Bicycle-related Injuries Research Articles

Trends in All-terrain Vehicle Injuries From 2000 to 2015 and the Effect of Targeted Public Safety Campaigns.

All-terrain vehicles (ATVs) represent a notable portion of orthopaedic injuries presenting to emergency departments (EDs) in the United States. Public awareness campaigns have targeted these injuries, and this study sought to examine the effect of the 2007 American Academy of Orthopaedic Surgeons public safety campaign on ATV use. The United States Consumer Product Safety Commission National Electronic Injury Surveillance System (NEISS) was used to obtain national estimates of ATV and dirt bike injuries for the years 2000 to 2015. ED visits resulting from ATV injuries and dirt bike injuries were identified using NEISS product codes (ie, 3285-3287, 3296, and 5036). Patient demographics, injury-related data, and total annual case numbers were estimated. Chi-square tests and logistic regression were used for comparative analyses as appropriate. All statistical analyses were performed using SAS statistical software v.9.4 (SAS Institute). Statistical significance was set at P < 0.05 a priori. Beginning in 2000, the incidence of ATV injuries consistently increased over time and peaked in 2007 (54.1/100,000 people). Since 2007, the incidence of ATV injuries has consistently decreased (33.7/100,000 people in 2015). The frequency of ATV injuries differed significantly (P < 0.001) by age group, with children aged 14 to 17 years experiencing the highest incidence of ATV injury (2.8× national average). ATV injuries were also more common in males (2.7× national average; P < 0.001). The most common injuries were contusions and abrasions (25.3%), fractures (24.5%), and lacerations (11.4%). The decreased rate of ATV injury beginning in 2007 did not differ significantly (P = 0.81) from a comparative decrease in dirt bike-related injuries. This study provides the most current data on ATV injuries presenting to EDs in the United States. The rate of ATV-related injuries has steadily decreased since 2007, which corresponds to the American Academy of Orthopaedic Surgeons public awareness campaign. However, the reasons for this decrease are likely multifactorial. Children aged 14 to 17 years are at high risk of ATV-related injuries, with orthopaedic injuries accounting for a notable proportion.

Characteristics and risk factors of bike-related accidents: Preliminary analysis.

The growing popularity of cycling not only enhances self-efficacy, physical well-being and improves quality of life, but it also leads to the increasing number of bike-related injuries. The aim of this study was to characterize the population of cyclists in Poland, assess the occurrence of safety behaviors among them and to precise the risk factors for bike accidents. Additionally, we analyzed bike-related injuries. The survey was based on a 39-item questionnaire created for this study. We collected data concerning the demographical status of respondents, their cycling preferences, attitude toward safety behaviors during cycling, and the characteristics of bike-related injuries. Our research covered 729 people who declared themselves as cyclists (302 women - average age: 31.5 ±10.3 years; 427 men - average age: 32.6 ±10.7 years). In the study, 71.3% of the interviewees declared that they did not always wear helmets. Women more often than men claimed that they did not always use head protection (p < 0.001). Among 729 people, 277 suffered from bike-related injuries. In this group, we noted 870 accidents that resulted in 1,671 different injuries. In our study, wearing helmets did not influence the region of trauma nor its type (p < 0.05). We noted 811 injuries of the upper extremities and 541 of the lower extremities. Young men constitute the main group of cyclists in Poland. The risk factors for bike-related accidents in our study proved to be: educational level (secondary education and incomplete higher education), number of children (having at least 3 children), frequency of using a bike (the more often, the more injuries), type of bike used (mountain bikes and fold-up bikes), and frequency of using a helmet (using helmets was correlated with a higher rate of injuries). The upper and lower extremities were the most common location of injuries.

Value of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries.

To characterise patients presenting to EDs for a bicycle-related injury, identify contributing factors to the injuries and describe the data gaps. 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. 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. 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.

