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Carole Millar Research
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The Scottish Executive commissioned Carole Millar Research to investigate the extent and severity of cycling accidents both on- and off- road. Cyclists who reported to one of five Accident and Emergency Departments across Lothian and Borders Health Board were asked to complete a questionnaire relating to their accident. In total, completed forms were received from 806 casualties aged five or over who had been injured as a result of a pedal cycle accident between 1 ^st September 2003 and 31 ^st August 2004. This data was compared with the STATS 19 accident data collected by the police for the same area.

Main Findings

• A large number of casualties reported to hospital with a cycling injury serious enough for medical attention, many of whom did not appear in STATS19 data. The STATS19 accident data appears to under-report the extent of on road cycling accidents.
• Males were over three times more likely than females to be involved in cycling accidents. Cycling accidents were more common in childhood.
• Thirteen per cent of cycling accidents where reported to have occurred on the main road. Adults were much more likely than children to have a cycling accident on the main road. There were large numbers of accidents on the pavement (29%), and 43% of all child accidents occurred on the pavement. The greatest proportion of accidents (41%) occurred off-road and, therefore, were not captured by STATS19. Adults were more likely to have off-road accidents than children.
• The majority of accidents (72%) from the hospital-based sample involved no other vehicles, while nearly all (96%) of the police recorded accidents involved other vehicles. Adult cycling casualties were much more likely to be involved with a car than children. This is associated with a greater likelihood of adults cycling on main roads.
• Thirty-four per cent of casualties were discharged from hospital on the same day without any need for follow up, and only 4% of casualties were admitted. Twenty-seven per cent required some follow up. There was no information on outcome for 35% of the sample. Children were more likely to be admitted than adults.
• Less than half the casualties (39%) had been wearing a helmet when the accident occurred. Adults were significantly more likely than children to be wearing a helmet (57% compared to 24%). Correlating with age, helmet-wearing was lower for those whose accident happened on the pavement (21%) and higher for those whose accident occurred on a main road (43%). Those who were wearing a helmet were less likely to have an injury to their head or neck (7% compared to 14%) and this difference was more distinct for children.
• Accidents were caused by a very wide range of circumstances and no single cause stood out. By contrast, STATS19 data describes a narrow range of causes, with the involvement of a motorised vehicle being the predominant factor. STATS19 was much less likely to record accidents sustained by children and more likely to record those sustained by adults.

Introduction

The police currently collect statistics ( STATS19) on the number of road accidents involving cyclists on Scottish roads. This does not provide data on off-road accidents, or on those accidents that the police do not attend, thereby limiting data on the full extent of cycle accidents, their severity and/ or their cause.

This study aimed to:

• Compare hospital accident and emergency statistics on cycle casualties with STATS19 data to measure the extent of any gap.
• Establish how many cycle accidents occur off-road compared to on-road.
• Identify any patterns emerging on the type of accident, the location and the nature of the injury.

The five hospitals providing an Accident and Emergency service within the Lothian and Borders area agreed to take part in this study. Data was collected from September 2003 to August 2004.

The hospitals were asked to complete a form for ALL casualties presenting to Accident and Emergency who had been riding a bicycle at the time of the accident.

Completed forms were received from 806 casualties who had been injured as a result of a cycle accident. For comparison, Lothian & Borders Police provided STATS19 data for the same period on 221 cycle casualties resulting from road accidents.

Who is involved in cycling accidents?

By a ratio of 3:1, many more males than females were involved in cycling accidents. While less marked under the age of 10, this gender imbalance occurred across all age groups.

Children were also more likely to be casualties. Fifty-four per cent of all the casualties were under the age of 16, with the 11-14 age group being most at risk.

When do cycle accidents happen?

Most cycling accidents occurred in the summer months. April to September accounted for 72% of all casualties presenting to hospital.

More accidents occurred at the weekend than on weekdays, pointing to increased levels of cycling at weekends. The peak time for accidents was late afternoon and early evening.

Were other vehicles involved?

Most accidents where the casualty presented to hospital involved no other vehicle (72%). If another vehicle was involved, it was most likely to be a car (10%) or another bicycle (11%).

Children under the age of 16 were much less likely than adults to have an accident which involved a car (6% compared to 15%), whilst those in the 19-24 age group were at greatest risk of a cycle accident involving a car.

Children were much more likely to be involved in a collision with another bicycle than adults (16% compared to 5%), and accidents involving other bicycles were largely confined to the summer months.

Where do accidents happen?

The greatest proportion of accidents occurred off-road (41%) with a very high proportion occurring on cycle tracks, forest tracks or mountain bike trails (57%).

Adults were more likely than children to sustain accidents off-road. Off-road accidents accounted for half of all adult accidents but only a third of child accidents. This was attributable to greater cycling on cycle tracks and forest tracks by adults than by children.

