Bicycle Injuries Research Articles

The Burden of Injuries Associated With E-Bikes, Powered Scooters, Hoverboards, and Bicycles in the United States: 2019‒2022.

Objectives. To describe the national burden of injuries associated with e-bikes, bicycles, hoverboards, and powered scooters (micromobility devices) in the United States. Methods. We compared patterns and trends for 1 933 296 estimated injuries associated with micromobility devices from 2019 to 2022 using National Electronic Injury Surveillance System data. Results. The population-based rates of e-bike and powered scooter injuries increased by 293.0% and 88.0%, respectively. When reported, powered scooter injuries had the highest proportion for alcohol use (9.0%) compared with other modes, whereas e-bike injuries had the highest proportion for motor vehicle involvement (35.4%). Internal injuries were more likely among e-bike diagnoses than hoverboard and bicycle (P < .05), but fractures and concussions were more likely among hoverboard diagnoses compared with all other devices (P < .05). When helmet use was identified in clinical notes (20.3%), helmet usage was higher among e-bike injuries (43.8%) compared with powered scooter (34.8%) and hoverboard (30.3%) injuries but lower compared with bicycle injuries (48.7%). Conclusions. The incidence of severe e-bike and powered scooter injuries increased over the 4-year period. Public health stakeholders should focus on improved surveillance and prevention of injuries associated with electric micromobility devices. (Am J Public Health. 2024;114(12):1365-1374. https://doi.org/10.2105/AJPH.2024.307820).

Trends and Patterns in Bicycle Injuries: The Significance of Protective Equipment.

Introduction This research presents a five-year comprehensive analysis of trends and efficacy related to helmetand protective equipment use in bicycle-related incidents. Our areas of comparison included injury severity, hospital stay, theGlasgow Coma Scale(GCS) scores, and demographic data. In light of the current increasein bicycle use popularity, this study aimed to provide clear information regarding the significance of protective equipment to combat the surge in bicycle-related incidents in recent years. Methods A retrospective analysis was performed using the National Trauma Data Standard (NTDS) as a data source. Our inclusion criteria considered the mechanism of injury involving bicycle incidents, narrowing our pool of patients to 135,605. These cases were screened based on the following parameters: use of helmet/protective equipment, demographic criteria, and several other injury markers. Statistical analyses, including two sample t-tests, were performed using SAS. Results A total of 5.7 million patients were screened for inclusion criteria, yielding 135,605 cases involving bicycle-related injuries between 2018 and 2022. Of the patients who met the inclusion criteria, patients wearing helmets had an overall high GCS score (p<0.001) and decreased hospital stay (p<0.001) compared to those without helmet use. Similar findings were drawn related to protective equipment use and GCS (p<0.001). The Injury Severity Score (ISS) on average was higher for those wearing helmets (p<0.001). Overall, an increase in helmet use was noted for the years in question (R2=0.467). Additional observations made include large variations in helmet use in different age groups. Patients aged <17 yearswore helmets in just 6,514 (22%) cases while those aged +65 years wore helmets in 10,925 (51%)cases. Conclusions This study observed a statistically significant difference between GCS values in helmet/non-helmet-wearing groups. Similar findings were found regarding other protective equipment use as well. A statistically significant difference was also found regarding increased ISS with helmet use. This challenges our current assumptions aboutimproved injury severity with the use of protective equipment. In line withother studies, we determined that helmet use tends to decrease the level of injuries on the head. Overall, helmet use has increased in the past five years, but several demographic groups were found towear protective equipment less often. We recommend future research that focuseson understanding the trends in protective equipment use among bicycle-riding individuals under the age of 25 years, Native Americans, and African Americans. Continued research regarding injury reduction interventions is of utmost importance, especially given the widespread increase in the popularity of bicycle use.