Bicycle-related injuries among children treated in US emergency departments, 2006-2015

ObjectiveOne of the leading causes of non-fatal injury among children is bicycling. Past studies indicate that helmets are protective against bicycle-related injuries and involvement of motor vehicles is associated with severe injuries, but research utilizing a nationally representative data set for this population and focusing on these risk factors does not exist. The objective of this study was to describe the epidemiology of bicycle-related injuries among children treated in hospital emergency departments (EDs) in the United States (US). MethodsA retrospective analysis was conducted with data from the National Electronic Injury Surveillance System for children 5–17 years of age who were treated in US EDs from 2006 through 2015 for a bicycle-related injury. Helmet use and motor vehicle involvement were two variables that were created and coded using keyword searches of the case narratives. Rates of injuries over time were described. Multivariate logistic regression along with 95% confidence intervals (CIs) were used to contrast types of injuries sustained among injured helmet users with non-users. ResultsAn estimated 2 219 742 (95% CI: 1 871 120-2 568 363) children 5–17 years of age were treated in US EDs for bicycle-related injuries over the 10-year study period, an average of 608 injuries per day. Most injuries (45.7%) involved children 10–14 years of age. The rate of bicycle-related injuries significantly decreased from 447.4 per 100 000 children in 2006 to 321.1 per 100 000 children in 2015 (P < 0.001). Helmet use at the time of injury was significantly associated with lower likelihood of head and neck injuries (OR: 0.52 [95% CI: 0.40-0.59]) and hospitalizations (OR: 0.71 [95% CI: 0.54-0.94]), but there was no significant change in the rate of injury among helmet users over the study period (P = 0.224). Motor vehicle involvement increased the odds of bicycle-related traumatic brain injuries (TBIs) (OR: 1.98 [95% CI: 1.49–2.64]) as well as injury-related hospitalizations (OR: 4.04 [95% CI: 3.33–4.89]). ConclusionsDespite decreasing injury rates, bicycling remains an important source of injury for children. Helmet use has demonstrated significant protective effects for TBIs, head and neck injuries, and hospitalizations. Motor vehicle involvement increased the risk of hospitalization. More efforts are needed to promote use of helmets and to reduce the possibility of bicycle-motor vehicle collisions to prevent bicycle-related injuries among children.

Pediatric bicycle helmet legislation and crash-related traumatic brain injury in Illinois, 1999-2009

BackgroundBicycling is one of the most popular forms of play and exercise for children in the US. However, over 200,000 children per year are injured in bicycle crashes, and an estimated 22,000 pediatric bicycle-related traumatic brain injuries (TBIs) occur annually. Bicycle helmets are known to decrease the risk of head injury, but efficacy and magnitude of the effect of helmet legislation have not been fully elucidated. MethodsThis was a retrospective, observational study of children aged <18, who presented after a bicycle crash in Illinois from 1999 to 2009. Demographic information, injury types, injury severity, helmet usage, and location of injury data were collected. Multiple logistic regression analysis was used to quantify the independent effects of helmet usage on TBI. Data were compared between communities with and without helmet legislation. ResultsA total of 3080 pediatric bicycle-related crashes were identified. Children wearing helmets were less likely to sustain a TBI, odds ratio [OR] = 0.56 (95% confidence interval [CI] 0.37-0.84, P < 0.001). Overall 5.0% of patients were noted as wearing helmets. Black and Hispanic children were less likely to wear helmets, OR = 0.24 (95% CI 0.09-0.68, P < 0.001) and OR = 0.10 (95% CI 0.02-0.42, P < 0.001), respectively. There was no significant change in helmet usage between before and after legislation in helmet legislation areas or over time in non–helmet legislation areas. DiscussionHelmet use was protective against TBI, but socioeconomic and racial disparities exist in usage. Local legislation did not appear to impact helmet usage or admissions for bicycle-related TBIs in these areas.

3D assessment of damaged bicycle helmets and corresponding craniomaxillo-mandibular skull injuries: A feasibility study

