Bicycle-related accidents in Rome: Investigating clinical patterns, demographics, injury contexts, and health outcomes for enhanced public safety.

INTRODUCTION: This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents. METHODS: Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated. RESULTS: Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients. CONCLUSIONS: Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages.

Unraveling the relation between cycling accidents and built environment typologies: Capturing spatial heterogeneity through a latent class discrete outcome model.

Today, cities seek to transition to more sustainable transportation modes. Cycling is critical in this shift, promoting a more beneficial lifestyle for most. However, cyclists are exposed to many hazardous circumstances or environments, resulting in accidents, injuries, and even death. Transport authorities must understand why accidents occur, to reduce the risk of those who cycle. This study applies a new modeling framework to analyze cycling accident severities. We employ a latent class discrete outcome model, where classes are derived from a Gaussian-Bernoulli mixture, applied to data from Berlin, and augmented with volunteered geographic information. We jointly estimate model components, combining machine learning and econometric approaches, allowing for more intricate and flexible representations while maintaining interpretability. Results show the potential of our approach. Risk factors are indexed depending on where accidents occurred and their contribution. We can discover complex relations between specific built environments and accident characteristics and uncover differences in the impact of certain accident factors on one environment typology but not others. Using multiple data sources also proves helpful as an additional layer of knowledge, providing unique value to understand and model cycling accidents. Another critical aspect of our approach is the potential for simulation, where locations can be examined through simulated accident features to understand the inherent risk of various locations. These findings highlight the ability to capture heterogeneity in accidents and their relation to the built environment. Capturing such relations allows for more direct countermeasures to risky situations or policies to be designed, simulated, and targeted.

The association between head injury and facial fracture treatment: an observational study of hospitalized bicyclists from a level 1 trauma centre.

PURPOSE: To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. METHODS: Retrospective analysis of data from bicycle-related injuries in the period 2005-2016 extracted from the Oslo University Hospital trauma registry. RESULTS: A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1-2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3-6). The mean patient age was 40.2 years (range 3-91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03-3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30-8.60, p = 0.012). CONCLUSION: Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit.

An Assessment of Sikh Turban's Head Protection in Bicycle Incident Scenarios.

Due to religious tenets, Sikh population wear turbans and are exempted from wearing helmets in several countries. However, the extent of protection provided by turbans against head injuries during head impacts remains untested. One aim of this study was to provide the first-series data of turbans' protective performance under impact conditions that are representative of real-world bicycle incidents and compare it with the performance of bicycle helmets. Another aim was to suggest potential ways for improving turban's protective performance. We tested five different turbans, distinguished by two wrapping styles and two fabric materials with a size variation in one of the styles. A Hybrid III headform fitted with the turban was dropped onto a 45 degrees anvil at 6.3 m/s and head accelerations were measured. We found large difference in the performance of different turbans, with up to 59% difference in peak translational acceleration, 85% in peak rotational acceleration, and 45% in peak rotational velocity between the best and worst performing turbans. For the same turban, impact on the left and right sides of the head produced very different head kinematics, showing the effects of turban layering. Compared to unprotected head impacts, turbans considerably reduce head injury metrics. However, turbans produced higher values of peak linear and rotational accelerations in front and left impacts than bicycle helmets, except from one turban which produced lower peak head kinematics values in left impacts. In addition, turbans produced peak rotational velocities comparable with bicycle helmets, except from one turban which produced higher values. The impact locations tested here were covered with thick layers of turbans and they were impacted against flat anvils. Turbans may not provide much protection if impacts occur at regions covered with limited amount of fabric or if the impact is against non-flat anvils, which remain untested. Our analysis shows that turbans can be easily compressed and bottom out creating spikes in the headform's translational acceleration. In addition, the high friction between the turban and anvil surface leads to higher tangential force generating more rotational motion. Hence, in addition to improving the coverage of the head, particularly in the crown and rear locations, we propose two directions for turban improvement: (i) adding deformable materials within the turban layers to increase the impact duration and reduce the risk of bottoming out; (ii) reducing the friction between turban layers to reduce the transmission of rotational motion to the head. Overall, the study assessed Turbans' protection in cyclist head collisions, with a vision that the results of this study can guide further necessary improvements for advanced head protection for the Sikh community.

Comparison of two bicycle handlebar trauma cases.

