-Facial Surgery, Eastbourne Hospital, Eastbourne, UK.
| | - M Goh
- Department of Maxillo-Facial Surgery, Eastbourne Hospital, Eastbourne, UK
| | - D C Howlett
- Department of Maxillo-Facial Surgery, Eastbourne Hospital, Eastbourne, UK
| | - M Williams
- Department of Maxillo-Facial Surgery, Eastbourne Hospital, Eastbourne, UK
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19
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Craig A, Elbers NA, Jagnoor J, Gopinath B, Kifley A, Dinh M, Pozzato I, Ivers RQ, Nicholas M, Cameron ID. The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study. Traffic Inj Prev 2017; 18:273-280. [PMID: 27764546 DOI: 10.1080/15389588.2016.1248760] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated. METHODS An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury. RESULTS Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury. CONCLUSIONS These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.
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Affiliation(s)
- A Craig
- a John Walsh Centre for Rehabilitation Research , Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
| | - N A Elbers
- a John Walsh Centre for Rehabilitation Research , Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
| | - J Jagnoor
- a John Walsh Centre for Rehabilitation Research , Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
- b The George Institute for Global Health, Sydney Medical School, The University of Sydney , Sydney , New South Wales , Australia
| | - B Gopinath
- a John Walsh Centre for Rehabilitation Research , Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
| | - A Kifley
- a John Walsh Centre for Rehabilitation Research , Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
| | - M Dinh
- c Department of Trauma Services , Royal Prince Alfred Hospital , Sydney , New South Wales , Australia
| | - I Pozzato
- a John Walsh Centre for Rehabilitation Research , Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
| | - R Q Ivers
- b The George Institute for Global Health, Sydney Medical School, The University of Sydney , Sydney , New South Wales , Australia
| | - M Nicholas
- d Pain Management Research Institute, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
| | - I D Cameron
- a John Walsh Centre for Rehabilitation Research , Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , St. Leonards , New South Wales , Australia
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20
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 11/13/2022] Open
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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