ObjectivesIn the Netherlands, cyclists continue to outnumber other road users in injuries and deaths. The wearing of bicycle helmets is not mandatory in the Netherlands even though research has shown that wearing bicycle helmets can reduce head and brain injuries by up to 88%. Therefore, the aim of this study was to assess the feasibility of using 3D technology to evaluate bicycle-related head injuries and helmet protection. MethodsThree patients who had been involved in a bicycle accident while wearing a helmet were subjected to multi-detector row computed tomography (MDCT) imaging after trauma. The helmets were separately scanned using the same MDCT scanner with tube voltages ranging from 80kVp to 140kVp and tube currents ranging from 10mAs to 300mAs in order to determine the best image acquisition parameters for helmets. The acquired helmet images were converted into virtual 3D surface hence Standard Tessellation Language (STL) models and merged with MDCT-derived STL models of the patients’ skulls. Finally, all skull fractures and corresponding helmet damage were visualized and related. ResultsImaging bicycle helmets on an MDCT scanner proved to be feasible using a tube voltage of 120kVp and a tube current of 120mAs. Merging the resulting STL models of the patients’ skull and helmet allowed the overall damage sustained by both skull and helmet to be related. ConclusionOur proposed 3D method of assessing bicycle helmet damage and corresponding head injuries could offer valuable information for the development and design of safer bicycle helmets.

The spectrum and outcome of paediatric traumatic brain injury in KwaZulu-Natal Province, South Africa has not changed over the last two decades.

This retrospective review of a prospectively entered and maintained hybrid electronic trauma registry was intended to develop a comprehensive overview of traumatic brain injury (TBI) in children and adolescents and to compare it with previous audits from our local environment and from other developing world centres. All TBI patients admitted to hospital were included in this study. We reviewed the age, gender, outcomes, radiological findings and treatment of the patients. All patients aged ≤18 years old who were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS) with TBI between December 2012 and December 2016 were included in this audit. During the 4-year period under review, a total of 563 children and adolescents were treated for TBI by the PMTS. The median age was 6.4 years and 29% (n=165) were females. The mechanism of TBI was blunt trauma in 96% (n=544) of cases, with 4% (n=19) suffering penetrating trauma. The penetrating mechanisms included impalement by a cow horn and miscellaneous injuries due to saws, axes, barbed wire, spades, stones and knives. The blunt mechanisms included falls (n=102), assaults (n=108), collapse of a building (n=28), bicycle-related injury (n=14), falling off a moving vehicle (n=280), motor vehicle accident (MVA; n=59), pedestrian vehicle accident (PVA; n=183) and animal-related injuries (n=8). There were 454 (80%) mild, 67 (12%) moderate and 42 (7%) severe cases of TBI. A total of 48 patients were admitted to the intensive care unit and 23 were admitted to the high care unit. Nine patients died. All the deaths were in the MVA and PVA group. The spectrum of TBI as diagnosed on computed tomography scans was nonspecific cerebral contusion (n=92), depressed skull fracture (n=70), sub-arachnoid haemorrhage (n=60), extradural haemorrhage (n=41), intracerebral haemorrhage (n=19), free air (n=19), subdural haemorrhage (n=13), intraventricular haemorrhage (n=9). A total of 62 (11%) patients required surgery. There is a significant burden of paediatric TBI in Pietermaritzburg. The majority of TBI was related to blunt trauma and assaults were very common. Although the short-term outcomes are good, the long-term consequences are poorly understood. Injury prevention programmes are needed to help reduce this burden of disease and a nationwide trauma registry is long overdue.

Trends in the incidence and outcomes of bicycle-related injury in the emergency department: A nationwide population-based study in South Korea, 2012-2014.

ObjectiveThis study aimed to examine trends in the incidence and outcomes of bicycle-related injuries in emergency departments (ED) in South Korea.MethodsWe analysed data from the National Emergency Department Information System database for adult patients (≥20 years) with bicycle-related injuries presenting to EDs in South Korea between January 2012 and December 2014. Riders and bicycle passengers whose injuries were associated with bicycle use were included. Serious outcomes were defined as death at the ED, need for emergency operation, or intensive care unit admission.ResultsThe number of people who commute to work by bicycle increased by 36% from 205,100 in 2005 to 279,544 in 2015. Of 529,278 traffic-related trauma cases, 58,352 (11.0%) were bicycle-related, which increased from 7,894 (10.2%) in the first half of 2012 to 12,882 (12.2%) in the second half of 2014 (p < 0.001). However, the proportion of serious outcomes decreased from 5.0% to 4.2% during the study period (p < 0.001). Serious outcomes were most frequent in the elderly (65–74 years) and older elderly (≥75 years) groups and decreased for all but the elderly age group from 10.3% to 9.8% (p = 0.204). The helmet use rate increased from 14.2% to 20.3% (p < 0.001) but was the lowest in the older elderly group (3.6%) without change during the study period (from 4.7% to 3.7%, p = 0.656). A lack of helmet use was significantly associated with serious outcomes (odds ratio, 1.811; 95% confidence interval, 1.576–2.082).ConclusionsAlthough the incidence of bicycle-related injuries increased, the proportion of serious outcomes decreased, possibly due to increased helmet use. Public education on safety equipment use is required, especially in elderly populations.

