Transport Research Series

Transcription

1 Transport Research Series Extent and Severity of Cycle Accident Casualties Transport Research Planning Group

2 EXTENT AND SEVERITY OF CYCLE ACCIDENT CASUALTIES Carole Millar Research Scottish Executive Social Research 2005

3 CONTENTS EXECUTIVE SUMMARY CHAPTER ONE INTRODUCTION BACKGROUND AIMS AND OBJECTIVES METHODOLOGY STATS STRUCTURE OF THIS REPORT 3 CHAPTER TWO WHO IS INVOLVED IN CYCLING ACCIDENTS? GENDER AGE PROFILE OF CASUALTY 5 CHAPTER THREE WHEN DO CYCLE ACCIDENTS HAPPEN? TIME OF YEAR DAY OF THE WEEK TIME OF DAY 9 CHAPTER FOUR WERE OTHER VEHICLES INVOLVED? RELEVANCE OF GENDER AND AGE ACCIDENTS INVOLVING A CAR ACCIDENTS INVOLVING ANOTHER BICYCLE 14 CHAPTER FIVE WHERE DO ACCIDENTS HAPPEN? 15 CHAPTER SIX WHAT SAFETY AIDS WERE USED? INCIDENCE OF HELMET WEARING VISIBILITY AIDS 23 CHAPTER SEVEN WHAT CAUSED THE ACCIDENT? 25 CHAPTER EIGHT OUTCOME PATIENT OUTCOME INJURIES SUSTAINED EFFECT OF WEARING A HELMET ON INJURIES SUSTAINED TYPE OF TRAUMA 32

4 CHAPTER NINE STATS DEPICTING THE EXTENT OF CYCLE ACCIDENT CASUALTIES DEPICTING THE NATURE OF CYCLE ACCIDENT CASUALTIES 36 CHAPTER TEN CONCLUSION EXTENT AND SEVERITY OF CYCLE ACCIDENT CASUALTIES METHODOLOGY 40 APPENDICES 1 QUESTIONNAIRE 2 PATIENT INFORMATION SHEET 3 CYCLING CASUALTIES BY POST CODE 4 DETAILED DISTRIBUTION OF CASUALTIES

5 ACKNOWLEDGEMENTS Carole Millar Research would like to thank all of the staff at the Accident and Emergency departments of the five participating hospitals for their help throughout the year of this study. Thanks must also go to the cycling casualties themselves who took the time to complete forms. I would also like to thank Alan Murphy of Lothian and Borders Police who helped with provision of STATS19 data. I would also like to thank the members of the advisory group set up within the Scottish Executive but in particular Janet Ruiz and Tom Lamplugh who provided support and guidance throughout the project.

6 EXECUTIVE SUMMARY The police currently collect statistics (STATS19) on the number of cycle accidents and casualties on Scottish roads. This is confined to on-road accidents and excludes off road accidents or those accidents that the police do not attend. The Scottish Executive Development Department commissioned research to explore the extent, the severity and the circumstances of all accidents in which pedal cyclists are injured. Cycling casualties who reported to 5 Accident and Emergency departments across Lothian and Borders Health Board were asked to complete a questionnaire relating to their accident. In total completed forms were received from 806 casualties aged 5 or over who had been injured as a result of pedal cycle accident between 1 st September 2003 and 31 st August This data was compared with the STATS 19 data for the same area. Main Findings: More males than females are injured in cycling accidents by a ratio of 3:1 and this increases to 4:1 in adulthood. Cycle accidents are more common in childhood. Fifty-four per cent of all accidents involved under 16 year olds with older children (aged year old) being the most at risk. Cycling accidents peak in the summer when there is greater scope for leisure cycling. The 6 months between April and September account for over 70% of all accidents and nearly 80% of all child casualties. The accident rate increases at the weekend coinciding with greater opportunity for leisure cycling. The peak time of day for accidents is late afternoon or early evening. A third of all cycling casualties indicated that they had their accident on the road. Thirteen per cent of cycling accidents occurred on the main road. Adults were much more likely than children to have a cycling accident on the main road. There were large numbers of accidents on the pavement (29%). Forty three per cent of child accidents are sustained on the pavement. The greatest proportion of accidents (41%) occurred off-road and are not therefore captured by STATS19. A high proportion of off road accidents happened on cycle tracks, forest tracks or mountain bike trails (57%). Adults were more likely to have off-road accidents. i

