The Epidemiology of Injuries to Bicycle Riders

doi:10.1016/S0031-3955(16)34762-9

Pediatric Clinics of North America

Volume 32, Issue 1, February 1985, Pages 141-151

https://doi.org/10.1016/S0031-3955(16)34762-9 Get rights and content

Over half a million injuries related to bicycle crashes were seen in U.S. hospital emergency rooms in 1982. The data reviewed show a strong link between bicycle/motor vehicle collisions, head injury, and serious morbidity and mortality.

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Cited by (80)

Recent bicycle helmet designs and directions for future research: A comprehensive review from material and structural mechanics aspects
2022, International Journal of Impact Engineering
Citation Excerpt :
Despite the popularity of cycling, it often comes with high level of risk. Head injury is the typical one with the greatest concern [8, 9], as it contributes to one-third of treatment in emergency departments and three-quarter of the deaths [10–12]. Particularly, traumatic brain injury (TBI), known as ‘silent epidemic’, can affect human in a delayed manner regarding thinking, emotion, sensation, etc. [13, 14].
Cycling becomes more and more popular for recreation, exercising and commuting in many countries. Despite the popularity of cycling, it often comes with high level of risk. Conventional bicycle helmets, with expanded polystyrene foam (EPS) liners, can effectively mitigate impact by linear acceleration. However, there has been an urgent call for further improvement in bicycle helmets, as rotational acceleration has been found to be more dominant in severe head injuries. Recent advancements in manufacturing technologies have enabled various novel conceptual ideas and designs of bicycle helmets, which are previously deemed impracticable due to complexities in structures and materials, to become feasible. There are various bicycle helmet designs in terms of structures and materials used in both the helmet shell and liner, targeting at reducing both linear and rotational acceleration. Moreover, inspired by biological structures in nature, bio-inspired structures have been developed rapidly with excellent energy absorption capacity. As a piece of protective equipment, Bicycle helmet is a representative example where researchers are attempting to apply bio-inspired structures. The objective of the paper is to review the development of bicycle helmets and recent exploration for improvement. This includes the history of bicycle helmets, current test standards, designs of conventional bicycle helmets and the latest research (e.g. material replacement and novel structures), as well as application of bio-inspired structures to helmets. This review also identifies the limitations of current designs and standards, and challenges for future investigations.
Unicycle injuries in the United States
2013, Journal of Emergency Medicine
Citation Excerpt :
However, interesting comparisons can be made with reports on bicycle injuries. Unlike this study, where the majority of injuries were related to the extremities, bicycle injury research mostly shows a tendency toward head and neck injuries (7−16). In this unicycle study, very few injuries required admission to the hospital, and none of the admitted patients had head or neck injuries.
Unicycles are single-wheel machines ridden for transportation or recreation. To our knowledge, no studies have been performed that describe injury rates of unicycle use.
The objective of this study was to describe the epidemiological characteristics of unicycle injuries treated in United States (US) emergency departments (EDs).
A retrospective analysis was performed using data from the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission from 1991 through 2010.
An estimated 3360 patients were treated for unicycle injuries from 1991 to 2010, averaging 168 injuries per year in the United States. Ten to fourteen-year-old patients represented 41% of the entire study cohort. Fractures represented approximately one third (32.9%) of all injuries treated. More than half (52.9%) of all injuries involved an extremity. Six of the 85 cases studied involved a head injury; all were aged younger than 18 years. Only 3.53% of all studied cases were admitted for further treatment. The rest were treated in the ED and discharged to home. Fractures were the primary diagnosis in all admitted cases.
Based on NEISS data, unicycle injuries treated in EDs are relatively uncommon and rarely require admission. Of documented injuries, fractures and extremity injuries are most common. Additional research is needed to understand the underlying mechanisms of these injuries as well as the potential need for helmet use advocacy.
Bicycle-related maxillofacial injuries: A double-center study
2013, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
Instead, no further statistically significant associations were observed between FISS, age, gender, date of injury, and site of fracture. The head is a common site of injury following bicycle accidents, with percentages ranging between 14% and 73.9% of all cycling injuries.1-41 In particular, bicycle-related injuries constitute an important etiological mechanism of maxillofacial fractures, being responsible for 1.1%-18% of all maxillofacial fractures according to the various epidemiological studies (Table VII).
Bicycle-related injuries account for an important proportion of road injuries all over the world. As only few reports have focused on the characteristics of maxillofacial fractures sustained in bicycle accidents, the purpose of this study was to present and compare epidemiological data about bicycle-related maxillofacial injuries in two European centers between 2001 and 2010.
Bicycle-related facial fractures occurred in 105 patients (79 males, 26 females) in Turin, with a percentage of 5.77 among all facial fractures, and in 103 patients (55 males, 50 females) in Amsterdam, with a percentage of 19.69.
The major risk groups include young people between their first to third decades. The mandible is the most frequently involved facial bone. Among mandibular injuries the most commonly involved site was the condyle.
Bicycle-related injuries must be considered an important etiological factor in maxillofacial fractures with typical patterns, such as a peculiar seasonal incidence.
Developmental biomechanics of neck musculature
2013, Journal of Biomechanics
Citation Excerpt :