Handlebar injury is an uncommon mechanism of blunt injury with a recognised risk of injury to groin vasculature. We describe two cases involving bicycle handlebar injury to the groin and their different respective outcomes. Patient A sustained a significant limb-threatening injury following significant arterial and venous disruption. Surgical intervention was able to restore arterial flow via interpositional vein graft, while venous injuries were ligated. As a result, the patient was discharged with a viable limb and a non-disabling swelling from venous pathology. Patient B, of identical age, also sustained a bicycle handlebar injury to the groin but without the need for surgical intervention. Active observation and the use of repeat imaging suggested spontaneous cessation of any minor arterial bleeding; the patient made a rapid recovery and was discharged soon thereafter. These cases highlight the variability in outcome stemming from this injury mechanism and that early recognition is vital for limb viability.

Comparison of the number of pedestrian and cyclist injuries captured in police data compared with health service utilisation data in Toronto, Canada 2016-2021.

INTRODUCTION: Pedestrian and cyclist injuries represent a preventable burden to Canadians. Police-reported collision data include information on where such collisions occur but under-report the number of collisions. The primary objective of this study was to compare the number of police-reported collisions with emergency department (ED) visits and hospitalisations in Toronto, Canada. METHODS: Police-reported collisions were provided by Toronto Police Services (TPS). Data included the location of the collision, approximate victim age and whether the pedestrian or cyclist was killed or seriously injured. Health services data included ED visits in the National Ambulatory Care Reporting System and hospitalisations from the Discharge Abstract Database using ICD-10 codes for pedestrian and cycling injuries. Data were compared from 2016 to 2021. RESULTS: Injuries reported in the health service data were higher than those reported in the TPS for cyclists and pedestrians. The discrepancy was the largest for cyclists treated in the ED, with TPS capturing 7.9% of all cycling injuries. Cyclist injuries not involving a motor vehicle have increased since the start of the pandemic (from 3629 in 2019 to 5459 in 2020 for ED visits and from 251 in 2019 to 430 for hospital admissions). IMPLICATIONS: While police-reported data are important, it under-reports the burden. There have been increases in cyclist collisions not involving motor vehicles and decreases in pedestrian injuries since the start of the pandemic. The results suggest that using police data alone when planning for road safety is inadequate, and that linkage with other health service data is essential.

Age, crash type and the changing patterns of cycling fatalities in Australia between 1991 and 2022.

BACKGROUND: Australia has made significant efforts in recent years to promote cycling. METHODS: Trends in cyclist fatalities in Australia between 1991 and 2022, particularly in those aged 60 years and over, were examined using Poisson regression modelling. RESULTS: Overall, cyclist fatalities decreased by 1.1% annually. However, while there was an annual decline of 2.5% in those aged <60 years, fatalities in the 60+ age group increased by 3.3% annually. Mortality rates also showed an annual decrease of 3.5% for cyclists aged <60 years but remained almost stable in the 60+ age group over the study period. Single vehicle fatalities increased markedly, particularly among the 60+ age group (4.4% annually). DISCUSSION: The observed increase in 60+ fatalities is due to the ageing of the population rather than a rise in cycling popularity as previously thought. The rise in single vehicle fatalities is likely to be related to the increase in the availability and use of dedicated cycling infrastructure.

Secular trends in the incidence and severity of injuries sustained by riders of electric bikes and powered scooters: The experience of a level 1 adult trauma center.

BACKGROUND: The incidence of injuries caused by electric bicycles (E-bikes) and powered scooters (P-scooters) continues to increase. Data on the severity of those injuries is conflicting. The purpose of this study was to explore secular trends in the incidence and severity characteristics of patients following E-bike and P-scooter injuries and predictors for major trauma. METHODS: A retrospective cohort study of patients aged ≥16 years following E-bike and P-scooter injuries was performed at a level 1-trauma center between 2017 and 2022. We explored secular trends in major trauma cases (primary outcome), emergency department (ED) visits, hospitalizations, and surgical interventions (secondary outcomes). Major trauma was defined by either an injury severity score (ISS) >15 or the patient's need for acute care, defined by any of the following: Intensive care unit admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death. Primary and secondary outcomes were compared between two time frames (2017-2018 vs.2019-2022). RESULTS: In total, 9748 patients were presented following P-scooter and E-bike injuries. Of them, 1183 patients (12.1%) were hospitalized (854 males [72.2%],median age 33 years, median ISS 9).During the study period, the number of ED visits increased by 21-fold, with a parallel increase hospitalizations and surgical interventions numbers, which increased by 3.4-and 3.8-fold, respectively. Numbers of patients with ISSs >15 and patients who required acute care sharply increased during the study period, but no significant differences were found in the percentages of patients with ISSs >15 (p = 0.78) or patients' need for acute care (p = 0.32) between early and late periods. A severity analysis revealed that male sex (adjusted odds ratio [aOR] 1.7 [95% confidence interval (CI): 1.2-2.4], p = 0.001) and E-bike riders compared to P-scooter riders (aOR 1.5 [95% CI:1.1-2.0], p = 0.005) were independent predictors for severe trauma. CONCLUSIONS: The incidence of E-bike and P-scooter injuries sharply increased over time, with a parallel elevation in numbers of hospitalizations, surgical interventions, and major trauma cases. Major trauma percentages did not increase during the study period. Male sex and E-bikes emerged as independent predictors for major trauma.