Econometric approaches to examine the onset and duration of temporal variations in pedestrian and bicyclist injury severity analysis

There is considerable evidence in existing safety literature that the exogenous variable effects are likely to be time-varying in the injury severity analysis. The majority of these earlier studies tested time-varying effects of exogenous variables by crash year. However, there might be variability in the variable effects within a year, while the same effect might carry over in some or all parts of the preceding years. Towards that end, in this study, we propose a flexible framework to identify when the time-varying effect is likely to occur (the onset of temporal variation) and how long such time-varying effect lasts (duration of temporal variation) in the model estimates. In the study design, we assume that the onset of temporal variation can be any quarter of a year under consideration, while the time-varying effect can continue over different quarters after the onset of temporal variation in a variable effect. The injury severity model is estimated by using Correlated Random Parameter Generalized Ordered Logit formulation with piecewise linear functions. The empirical analysis is demonstrated by employing active traveler (pedestrian and bicyclist) crash data from Queensland, Australia for the years 2015 through 2020. The estimation results are further augmented by computing elasticity effects. The results indicate that the time-varying effects are likely to be different across years for several variables, while for other variables, the onset of time-varying effects could be different than the start of a year. Such flexibility in model specification is likely to have significant implications for devising and implementing effective countermeasures since it allows us to understand how road traffic injuries are evolving over time and when a new road safety issue might be arising.

The role of posted speed limit on pedestrian and bicycle injury severities: An investigation into systematic and unobserved heterogeneities

The posted speed limit, as a proxy of actual speed, is one of the most fundamental predictors of active travelers’ (pedestrian and bicyclist) injury outcomes when involved in crashes with motor vehicles. Although earlier studies predominantly considered posted speed limit as an exogenous variable and provided highly insightful findings, majorities of them assume the effects of active traveler behavior to remain the same across different posted speed limits, which in turn neglect the heterogeneity in active traveler behaviors on high-speed roads vs. low-speed roads. This study proposes to develop a latent segmentation-based active traveler injury severity model to relax the homogeneity assumption of the posted speed limit by active traveler behavior. Specifically, this study proposes to estimate a latent segmentation-based correlated random parameters generalized ordered logit model to examine active travel injury severity mechanisms. The proposed model accommodates systematic heterogeneity in the effects of posted speed limit, crash year and active traveler group by using a piecewise linear function in injury severity component of the latent segment model. The model is demonstrated by using active traveler crash data from Queensland, Australia, for the years 2015 through 2019. To demonstrate the implications of the estimated models, a number of hypothetical scenario analyses are performed with a specific focus on active traveler behavior and reduction in posted speed limits. The outcomes from the hypothetical scenario analysis highlighted that a 76 % (73 %) reduction in active traveler fatalities can be achieved by converting 50–60 km/hr roadways to 10–40 km/hr roadways in the urban areas (rural areas) of Queensland. The outcomes of the study will allow us to identify effective speed management strategies while targeting those with high-risk behavior.

Cycle safe or cycle cool? Adolescents’ views on bicycle helmet use and injury prevention campaigns in Belgium

ObjectivesAlthough cycling is a healthy, ecological and practical way of transportation, it is not without risk. The effect of bicycle helmets to prevent head injuries on crashing has been extensively...

Ascertainment and description of pedestrian and bicycling injuries and fatalities in Ontario from administrative health records 2003–2017: contributions of non-collision falls and crashes

IntroductionPedestrian and bicycling injuries may be less likely to be captured by traffic injury surveillance relying on police reports. Non-collision injuries, including pedestrian falls and single bicycle crashes, may be...

A Five-Year Overview of Bicycle Injuries in the United States Between the Years 2017 and 2021.

