Bicycle trauma and it‘s consequences

Abstract

The popularity to ride a bicycle is increasing worldwide and significant political efforts are made to promote cycling. To bike to work is generally seen as a health-conscious and environment friendly way of commuting. Bicyclists, however, are vulnerable road users and in a crash, the risk of injury is substantial. Cyclists often are individuals in working age, hence injuries, persisting disability or pain following bicycle trauma can cause serious consequences for the individuals as well as for the society.

In study I, we performed a retrospective study of 186 bicycle trauma patients at Karolinska Trauma Center during a 3-year period, to assess helmet use and injury pattern following a bicycle accident. Data was collected from the hospital records. Less than half of the patients (43.5 %) used a bicycle helmet at the time of the crash. Non-helmet use was associated with an increased risk of injury to head and face in collisions, whereas helmet use was associated with an increased risk of limb injuries in all types of crashes. In study II, we performed a retrospective database study including 127 bicycle trauma patients admitted to Karolinska Trauma Center with admission samples of the brain injury marker S100B. Computed tomography (CT) scans of the head were reviewed and categorized, and clinical data was collected from case records. S100B levels were independently correlated with intracranial pathology as well as with the extent of extracranial injury. Admission levels of S100B correlated with both Injury Severity Score (ISS) and length of stay suggesting S100B to be a good marker of aggregated injury severity. For study III, 173 bicycle trauma patients treated at Karolinska Trauma Center from 2010 to 2012 received Hadorn’s Quality of Life (QoL) questionnaire six months after the trauma. Medical data was collected from the hospital records. More than 70% of the bicycle trauma patients still suffered from physical symptoms even though only 15% were severely injured. Risk factors for an impaired QoL were cervical spine injuries, facial fractures, Glasgow Coma Scale (GCS) £ 13 and ISS > 15. For study IV, 907 bicycle trauma patients registered in Karolinska Trauma Register (KTR) between 2006 – 2015 were matched with comparators from the general population on age, sex, and municipality. Information about dispensed prescription opioids, data on injuries, comorbidity, and socioeconomic factors were retrieved from national registers. Of all bicycle trauma patients, 46 % used prescription opioids after the trauma whereof 8 % became longterm opioid users. Severe injury to the lower extremities was associated with an increased risk of long-term opioid use whereas high educational level was associated with a risk reduction.