Bicycle and helmet use of adolescents in Markham, Canada.

Bicycle crashes are the second most common sports- or recreation-associated cause of serious injury. While the literature suggests that wearing protective helmets can significantly decrease risks associated with bicycle-related injuries, overall helmet use remains sub-optimal. A recent study by Chow et al. suggested that helmet-wearing rates in adolescent boys are negatively correlated with age. The aim of this study was to determine if similar trends are observed in a co-educational high school setting. A questionnaire was circulated at Unionville High School, a co-ed public high school in Markham, Canada. Of the 144 participants, 27 of them were in Grade 9 or 10, and 117 of them were in Grade 11 or 12. While there was no statistical difference between helmet-wearing rates in Grade 9-10 and Grade 11-12 students, overall usage rates were low (41% and 38%, respectively, for recreational cyclists). This trend is interesting, considering that nearly 90% of all students were aware that wearing a helmet while cycling is required under Ontario law. Further studies should be conducted among the young adult population to determine whether the alarming trends discovered by this study and Chow et al. continue.

Electric bicycle-related injuries presenting to a provincial hospital in China: A retrospective study.

The use of electric bicycles (EBs) in China is growing. In the present study, we aimed to characterize the pattern and outcomes of EB-related injuries presenting to a major general hospital in China.This was a retrospective review of EB-related injuries presenting to Zhejiang Provincial People's Hospital from 2008 to 2011. Cases were identified from medical records according to diagnosis codes. Data captured included demographics, injury characteristics, and outcomes.A total of 3156 cases were reviewed in the present study. There were 1460 cases of traffic accidents, of which 482 cases were EB-related (32.7%). In addition, most of EB-related cases (44.6%) belonged to the 41- to 60-year-old age group. Median injury severity score was 10. Moreover, 34.9% underwent surgery and 24.7% were admitted to intensive care unit. The median hospitalization cost was 14,269 USD. Fracture (56.5%) was the most frequently diagnosed injury type, and head was the most commonly injured body region (31.1%).EB-related injuries have become a major health concern, making up a sizeable proportion of injuries presenting to the emergency department. Therefore, it is necessary to establish injury prevention and strategies for EB road safety. Implementation of policy such as compulsory helmet use, as well as popularization of EB road safety education should be considered to improve the current situation of EB-related injuries in China.

Emergency department outpatient treatment of alcohol-intoxicated bicyclists increases the cost of medical care in Japan.

Riding a bicycle under the influence of alcohol is illegal in Japan. Nevertheless, intoxicated bicyclists are frequently treated at hospital emergency departments for bicycle-related injuries. This patient population usually requires more hospital resources, even for relatively minor injuries. Therefore, we hypothesized that bicycle-related crashes involving bicyclists under the influence of alcohol cost more to treat than those that do not involve alcohol intoxication. The aim of the present study was to examine the costs associated with bicycle-related minor injuries and alcohol intoxication of the bicyclist. The study was conducted at the Tokyo Bay Urayasu Ichikawa Medical Center Emergency Department, Japan. All minor bicycle crashes involving 217 individuals aged ≥20 years treated from September 1, 2012 to August 31, 2013 were included in the analysis of data obtained from medical records. Variables included alcohol intoxication, sex, age, collision with a motor vehicle, Glasgow Coma Scale, injury severity score (ISS), laboratory tests, treatment of wounds, number of X-ray images, number of computed tomography scans, and medical costs. Multiple linear regression analysis was performed to evaluate the association between alcohol intoxication and medical costs. Seventy (32%) patients consumed alcohol, and the median medical cost was 253 USD (interquartile range [IQR], 164–330). Multivariable analysis showed that alcohol intoxication was independently associated with higher medical costs (p = 0.030, adjusted R-square value = 0.55). These findings support our hypothesis and should encourage authorities to implement comprehensive measures to prohibit bicycling under the influence of alcohol to prevent injuries and to reduce medical costs.

