Bicycle-related traumatic injuries: a retrospective study during COVID-19 pandemic

doi:10.5847/wjem.j.1920-8642.2024.043

Abstract

Abstract:

BACKGROUND: This study aimed to review bicycle-related injuries during the COVID-19 pandemic to assist with reinforcement or implementation of new policies for injury prevention.

METHODS: This is a retrospective descriptive analysis of injuries sustained during cycling for patients 18 years old and above who presented to Singapore General Hospital from January to June 2021. Medical records were reviewed and consolidated. Descriptive analyses were used to summarize patient characteristics, and differences in characteristics subgrouped by triage acuity and discharge status were analyzed.

RESULTS: The study included 272 patients with a mean age of 43 years and a male predominance (71.7%). Most presented without referrals (88.2%) and were not conveyed by ambulances (70.6%). Based on acuity category, there were 24 (8.8%) Priority 1 (P1) patients with 7 trauma activations, 174 (64.0%) and 74 (27.2%) P2 and P3 patients respectively. The most common injuries were fractures (34.2%), followed by superficial abrasion/contusion (29.4%) and laceration/wound (19.1%). Thirteen (4.8%) patients experienced head injury and 85 patients (31.3%) were documented to be wearing a helmet. The majority occurred on the roads as traffic accidents (32.7%). Forty-two patients (15.4%) were admitted with a mean length of stay of 4.1 d and 17 (6.3%) undergone surgical procedures. Out of 214 (78.7%) discharged patients, no re-attendances or mortality were observed. In the subgroup analysis, higher acuity patients were generally older, with higher proportions of head injuries leading to admission.

CONCLUSION: Our study highlights significant morbidities in bicycle-related injuries. There is also a high proportion of fractures in the young healthy male population. Injury prevention is paramount and we propose emphasizing helmet use and road user safety.

Key words: Cycling, Injuries, Emergency department

Jie Er Janice Soo, Yuan Helen Zhang, Gek Hsiang Lim, Fatimah Lateef. Bicycle-related traumatic injuries: a retrospective study during COVID-19 pandemic[J]. World Journal of Emergency Medicine, 2024, 15(4): 256-262.

Figures/Tables 3

Table 1.

Table 2.

Comparison between triage acuity groups, n (%)

Characteristics	Triage acuity			P-value*
Characteristics	P1 (n=24)	P2 (n=174)	P3 (n=74)	P-value*
Gender				0.93
Female	6 (25.0)	50 (28.7)	21 (28.4)
Male	18 (75.0)	124 (71.3)	53 (71.6)
Age, years, mean±SD	44.7±15.6	44.7±15.6	39.6±15.4	0.06
Race				0.32
Chinese	18 (75.0)	110 (63.2)	45 (60.8)
Malay	3 (12.5)	13 (7.5)	7 (9.5)
Indian	1 (4.2)	13 (7.5)	8 (10.8)
Caucasian	0 (0.0)	20 (11.5)	3 (4.1)
Others	2 (8.3)	18 (10.3)	11 (14.9)
Injuries
Head injury	2 (8.3)	10 (5.8)	1 (1.4)	0.17
Abdominal injuries	1 (4.2)	1 (0.6)	1 (1.4)	0.15
Fracture	9 (37.5)	65 (37.4)	19 (25.7)	0.19
Dislocation	4 (16.7)	7 (4.0)	0 (0.0)	0.004
Laceration / wound	3 (12.5)	31 (17.8)	18 (24.3)	0.34
Abrasion / contusion	6 (25.0)	52 (29.9)	24 (32.4)	0.78
Musculoskeletal pain	2 (8.3)	25 (14.4)	12 (16.2)	0.69
Non-trauma	1 (4.2)	2 (1.2)	1 (1.4)	0.37
Circumstances of injury
Injury time				0.76
Morning (7 am-12 pm)	4 (16.7)	37 (21.3)	15 (20.3)
Afternoon (12 pm-7 pm)	7 (29.2)	37 (21.3)	13 (17.6)
Night (7 pm-7 am)	13 (54.2)	63 (36.2)	20 (27.0)
Not documented	0 (0.0)	37 (21.3)	26 (35.1)
Day of presentation				0.32
Weekends (Sat, Sun)	9 (37.5)	60 (34.5)	33 (44.6)
Weekdays	15 (62.5)	114 (65.5)	41 (55.4)
Place of injury				0.94
Public areas	8 (33.3)	54 (31.0)	22 (29.7)
Road	12 (50.0)	59 (33.9)	18 (24.3)
Recreational / Sports area	1 (4.2)	17 (9.8)	5 (6.8)
Workplace	0 (0.0)	3 (1.7)	1 (1.4)
Home/residential institution	0 (0.0)	2 (1.2)	1 (1.4)
Playground	0 (0.0)	1 (0.6)	0 (0.0)
Not documented	3 (12.5)	38 (21.8)	27 (36.5)
Helmet use				0.23
Yes	13 (54.2)	53 (30.5)	19 (25.7)
No	2 (8.3)	24 (13.8)	4 (5.4)
Not documented	9 (37.5)	97 (55.8)	51 (68.9)
Emergency visit
Referral source				0.02
Self	24 (100.0)	158 (90.8)	58 (78.4)
Polyclinic / General practitioner	0 (0.0)	15 (8.6)	14 (18.9)
Others (police, hospital)	0 (0.0)	1 (0.6)	2 (2.7)
Ambulance				<0.001
Non-ambulance	8 (33.3)	117 (67.2)	67 (90.5)
Ambulance	16 (66.7)	57 (32.8)	7 (9.5)
Outcome
ED disposition				<0.001
Admitted	12 (50.0)	26 (14.9)	4 (5.4)
Discharged against medical advice	2 (8.3)	11 (6.3)	3 (4.1)
Discharged	10 (41.7)	137 (78.7)	67 (90.5)
Admitting discipline				0.99
Medical	2 (16.7)	4 (15.4)	0 (0.0)
Surgical	10 (83.3)	22 (84.6)	4 (100.0)
Procedure				0.17
No procedure done	22 (91.7)	162 (93.1)	71 (96.0)
1 procedure done	0 (0.0)	9 (5.2)	3 (4.1)
2 procedures done	2 (8.3)	3 (1.7)	0 (0.0)
Length of stay, d, median (IQR)	2 (1.5 - 4)	2.5 (2 - 5)	3.5 (1 - 8)	0.86