7 The majority of accidents (72%) from the hospital based sample involved no other vehicles. This contrasts markedly with the police recorded statistics where 96% of accidents involved other vehicles. Adult cycling casualties were much more likely to be involved with a car than children. This is associated with a greater likelihood of cycling on main roads. Overall, less than half the casualties (39%) had been wearing a helmet. Adults were significantly more likely than children to be wearing a helmet (57% compared to 24%). Helmet wearing declines as children get older but rises again after the age of 16. Correlating with age, helmet wearing was lowest for those whose accident happened on the pavement (21%) and higher for those whose accident occurred on a main road (43%). Helmet wearing was highest of all (55%) for off-road cyclists. Those who were wearing a helmet were less likely to have an injury to their head or neck (7% compared to 14%) and this difference was more distinct for children. Accidents were caused by a very wide range of circumstances and no single cause stood out within the hospital sample. Only 7% of hospital respondents attributed the cause to a motorised vehicle. Thirty-four per cent of casualties were discharged on the same day without any need for follow up and only 4% of casualties were admitted. Twenty seven per cent required some follow up. There was no information on outcome for 35% of the sample. Children were more likely to be admitted than adults. There was little difference in outcome depending on whether the accident took place on or off road. Most common injuries were to upper limbs (38%) followed by lower limbs (20%). Injuries to the head or neck were sustained by 11% of total casualties. There are a large number of casualties who report to the hospital with an injury serious enough for medical attention who do not appear in STATS19. STATS19 describes a narrow range of causes with the involvement of a motorised vehicle being the predominant factor. STATS19 is much less likely to record accidents sustained by children and more likely to record those sustained by adults. It may be concluded that the STATS19 database underreports the full extent of on road cycling casualties in Scotland. ii

8 Consideration should be given to alternative means of collecting accident data relating to cycling accidents to improve coverage of on road reporting and extend coverage to include off road. iii

9 CHAPTER ONE INTRODUCTION 1.1 BACKGROUND The police currently collect statistics (STATS19) on the number of road accidents involving cyclists on Scottish roads. This, by its nature, is confined to those accidents which occur on roads and to which the police are asked to attend. It does not provide any data on off-road accidents or on those accidents that the police do not attend. As a result there is little data on the full extent of cycle accidents, their severity or their cause. 1.2 AIMS AND OBJECTIVES This study aimed to: Compare hospital accident and emergency statistics on cycle casualties with STATS19 data to measure the extent of any gap. Establish how many cycle accidents occur off road compared to on road. Identify any patterns emerging on the type of accident, the location and the nature of the injury occurring. 1.3 METHODOLOGY Five hospitals within the Lothian and Borders area which offer an Accident and Emergency (A&E) service agreed to take part in this study. They were: Royal Hospital for Sick Children Edinburgh Royal Infirmary Western General St John s Hospital Borders General Hospital Data was collected over the period of September 2003 to August A proforma was designed to collect data relating to the casualty and the cycle accident. This was designed after consultation with the consultants or senior nursing officers at each of the five participating hospital departments and the Advisory Group established at the Scottish Executive. It was essential that the form was kept as simple as possible and was easy to complete so that it could be fitted into the busy schedule that exists within all A&E departments. A copy of the proforma is appended to this report. (Appendix 1) The form was in two parts. The top half of the form was designed to be completed by the patients themselves and asked for simple details relating to: 1

