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CHAPTER TEN: CONCLUSIONS
10.1 EXTENT AND SEVERITY OF CYCLE ACCIDENT
CASUALTIES
This study of cycling casualties reporting to Lothian
and Borders hospitals provides quite a different picture of
cycling casualties than that painted by the police recorded
STATS 19 data.
There are a great many cycling casualties which are
never reported to the police. Forty one percent of all the
hospital based sample resulted from an off road accident
i.e. it occurred on a cycle track, in a park,
garden or on a mountain bike or forest trail. The police
would not record these accidents as they do not occur on
the road. A further 29% of all cycling casualties had their
accident on the pavement. Only a third of cycling
casualties had their accident on the road itself and only
13% had their accident on the main road
It can be concluded therefore that much of the effort
into the prevention of cycling accidents must be directed
at off road and cycling on pavements as well as safe
cycling on roads. Cycling accidents on pavements were more
likely amongst children and 43% of all of the children's
accidents reported occurred here. Off road accidents were
more common amongst adults and whilst cycling as a sport is
to be encouraged, further promotion of means to make this
safer should be explored. Some 55% of off-road cyclists
were wearing helmets, a higher percentage than that found
on the roads.
As might be expected from the location of many of the
accidents in this study only a minority of the accidents
reported involved a motorised vehicle (12.5%). This
contrasts sharply with the police reported data which shows
an involvement of motorised vehicles at (96%), reflecting
the type of accident that is likely to be brought to the
police's attention.
There are also key differences in the type of cyclists
likely to appear within
STATS19 which is much less likely to
record accidents sustained by children and more likely to
record those sustained by adults.
Overall, there are a large number of casualties who
report to the hospital with an injury serious enough for
medical attention who do not appear in
STATS19. It may be concluded that the
STATS19 database under reports the full
extent of cycling casualties in Scotland.
Cycling accidents were much more likely in the summer
months, at the weekend and in later afternoon or early
evening, all times when the opportunity for leisure cycling
is greater. They are also disproportionately common among
male cyclists.
Cycling accidents were extremely common during
childhood. Fifty four per cent of all the accidents
reported in this study were sustained by under 16 year
olds. There are already efforts made by the Scottish Road
Safety Campaign (
SRSC) to encourage safer cycling but
this could be promoted to younger age groups and involve
parents to a greater extent in order to ensure that cycling
is seen as a pursuit that requires an awareness of safety
at all stages. Even a greater encouragement of helmet
wearing at these young ages might be helpful.
Helmet wearing amongst children was not high although it
was higher for the 5-10 age groups than for the older
children. It was lowest for the 11-15 age group. Because it
is children who tend to cycle on pavements, the incidence
of helmet wearing for accidents occurring here was
particularly low.
By contrast adults were more likely to wear helmets than
children (57% compared to 24%). Accidents which occurred on
the main road were likely to involve adults and
correspondingly have a higher incidence of helmet
wearing.
One interpretation of the data on helmet wearing is that
there is a perceived lower risk for people who are cycling
on pavements and side roads. That would suggest the
possibility of needing a stronger message on the importance
of wearing a helmet no matter where the location of the
cycling activity.
Most injuries identified in this survey were minor and
only a minority were admitted to hospital. Children were
more likely to be admitted but it is unclear whether this
was because of more serious injury or because of greater
caution with this age group.
The most common injuries were to upper limbs (38%)
followed by lower limbs (20%). Injuries to the head or neck
were sustained by 11% of total casualties. Those who were
wearing a helmet at the time of their accident were less
likely to have an injury to their head or neck (7% compared
to 14%) again reinforcing the benefits of wearing a helmet.
There was very little difference in outcome depending on
whether the accident was on or off road.
The causes of accidents were extremely varied and no
single cause stood out within the hospital sample. This
complicates the task of providing a single message to
improve safety.
In summary this study highlights the fact that there are
many accidents which do not occur on the roads themselves
and that cycling safety messages should not be confined to
messages about safer road use.
10.2 METHODOLOGY
The methodology chosen for this study was an examination
of cycling casualties who reported to Accident and
Emergency Departments across Lothian and Borders Health
Board area. Accident and Emergency Departments are busy
places with their focus on helping patients. It is very
difficult therefore to rely on the goodwill of medical
staff who even with the best of intentions of assisting
with a study such as this, must find their attention drawn
elsewhere.
Equally the police cannot be expected to attend minor
accidents where there has been no material damage and only
minor injury. If we wish to collect statistics relating to
cycle accidents over a longer time period than ad hoc
studies of this type would allow, consideration should be
given to other means of data collection.
Given the lack of any means of checking whether or not
ALL data concerning a cycling accident is collected the
methodology would be much improved by placing the
collection of basic accident statistics within the everyday
process of administration of casualties presenting at
Accident and Emergency Departments. Currently most
departments do already keep a log of casualties and code
the cause of their injury. However the coding that is used
is insufficiently discriminatory to provide any meaningful
data in relation to cycling accidents. With a small change
to this aspect of administration, more accurate information
could be collected on accident details. Whilst the current
study aimed to pick up much more complex information than
simply whether there was a cycle accident or not, a more
accurate database could provide a sampling frame for future
studies allowing access to casualties after the event. Even
without this follow up it would give a more accurate
population figure against which a sample might be
measured.
Patient confidentiality must continue to be protected.
Researchers would need to seek Ethics Committee approval
and require the Caldicott Guardians responsible for
protecting patient confidentiality to write to potential
respondents asking for their willingness to participate.
Whilst this would be a time consuming and burdensome
process, it would restrict studies only to those deemed of
benefit and yield more accurate data.
In conclusion it is suggested that discussions take
place to explore the possibility of accessing accident data
in this way.
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