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• W1972510140 abstract "The purpose of this study was to describe the epidemiology of bicycle-related injuries presenting to United States emergency departments (EDs). The National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) database was used to derive national, weighted estimates of nonfatal ED visits for bicycle-related injuries by patient age, sex, diagnosis, injured body part, locale of incident, traffic-relatedness of incident, and month of incident. Males accounted for 73% of all bicycle-related injury ED visits. Patients aged 10 to 14 years represented the 5-year age interval with the highest rate of bicycle injury visits (488 per 10,000). Fifty-six percent of ED visits for bicycle-related injuries came from cyclists who were riding on the street, with increased street ridership in those who were older than 15 years, and 99.7% of all patient injuries occurring on the street (as opposed to other locations) were related to motor vehicle collisions (MVCs). The head and face were the most injured body parts in the overall population. In addition, the largest proportion of head injuries, relative to total injuries in the age group, occurred in the very young (0 to 4 years) and elderly (65+ years) populations. The leading rider injury diagnoses were contusion, abrasions, and hematomas. The incidence of bicycle-related injuries peaked in the month of July. The study identified the characteristics of bicycle-related injuries across various age groups of riders. This information will aid in developing more effective age-appropriate injury prevention strategies. The frequency of MVC-related injuries deserves attention and suggests the need to examine strategies for limiting interactions between moving vehicles and bicyclists. Epidemiología de la Lesiones No Fatales en Bicicleta que consultaron en los Servicios Urgencias de Estados Unidos entre 2001 y 2008 El propósito de este estudio fue describir la epidemiología de las lesiones relacionadas con la bicicleta en los servicios de urgencias (SU) de Estados Unidos. La base de datos del National Electronic Injury Surveillance System All Injury Program se utilizó para derivar las estimaciones de visitas al SU por lesiones no fatales relacionadas con la bicicleta según la edad del paciente, el sexo, el diagnóstico, la parte del cuerpo de la lesión, la localización del incidente, la relación del incidente con aspectos del tráfico y el mes del incidente. Los hombres explicaron el 73% de todas las visitas de lesión relacionada con la bicicleta en el SU. La edad del paciente de 10 a 14 años representó el intervalo de 5 años de edad con el mayor porcentaje de vistas por lesión de bicicleta (488 por 10,000). El 56% de las visitas al SU por lesiones relacionadas con la bicicleta vino de ciclistas que estaban yendo por la calle. Entre éstos, había un incremento de pacientes mayores de 15 años; y el 99,7% de todos los pacientes lesionados fue por colisión relacionada con un vehículo de motor. La cabeza y la cara fueron las partes del cuerpo más lesionadas en toda la población. Además, la mayor proporción de lesiones en la cabeza en relación al total de lesiones por grupo de edad, ocurrió en los más jóvenes (0 a 4 años) y en la población anciana (>65 años). Los principales diagnósticos fueron la contusión, las abrasiones y los hematomas. La incidencia de lesiones de bicicleta tuvo un máximo en el mes de julio. El estudio identificó las características de las lesiones relacionadas con la bicicleta en varios grupos de edad de ciclistas. Esta información ayudará en el desarrollo de estrategias más efectivas de prevención de lesiones según los grupos de edad. La frecuencia de las lesiones relacionadas con la colisión con vehículos de motor merece atención, y sugiere la necesidad de examinar estrategias para limitar las interacciones entre los vehículos en circulación y las bicicletas. Bicycle riding is a popular activity that has both health and environmental benefits. In recent years, with increases in traffic congestion1 and the number of bike lanes,2 and installation of bicycle sharing systems,3 bicycling has become an increasingly viable and popular option for transportation. As a result, bicycle-related injuries may become more common emergency department (ED) presentations. Currently, such bicycling injuries have not been well characterized in the United States. Previous studies describing bicycling injuries have been limited by geographic location,4-6 type of injury,7, 8 specific context (e.g., bike racing),9, 10 specific injury trends (e.g., temporal trends),11 or older data.12 More detailed information on biking injuries will aid in identifying and implementing preventive strategies that effectively target specific subsets of the population. The purpose of this study was to describe the epidemiology of nonfatal bicycling-related injuries in the U.S. population presenting to U.S. EDs. This is the first large-scale national study to use data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) to examine the incidence and characteristics of bicycle-related injuries treated in U.S. EDs. This was a retrospective cohort study using data from the NEISS-AIP. The study received institutional review board exemption from the Rhode Island Hospital Committee on the Protection of Human Subjects. The NEISS-AIP database includes data from 66 of the 100 NEISS hospitals, which are representative of the 5,000 hospitals that have a minimum of six beds and a 24-hour ED in the United States and its territories. The NEISS-AIP collects data on nonfatal injuries treated in U.S. EDs, and each NEISS case is assigned an inverse probability weight (IPW), which represents the inverse of the probability of the case being selected into the sample. These IPWs can be used to derive annual, weighted estimates of nonfatal injuries treated in EDs. We reviewed patient data for all nonfatal bicycle injuries occurring from January 1, 2001, through December 31, 2008. NEISS-AIP data include information on patient age and sex, injured body part, principal diagnosis, locale of incident, case disposition, immediate and precipitating cause, and sports/activity-relatedness. The NEISS-AIP also collects data