Evaluation of an Elastomeric Honeycomb Bicycle Helmet Design to Mitigate Head Kinematics in Oblique Impacts.

Head impacts in bicycle accidents are typically oblique to the impact surface and transmit both normal and tangential forces to the head, causing linear and rotational head kinematics, respectively. Traditional expanded polystyrene (EPS) foam bicycle helmets are effective at preventing many head injuries, especially skull fractures and severe traumatic brain injuries (TBIs) (primarily from normal contact forces). However, the incidence of concussion from collisions (primarily from rotational head motion) remains high, indicating need for enhanced protection. An elastomeric honeycomb helmet design is proposed herein as an alternative to EPS foam to improve TBI protection and be potentially reusable for multiple impacts, and tested using a twin-wire drop tower. Small-scale normal and oblique impact tests showed honeycomb had lower oblique strength than EPS foam, beneficial for diffuse TBI protection by permitting greater shear deformation and had the potential to be reusable. Honeycomb helmets were developed based on the geometry of an existing EPS foam helmet, prototypes were three-dimensional-printed with thermoplastic polyurethane and full-scale flat and oblique drop tests were performed. In flat impacts, honeycomb helmets resulted in a 34% higher peak linear acceleration and 7% lower head injury criteria (HIC15) than EPS foam helmets. In oblique tests, honeycomb helmets resulted in a 30% lower HIC15 and 40% lower peak rotational acceleration compared to EPS foam helmets. This new helmet design has the potential to reduce the risk of TBI in a bicycle accident, and as such, reduce its social and economic burden. Also, the honeycomb design showed potential to be effective for repetitive impact events without the need for replacement, offering benefits to consumers.

Risk Factors and Inequities in Transportation Injury and Mortality in the Canadian Census Health and Environment Cohorts (CanCHECs).

BACKGROUND: Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode. METHODS: Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population. RESULTS: We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes. CONCLUSIONS: This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.

Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis.

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.

Quad bike related trauma in Ireland.

INTRODUCTION: A quad bike or an all-terrain vehicle is a four-wheeled powered vehicle generally designed for off-road use. They are widely used for farm-related work and more recently for recreational purposes. The potential for serious injury and death with quad bike use is a growing public health concern. There is an inherent instability in their design and they are typically used on rugged terrain characterised by dangerous driving surfaces. This study examines quad bike related trauma in Ireland using a national trauma registry to identify patient demographics, injury mechanism and type, treatments received and outcomes. METHODS: All quad bike related trauma cases recorded on the Major Trauma Audit (MTA), National Office of Clinical Audit in Ireland for the period 2014-2019 were gathered and analysed. RESULTS: There were 69 cases identified and 63 (91 %) of these were male. The median (IQR) age was 27 (19 - 49.1). There were 25 % (n = 17) aged 0-18 years, 64 % (n = 44) aged 19-65 and 12 % (n = 8) aged greater than 65 years. The median injury severity score (ISS) was 10 (IQR 9-22). The most severely injured body region was the head (n = 21, 30 %). No helmet use was recorded in 50 % (n = 34) of cases. October recorded the highest number of cases (n = 9, 13 %), and Sunday was the most common day (n = 17, 25 %). The median length of hospital stay was five days (IQR 3-9). One patient died after arrival to hospital. CONCLUSION: Quad bike related trauma predominantly affects a young male cohort with serious injury characteristics. A sizeable proportion of patients are under 18 years of age. This data can better inform national policies and public awareness campaigns targeting this trauma subset. The head was the most common severely injured body region, highlighting the potential need for legislative intervention regarding mandatory helmet use. A large cohort of patients required transfer for definitive care which has implications for trauma care pathways and advocates for the development of an integrated trauma system in Ireland.

