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Epidemiology of bicycle injuries and risk factors for serious injury
F P Rivara1, D C Thompson, R S Thompson
1Harborview Injury Prevention and Research Center, Department of Pediatrics and Epidemiology, University of Washington, Seattle USA.
Objective:
To determine the risk factors for serious injury to bicyclists, aside from helmet use.
Design:
Prospective case-control study.
Setting:
Seven Seattle area hospital emergency departments and two county medical examiner's offices.
Patients:
Individuals treated in the emergency department or dying from bicycle related injuries.
Measurements:
Information collected from injured bicyclists or their parents by questionnaire on circumstances of the crash; abstract of medical records for injury data. Serious injury defined as an injury severity score > 8.
Analysis:
Odd ratios computed using the maximum likelihood method, and adjusted using unconditional logistic regression.
Results:
There were 3854 injured cyclists in the three year period; 3390 (88%) completed questionnaires were returned 51% wore helmets at the time of crash. Only 22.3% of patients had head injuries and 34% had facial injuries. Risk of serious injury was increased by collision with a motor vehicle (odds ratio (OR) = 4.6), self reported speed > 15 mph (OR = 1.2), young age (< 6 years), and age > 39 years (OR = 2.1 and 2.2 respectively, compared with adults 20-39 years). Risk for serious injury was not affected by helmet use (OR = 0.9). Risk of neck injury was increased in those struck by motor vehicles (OR = 4.0), hospitalized for any injury (OR = 2.0), and those who died (OR = 15.1), but neck injury was not affected by helmet use.
Conclusions:
Prevention of serious bicycle injuries cannot be accomplished through helmet use alone, and may require separation of cyclists from motor vehicles, and delaying cycling until children are developmentally ready.