Twenty-nine per cent of all accidents occurred on the pavement. Nearly one-in-five of those also reported their accident as being 'on the road'.

Children were more likely than adults to have their accident on the pavement (43% versus 12%).

A third of all cycling casualties had their accident on the road itself. Children were less likely than adults to have an accident on the road. This was most noticeable on main roads, which accounted for only 3% of children's accidents, but 24% of adult accidents.

Nearly half of all accidents (49%) took place in a town or a city. Innerleithen, where Glentress mountain bike centre is based, showed the highest number of casualties per head of population, and this was attributable to visitors to the centre.

What Safety Aids were used?

Thirty-nine per cent of all casualties reported wearing a helmet at the time of the accident. Adults were much more likely than children to be wearing a helmet (57% compared to 24%).

Among children, helmet-wearing was higher in younger children (5-10 years) than older children (11-15 years), 29% compared to 18%, supporting findings of other studies indicating a reluctance to wear a helmet at this age. However, once over the age of 16, helmet wearing increases with age throughout adulthood.

Thirty-eight per cent of those whose accident involved a car were wearing a helmet, only slightly less than the average for the entire sample.

Those whose accident occurred on a pavement were less likely to be wearing a helmet (21%) and this correlates with the high number of children within this group. Cyclists were more likely to be wearing a helmet if their accident occurred on a main road, rather than on a side road (43% compared to 29%) - a group which is more likely to include adults.

Ninety-five per cent of those who specifically said their accident occurred at Glentress were wearing a helmet.

Incidence of helmet-wearing did not seem to vary much by the seriousness of the injury. Of those who required admission or follow up, 38% were wearing a helmet, compared to 42% of those who were discharged without any follow up.

What caused the accident?

Casualties were asked to indicate what factors contributed to the accident, but 45% left this question blank. A wide range of circumstances were attributed. The most common reason (7%) was a motorised vehicle. Car doors opening, vehicles cutting in front of cyclists and cars pulling out unexpectedly were all mentioned. This cause was rare amongst children (1%) contrasting with 15% for adults.

Six per cent specifically mentioned some sporting activity as being the main cause, mostly attempting cycle stunts, but also high-risk jumping, or trail or mountain biking. This was more likely to be mentioned by adult males and older children.

Other reported factors included slippy or uneven surfaces, mechanical failure due to brakes or tyres, and the weather causing icy, muddy or wet conditions.

Outcome

Clinical staff did not always provide data on the outcome. It was reported only for 65% of the sample.

The greatest proportion (34%) of casualties were discharged on the same day without any need for follow-up. Only 4% of casualties were admitted and 27% required follow-up treatment either later, or by another department. Children were more likely to be admitted than adults.

Wearing a cycle helmet made little difference to the outcome in terms of the need for admission or follow-up treatment.

The most common injuries were to upper limbs (38%) followed by lower limbs (20%). Injuries to the head or neck were sustained by 11%.

Those 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%).

The most common trauma to be sustained was an abrasion (41%) followed by laceration (35%). Simple fractures were common when the injury was to the upper limbs (36%).

STATS 19

A large number of casualties who reported to the hospital with an injury serious enough for medical attention did not appear in STATS19.

Even when comparing only those casualties within the hospital-based sample who reported their accident as being on the road (excluding pavements), the STATS 19 accident data appears to under-report the extent of on-road cycling accidents.

STATS19 data described a narrow range of causes, with the involvement of a motorised vehicle being the predominant factor, and was much less likely to record accidents sustained by children than by adults.

Conclusion

The large proportion of cycling casualties occurring off-road implies that efforts aimed at preventing cycling accidents must be directed at off-road use as well as safer cycling on-road.

The hospital-based sample revealed a much wider range of accidents than that described by the police STATS19 data. However, no single cause stood out, complicating the task of providing a single message to improve safety.

The high proportion of children among casualties, however, would suggest that safer cycling could be promoted to younger age groups to ensure that cycling is seen as a pursuit requiring safety awareness at all stages.

An interpretation of the lower propensity of children to wear helmets 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.

The large number of casualties reporting to hospital with an injury serious enough for medical attention, but who did not appear in STATS19 data, suggests that this database under-reports the full extent of cycling casualties in Scotland.

Consideration should be given as to how the extent of cycling accidents could be more accurately recorded in the future. A more accurate representation may be achieved by recording casualties presenting to hospitals, rather than relying solely on accidents which are reported to the police. This could be achieved by including a separate category for cyclists when hospitals record the cause of injury.

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The Research Report "Extent and Severity of Cycle Accident Casualties" which is summarised in this research findings is available to download from the Publications Page on the Scottish Executive Website.
http://www.scotland.gov.uk/Publications/Recent

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