In an effort to ameliorate child safety, helmets and safety systems have been developed to mechanically protect the maturing head and neck. Helmet design aims to protect the skull and brain during an impact and also minimize fatigue and injury to the neck (Friede et al., 1985). Child helmet design has utilized data collected on head dimensions throughout growth and maturation; (Bradtmiller and Shirley, 1995) however, head-to-body allometric relationships throughout development change significantly, where head mass and dimensions may not predict neck muscle ability.
Neck mechanics is central to head injury prevention since it is the musculoskeletal neck, which dictates the position and movement of the head. In the US, traumatic injury is the leading cause of death for children; however prevention is hampered by the lack of data concerning the mechanics of the immature head-and-neck. Thus, the objective of this study was to quantify neck muscle strength and endurance across the maturation spectrum and correlate these with head-and-neck anthropometry. A factorial study was performed on 91 human subjects measuring head-and-neck anthropometry and neck strength and endurance in three bending directions (flexion, extension, and lateral) as a function of age (6–23 years). Using a custom device, neck maximum voluntary contraction (MVC) force was measured in triplicate. Next, neck muscle endurance (sustained effort) was measured as the subjects' ability to maintain 70% of peak force over 30 s. Linear regression of peak force and endurance as a function of age revealed each direction to significantly (p<0.0001) increase with age. The MVC force, averaged across all directions and normalized to the adult values, exhibits the following maturation curve: %MVC Force=−0.0879(age)²+6.018(age)+8.120. Neck muscle strength, similar between young males and females, becomes disparate in adolescence and adulthood with males exhibiting greater strength. Bending direction differences were also found with extension strength being the greatest regardless of age and sex. Furthermore, neck circumference appears predictive of neck strength and endurance in children. Together, these relationships may facilitate improved design of injury prevention interventions.
Trends in head injuries associated with mandatory bicycle helmet legislation targeting children and adolescents
2013, Accident Analysis and Prevention
Citation Excerpt :
These estimates were presented within subgroups of activity (bicycling/pedestrians), age group (<13, 13–17, 18+), sex, and urban/non-urban areas. These variables were chosen as studies have suggested differences in bicycling injury risk according to these factors (Friede et al., 1985; Acton et al., 1995; Powell and Tanz, 2000; Macpherson et al., 2004; Berg and Westerling, 2007; Mehan et al., 2009), differences have been found in Alberta bicycle helmet prevalence by these age groups (Karkhaneh et al., 2011a,b) and pedestrians represented our similarly vulnerable road user control group. The data from 2002 were excluded, since legislation was introduced mid-way through the year.
Bicycling related head injuries (HIs) can be severe. Helmet use reduces head injury risk; however, there are few controlled studies of the effect of helmet legislation. We conducted this study to investigate changes in HIs after bicycle helmet legislation targeting those <18 in Alberta, Canada in 2002.
Bicyclist and pedestrian (control) HI rates and HIs as a proportion of all injuries were compared for the three years (1999–2001) before and four years (2003–2006) after bicycle helmet legislation in three age groups (children: <13, adolescents: 13–17, and adults: 18+).
There were 41,270 ED visits and 2782 hospitalizations for bicyclists and 9836 ED visits and 2029 hospitalizations for pedestrians (excluding the legislation year 2002). The rate of ED HIs declined for child bicyclists and child pedestrians, while the rate of non-HIs declined in adult bicyclists and child pedestrians. The rate of hospitalized HIs declined in child bicyclists and all ages of pedestrians while non-HI rates declined for child and adult pedestrians. Non-HI rates for adolescent and adult bicyclists increased. After adjusting for sex and location, the proportion of ED bicycle HIs declined by 9% (APR = 0.91; 95% CI: 0.86, 0.95) in children, was unchanged among adolescents and increased in adults (APR = 1.08; 95% CI: 1.01, 1.15). The proportion of bicycle HI related hospitalizations decreased by 30% (APR = 0.70; 95% CI: 0.55, 0.90) in children, 36% (APR = 0.64; 95% CI: 0.49, 0.84) in adolescents and 24% (APR = 0.76; 95% CI: 0.63, 0.91) in adults. There were no observed changes in the proportion of pedestrian HIs resulting in ED visits or hospitalizations.
Our data indicate significant declines in the proportion of child bicyclist ED HIs and child, adolescent and adult bicyclist HI hospitalizations. This is in contrast to no significant trends in the proportion of ED or hospitalized HIs among pedestrians and the unexpected increases in the proportion of ED HIs for adult bicyclists. Comparing bicyclist and pedestrian trends in the proportion of child and adolescent HIs suggests a bicycle helmet legislation effect.
Bicycle helmets: Their role in injury prevention
1999, Current Paediatrics
As part of the ‘Our Healthier Nation’ targets, along with the Government's road casualty reduction targets, a more active stance must be taken if we are to move more effectively to promote helmets as a method of health protection. We believe health professionals have a direct responsibility to advocate helmet use. A unified display in hospital units, casualty departments, health centres, dentists' waiting rooms and schools could bring about greater awareness and more encouragement of helmet use.
Brain injuries are devastating. Bicycle helmets have a proven place in their reduction. Any further procrastination will be measured in more human loss.

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: Massachusetts Department of Public Health, Boston, Massachusetts 02111

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The Epidemiology of Injuries to Bicycle Riders

Bicycle helmets: Which one?

Bicycling

Identification and development of countermeasures for bicyclist/motor vehicle problem types. Vol. I. Methods and Training Program Description. Vol. II. Public Information and Education Messages. Vol. III. Model Regulations

DOT Pub. Nos. H5-806-326, 327, 328

Bicycle safety education

Study of Bicycle/Motor Vehicle Accidents: Identification of Problem Types of Countermeasure Approaches. Vols. I and II. DOT-HS-803-315 and DOT-HS-803-316

Fatal injuries to bicyclists: the experience in Dade County

Florida. J. Trauma

Effective cycling instructor’s manual

Bicycle injuries: One-year sample in Calgary

J. Trauma

150 bicycle injuries in children: A comparison with accidents due to other causes

Injury

Head injuries in childhood: A 2- year survey

Can. Med. Assoc. J.