10 The patient The timing of the accident The involvement of other vehicles The presence of any safety aids The location of the accident Any other circumstances relating to the accident. The bottom section of the form was designed to be completed by clinical staff and comprised of two main questions relating to: The outcome - discharged with or without follow up, or admitted Extent of injury and which part of the body was injured. It was important that the staff at the A&E departments co-operated fully with this study if it was to be successful. Every effort was undertaken to maintain that vital co-operation including personal visits to ensure that staff had a say in how the study was designed, briefings for staff at appropriate points in the year and personal collection of completed data sheets throughout the year. In addition a small goodwill incentive was provided to participating hospitals. All staff were briefed at the start of the study explaining it s purpose and the data collection requirements. An information sheet was also prepared for patients which clinical staff were asked to distribute with the questionnaire. A copy of the information sheet is also appended to this report. (Appendix 2) In some hospitals the researcher was given access to clinical staff to brief them herself and in others she briefed only senior staff who then took on this role with other staff. At no location was it possible to brief all staff due to the shift system in operation but efforts were made to brief as many staff as possible. There was therefore a need to cascade information and there was a system in place in hospitals to undertake this. Staff at the hospitals were asked to complete a form for ALL casualties who were riding a bicycle at the time of their accident and who presented at a hospital Accident and Emergency department. Regular visits were made throughout the year to collect forms and to ensure that there were no difficulties. Junior doctors at the Royal Hospital for Sick Children and Edinburgh Royal Infirmary who joined the departments in February 2004 were provided with another briefing similar to that given at the start of the study. There was no practical means of auditing how well the data was being collected by the A&E departments and whether there was a form collected for every cycling casualty, as requested. There were some problems in getting the clinical staff to complete the outcome section of the form and in 35% of the sample this was left blank. 2

11 1.4 STATS19 Lothian and Borders Police provided their STATS19 data on pedal cycle casualities resulting from road accidents. This was compared to the data collected in this hospital based study. 1.5 STRUCTURE OF THIS REPORT Across all five hospitals completed forms were received from 806 casualties aged 5 or over who had been injured as a result of a pedal cycle accident between 1 st September 2003 and 31 st August Chapter 2 of this report provides data on who was involved in those cycle accidents. Chapter 3 explores when cycle accidents happened. Chapter 4 examines the extent to which other vehicles were involved in the accident and Chapter 5 looks at the location of cycle accidents, in particular examining those that were on-road compared to those off-road. Chapter 6 examines the incidence of safety aids at the time of the accident. Chapter 7 looks at the factors contributing to the accident whilst Chapter 8 goes on to examine the extent of the injury caused by the accident, looking at the outcome for the casualty and the type of injury sustained. Chapter 9, examines the STATS19 data, looking at the differences between this dataset and that collected via the hospitals. Chapter 10 concludes the report and raises some methodological issues in relation to the future collection of data on cycling accidents. 3

12 CHAPTER TWO WHO IS INVOLVED IN CYCLING ACCIDENTS? This chapter explores the characteristics of those most likely to be involved in a cycling accident. 2.1 GENDER There are many more males than females involved in cycling accidents that result in a presentation to a hospital. Overall, some 75% of the casualties were male. Table 1 ; Cycling casualties by gender Gender % Male 75 Female 25 Base 806 This gender imbalance could be seen across all age groups and whilst the difference was not quite so marked amongst young children aged 10 or under, it was still quite detectable (59% male compared to 41% female). Table 2 ; Cycling casualties by gender by age Gender % % % % % % % Male Female Base After the age of 11 the difference between males and females becomes even more marked, but particularly amongst the age group where 91% of casualties were male. It may be that cycling is not undertaken to the same extent by teenage girls and women than it is for teenage boys and men. A separate study of the gender profile of cyclists 1 shows that 55% of cyclists are male and 45% are female and that male cycle journeys tend to be longer. The following graph (Figure 1) examines the ratio of male to female cycle accidents by time of day. It is evident from this that there are differences in accident patterns by gender and the extent of these seems to support the view that cycle usage patterns vary by gender. 1 Defined as those who ever cycle : Survey of Cycling in Scotland, Tom Costley, NFO System Three,

