analysis of bicycle crashes during winter period€¦ · cyclist injuries treated in emergency...
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Cyclist Injuries
Treated in Emergency Department (ED)
in South-eastern Finland:
Analysis of bicycle crashes
during winter period
Noora Airaksinen , MSc (Civ. Eng.), Sito LtdPhD 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
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|Study area is situated in Kouvola, southStudy area is situated in Kouvola, south --east of east of FinlandFinland
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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
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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)
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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
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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 %
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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.
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Results – Severity of the most serious injury (MAIS) of bicycle crashes
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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)
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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
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Results – Alcohol in male cyclists by age11
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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)
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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
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Results - costs
• The total cost* of injuries was 734 000 €, 3 400 € per patient where:
• Treatment of injuries: 409 000 €
• Patients’ disability to work: 303 000 €
• 81 % of the medical treatment costs fell to municipalities, 13 % to insurance companies and 7 % to patients’
* 2012 price level
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Results by time period
• Winter period (1st November – 30th 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 (1st May – 31st October): • 163 crashes (74 % of all), • 239 injuries (77 % of all, 1.5 injuries/person)
• one fatal case (50 % of all)
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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
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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.
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Severity of the most serious injury (MAIS = Maximum AIS) by time period
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p= 0.166 (n.s.)
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Helmet wearing by time period
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• 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 %
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Comparison between hospital data and official statistics
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Statistics Finland:
54 accidents
Hospital data: 219 injuries
Finnish Road Administration: 41 accidents
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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
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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
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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. 2008.
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• 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. 2008.
Conclusions
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• 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. 2001
**Crocker et al. 2010
Conclusions
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Conclusions
• Bicycle crashes resulting in physical injuries were considerably more common than the official statistics indicate. The systematic collection of data should be developed
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