The Impact of the COVID-19 Shelter-in-Place Order on Traumatic Brain Injuries in San Francisco, California.

BACKGROUND: In response to the COVID-19 pandemic, San Francisco, California issued a shelter-in-place (SIP) order in March 2020, during which emergency physicians noted a drop in trauma cases, as well as a change in traditional mechanisms of trauma. OBJECTIVES: Our objective was to determine the epidemiology of traumatic brain injury (TBI) pre- and post-COVID-19 SIP. METHODS: We reviewed the electronic medical record of the only trauma center in the city of San Francisco, to determine the number of and characteristics of patients with a diagnosis of head injury presenting to the emergency department between December 16, 2019 and June 16, 2020. Using chi-squared and Fisher's exact tests when appropriate, we compared pre- and post- COVID-19 lockdown epidemiology. RESULTS: There were 1246 TBI-related visits during the 6-month study period. Bi-weekly TBI cases decreased by 36.64% 2 weeks after the COVID-19 SIP and then increased to near baseline levels by June 2020. TBI patients during SIP were older (mean age: 53.3 years pre-SIP vs. 58.2 post-SIP; p < 0.001), more likely to be male (odds ratio 1.43, 95% confidence interval 1.14-1.81), and less likely to be 17 or younger (8.9% vs. 0.5%, pre- to post-SIP respectively, p = 0.003). Patients were less likely to be Hispanic (27.2% vs. 21.7% pre- to post-SIP, respectively, p = 0.029). The proportion of TBI visits attributable to cycling accidents increased (14.1% to 52.7%, p < 0.001), whereas those attributable to pedestrians involved in road traffic accidents decreased (37.2% to 12.7%, p = 0.003). CONCLUSIONS: Understanding the changing epidemiology of TBI during the COVID-19 pandemic can aid in immediate and future disaster resource planning.

Traumatic orthopaedic motor vehicle injuries: Are there age and sex differences in pedestrian and cyclist accidents in a major urban center?

INTRODUCTION: Injuries caused by road traffic have become the leading cause of death in people aged 5 to 29 years, with pedestrians and cyclists being disproportionately affected. Research has demonstrated age and sex differences in road accidents in European populations. The purpose of this study was to determine age and sex-specific differences in pedestrian and cyclist accidents involving passenger cars at a single Level 1 Trauma Center in a major US metropolitan area. METHODS: We performed a retrospective chart review of 1,845 patients that presented to a single level 1 trauma center from January 1, 2016 - October 1st, 2021, and were involved in a motor vehicle vs. pedestrian or motor vehicle vs. cyclist accidents. Demographics, injury pattern, abbreviated injury scores (AIS), and hospital stay were analyzed, and the data was stratified by pedestrian vs. cyclist, biological sex, and race. Chi square analysis, t tests, and binomial logistic regression was used to examine sex and age-based differences. RESULTS: Pedestrian vs. motor vehicle collisions (N = 1359, 74%) occurred more frequently than cyclists (N = 475, 26%) with an overall mortality rate of 6%. The mean age of pedestrians and cyclists was 39 and 42 years of age, respectively. Overall, more female than male patients had hand (mean=0.05 vs. 0.02) (p = 0.03) and pelvis fractures (mean 0.28 vs. 0.19) (p = 0.007). Females had a 1.2 times higher likelihood of getting a pelvis fracture than males (95% CI, 1.06 to 1.43). Linear regression analysis found a statistically significant relationship between older age and increased AIS severity (p < .001). Half of our sample consisted of Black patients (49.6% Black vs. 42.1% white). CONCLUSION: Female pedestrians and cyclists are at increased risk of obtaining pelvis fractures when in a traumatic road accident than males, regardless of age stratification, and age is a predictor of injury severity. Our study also found that race-based differences exist, with Black patients being injured more frequently. Further research is needed to better understand demographics at risk for traumatic road accidents, as well as evaluation of city infrastructure for biking and walking.

Cycling injuries requiring orthopaedic intervention during the first COVID-19 lockdown period: A multi-centre SCottish Orthopaedic Research collaborativE (SCORE) study.

INTRODUCTION: The COVID-19 lockdown resulted in decreased vehicle use and an increased uptake in cycling. This study investigated the trends in cycling-related injuries requiring orthopaedic intervention during the COVID-19 lockdown period compared with similar time periods in 2018 and 2019. METHODS: Data were collected prospectively for patients in 2020 and collected retrospectively for 2019 and 2018, from hospitals within four NHS Scotland Health Boards encompassing three major trauma centres. All patients who sustained an injury as a result of cycling requiring orthopaedic intervention were included. Patient age, sex, mechanism of injury, diagnosis and treatment outcome from electronic patient records. RESULTS: Number of injuries requiring surgery 2020: 77 (mean age/years - 42.7); 2019: 47 (mean age/years - 42.7); 2018: 32 (mean age/years - 31.3). Overall incidence of cycling injuries 2020: 6.7%; 2019: 3.0%; 2018: 2.1%. Commonest mechanism of injury: fall from bike 2020 n = 54 (70.1%); 2019 n = 41 (65.1%); 2018 n = 25 (67.6%). Commonest injury type: fracture 2020 n = 68 (79.1%); 2019 n = 33 (70.2%); 2018 n = 20 (62.5%). Commonest areas affected: Upper extremity: 2020 n = 45 (58.5%); 2019 n = 25 (53.2%); 2018 n = 25 (78.1%). Lower extremity: 2020 n = 23 (29.9%); 2019 n = 14 (29.7%); 2018 n = 7 (21.8%). CONCLUSION: A significant increase in the number of cycling related injuries requiring orthopaedic intervention, a greater proportion of female cyclists and an older mean age of patients affected was observed during the COVID-19 lockdown period compared with previous years. The most common types of injury were fractures followed by lacerations and fracture-dislocations. The upper extremity was the commonest area affected.

Lower extremity and spine pain in cyclists.

INTRODUCTION: The number of cyclists increases each year. Some people treat cycling as a passion and practice it at every possible occasion, while for others it is a mean of transport or a form of relaxation at the weekend. However, very few people realize that cycling can also have a negative impact on their health. OBJECTIVE: To assess the prevalence of lower extremity and spine pain in cyclists, and evaluate the influence of various factors causing it. MATERIAL AND METHODS: The study was performed on 167 subjects during amateur cycling competitions in the Greater Poland and Kuyavian-Pomeranian Provinces. A specially prepared questionnaire was used in the study. The questions related to the pain caused by cycling, the character and the localization of the pain, and the presence of warm-up and stretching. RESULTS: Knee pain was reported in 40% of the study subjects (mostly anterior pain - 26%). Spine pain was reported in 41% of the studied athletes, where 26% was related with the lumbar spine. Variables, such as age, weight, age, BMI, training experience and number of hours devoted to training per week had no influence on the incidence and the localization of leg pain, but it had influence in the case of spine pain. Stretching after cycling was the factor which significantly distinguished the studied groups with regard to the incidence of knee pain. CONCLUSIONS: The most common type of leg pain was knee pain (anterior knee pain) whereas spine pain was most commonly reported in the lumbar spine. Statistical analysis showed that spine pain is more often reported by people who are older, have higher weight, and people who spend more time training per week. Warm-up and stretching after cycling are recommended to cyclists who experience pain.

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study.

OBJECTIVE: The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated. METHODS: An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury. RESULTS: Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury. CONCLUSIONS: These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.