13 Figure 1 ; Cycling casualties by time of day by gender Number Female (181) Male (570) Time of day Note: Excludes casualties where time of accident is unspecified Although there are very few accidents between midnight and 6.00pm, all casualties as a result of accidents that occur between these hours are male. There is also a high ratio of males to females in the later part of the day between 9.00pm and midnight. The ratio is least marked between 6.00am and 9.00am, and 6.00pm to 9.00pm, when the proportion of female cycling casualties rises to 29% and 30%. At no time of day does the proportion of female accidents come near the 55:45 ratio of male to female cyclists. In other words, male cycling is consistently more prone to accident. 2.2 AGE PROFILE OF CASUALTY Casualties resulting from cycle accidents are most likely to happen in childhood. Over half of the sample of casualties were children under the age of 16 (54%). This age group only accounts for 13.8% of the population over the age of 5 within Lothian and Borders. Table 3; Age profile of casualty Age band % Over 60 1 Not stated 3 Base 806 It is likely than there are more cyclists among the child population than amongst the adult population. The following table compares the age profile of cycling accident casualties with 5

14 the age profile of Scottish cyclists 2. 3 There are many more cycling casualties than cyclists amongst the younger age groups. Over half of all casualties were in the 5-14 age group which accounts for approximately 35% of cyclists. Table 4; Age profile of cycling casualties compared to cyclists Age range 4 Cycling accidents Age profile of Scottish cyclists % % and over Not stated 3 Base 806 This suggests that the ages of are the most risky for cyclists in Scotland followed closely by those in the 5-10 year old age range. Of the adult age groups year olds are at greatest risk of accident and risk declines thereafter with age. Summary of key findings There are many more males than females involved in cycling accidents that result in presentation to a hospital by a ratio of 3:1. The gender imbalance occurs across all age groups although is less marked in children under the age of 10. The ratio of casualties is greater than the ratio of male to female cyclists suggesting that whilst there are more male cyclists they are also more prone to accident. Casualties resulting from cycling accidents are more likely in childhood and 54% of all the casualties in this study were under the age of 16 with the age group being the most at risk. 2 Defined as those who ever cycle 3 Survey of Cycling in Scotland, Tom Costley, NFO System Three, Note that age breaks are slightly different from previous table in order to be comparable with Survey of Cycling 6

15 CHAPTER THREE WHEN DO CYCLE ACCIDENTS HAPPEN? This chapter explores the timing of cycling accidents by examining the time of year, the day of the week and the time of day when accidents are more likely to occur. 3.1 TIME OF YEAR The number of casualties as a result of cycle accidents varies markedly by the time of year, with the greater proportion of casualties occurring over the summer months, with April to September accounting for the majority (72%). Without a profile of cycle use by month we cannot directly quantify whether cycling accidents are more likely per cycle trip at particular times of the year. However there is strong evidence that there is less cycling activity in the winter months. The findings in an earlier survey of cycling in Scotland indicates that poor weather was the predominant reason for not cycling more often amongst households with a cyclist. Given leisure is also mentioned as a key reason for cycling this would be consistent to more cycling activity in summer in better weather and hence more cycle accidents. Figure 2; Cycling casualties by month % of annual volume Base = 806 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 7

16 An examination of the data by age indicates that adults show a much flatter curve than children suggesting that they are more likely to be all-weather, year-round cyclists and that many in the children s age group cycle considerably less in the poor weather of the winter months. Seventy-nine per cent of children s accidents occur over the 6 months between April and September compared to only 65% of the adult s accidents. Figure 3: Cycling casualties by month by adult / child % of annual volume Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month Child (431) Adult (350) 3.2 DAY OF THE WEEK The distribution of accidents by day of the week shows a greater proportion of accidents occurring at the weekend than on weekdays. This may be attributable to the greater amount of leisure cycling which presumably occurs on these days. Figure 4: Cycling casualties by day of the week % of week Base = 806 Mon Tue Wed Thu Fri Sat Sun Day of week Across weekdays there are dips on Tuesday and Thursday. There is no obvious reason for this pattern which is exhibited consistently across most age groups. 8