Safe System approach for cyclists in the Netherlands: Towards zero fatalities and serious injuries?

More than one third of all road deaths in the Netherlands and more than two thirds of seriously injured casualties are cyclists. In recent years these shares have increased, despite the fact that the implementation of Safe System principles has been leading in road safety policy and has been successful in reducing the total number of road deaths. However, the annual number of fatalities among cyclists failed to decline and the number of injuries among cyclists has been increasing, especially in single-bicycle crashes. This raises the question why until now Safe System implementation has failed to contribute to the reduction of the number of casualties among cyclists. This question is urgent because of the goal to reduce the number of road deaths and serious traffic injuries in the Netherlands to (virtually) ZERO by 2050. This ambition is in line with the objectives of the European Union. The causes of the unfavourable developments in road safety for cyclists in the Netherlands and which problems require a solution are examined. This raises two questions: can improved implementation of Safe System measures reverse the negative trend, and can this result in ZERO cycling casualties in the future. The discussion involves investigating three dimensions: exposure, crash risk, and injury risk. The opportunities that technological developments may offer in future decades are also considered. It is concluded that Safe System implementation will include opportunities to make cycling considerably safer in the Netherlands. However, we face too many uncertainties to allow for developing scenarios that show how close the Netherlands will be to ZERO cyclists casualties.

Longitudinal and Concurrent Effortful Control as Predictors of Risky Bicycling in Adolescence: Moderating Effects of Age and Gender.

OBJECTIVE: Collisions between bicycles and motor vehicles are one of the leading risk factors for injury and death in childhood and adolescence. We examined longitudinal and concurrent effortful control (EC) as predictors of risky bicycling behavior in early- to mid-adolescence, with age and gender as moderators. We also examined whether EC was associated with parent-reported real-world bicycling behavior and all lifetime unintentional injuries. METHODS: Parent-reported EC measures were collected when children (N = 85) were 4 years old and when they were either 10 years (N = 42) or 15 years (N = 43) old. We assessed risky bicycling behavior by asking the adolescents to bicycle across roads with high-density traffic in an immersive virtual environment. Parents also reported on children's real-world bicycling behavior and lifetime unintentional injuries at the time of the bicycling session. RESULTS: We found that both longitudinal and concurrent EC predicted adolescents' gap choices, though these effects were moderated by age and gender. Lower parent-reported early EC in younger and older girls predicted a greater willingness to take tight gaps (3.5 s). Lower parent-reported concurrent EC in older boys predicted a greater willingness to take gaps of any size. Children lower in early EC started bicycling earlier and were rated as less cautious bicyclists as adolescents. Adolescents lower in concurrent EC were also rated as less cautious bicyclists and had experienced more lifetime unintentional injuries requiring medical attention. CONCLUSION: Early measures of child temperament may help to identify at-risk populations who may benefit from parent-based interventions.

Comparison of single bicycle crashes and collisions among severely injured cyclists-A 16-year analysis based on the Helsinki Trauma Registry (HTR).

OBJECTIVE: The Finnish national Traffic Safety Strategy 2022-2026 seeks to halve the number of road fatalities and serious injuries from 2020 to 2030. The strategy states that better information on bicycle crashes is needed for safety promotion. The aim of this study was to describe the demographics, injury characteristics, alcohol involvement, and helmet use of severely injured cyclists and to compare single bicycle crashes (falling alone or hitting a fixed object) to collisions. MATERIAL AND METHODS: We identified all bicycle crashes between 2006 and 2021 from the Helsinki Trauma Registry (HTR). Variables analysed were basic patient demographics, Abbreviated Injury Scale (AIS) codes, AIS 3+ injuries, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS), 30-day in-hospital mortality, ICU length of stay, injury mechanism, alcohol use by the injured cyclists, and helmet use. RESULTS: Of the 325 severe (NISS >15) cycling injury patients in the HTR, 53.5 % were injured in single crashes and 46.5 % in collisions with a moving object. Most (71.4 %) patients were men and mean age of all patients was 54.1 years (SD 16.7). Alcohol was detected in 23.1 % of cases and more often in single crashes (32.8 %) than in collisions (11.9 %). Less than a third (29.2 %) of all cyclists wore a helmet; those who wore a helmet had fewer serious (AIS 3+) head injuries than those who did not. Cyclists injured in collisions had higher ISS and NISS scores than those injured in single crashes. Serious (AIS 3+) injuries in extremities or in pelvic girdle were more common in collisions than in single crashes. CONCLUSIONS: Among severely injured cyclists, single bicycle crashes were more common; alcohol was more often detected in single bicycle crashes than in collisions. Overall injury severity was higher in collisions than in single crashes. Helmet users had less AIS 3+ head injuries than non-users. Attention should be focused on preventing alcohol-related cycling injuries, promoting use of bicycle helmets, and more precise and comprehensive documentation of bicycle crashes in health care units.

