Cycling accidents registered at a department of radiology in 2010

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1 Cycling accidents registered at a department of radiology in 2010 Poster No.: C-0880 Congress: ECR 2013 Type: Authors: Scientific Exhibit J.-H. Opsahl 1, F. Wexels 2, T. E. Gudmundsen 1 ; 1 Drammen/NO, 2 Oslo/NO Keywords: DOI: Musculoskeletal bone, Trauma, Conventional radiography, CT, Structured reporting, Socio-economic issues, Athletic injuries /ecr2013/C-0880 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Purpose Bicyclists carry a higher risk of injury requiring physician consultation, radiological evaluation and hospitalization than motor vehicle occupants. The purpose of our study was to determine the incidence of cycling-related injuries of a severity requiring radiological evaluation at our hospital. Drammen hospital provides emergency care for approximately inhabitants. Methods and Materials A retrospective analysis of our departments digital archives in the period to was conducted. From the archives, we extracted all emergency studies based on incoming physician referrals with inquiry of injury related to leisure activity. Information abour gender, age, mechanism and time of injury, type of imaging study and reported findings were registered. All data was anonymized and systematized for processing in Excel. Results In the given time period, 2265 studies was conducted in total. Of these, 321 (14,2 %) of the referrals were with a question of acute injury related to cycling.147 patients had positive findings of one or more injuries. Most accidents occured in males (68 %), and in the age groups 10 to 19 and 30 to 49 years, with a mean age of 31 (fig. 1,2). 76 % were single-injuries, 24% collisions, and fractures of the upper extremity was the most common injury (table 1). Only two patients had head injuries - both consisting of cranial fracture and intracranial bleed. Pneumothorax was seen in two patients, of which one had rib-fractures. In addition to the examinations in table 1, 14 patients were examined with 7 full-body CT scans, 5 ultrasounds and one oesophagal examination. A report from the Norwegian Institute of Transport Economics (ITE), states that the number of casualties and severely injured persons in bicycle accidents has decreased significantly the later years (1). The numbers are, however, somewhat incomplete due to underreporting of person-injuries not in need of medical treatment or a police report (1). Bicyclists carry a higher risk of injury requiring physician consultation, radiological evaluation and hospitalization than motor vehicle occupants. Estimates from North- America and Western-Europe show that cyclists incur a 7-70 times increased risk of injury per trip or per kilometer, when compared to motor vehicle occupants (2,3). A proper Page 2 of 8

3 overwiew over the different cycling-injuries and factors related to these, is essential for working out and implementing injury-reducing measures. As in the national numbers from ITE, we found that most accidents occured in males and in the age groups and years. This can be due to the high number of bicyclists in these groups, but also the tendency to more risk-seeking conduct (speed, competetiveness, aggressivity) that can increase the injury-rate substantially. In our material we have relatively few head injuries and severe injuries; a thing that might be accredited the use of bicycle helmets, but we have not registered this in our numbers Elvik et al. (4) has documented that bicycle helmets provide protection against head injuries, and is associated with a lighter degree of injury when accidents occur. We also know that some of the severe injuries are transported to a central hospital with a national trauma centre, and thereby will not be registered in our numbers. Numbers from ITE and Statistics Norway show a gradual decrease in the number of persons killed or injured in cycling accidents from (1). They also show an overall reduction in the number of cyclists, especially in the younger age groups. The economic costs of physical inactivity is well documented (5), and cost-benefit analysis show that the benefits of increased cycling can be worth four to five times the cost of investments in improved cycling infrastructure (6,7). Building cycling-specific infrastructure reduces the number of collisions and injuries amongst cyclists (8,9), and have the benefit of being universal measures that affect everyone without requiring individual efforts, or a great deal of regulation and information from governmental institutions. As a part of a national transport plan, the Norwegian Public Roads Administration has developed National Cycling Strategy , with a goal of an 8% cycling share. Today, the percentage of cyclists is around 4,5%. Many cities have already developed local cycling strategies as a part of this plan (10). Hopefully, measures like these with increased safety and better facilities will encourage more people to cycle. Another positive effect derived from this, is that the number of injuries has been proven to decrease with an increased share of cyclists in traffic. This is supported by several studies om injuries and cycling patterns in USA, Australia and Europe - as well in between cities and in local communities over time (11-14). Images for this section: Page 3 of 8