17 3.3 TIME OF DAY Cycling accidents are more likely to occur in the afternoon and early evening. The peak time for accidents is 3.00pm to 6.00pm ( 28%) followed closely by 6.00pm to 9.00pm (23%). Table 5; Cycling Casualties by Time of day Time % Midnight 3.00am am to 6.00am * 6.01am to 9.00am am to noon 10 Noon to 3.00pm pm to 6.00pm pm to 9.00pm pm to midnight 4 Not stated 7 Base 806 Adult cycling accidents would appear to be more evenly distributed across the day than children s cycling accidents. Figure 5: Cycling casualties by time of day by adult / child % of day Child (431) Adult (350) Time of day Children s accidents show a distinct peak after 3.00pm. Children are notably less likely to have an accident in the morning. Adults by contrast show a spread of times over which their accidents occur and a greater proportion of the adults will have their accident in the morning. Young adults between the ages of 19 and 24 were more likely than other groups to sustain their accident between 9.00pm and midnight. This time period accounts for 13% of the 55 accidents sustained by this age group. The general picture shows the accident peak for weekends as occurring earlier than for weekdays. It is also notable that the proportion of accidents occurring between 6.00am and 9.00am at the weekends drops sharply compared to weekdays presumably reflecting less travel to work or place of education at this time. 9

18 Figure 6: Cycling casualties by time of day by weekday / weekend % of week Weekday (515) Weekend (278) Time of day Although the total number of accidents are significantly reduced over the winter months, the proportion which occur in the early hours of the morning is much greater. Sixteen per cent of accidents between December and February occur between 6.00am and 9.00am compared to an average of 7% across the entire year. Although this is based on a very low sample it would suggest that the winter morning cycle journey is more risky than that at other times of the year. During the summer months there are a greater proportion of accidents occurring in the mid afternoon from 3.00pm to 6.00pm (32%). This might be attributable to increased cycling for leisure purposes. Table 6 ; Time of accident by season Time Total Spring Mar May Summer June - Aug Autumn Sept - Nov Winter Dec - Feb % % % % % Midnight to 3.00am 1 1 * am to 6.00am * * am to 9.00am am to noon Noon to 3.00pm pm to 6.00pm pm to 9.00pm pm to midnight Not stated Base

19 Summary of key findings Most cycling accidents occur during the summer months with April to September accounting for 72% of all casualties presenting to hospital. Seventy-nine per cent of children s accidents occur between April and September compared to 65% of adult s accidents suggesting that cycling amongst children is more seasonal. More accidents occur during the weekend than weekdays, pointing to increased levels of cycling at weekends. The peak time for accidents is late afternoon and early evening. The time of accidents varies by season 11

20 CHAPTER FOUR WERE OTHER VEHICLES INVOLVED? This chapter examines the extent to which other vehicles were involved in the cycling accident. For the greater proportion of this sample of bicycle accident casualties, no other vehicle was involved in their accident (72%). In 11% of cases another bicycle was involved and a similar proportion involved a car (10%). The involvement of a car rose to 25% if only those accidents which occurred on road are considered. Table 7; Other vehicles involved Vehicle % Car 10 Bus 1 Motorcycle * Commercial vehicle 1 Other bicycle 11 Other 5 None / not stated 72 Base RELEVANCE OF GENDER AND AGE Of the females involved in an accident a slightly higher proportion involved a car than males (12% compared to 10%) and a higher proportion involved another bicycle (15% compared to 10%). Children under the age of 16 were much less likely than adults to have an accident which involved a car (6% compared to 15%) suggesting that parental restrictions on the use of busy roads might have some impact. Children were by contrast much more likely than adults to be involved with a collision with another bicycle (16% compared to 5%). Table 8; Other vehicles involved by adult / child Vehicle Total Child Adult % % % Car Bus 1 * 1 Motorcycle * * * Commercial vehicle 1 * 3 Other bicycle Other None / not stated Base