on traffic-relatedness, defining traffic-related injuries as those resulting from motor vehicle collisions (MVCs) occurring on a public highway, street, or road. The NEISS-AIP defines nonfatal injury as bodily harm resulting from severe exposure to an external force, substance, or submission. We reviewed data from 2001 through 2008 for all nonfatal bicycle injury visits by patients of all ages. Only injuries coded as “8 – BICYCLE” under the “SPORTS” variable were used for the purposes of analysis. Even though the code for an injury related to a bicycle falls under the “SPORTS” variable, any bicycle injury (not just in a sports setting) was coded as “8” under the “SPORTS” variable. Using the national estimates, proportions of injuries were calculated by sex, age, injured body part, diagnosis, locale of incidence, MVC-relatedness (defined as a coding of “yes” to the variable for “traffic-relatedness”), disposition, and month of injury. Along with the estimated data, raw data (the actual number of cases reported) were also reported in the tables under the columns labeled “Sample Size.” Census data were used when calculating the number of injuries per 10,000 in each age group. The breakdown of injuries by specific body part was calculated for separate age groups to determine body regions where each age group was more prone to injury. In addition, the body parts with the highest incidences of injury within each age group were further broken down by diagnosis to shed light on the severity of injuries to the body parts with higher incidences of injury. Diagnoses of concussion and internal injury to the head were reclassified as traumatic brain injury (TBI),13 and internal injuries to all other body parts were put into the “other” category. There were no missing data for month of injury, and there were minimal missing data for age (0.016% unknown); only cases with known ages were included in the analyses using percentage breakdown by age. Missing data for injured body part and diagnosis are listed in the tables under categories of “unknown” and “other,” respectively. Missing data for locale (27% unknown) were treated as missing at random (MAR), so the percentage breakdown for the different locales of incident only took into account those cases with a recorded locale. Similarly, missing data for MVC status (31% missing) were assumed to be MAR, so only the cases with observed MVC status were used to calculate the percentage of ED visits precipitating from an MVC. Data analysis was performed with STATA 12 (StataCorp, College Station, TX), and the NEISS-assigned IPWs were applied using the pweight option under the svy command. From 2001 through 2008, there were an estimated 30,445,478 sports-related injury visits to U.S. EDs by patients of all ages. Bicycle injuries were the second largest contributor to sports-related injury visits after basketball, accounting for 12.7% of all sports injury visits (3,868,680 of 30,445,478). Males accounted for 73% of all bicycle injury visits. Patients aged 10 to 14 years represented the 5-year age interval with the highest percentage of bicycle injury visits (26%), and patients aged 0 to 34 years accounted for 78% of all bicycle related visits (see Table 1). The mean ages (± standard deviation [SD]) of injured males and females were 22.6 (±0.98) and 22.3 (±1.14) years, respectively. Table 2 summarizes the proportion of injuries by body part. The three body parts with the highest incidences of injury are marked within each age group. Among those aged 0 to 14 years, the greatest incidence of injuries occurred to the face, head, hand, arm, and wrist (percentages vary by age group breakdown). For those aged 15 to 64 years, the upper trunk, face, and head were the most injured body parts. For the elderly (65 years and older), the head, upper trunk, and lower trunk had highest incidence of injury. Overall, the body parts comprising the largest proportions of injury were the face (15.6%), head (12.6%), and upper trunk (12.1%). The top three injured body parts when the injury involved an MVC were the head (15.2%), upper trunk (14.5%), and face (13.5%) Common diagnoses for the most frequently injured body parts are summarized in Table 3. Although contusion/abrasions/hematoma was the most common diagnosis overall, the most common diagnosis within body part categories varied across different body parts. The most common diagnosis for head injuries was TBI (66%). For face injuries, lacerations were most common (61%); for wrist, hand, arm, and upper trunk injuries, fracture/dislocations were most common. Overall, the most common diagnoses were contusion/abrasion/hematoma (30%), fracture/dislocations (23%), and lacerations (22%). Bicycling-related injury locations are summarized in Table 4. The highest incidences of bicycling injuries occurred on the street (56%), around the home (28%), during sports activity (9.5%), and in public areas (5.7%). Overall, MVCs accounted for 58% of all bicycle-involved injuries, and this percentage has been relatively constant from 2001 to 2008 (see Figure 1). The percentage of injuries by age arising from MVCs is summarized in Table 5. Whereas only 17% to 39% of injuries to those aged 0 to 9 years resulted from MVCs, 69% to 76% of injuries to those aged 15 years and older resulted from MVCs. In addition, 99.7% of all injuries occurring on the street were MVC-related, and this percentage did not change from 2001 to 2008. Disposition of injuries was as follows: 94% of patients were treated and released, 4% were hospitalized, and 1% were transferred and released. Figure 1 shows the breakdown of bike injuries by treatment month. The 5-month range from May through September accounted for 64% of all bike injuries, with incidence of bike injury peaking in July, which contained 12% of all bike injuries. This study examined epidemiologic features of bicycling-related injuries seen in U.S. EDs from 2001 through 2008. We found that those aged 5 to 14 years have the highest rate of injury, but their injuries were more likely to occur off the street and were less likely to be MVC-related when compared to the injuries to older cyclists 15 years and older. In contrast, the majority (70%) of all ED bicycle injuries to those 15 years and