4 Fig. 1: Number of referrals sorted by gender Page 4 of 8

5 Fig. 2: Number of referrals and positive findings in all age groups Page 5 of 8

6 Table 1: Referrals and examinations with a positive fracture diagnosis distributed by the performed radiologic examination Page 6 of 8

7 Conclusion In our country we see an overall tendency with a reduced number of cycling-related injuries the later years. However, there is also a substantial decrease of people using the bicycle as a means of transportation and in leisure activity, especially in the younger age groups. Our registration seem to match the numbers from national registrations fairly well. Even so, we believe that both our numbers and the national registrations of bicycleuse and cycling-related injuries, probably are incomplete because of underreporting (1). There is good documentation of the significant positive health-, environmental- and economic consequences associated with cycling. Implementing measures for making cycling an avaliable, attractive and safe means of active transportation, should therefore be of high priority. Systematic registration of cyclist numbers and related injuries may contribute to an increased knowledge-base that can be useful in the development of local and national cycling strategies. References 1. Bjoernskau: "Sykkelulykker - Ulykkestyper, skadekonsekvenser og risikofaktorer"; ITEreport 793/ Pucher J, Dijkstra L: "Promoting safe walking and cycling to improve public health: lessons from the Netherlands and Germany.", Am J Public Health 2003, 93: Aultman-Hall L, Kaltenecker MG: "Toronto bicycle commuter safety rates.", Accid Anal Prev 1999, 31: Elvik et. al.:"trafikksikkerhetshåndboken"; ITE Katzmarzyk PT, Janssen I: "The economic costs associated with physical inactivity and obesity in Canada: an update". Can J Appl Physiol 2004, 29: Cavill N, Kahlmeier S, Rutter H, Racioppi F, Oja P: "Economic analyses of transport infrastructure and policies including health effects related to cycling and walking: A systematic review.", Transp Pol 2008, 15: Page 7 of 8

8 7. Saelensminde K: "Cost-benefit analyses of walking and cycling track networks taking into account insecurity, health effects and external costs of motorized traffic.", Transp Res A-Pol 2004, 38(8): Reynolds, C et. al.:"the impact of transportation infrastructure on bicycling injuries and crashes: a review of the literature.", Env Health 2009,8: Veisten, Sælensminde og Hagen: "Syklistskader, risiko ved sykling og nyttekostnadsanalyseverktøyet for sykkeltiltak"; ITE-report 816/ The Municipality of Drammen, Norway: "Sykkelstrategi for Drammen " 11. Robinson DL: "Safety in numbers in Australia: more walkers and bicyclists, safer walking and bicycling.", Health Promot J Austr 2005, 16: Jacobsen P: "Safety in numbers: more walkers and bicyclists, safer walking and bicycling.", Inj Prev 2003, 9: Vandenbulcke G, Thomas I, de Geus B, Degraeuwe B, Torfs R, Meeusen R, Int Panis L: "Mapping bicycle use and the risk of accidents for commuters who cycle to work in Belgium.", Transp Pol 2009, 16: Elvik R: "The non-linearity of risk and the promotion of environmentally sustainable transport.", Accid Anal Prev 2009, 41: Personal Information Jan-Henrik Opsahl MD, Department of Imaging, Drammen Hospital, Vestre Viken HF, Drammen, Norway; Fredrik Wexels MD, Department of Imaging, Drammen Hospital, Vestre Viken HF, Drammen, Norway; Tor Erik Gudmundsen MD, formerly Department of Imaging, Drammen Hospital, Vestre Viken HF, Drammen, Norway; Page 8 of 8

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