Introduction This study investigates the changes in bicycle-related injury rates between 2017 and 2021. We focus specifically onchanges in age demographics, and the most common diagnosesand body parts injured. Methods We queried the National Electronic Injury Surveillance System (NEISS) for injuries associated with bicycles from 2017 to 2021. Chi-square analysis was used to evaluate trends in injuries vs. time for the entire sample, age groups in five-year increments, and the proportion of injury types by diagnosis and body part. Results The highest annual injury rate (12,800 counts) occurred in 2020, coinciding with the COVID-19 safer-at-home order. Pediatric patients continue to make up the majority of injured cyclists (48% of patients are younger than 19 years), but their percentage is decreasing (zero to four years (-13%, p < 0.005), five to nine years (-17%, p < 0.005), 10-14years (-5%, p < 0.005), 20-24years (-16%, p < 0.005), 25-29 years (-2%, p < 0.005), and 50-54 years (-14%, p < 0.005)) and mirrored by an increase in the proportion of older injured cyclists (40-44years (+26%, p < 0.005), 60-64years (+44%, p< 0.005), 65-69years (+69%, p < 0.005), and 70+years (+57%, p < 0.005)). The past five years saw an increase in injuries associated with higher impact forces and the potential for more severe morbidity and mortality, such as internal organ injuries (+13%, p < 0.01). The incidence of concussions, however, has not changed significantly. The extremities are the most commonly injured body parts(upper and lower arm, elbow, wrist, hand, fingers, upper and lower leg, knee, ankle, foot, and toe = 47% total) and continue to increase in frequency (lower arm (+2%, p < 0.005), lower leg (+3%, p < 0.01), upper arm (+18%, p < 0.005), and hand (+11%, p < 0.05)), while facial injuries are becoming less common(-3%, p < 0.05), and head injuries have not experienced a significant change of incidence. Conclusion Although there was an increase in bicycle-related injuries during the COVID-19 safer-at-home order, numbers have since returned to pre-COVID-19 levels. Other changes in bicycle injury demographics and mechanisms, such as a rise in older adult cyclists and high-force mechanism injuries, however, call for a re-evaluation of preventive and treatment priorities.

Electric scooter and electric bike injuries

Electric scooter and electric bike injuries

A temporal statistical assessment of the effectiveness of bicyclist safety helmets in mitigating injury severities in vehicle/bicyclist crashes

This study estimates mixed logit models taking into account heterogeneity in means and partially constrained parameters in order to explore possible shifts within parameters over time to study factors influencing bicyclist injury severity outcomes. Separate statistical models are estimated for two bicyclist helmet-wearing scenarios (helmet and non-helmet) using a comprehensive dataset from Florida covering a three-year period to assess COVID-19 effects from the 1st of January 2019 to the 31st of December 2021. This research evaluates several factors influencing helmeted and non-helmeted bicyclist injury severity, encompassing the attributes of drivers and cyclists, the environment and weather, the features of the roads and their temporal aspects, and the different types of vehicles. The performed analysis further enhances model robustness by assessing the temporal stability and transferability across different contexts through likelihood ratio tests, alongside an in-depth examination of the temporal consistency of explanatory variables via marginal effects analysis, confirming significant variations between non-helmeted and helmeted bicyclist models and revealing temporal shifts in factors affecting injury severity during the study period. Findings from the model estimations identify several significant variables with consistent parameter estimates across years. Stop signs, cycling with traffic, and dark, unlit conditions increase severe injury risk in non-helmet models, while the stop sign indicator consistently reduces severe injury risk in helmet models. Statistically significant random parameters are identified across different years and helmet-wearing scenarios, including the male driver indicator, which exhibits varying effects on injury severity. Out-of-sample prediction analysis suggests helmets reduce severe injury probability but may increase minor injuries and decrease no-injury accidents, indicating potential risk compensation behavior among helmeted bicyclists. Although helmets offer protection against severe injuries for bicyclists, it is crucial to adopt a comprehensive safety approach, particularly given the evolving demographics of bicyclists amid the COVID-19 outbreak. This entails considering factors like bicyclist and driver behavior, environmental conditions, and infrastructure enhancements. Policymakers, road safety professionals, and advocacy groups should collaborate to develop holistic strategies to address the determinants of bicycle crash severity outcomes and enhance safety measures for bicyclists across diverse road environments.