Table 2.

Table 3.

References 24

[1]	Dinh MM, Kastelein C, Hopkins R, Royle TJ, Bein KJ, Chalkley DR, et al. Mechanisms, injuries and helmet use in cyclists presenting to an inner city emergency department. Emerg Med Australas. 2015; 27(4): 323-7. doi: 10.1111/1742-6723.12407 pmid: 25939667
[2]	Beckwith K, James V, Kalaiselvan K, Ganapathy S. Bicycle injuries among the paediatric population at an emergency department in Singapore. Singapore Med J. 2019; 60(7): 343-6.
[3]	Faulkner A, MacDonald DRW, Neilly DW, Davies PSE, Ha TT, Stevenson IM, et al. Cycling injuries requiring orthopaedic intervention during the first COVID-19 lockdown period: a multi-centre SCottish Orthopaedic Research collaborativE (SCORE) study. Surgeon. 2022; 20(4): 252-7.
[4]	Mumtaz S, Cymerman J, Komath D. Cycling-related injuries during COVID-19 lockdown: a North London experience. Craniomaxillofac Trauma Reconstr. 2022; 15(1): 46-50. doi: 10.1177/19433875211007008 pmid: 35265277
[5]	Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Available at: www.cdc.gov/injury/wisqars
[6]	Singapore Police Force. Annual traffic statistics 2021. Available at: www.police.gov.sg/media-room/statistics
[7]	Foley J, Cronin M, Brent L, Lawrence T, Simms C, Gildea K, et al. Cycling related major trauma in Ireland. Injury. 2020; 51(5): 1158-63. doi: S0020-1383(19)30746-6 pmid: 31784058
[8]	Sadiqi S, Leenen LPH, Oner CF, Injuries related to bicycle accidents: an epidemiological study in The Netherlands. Eur J Trauma Emerg Surg. 2020; 46(2): 413-8.
[9]	Schwellnus MP, Derman EW. Common injuries in cycling: prevention, diagnosis and management. S A Fam Pract. 2005; 47(7): 14-9.
[10]	Peter L, Hong CC, Daniel P, Aoyama R, Murphy D, Kuan WS. Bicycle-related injuries in paediatric patients. Ann Acad Med Singap. 2018; 47(10): 424-8. pmid: 30460970
[11]	Kwan JR, Lim SHC, Ong WLL, Tan YHA, Kam JH, Pek JH.Recreational cycling related injuries at the emergency department. Proceedings of Singapore Healthcare. 2023; 32:201010582311672.
[12]	Heng KW, Lee AH, Zhu S, Tham KY, Seow E. Helmet use and bicycle-related trauma in patients presenting to an acute hospital in Singapore. Singapore Med J. 2006; 47(5): 367-72.
[13]	Rojas López MC, Wong YD. Attitudes towards active mobility in Singapore: A qualitative study. Case Stud Transp Policy. 2017 Dec;5(4):662-70.
[14]	Lateef F. The emergency medical services in Singapore. Resuscitation. 2006; 68(3): 323-8. doi: 10.1016/j.resuscitation.2005.12.007 pmid: 16503277
[15]	Mjåland O, Nygaard A, Storm-Larsen C, Brommeland T. Cycling-related injuries at Sørlandet Hospital, Kristiansand. Tidsskr Nor Laegeforen. 2019; 139(12).
[16]	Cha Sow King C, Liu M, Patel S, Goo TT, Lim WW, Toh HC. Injury patterns associated with personal mobility devices and electric bicycles: an analysis from an acute general hospital in Singapore. Singapore Med J. 2020; 61(2): 96-101.
[17]	Siebentritt HM, Keppner V, Britting S, Kob R, Rappl A, Sieber CC, et al. Safer cycling in older age (SiFAr): a protocol of a randomized controlled trial. BMC Geriatr. 2021; 21(1): 546.
[18]	Eid HO, Bashir MM, Muhammed OQ, Abu-Zidan FM. Bicycle-related injuries: a prospective study of 200 patients. Singapore Med J. 2007; 48(10): 884-6.
[19]	Scott LR, Bazargan-Hejazi S, Shirazi A, Pan DY, Lee S, Teruya SA, et al. Helmet use and bicycle-related trauma injury outcomes. Brain Inj. 2019; 33(13-14): 1597-601. doi: 10.1080/02699052.2019.1650201 pmid: 31514542
[20]	Ning PS, Zong HY, Li L, Cheng PX, Schwebel DC, Yang Y, et al. Effectiveness of a helmet promotion campaign, China. Bull World Health Organ. 2022; 100(5): 329-36.
[21]	Farag N, Germain A, Caminsky NG, Busque AA, Grenier T, Bracco D, et al. Factors associated with bicycle helmet use and proper fit: a cross-sectional survey of Montreal cyclists during the COVID-19 pandemic. Rev Can De Sante Publique. 2023; 114(2): 195-206.
[22]	Benhamed A, Gossiome A, Ndiaye A, Tazarourte K. Characteristics and comparison between e-scooters and bicycle-related trauma: a multicentre cross-sectional analysis of data from a road collision registry. BMC Emerg Med. 2022; 22(1): 164.
[23]	Hardwicke J, Baxter BA, Gamble T, Hurst HT. An investigation into helmet use, perceptions of sports-related concussion, and seeking medical care for head injury amongst competitive cyclists. Int J Environ Res Public Health. 2022; 19(5): 2861.
[24]	Panigrahi S, Parveen S, Kshatri JS, Pati S, Bhaumik S. Facilitators and barriers to bicycle helmet use: a qualitative evidence synthesis. J Family Med Prim Care. 2022; 11(9): 5211-25. doi: 10.4103/jfmpc.jfmpc_2464_21 pmid: 36505541