Risk factors of bicycle traffic injury among middle school students in chaoshan rural areas of china

BackgroundBicycle 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.MethodsWe 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.ResultsMultivariable 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.ConclusionBicycle 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.

Epidemiology and Risk Factors for Bicycle-Related Severe Head Injury: A Single Center Experience.

ObjectiveHead 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.MethodsA 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.ResultsCollisions 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.ConclusionIn 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.

Orthopedic injury in electric bicycle-related collisions

ABSTRACTObjective: Although electric bicycle-related injuries have become the most common reason for hospitalization due to a road crash in China, no study has comprehensively investigated electric bicycle collisions and their impact on orthopedic injuries; such a study may provide evidence to support a new road safety policy.Methods: A retrospective review of orthopedic injuries from electric bicycle collisions was performed in an urban trauma center. We collected variables including age, gender, location of fracture, presence of open or closed fractures, concomitant vascular, and neurologic injuries.Results: A total of 2,044 cases were involved in electric bicycle collisions. The orthopedic injury victims were predominantly male and middle aged. The most common orthopedic injury was a femur fracture. Open fractures frequently involved the forearm and tibia/fibula. Male patients were more likely to suffer from multiple fractures and associated injuries than female patients. Fewer patients age 60 years old or older wore helmets at the time of the accident compared to those in other age groups.Conclusions: Orthopedic injuries from electric bicycle-related accidents cause patients substantial suffering that could lead to serious social consequences. Helmet use and protective clothing or similar safety gear, especially for electric bicycle users, should be required to provide greater protection.

DUI histories in intoxicated injured bicyclists.

It has been well documented that the use of alcohol correlates with injury risk, especially in DUI (driving under the influence) and DWI (driving while intoxicated). Consumption of alcohol in patients presenting with bicycle-related injuries is associated with greater injury severity, longer hospitalization, and higher health care costs. We hypothesized that intoxicated patients operating a bicycle with traumatic injuries have previous DUI or DWI convictions and had lost their privilege to drive a motor vehicle, resorted to bicycling, and had continued alcohol consumption despite negative previous consequences. We retrospectively collected data on injured bicyclists older than 18 years with positive blood alcohol content levels treated from the period January 2009 to June 2014 at a large Level 1 urban trauma center. We then matched each patient by name and date of birth and were able to obtain public criminal records through the Superior Court of California for the local of county. A total of 149 injured bicyclists with positive blood alcohol levels were identified. Their average blood alcohol content was 236.0 mg/dL, and their average age was 41 years. Sixty-six (44.2%) of these patients had prior DUI/DWI convictions with suspension of driving privileges. Ninety-five patients in this group (63.8%) had no health insurance, and 51 patients (34.2%) tested positive for other drugs. Intoxicated bicyclists trended toward longer hospital length compared with nonintoxicated bicyclists (4.60 vs. 3.44 days; p = 0.07). Three (0.02%) of 149 patients were charged with bicycling while intoxicated. Intoxicated bicyclists involved in trauma are more likely to have a previous DUI/DWI, have other drug use, tend to have longer hospital stays, and are less likely to have insurance. Bicycle safety education and behavior modification targeting DUI/DWI offenders are warranted. In order to promote injury prevention, resources to increase awareness of this underestimated public health issue should be promoted. Epidemiologic study, level III.

Long-Term Effects of Education and Legislation Enforcement on All-Age Bicycle Helmet Use: A Longitudinal Study.