Post-lockdown burden of road injury involving hospitalisation in Victoria, Australia: A statewide, population-based time series analysis.

Ever since COVID-19, short-term changes in transport injury patterns have been observed. The aim is to examine both the initial and the enduring impact of government lockdown and the pandemic on road injuries requiring hospitalisation and road fatalities. Time series analysis of Transport Accident Commission (TAC) claims involving hospitalisation and fatalities in Victoria, Australia, from July 2016 to May 2023, including lockdown (March 2020 to October 2020) and post-lockdown (November 2020 onwards). A total of 46 450 TAC claims were included. Average claims during the pre-pandemic period were 652/month. Lockdown restrictions were associated with a statistically significant fall in monthly claims (-255, 95% confidence interval [CI] = -315 to -194, P < 0.01). This was consistent across road users, days of the week, hours of the day, injury severity, sex and central versus rural locations. The post-lockdown period had a statistically significant reduction in monthly claims to 76% (95% CI = 67-84) of pre-pandemic levels (-158, 95% CI = -213 to -102, P <0.01). This was consistent across all subgroups except bicyclist injuries, which remained constant (-8, 95% CI = -16 to 0, P = 0.05). There was a significant upward trend in the fatality-to-claim ratio post-lockdown (0.001, 95% CI = 0-0.001, P <0.01). Road injury requiring hospitalisation decreased significantly during governmental lockdown and has returned to three-quarters of pre-pandemic levels (except bicyclist injuries that have remained constant), but there is an increasingly disproportionate number of fatalities. This represents a new baseline of injury burden for EDs and hospitals that manage trauma patients.

Trend differences in cervical spinal cord injuries before and after the coronavirus disease 2019 pandemic.

Cross-Sectional Study. To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan. Hospital with an emergency center in Chiba, Japan. Patients eligible for the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital. Medical records were retrospectively examined to investigate the number and characteristics of patients with CSCI. The clinical variables of patients with CSCI were compared according to the time of admission as related to the COVID-19 pandemic: 2018-19 (before) or 2020-21 (after). The total number of patients with CSCI from 2018 to 2021 was 108, with 57 before the COVID-19 pandemic and 51 after the COVID-19 pandemic. The number of severe cases with an injury severity score (ISS) of >16 decreased after COVID-19 (p < 0.05). Falls on level surfaces were the most common cause of injury both before and after COVID-19. Although the ranking of traffic accidents decreased after COVID-19, among those, the number of bicycle injuries tended to increase. The number of serious cases with an ISS > 16 decreased, presumably because of the decline in high-energy trauma due to the background decrease in the number of traffic accidents.

An evaluation of a Vision Zero traffic-calming intervention, an urban transportation safety policy

ABSTRACT Today over 40 major metropolitan areas in the United States have formally adopted a new “Vision Zero” road design framework to prioritize roadway safety and eliminate traffic-related fatalities. This policy framework diffused across much of Europe and, more recently, the United States. In 2019, the City of San Francisco, California, implemented a series of traffic-calming interventions designed to lower speeds on left-hand turns and thereby reduce severe pedestrian and bicyclist injuries. This study uses a quasi-experimental design to evaluate this innovation. Results show that these safety measures reduced speeds between 1.4 and 1.9 miles per hour and that these reductions were sustained for at least 1 year. A conservative cost-benefit analysis suggests that these interventions have a large, positive return on investment, and that they are justified for any intersection with 2.5 or more pedestrian- or cyclist-involved crashes over a 5-year window.

Collecting behavioral evidence from a highly mobile and seasonal population: A protocol for a survey on quad bike injuries.