A correlated random parameters ordered probit approach to analyze the injury severity of bicycle-motor vehicle collisions at intersections.

Bicycle-motor vehicle (BMV) accidents hold paramount importance due to their substantial impact on public safety. Specifically, road intersections, being critical conflict points, demand focused attention to reduce BMV crashes effectively and mitigate their severity. The existing research on the severity analysis of these crashes appears to have certain gaps that warrant further contribution. To address the mentioned limitations, this study first integrates multiple pre-collision features of the bicycles and vehicles to classify crash types based on the mechanism of the crashes. Then, the correlated random parameters ordered probit (CRPOP) model is employed to examine the factors influencing injury severity among bicyclists involved in intersection BMV crashes in Pennsylvania from 2013 to 2018. To gain deeper insights, this study conducts a separate analysis of crash data from 3-leg intersections, 4-leg intersections, and their combined scenarios, followed by a comparative examination of the results. The findings revealed that the presented crash typing approach yields new insights regarding injury severity outcomes. Moreover, in addition to exhibiting a comparable statistical performance contrasting to the more restricted models, the CRPOP model identified hidden correlations between three random parameters. Furthermore, the study demonstrated that analyzing combined crash data from the two intersection types obscured certain factors that were found significantly influential in the injury outcomes through analyzing sub-grouped data. Consequently, it is recommended to implement tailored countermeasures for each type of intersection.

Do electric bicycles cause an increased injury risk compared to conventional bicycles? The potential impact of data visualisations and corresponding conclusions.

The increasing number of bicycle crashes leading to injuries in the Netherlands is frequently related (e.g., in the media) to increased use of the electric bicycle. For this reason, policy makers face the challenge of selecting and implementing the most promising countermeasures including those focused on electric bicycles. It may be questioned, however, to what extent the electric bicycle itself is a (direct) cause of crashes leading to injuries or whether other factors are important for explaining the increased number of bicycle injury crashes. On the basis of an abbreviated list of criteria by Elvik (2011), this paper illustrates the potential influence of factor inclusions, analysis selections, and data presentations on the general impression about crash causation with the electric bicycle as an example. The aim is to provide a 'best practice guide' by taking into account (1) a theoretical explanation of causal mechanisms, (2) control for confounders, and (3) a statistical association of sufficient strength and consistency in the expected direction. We conclude that an apparent increased risk of electric bicycles may be explained by factors such as age, exposure, health factors, and gender of the cyclist. A relatively simple analysis, by comparing fatality numbers of conventional and electric bicycles, showed that including or excluding these factors may lead to vastly different interpretations of fatality causes and the relative risk of electric bicycles compared to conventional bicycles.

Pediatric Fractures Associated With Riding Bicycles: A National 20-year Analysis.