21 A more detailed analysis by age band reveals that it is the age group who are at greatest risk of a cycle accident involving a car. Twenty four per cent of year old casualties reported an accident involving a car. An examination of only those accidents that involved a car or another bicycle by month shows that the proportion of accidents involving cars does tend to increase in the winter months but remains relatively low during the summer. Despite the proportion falling, the actual number of accidents involving cars does rise as the total number of casualties rises over the summer months. By contrast the proportion of accidents that involved another bicycle increases in the summer but is very low in the winter. This would seem consistent with the differing opportunities for leisure-based cycling. Figure 7 : Share of accidents by other vehicle involved Number of accidents None/unspec (581) Another vehicle (61) Another cycle (92) Car (81) 20 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec D/K Month Note: Figures add to more than 806 because of multiple coding. Although only 7% of all cycle accidents recorded in this study occurred between 6.00am and 9.00am in the morning a very high (33%) proportion of them involved a car. Nineteen per cent of all accidents involving another bicycle occur between the hours of 6.00pm and 9.00pm, consistent with the hours that children are more likely to be out playing on their bicycles. 4.2 ACCIDENTS INVOLVING A CAR In total 81 casualties in this study had been in an accident involving a car. Of this number just over a fifth (22%) occurred between 6.00am and 9.00am in the morning. Nearly a third (30%) occurred between 3.00pm and 6.00pm in the late afternoon. These times tend to coincide with the main commuting hours. Of the 81 casualties, 72% were male and 28% were female. The majority of accidents involving a car were experienced by adults (67%), with the age group accounting for 42% of all accidents involving a car. 13

22 The three months of July, August and September together accounted for 38% of all accidents involving a car. These months are associated with a higher incidence of cycling rather than greater inherent risk. 4.3 ACCIDENTS INVOLVING ANOTHER BICYCLE There were 92 accidents involving another bicycle in the sample. Of these, 68% were male and 32% female. The majority of accidents involving another bicycle were experienced by children (76%). Forty-four per cent involved children aged Accidents with another bicycle mostly occurred over the summer months. Accidents from April to September accounted for 89% of all accidents involving another bicycle. The weekend accounted for 35% of all accidents involving another bicycle. Again, this might be attributed to increased leisure cycling at this time of the week. Over a third (38%) of accidents involving another bicycle occurred between 6.00pm and 9.00pm. Another common time for these accidents to occur was between 3.00pm and 6.00pm (29%). Summary of key findings The majority of accidents for which casualties presented to hospital, involved no other vehicles (72%). 11% of casualties said their accident involved another bicycle. 10% of casualties said their accident involved a car. Children under the age of 16 were much less likely than adults to have an accident which involved a car ( 6% compared to 15%). Those in the age band are at greatest risk of a cycle accident involving a car. The proportion of accidents involving a car increases over the winter months although remains low in actual terms due to the reduced incidence of total cycling accidents at this time. Although only 7% of accidents occur in the early morning a very high proportion of them (33%) involve a car. Children are much more likely to be involved in a collision with another bicycle than adults ( 16% compared to 5%). Accidents involving other bicycles are largely confined to the summer months. 14

23 CHAPTER FIVE WHERE DO ACCIDENTS HAPPEN? This chapter examines where the accident took place and the extent to which off road accidents contribute to the overall casualty rate. Forty-one per cent of cycling accidents occur off road. A very high proportion of these offroad accidents occur on cycle tracks (51%) or forest tracks / mountain bike trails (6%). Many who were on a mountain bike tracks such as Glentress simply coded their response as cycle track and so these two categories should be examined together. Another 20% of off road accidents occurred in parks. A significant proportion (29%) of accidents occur on the pavement. Of those who reported their accident as occurring on a pavement, 18% also said it had occurred on road, mostly on a side road. Table 9; Location of cycle accident Location of cycle accident Number of casualties % Pavement Off road Gardens / driveway 44 5 Cycle track Park 66 8 Cul de sac 4 * Car park 9 1 School playground / playing fields 6 1 Forest track / mountain bike trail 20 2 Other 16 2 On road Cycle lane 23 3 Dashed white line 19 2 Solid white line 3 * Don t know 25 3 Main road Side road Other 17 2 Not stated 22 3 Base 806 Note: percentages add to greater than 100% as cyclists coded more than one location A third of all cycling casualties (34%) excluding those who were solely on the pavement occurred on-road. Whilst pavements are by definition part of the road in STATS19, it is within the on-road sample that we might expect to find matches with the data collected by the police. The greater proportion of on-road accidents occurred on a side road representing 45% of all on-road accidents reporting to hospitals. Some 16% of those who were on-road at the time of their accident had been in a cycle lane. The profile of male and female casualties is broadly similar in terms of where the accident took place with similar proportions on and off road. There was however a significantly 15