Quad bikes are popular recreational, four-wheeled bikes in the Middle East. Injury prevention programs targeting quad bike crashes in the United Arab Emirates (UAE) need evidence about the risk factors and behaviours associated with these crashes in the target population. This is a protocol for a study aiming to investigate quad bike rider behaviours and to assess the risk factors associated with related injuries in the UAE. This is a cross-sectional observational study aiming to describe a seasonal sport in a desert environment. With an estimated sample size of 451, the survey will follow a three-stage, location-based sampling strategy using the line-transect method. A sampling frame of desert locations with high injury incidences was developed, using Dubai ambulance injury records. Further expansion of the sampling frame was participatory, involving police, enthusiasts, emergency responders and gas station employees. The data collection will be limited to the winter months in fifteen high-injury desert locations across three major Emirates in the UAE. Trained researchers will observe the riders directly in the desert to note their riding habits, followed by a researcher-administered interview on riding and injury history. The interviews will be administered in Arabic and English using Qualtrics software on handheld tablets with offline and online entry mode. In addition, paper-based entry with the same format will be used as a contingency in busy quad bike locations. The objective of this study protocol is to develop a comprehensive survey that will furnish substantial evidence for the formulation of effective injury prevention strategies. To enhance the credibility of the recorded riding behaviors, field observations will be employed. The uniqueness of this study lies in its innovative sampling strategy, custom-tailored to accommodate the highly mobile and transient population of desert bikers in the UAE.

Electric Bicycle Injuries and Hospitalizations

This cross-sectional study investigates injury trends associated with electric bicycles in the US from 2017 to 2022.

Do electric bicycles cause an increased injury risk compared to conventional bicycles? The potential impact of data visualisations and corresponding conclusions

The increasing number of bicycle crashes leading to injuries in the Netherlands is frequently related (e.g., in the media) to increased use of the electric bicycle. For this reason, policy makers face the challenge of selecting and implementing the most promising countermeasures including those focused on electric bicycles. It may be questioned, however, to what extent the electric bicycle itself is a (direct) cause of crashes leading to injuries or whether other factors are important for explaining the increased number of bicycle injury crashes. On the basis of an abbreviated list of criteria by Elvik (2011), this paper illustrates the potential influence of factor inclusions, analysis selections, and data presentations on the general impression about crash causation with the electric bicycle as an example. The aim is to provide a ‘best practice guide’ by taking into account (1) a theoretical explanation of causal mechanisms, (2) control for confounders, and (3) a statistical association of sufficient strength and consistency in the expected direction. We conclude that an apparent increased risk of electric bicycles may be explained by factors such as age, exposure, health factors, and gender of the cyclist. A relatively simple analysis, by comparing fatality numbers of conventional and electric bicycles, showed that including or excluding these factors may lead to vastly different interpretations of fatality causes and the relative risk of electric bicycles compared to conventional bicycles.

Incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital

Objective: The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment. Materials &amp; Methods: A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &amp;sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &amp;dislocations), ligamentous injuries &amp; SCIWORA. The primary outcome was the functional status at 6 months following treatment. Results: There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery. Conclusion: Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality.

Enhancing Health through Built Environment Improvement: A Southern Nevada Health Impact Assessment Case Study

Background: Health Impact Assessment (HIA) is a public health tool to evaluate how choices made outside the health sector can affect health. HIAs are utilized in transportation, housing, planning, and other fields. Since the built environment can impact community health outcomes, including physical activity rates, injuries, and overweight and obesity, an interdisciplinary team composed of public health, planning, transportation, and land use professionals conducted an HIA in Las Vegas, Nevada.&#x0D; Methods: The HIA consisted of (1) screening, (2) scoping, (3) assessment, (4) recommendations, (5) reporting, and (6) monitoring and evaluation. It examined proposed physical improvements to a 0.66 mile stretch of a major arterial roadway in the City of Las Vegas where nearby residents experience many health inequities. Collection and analysis of land use and survey data, analysis of secondary data, and literature reviews were completed to predict potential health effects produced by built environment changes. Stakeholder feedback informed each HIA step.&#x0D; Results: The HIA generated recommendations to improve physical activity, reduce pedestrian and bicyclist injury rates, and decrease obesity and overweight prevalence, by presenting “good,” “better,” and “best” physical infrastructure improvements. The process and resulting recommendations enhanced collaboration among health and nonhealth sectors.&#x0D; Conclusions: Data and analysis revealed that the proposed changes could improve walkability and bikeability and reduce pedestrian and bicyclist injury. By encouraging active transportation through bicycling and walking, the plan could, over time, contribute to reduced overweight and obesity. The HIA facilitated inter-sector cross collaboration and the integration of health into future decision-making.

