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Editor,—In a recent edition of Injury Prevention, Leonard and colleagues argue that the monitoring of recent changes in bicycle road safety policy in Scotland require “accurate measurement to generate robust findings” (p303).1 Regrettably what they propose, “a national computerised data collection system for all A&E [accident and emergency] departments” (p304), will not meet their specification. This is primarily because there would be many cyclists who do not attend A&E who have injuries of similar anatomical or physiological severity to those that do attend. There is evidence that the probability of attendance at A&E depends on factors other than injury occurrence, including demographic and access factors such as distance from hospital.2–4 Equally important is that delivery of A&E services may change within and across providers over time in response to changes in health service policy and practice.5
If Scotland wishes to monitor the impact of its transport policy on injury to bicyclists it needs an indicator which ideally meets the following criteria:
The indicator should reflect the occurrence of injury satisfying some case definition of anatomical or physiological damage;
The injury cases ascertained should be important in terms of incapacity, impairment, disability, quality of life, cost, and/or threat to life;
Cases should be completely ascertained from routinely or easily collected data;
The probability of a case being ascertained should be independent of social, and of health services supply and access factors.5
An indicator based on all attendances for injury at A&E departments will not satisfy these criteria. We have argued that, in the context of routinely collected data in England, a reliable indicator is one based on identifying cases of serious long bone fractures admitted to hospital.5 This indicator may be a useful starting point for the measurement of recent changes in bicycle road safety policy where, like in England and Wales, no direct measures of injury severity are routinely collected.
A national computerised data collection system for all A&E departments in Scotland is likely to be expensive. A better use of any additional resources would be to introduce severity coding of injury admissions, and to use an indicator based on serious injury cases to monitor the effect of this and other policy changes.
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