Analysis of bicycle crashes during winter period

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1 Cyclist Injuries Treated in Emergency Department (ED) in South-eastern Finland: Analysis of bicycle crashes during winter period Noora Airaksinen, MSc (Civ. Eng.), Sito Ltd PhD Student, Tampere University of Technology, Finland Co-Authors: Peter Lüthje, MD, PhD, North Kymi Hospital, Kouvola Ilona Nurmi-Lüthje, PhD (Public health), Centre for Injury and Violence prevention Kouvola

2 2 Study area is situated in Kouvola, south-east of Finland

3 Objectives To describe the epidemiology, consequences and costs of bicycle crashes among patients treated in ED To compare crashes occurring in winter period and non-winter period To determine the accuracy of the official statistics on bicycle related crashes

4 4 Data gathering Hospital injury data (bicycle crashes; codes V10- V19 in ICD-10,FM) from Kuusankoski Regional Hospital Kouvola, Finland Reports from Road Investigation Teams (fatal crashes) Questionnaire for patients Medical records (Peter Lüthje, MD)

5 5 Variables age gender time of crash BAC (breath alcohol concentration) on admission helmet wearing injuries severity of injuries (AIS, Abreviated Injury Scale 2005) fatalities treatment sick leave cost

6 6 Results A total of 219 crashes, 311 injuries (1.4/ person). Two fatal cases. 61% were males (mean age 37 years) and 39% females (mean age 43 years) 81 % occurred when the injured was alone Use of helmet: - Helmet users 14 % - Non-users 56 % - Helmet use unknown 30 %

7 7 Results - injuries Head injury was the most common type of injury; over one third (35%) of all injuries. Majority of head injuries were minor (AIS 1-2), 6% serious (AIS 3-5) and one was fatal (AIS 6). One third of all injuries were located in the upper and one fifth in the lower extremity.

8 8 Results Severity of the most serious injury (MAIS) of bicycle crashes

9 9 Results - alcohol 31% (n=67) of patients were under the influence of alcohol when attending to ED In 87 % of all alcohol positive crashes the concentration was more than 1.2 g/l Alcohol-related crashes led to head injuries more often (60%) than those where the cyclist was sober (29%) (p=0.000)

10 10 Results - alcohol Positive alcohol concentration was more often found in males than in females (43% vs. 12%) (p=0.000) Nearly half (46%, n=26) of the drunken males belonged to the age-group of 35 to 49 years

11 11 Results Alcohol in male cyclists by age

12 12 Results Helmet and Injuries Proportion of head injuries was less frequent among patients who were wearing a helmet than among those who did not (14 % vs. 43 %) 20 % of helmet users and 46 % of non-users were injured to the head (p=0.011)

13 13 Results Helmet and Alcohol None of the helmet users and over a third (35 %) of non-users were under the influence of alcohol 24 (37%) of the patients whose helmet use was not known were under the influence of alcohol

14 14 Results - costs The total cost* of injuries was , per patient where: Treatment of injuries: Patients disability to work: % of the medical treatment costs fell to municipalities, 13 % to insurance companies and 7 % to patients * 2012 price level

15 15 Results by time period Winter period (1 st November 30 th April): 56 (26 % of all) crashes, 72 injuries (23 % of all, 1.3 injuries/person) one fatal case (50 % of all fatal crashes) Non-winter period (1 st May 31 st October): 163 crashes (74 % of all), 239 injuries (77 % of all, 1.5 injuries/person) one fatal case (50 % of all)

16 16 Results by time period Winter period (n=56) 57 % were males (mean age 45 years) and 43 % females (41 years) 82 % occurred when the injured was alone 18 % of crashes were alcohol-related Non-winter period (n=163) 62 % were males (mean age 38 years) and 38 % females (37 years) 79 % were single crashes 35 % of crashes were alcohol-related

17 17 Injuries by time period Winter period (n=56) 29 % of crashes (n=16) led to head injuries 86 % of crashes led to minor (MAIS 1-2) injuries and 14 % to serious or fatal (MAIS 3-6) injuries Non-winter period (n=163) 42 % of all crashes (n=69) led to head injuries 92% of crashes led to minor (MAIS 1-2) and 8 % to serious of fatal (MAIS 3-6) injuries.

18 18 Severity of the most serious injury (MAIS = Maximum AIS) by time period p= (n.s.)

19 19 Helmet wearing by time period Winter period (n=56) Helmet users: 9 % Non-users: 59 % Helmet use was unknown: 32 % Non-winter period (n=163) Helmet users: 15 % Non-users: 55 % Helmet use was unknown: 30 %

20 20 Comparison between hospital data and official statistics Hospital data: 219 injuries Statistics Finland: 54 accidents Finnish Road Administration: 41 accidents

21 21 Limitations of the study The sample was recruited from one Finnish hospital only Number of crashes in winter period is small results should be considered as a case study

22 22 Strengths of the study Accuracy of the data is good and we used many data sources The total injury data were checked by a 10 % random sample, and the missing information was completed The data (bicycle crashes) were manually checked in the patients records

23 23 Conclusions There were no remarkable differences between the crashes in winter period and non-winter period The rate of helmet use was low although bicycle helmet reduces the risk of head injuries * Most of the cyclists were not wearing a helmet despite the law which requires the cyclists usually to wear it (no punishment) * Attewell et al. 2001; Macpherson and Spinks, 2008; Thompson et al

24 24 Conclusions The rate of helmet use can be effectively increased by setting a law in which cycling without a helmet is punishable** Cycling without wearing a helmet should be punishable It seems that those who cycle under the influence of alcohol are not wearing a helmet ** Macpherson and Spinks 2008; Vulcan et al. 2008; Wesson et al

25 25 Conclusions The proportion of alcohol related injuries was alarming. From previous studies we know that: Cycling under the influence of alcohol and without a helmet produces an increased risk of serious injury and death* Alcohol use shows a strong correlation with head injury ** * Olkkonen 1993; Spaite et al. 1995; Li et al **Crocker et al. 2010

26 26 Conclusions Bicycle crashes resulting in physical injuries were considerably more common than the official statistics indicate. The systematic collection of data should be developed

27 27 Thank you! Contact information:

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