Bicycle-related injuries are a leading cause of child and youth hospitalizations in Canada. The use of helmets while bicycling reduces the risk of brain injuries. This study investigated the long-term effect of legislation coupled with enforcement to improve helmet use rates. We conducted a longitudinal observational study of helmet use at 9, 11, and 14years after bicycle helmet legislation was enacted. Data were compared to baseline observations collected after legislation was passed in 1997. A comprehensive enforcement and educational diversion program, Operation Headway-Noggin Knowledge (OP-NK), was developed and implemented in partnership with regional police during the study period. Helmet use was sustained throughout the post-legislation period, from 75.3% in the year legislation was enacted to 94.2% 14years post-legislation. The increase in helmet use was seen among all age groups and genders. Helmet legislation was not associated with changes in bicycle ridership over the study years. OP-NK was associated with improved enforcement efforts as evidenced by the number of tickets issued to noncompliant bicycle riders. This observational study spans a 16-year study period extending from pre-legislation to 14years post all-age bicycle helmet legislation. Our study results demonstrate that a comprehensive approach that couples education and awareness with ongoing enforcement of helmet legislation is associated with long-term sustained helmet use rates. The diversion program described herein is listed among best practices by the Public Health Agency of Canada.

Bicycle-Related Injuries Presenting to Tabriz Imam Reza Hospital, Iran.

BackgroundRising fuel cost and subsequent increase in transportation prices encourage people to use cheap transportation such as a bicycle. This vehicle can also be used for sports and recreation. Bicycles are widely used in Iran, like other countries. There is not enough data about bicycle-related traumas in our country.ObjectivesThe aim of this study was to obtain the epidemiology of this type of injury in Tabriz Imam Reza Hospital as a referral center in northwest of Iran during 2009 to 2012.Materials and MethodsOne hundred bicycle-related patients during the three years were entered in this descriptive cross-sectional study. Patient’s demographics, place and time of crash, mechanism of trauma, helmet and other safety device usage, and disposition information were gathered by a researcher-made checklist. Admission rate and ward as well as the site of injuries were also collected. The data were analyzed by SPSS 16 software using descriptive statistics.ResultsAll the patients were males with a mean age of 31.3 ± 23.12. Seventy six bicycle-related injuries occurred during weekdays and 24 happened on holidays; 71 patients attended the emergency department in the morning and 29 at night. Only three of 100 cyclists had helmets during the accident. The rates of injuries were as follows: 65 head and face, 20 abdomen, 14 chest, 11 soft tissue, eight lower limb, eight cervical spine, six upper limb, four thoracic and lumbar spine, and three pelvis injuries.ConclusionsHead and face are the most common sites of injury and skull fracture is the most common one. Considering the preventable entity of trauma, the use of helmets seems to be beneficial to prevent most bicycle-related injuries.

Bicycle handlebar injuries in children: Is “ring sign,” an indicator of intra?abdominal organ injuries?

Background: Children are vulnerable to a wide range of bicycle-related traumatic injuries. Bicycle handlebar injuries often cause diagnostic dilemma and delay in diagnosis due to trivial nature of the incident. Objectives: To study the bicycle handlebar injuries in children and their management. Materials and Methods: A retrospective review of all the children with blunt abdominal injuries secondary to bicycle handlebar injuries at our institution, between April 2011 and March 2015 was done. The patient medical records were examined, and all the data pertaining to the demographic information, clinical history, hematological investigations, imagingstudies, operative technique, post-operative recovery and complications, and duration of hospitalization were obtained. Results: During the study period of 48-month, 26 children with blunt abdominal injuries were treated at our institution. Among these patients, 7 children had bicycle handlebar abdominal injuries. All 7 patients were male. Mean age of the patients was 9.6 years (range 5-12 years). The average time gap between trauma and presentation to our institution was 46 h (range 22-96 h). All the 7 children had circular patternedabrasion of the bicycle handlebar over the abdominal wall. Mean duration of hospital stay was 16.1 (range: 9-28) days, and the average duration of follow-up was 35.6 months (range 7-55 months). Conclusion: “Ring sign” indicates a higher probability of associated intraabdominal injury, and these children should be thoroughly evaluated and managed with close observation, repeated clinical examination, appropriate imaging studies, and surgical or endoscopic intervention as required.