Characteristics	Admitted (n=42)	Discharged (n=214)	P-value*
Gender			0.29
Female	9 (21.4)	63 (29.4)
Male	33 (78.6)	151 (70.6)
Age, years, median (IQR)	45.5 (32-59)	40 (29-54)	0.15
Race			0.77
Chinese	30 (71.4)	135 (63.1)
Malay	2 (4.8)	18 (8.4)
Indian	4 (9.5)	17 (7.9)
Caucasian	3 (7.1)	16 (7.5)
Others	3 (7.1)	28 (13.1)
Injuries
Head injury	5 (11.9)	8 (3.7)	0.03
Abdominal injuries	2 (4.8)	1 (0.5)	0.07
Fracture	18 (42.9)	67 (31.3)	0.15
Dislocation	3 (7.1)	7 (3.3)	0.22
Laceration / wound	12 (28.6)	37 (17.3)	0.09
Abrasion / contusion	9 (21.4)	69 (32.2)	0.16
Musculoskeletal pain	1 (2.4)	37 (17.3)	0.01
Injury time			0.80
Morning (7 am-12 pm)	9 (21.4)	40 (18.7)
Afternoon (12 pm-7 pm)	13 (31.0)	42 (19.6)
Night (7 pm-7 am)	18 (42.9)	75 (35.1)
Not documented	2 (4.8)	57 (26.6)
Place of injury			0.76
Public areas	11 (26.2)	66 (30.8)
Road	16 (38.1)	69 (32.2)
Recreational / Sports area	3 (7.1)	20 (9.4)
Workplace	1 (2.4)	2 (0.9)
Home / Residential institution	0 (0.0)	3 (1.4)
Playground	0 (0.0)	1 (0.5)
Not documented	11 (26.2)	53 (24.8)
Day of presentation			0.62
Weekends (Sat, Sun)	17 (40.5)	78 (36.5)
Weekdays	25 (59.5)	136 (63.6)
Helmet use			0.59
Yes	14 (33.3)	66 (30.8)
No	6 (14.3)	21 (9.8)
Not documented	22 (52.4)	127 (59.4)
Referral source			0.22
Self	39 (92.9)	187 (87.4)
Polyclinic / General practitioner	2 (4.8)	25 (11.7)
Others (police, hospital)	1 (2.4)	2 (0.9)
Triage acuity			<0.001
P1	12 (28.6)	10 (4.7)
P2	26 (61.9)	137 (64.0)
P3	4 (9.5)	67 (31.3)
Ambulance			<0.001
Non-ambulance	16 (38.1)	165 (77.1)
Ambulance	26 (61.9)	49 (22.9)