Bicycle commuter injury prevention: it is time to focus on the environment.

BACKGROUND: Few data exist on the risk of injury while commuting to work or school by bicycle. The proportion of commuters choosing to travel by bike is increasing in the United States, and information on injury incidence and the influences of rider characteristics and environmental factors may suggest opportunities for prevention actions. METHODS: Bicycle commuters in the Portland, OR, metropolitan area were recruited via the websites and community advertising to participate in a 1-year study. Riders completed an initial online survey along with 12 monthly surveys describing their commutes and injury events from September 2007 to August 2008. A traumatic event was considered a serious traumatic event if medical attention was sought. RESULTS: Nine hundred sixty-two adult bicyclists (52% men and 48% women) with a mean age of 36.7 ± 0.4 years (range, 22-70 years) commuted an average of 135 miles (range, 7-617) per month. There were 225 (23%) beginner, 256 (27%) intermediate, and 481 (50%) advanced riders. Four hundred twenty (44%) had a prior traumatic event. Over the 1-year period, 164 (18%) riders reported 192 traumatic events and 49 (5%) reported 50 serious traumatic events. The incidence rates of traumatic events and serious traumatic events were 15.0 (95% CI, 13.2-17.5) and 3.9 (95% CI, 2.9-5.1) per 100,000 miles commuted. There were no differences in age, gender, safety practices, and experience levels between commuters who experienced a traumatic event and those who did not. CONCLUSIONS: Approximately 20% of bicycle commuters experienced a traumatic event and 5% required medical attention during 1 year of commuting. Traumatic events were not related to rider demographics, safety practices, or experience levels. These results imply that injury prevention should focus on improving the safety of the bicycle commuting environment.

Lidocaine patches reduce pain in trauma patients with rib fractures.

Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P < 0.01), although only one patient was still using a patch. There was no difference in time to return to baseline activity (LP 73, C 105 days, P = 0.16) and no adverse events. Lidocaine patches are a safe, effective adjunct for rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.