older occurred on the street, and this percentage for the overall age range has been relatively constant from 2001 through 2008, ranging from 50% to 62%. Nearly all injuries on the street involved collisions with motor vehicles. This suggests that in the last 10 years, even with extensive promotion of bike lanes,14, 15 there has been no decrease in MVC-related injuries on the street or in general. The body parts most commonly injured when the injury involved a MVC were the head, upper trunk, and face. This finding has several implications for the prevention of bicycle injuries, particularly in the area of safety gear recommendations and biking infrastructure. First, since upper trunk and face injuries are similar in frequency to head injuries resulting from MVCs, bikers on the street might receive additional protection through development of new safety gear, such as rigid protective vests and facial protection. Numerous studies, along with current biking education, describe the importance of helmet use,16-20 but they have not focused on protection for the upper trunk or face, which have injury incidences nearly as high as the head for cyclists on the street. Wearing gear such as rigid protective vests and face shields may minimize injury to the upper trunk (e.g., rib fractures, damage to internal organs, shoulder dislocations) and to the face (e.g., face lacerations). For children aged 10 to 14 years, the age group with the highest injury rate, wrist and hand injuries were almost as prevalent as head injuries and face injuries, suggesting that children might benefit from development of new safety gear such as gloves and wrist stabilizers for the hands and wrists, since these might minimize injury to those body parts that are often first used to break a fall. Our findings have implications with regard to transportation infrastructure. Because 99.7% of bike injuries incurred on the street involve MVCs, traffic engineering interventions might further minimize the interaction between bicyclists and motor vehicles. Previous studies have shown that clearly marked, bicycle-specific facilities (i.e., bike routes, bike lanes, and bike paths) provide increased safety for cyclists compared to on-road cycling with traffic.21-25 In addition, in a 2010 study, Lusk et al.26 reported that the relative risk of MVC-related injury was lower on cycle tracks (physically separated bicycle-exclusive paths along roads) compared with bicycling in reference roads (a parallel road with the same intersection frequency and cross-traffic). Furthermore, a study by Teschke et al.27 found that cyclists on cycle tracks had lower odds of injury compared to those biking on streets with parked cars. Teschke et al. also found that cyclists biking on a major street with no parked cars had lower odds of injury than those biking on a major street with parked cars. These findings suggest implications for the revision of current city transportation engineering guidelines toward separating bicyclists from motor vehicles (both parked and moving) to decrease the risk of collisions between cyclists and motor vehicles. Other more immediate policy implementations that may decrease bicycling-related injuries include revisions to licensing examinations and road training. Potential revisions for future study include placing greater emphasis during driver's licensing road training and tests on performing “head checks” for cyclists prior to turning, changing lanes, and opening car doors. Our finding that the 5-month range from May through September accounted for 64% of all bike-related injuries, with incidence of injury peaking in July, is consistent with the findings of Loder and Abrams.12 This information could be used to guide injury prevention programs to increase educational campaigns for wearing proper safety gear immediately before the increase in cycling activity in the summer months. The NEISS database does not provide patient data on severity of injury or follow-up care, which prevented us from distinguishing the more severe bicycling injuries from the relatively minor ones. Second, the fact that only bicycling injuries treated in EDs were included implies that the total number of bicycling injuries is likely to be underestimated and tends to represent the more severe cases, as injuries that were treated at home, in urgent care clinics, and in physician offices were not reported. Third, the NEISS does not provide information on use of safety equipment by patients, so we were unable to assess the effects of safety helmet use (or nonuse) on head injury status. Fourth, because some cases did not contain information on locale of injury or MVC involvement, it is unknown in which direction the cases with unreported information could have caused bias. This study demonstrated that nearly three-fourths of bicycle injuries presenting to EDs in patients aged 15 years and older are related to motor vehicle collisions. The most injured body parts in motor vehicle collision–related injuries are the head, upper trunk, and face, suggesting that, in addition to the emphasis of proper helmet use, future research on the development of new safety gear (e.g., protective vests and face shields) may minimize injuries to these body parts. Also, as 99.7% of injuries on the street involve collisions with motor vehicles, cyclists might receive additional protection from infrastructure plans that physically separated bicycle-only paths along roads to decrease contact between bicyclists and motor vehicles. Children aged 10 to 14 years represent the age group with the largest proportion of bicycle injuries, although these injuries are less likely to stem from a motor vehicle collision than the injuries incurred by those aged 15 years and older. Children aged 10 to 14 years in particular have a high incidence of injury to the wrist and hand, suggesting that development of protective gloves and wrist stabilizers might prevent wrist fractures or damage to the hand in the event of a crash." @default.
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• W1972510140 title "Epidemiology of Nonfatal Bicycle Injuries Presenting to United States Emergency Departments, 2001-2008" @default.
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