Participation to the Tour of Turkey as an Emergency Physician

The Presidential Cycling Tour of Turkey (TUR) is a multi-day, prestigious, annual bicycle road race organized by the Turkish Cycling Federation with increasing popularity among elite athletes. The race started in Alanya, and it followed Mediterranean and Aegean coasts to Izmir. Istanbul is home to the spectacular finish. There were 166 athletes representing 21 teams, and they covered 1260 km over 8 days (124–185 km/day) (1). The 51st TUR was held between April 26 and May 3, 2015. A health team was organized by an emergency medicine (EM) residency-trained physician who is an associate professor and has participated in TUR for the past 4 years as well as by two senior residents from Dokuz Eylul University. In addition, 112 teams from Izmir with ambulances participated in the health team. Medical care was provided before and after the race at the start and finish lines, respectively, as well as during the race by physicians in moving vehicles (riders were re-examined after the stage) and on the scene of crashes. It is known that emergency physicians and residents provide health care for several mild to severely traumatized patients in their daily practice. Hence, bicycle-related injuries are referred to emergency departments, and emergency residents and attendants treat these patients. Based on this observation, it can be indicated that emergency experts are familiar with bicycle race-related injuries. On the other hand, non-traumatic medical problems are common in these types of organizations (2). Even simple diarrhea can be troublesome for athletes during race; hence, the management of non-traumatic medical complaints is also essential. Riders are different from patients in an emergency department. The riders do not have a tendency to worry much about minor injuries and mostly wish to continue racing. Most injuries require rapid and minimal interventions on the track, and the finish zone is more appropriate for advanced interventions. The abovementioned situations need the agility of emergency physicians. Although minor injuries are common in these races, life-threatening accidents as well as trauma-associated fatalities can be seen in elite bicycle races on roads. Cyclists ride at a speed of 40–50 km/h on a straight road, and they reach a speed of approximately 90–100 km/h downhill; hence, one can estimate the severity of injury. In this race, after an accident, one of the athletes had multiple rib fractures; in addition, pneumothorax needed tube thoracostomy. This indicates the importance of an emergency expert who can manage patients with a holistic approach. Although not seen in this race, it is known that sudden cardiac event may occur during elite organizations (3). These kinds of severe cases need the intervention of qualified physicians; hence, specific procedures including airway management, defibrillation, and cardiopulmonary resuscitation must be performed by experienced specialists. Emergency medicine has various patients and field diversity. In the United States (US), there are several fellowship training programs for EM Residency Graduates. Sport medicine is becoming the center of attention for emergency physicians in the US (4, 5). Sport medicine is still not popular in the EM community of Turkey, but sport-related traumas are already treated in emergency departments; thus, emergency physicians are familiar with these injuries. Although in Turkey, sport medicine is not yet a fellowship program of EM, it seems to be an interesting and unexplored area. Thus, sport medicine as well as the fellowship program of EM in Turkey must be taken into consideration.

Safety–critical events in everyday cycling – Interviews with bicyclists and video annotation of safety–critical events in a naturalistic cycling study

Research in cycling safety seeks to better understand bicycle-related crashes and injuries. The present naturalistic cycling study contributes to this research by collecting data about bicyclists’ behavior and impressions of safety–critical situations, information unavailable in traditional data sources (e.g., accident databases, observational studies). Naturalistic data were collected from 16bicyclists (8female; M=39.1years, SD=11.4years) who rode instrumented bicycles for two weeks. Bicyclists were instructed to report all episodes in which they felt uncomfortable while riding (subjective risk perception), even if they didn’t fall. After data collection, the bicyclists were interviewed in detail regarding their self-reported safety–critical events. Environmental conditions were also recorded via video (e.g., road surface, weather). In total, 63 safety–critical events (56 non-crashes, 7crashes) were reported by the bicyclists, mainly due to interactions with other road users – but also due to poorly maintained infrastructure. In low-visibility conditions, vehicle-bicycle and bicycle-bicycle events were the most uncomfortable for the bicyclists. Self-reported pedestrian–bicycle events primarily consisted of pedestrians starting to cross the bicycle path without looking. With one exception, all crashes found in the study belonged to poorly maintained road and infrastructure. In particular, construction work or obstacles in the bicycle path were reported as uncomfortable and annoying by the bicyclists. This study shows how naturalistic data and bicyclists’ interviews together can provide a more informative picture of safety–critical situations experienced by the bicyclist than traditional data sources can.