BACKGROUND: Biking is a popular childhood activity with an intrinsic risk of injury. While advocacy groups have promoted protective equipment to help mitigate these risks, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth. METHODS: The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged 18 years or below with fractures presenting to US emergency departments associated with riding bicycles. The patient narratives were analyzed to exclude patients not actively riding bicycles and to note helmet use and collisions with motor vehicles (MVs). RESULTS: A total of 33,955 fractures were identified in the database, representing an estimated 1,007,714 fractures from 2001 to 2020, or 50,331 fractures annually. Linear regression noted a significant decrease in fractures over the period ( R2 =0.899; P <0.001). Most fractures occurred in patients who were male (71.8%, 95% CI: 70.4% to 73.2%), White (53.1%, 46.0% to 60.0%), and aged 10 to 12 (30.6%, 29.6% to 31.7%) or 13 to 15 years (24.8%, 23.4% to 26.2%). Fractures occurred most frequently in the forearm (25.2%, 22.8% to 27.8%), wrist (21.2%, 19.5% to 22.9%), and shoulder (10.5%, 9.7% to 11.3%). Patients who sustained fractures after being struck by a MV were >6 times more likely to be admitted to the hospital (36.0%, 28.6% to 44.2%) compared with patients not struck by a MV (5.4%, 4.3% to 6.8%). When helmet use was recorded in patients with skull fractures, most patients were not wearing helmets at the time of injury (85.7%, 74.6% to 92.5%). CONCLUSIONS: Although the national burden of fractures associated with riding bicycles in pediatric populations has steadily decreased, it remains a significant cause of injury for children. Fractures involving MV more often require hospitalization, and an alarming number of skull fractures are noted in children not wearing helmets. These data support continued efforts to promote consistent helmet use and safer riding environments around MV in all children, but especially among 10- to 15-year-old males. LEVEL OF EVIDENCE: Level III-prognostic.

Development of German pedelec (and bicycle) crashes between 2013 and 2021.

INTRODUCTION: The continuous growth in the use of e-bikes (in Germany mostly pedelecs that support pedaling up to 25 km/h) raises questions about the use of historic crash data for the development of road safety measures. The aim of this study was to address this issue, by conducting a longitudinal analysis of pedelec and bicycle crash data over a period of nine years to identify trends and to clarify whether such trends are specific to pedelecs. METHOD: We analyzed 95,338 police reported pedelec and bicycle injury crashes from 2013 through 2021. The dataset consisted of crashes from three federal states of Germany: Brandenburg, Hesse and Saxony. Data were analyzed with respect to sex and age distribution, time, location and type of accident, conflict partner, cause of crash and injury severity. RESULTS: Many of the analyzed variables showed a considerable degree of temporal stability, with differences as well as similarities between the two bicycle types staying quite consistent over the years. One notable difference was the mean age of the involved riders, with crashed pedelec riders being significantly older than conventional cyclists. At the same time, however, the mean age of these pedelec riders has decreased by eight years over time. Single vehicle crashes were consistently more common for pedelec riders than for cyclists. Similarly, pedelec rider crashes went with a higher injury severity over all the years. CONCLUSIONS AND PRACTICAL APPLICATIONS: While, on a more detailed level, we found differences between the two bicycle types, overall crash characteristics were remarkably similar and consistent over time. Our findings provide no clear argument for road safety measures that are specifically designed to target pedelecs. Instead, the stable crash total, and the increases in ridership of both bicycles and pedelecs, highlight the demand for new, innovative solutions to improve cycling safety in general.

Cyclist's travel distances and risk of falls in snowy and icy conditions in German cities.

INTRODUCTION: So far, no studies are known that estimate distance-based risks for cyclist falls in snowy/icy conditions compared to other conditions to account for differences in cycling levels in the different weather situations. METHOD: The number of cyclist falls was gathered from retrospective surveys in Germany. Cycling distances were obtained from the German Household Travel Survey "Mobility in cities - SrV," assigned to meteorological data, and validated against counts and own surveys. The number of falls per distance cycled and Risk Ratios for snowy/icy versus other weather conditions were estimated. RESULTS: An average decrease of 53% in the distance travelled per person and day is estimated for snowy/icy days versus other days. This decrease is lower in regions with higher general cycling mode shares. We find average risks of falls from 9.5 to 16 (field surveys) up to 76.5 falls per 10,000 km (online survey) and average Risk Ratios for cycling in snowy/icy conditions of 20 (field survey conducted in times of other weather) to 36 (field survey conducted in times of snow/ice) and 38 (online survey conducted in times of snow/ice). The risk of suffering an injury in the event of a fall is lower in snowy/icy compared to other weather conditions. CONCLUSIONS: Seeing the current trend of growing general cycling levels in Germany, we expect more cycling in winter and, in case of unchanged winter weather and maintenance, a substantial increase of cyclist falls. The reduced risk of being injured in the event of a fall in snowy/icy conditions does not outweigh the higher risk of falling in the first place. PRACTICAL APPLICATIONS: Improved winter maintenance on cycling facilities can help increase winter cycling and reduce the risk of falls at the same time.