Exploring temporal instability effects on bicyclist injury severities determinants for intersection and non-intersection-related crashes

Cycling is a sustainable and healthy mode of transportation with direct links to reducing traffic congestion, lowering greenhouse gas emissions, and improving air quality. However, from a safety perspective, bicyclists represent a risky road user group with a higher likelihood of sustaining severe injuries when involved in vehicle crashes. With various determinants known to affect bicyclist injury severity and vary across locations, this study investigates the factors affecting bicyclist injury severity and temporal instability, considering the location of crashes. More specifically, the objective of this study is to understand differences in injury severities of intersection and non-intersection-related single-bicycle-vehicle crashes using four year crash data from the state of Florida. Random parameters logit models with heterogeneity in the means and variances are developed to model bicyclist injury severity outcomes (no injury, minor injury, and severe injury) for intersection and non-intersection crashes. Several variables affecting injury severities are considered in model estimation, including weather, roadway, vehicle, driver, and bicyclist characteristics. The temporal stability of the model parameters is assessed for different locations and years using a series of likelihood ratio tests. Results indicate that the determinants of bicyclist injury severities change over time and location, resulting in different injury severities of bicyclists, with non-intersection crashes consistently resulting in more severe bicyclist injuries. Using a simulation-based out-of-sample approach, predictions are made to understand the benefits of replicating driving behaviour and facilities similar to intersections for non-intersection locations, which could benefit in reducing bicyclist injury severity probabilities.

Epidemiology of electronic mountain biking injuries: an unexplored emerging extreme sport

Epidemiology of electronic mountain biking injuries: an unexplored emerging extreme sport

Development of German pedelec (and bicycle) crashes between 2013 and 2021

Introduction: The continuous growth in the use of e-bikes (in Germany mostly pedelecs that support pedaling up to 25 km/h) raises questions about the use of historic crash data for the development of road safety measures. The aim of this study was to address this issue, by conducting a longitudinal analysis of pedelec and bicycle crash data over a period of nine years to identify trends and to clarify whether such trends are specific to pedelecs. Method: We analyzed 95,338 police reported pedelec and bicycle injury crashes from 2013 through 2021. The dataset consisted of crashes from three federal states of Germany: Brandenburg, Hesse and Saxony. Data were analyzed with respect to sex and age distribution, time, location and type of accident, conflict partner, cause of crash and injury severity. Results: Many of the analyzed variables showed a considerable degree of temporal stability, with differences as well as similarities between the two bicycle types staying quite consistent over the years. One notable difference was the mean age of the involved riders, with crashed pedelec riders being significantly older than conventional cyclists. At the same time, however, the mean age of these pedelec riders has decreased by eight years over time. Single vehicle crashes were consistently more common for pedelec riders than for cyclists. Similarly, pedelec rider crashes went with a higher injury severity over all the years. Conclusions and practical applications: While, on a more detailed level, we found differences between the two bicycle types, overall crash characteristics were remarkably similar and consistent over time. Our findings provide no clear argument for road safety measures that are specifically designed to target pedelecs. Instead, the stable crash total, and the increases in ridership of both bicycles and pedelecs, highlight the demand for new, innovative solutions to improve cycling safety in general.