Elsevier

Accident Analysis & Prevention

Volume 106, September 2017, Pages 341-347
Accident Analysis & Prevention

Full length article
Predictors of recovery in cyclists hospitalised for orthopaedic trauma following an on-road crash

https://doi.org/10.1016/j.aap.2017.06.019Get rights and content

Highlights

  • The majority of on-road crashes were either non-collisions (41%) or collisions with a motor vehicle (35%).

  • At 6 months, most injured cyclists had returned to work (89%), but only 32% had returned to pre-injury levels of function.

  • Cyclists who collided with motor vehicles had poorer outcomes than collisions with other counterparts or non-collisions.

  • There is a need to provide dedicated and separated bicycle lanes to reduce the potential for collisions with motor vehicles.

Abstract

Background

As cycling-related injury rates are on the rise, there is a need to understand the long term outcomes of these patients in order to quantify the burden of injury and to inform injury prevention strategies. This study aimed to investigate predictors of return to work and functional recovery in a cohort of cyclists hospitalised for orthopaedic trauma from crashes occurring on-road.

Methods

A retrospective analysis of data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) was conducted for patients who were hospitalised for orthopaedic trauma following a cycling crash that occurred on-road between July 2007 and June 2015.

Results

There were 1787 injured cyclists admitted at the participating hospitals. Most cyclists were male (79%), resided in major cities (89%) and were in the highest socioeconomic quintile (52%). The majority of crashes were either non-collisions (41%) or collisions with a motor vehicle (35%). A smaller proportion of cyclists who collided with motor vehicles had returned to work and had returned to pre-injury functional levels at 12 months post-injury, when compared to collisions with other impact counterparts and non-collisions. Mixed effects logistic regression models revealed that compensable patients demonstrated lower odds of complete functional recovery and return to work when compared with non-compensable patients.

Conclusion

Cyclists who collided with motor vehicles had worse outcomes compared to crashes with other impact counterparts and non-collision events. These findings provide support for reducing the potential for interaction between cyclists and motor vehicles.

Introduction

Cycling has been demonstrated as a sustainable, healthy and cost-effective mode of transport, (Grabow et al., 2012, Oja et al., 2011, OECD, 2013) and governments and cycling-bodies continue to advocate for increased cycling participation globally. (Australian Bicycle Council, 2010, German Federal Ministry, 2012, United Kingdom Department, 2014) However, cyclists are recognised as vulnerable road users and serious injury rates are on the rise globally. (Henley and Harrison, 2012, Sikic et al., 2009, Sanford et al., 2015, Weijermars et al., 2016a, Tin et al., 2010) Furthermore, these injuries result in significant economic costs. (Hitchens and Palmer, 2012)

While long-term outcomes, such as return to work and functional outcomes, have been investigated in the road transport population as a whole (Gabbe et al., 2016, Holtslag et al., 2007, Vles et al., 2005, Hours et al., 2010), comparatively little is known about the outcomes of injured cyclists. Our work has previously demonstrated that while return to work rates were high in an injured cycling cohort (94%), less than 40% of patients had returned to their pre-injury level of function at 12 months post injury;(Beck et al., 2016) a finding that is consistent with international literature on functional outcomes in all road user groups. (Hours et al., 2010) Given this, there is a need to further identify crash characteristics and patient-level factors that are associated with long-term outcomes. Such information could be used to guide prioritisation of injury prevention efforts, as well as inform the delivery of health and disability services.

The aims of this study were to investigate the demographic, crash and injury characteristics as predictors of return to work and functional outcomes in a cohort of cyclists hospitalised for orthopaedic trauma following an on-road crash.

Section snippets

Study design

A retrospective analysis of data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) was conducted for patients who were hospitalised following a cycling crash between 1st July 2007 and 30th June 2015.

The Victorian Orthopaedic Trauma Outcomes Registry

The VOTOR is a sentinel site registry collecting data from four hospitals in Victoria; two adult level 1 equivalent trauma centres, one regional trauma centre and one metropolitan trauma centre. All adult patients (≥16 years) admitted for an orthopaedic injury via the emergency

Results

Over the 8 year study period, 1787 injured cyclists were admitted at the participating hospitals following on-road crashes. The median (IQR) age of participants was 44 (33–55) years and 79% were male (Table 1). Most patients had no pre-existing conditions and resided in major cities. Forty-one percent were compensated for their injury by a third-party insurer (ie. TAC or WorkSafe). Fifty-two percent were in the highest quintile (most advantaged) for Index of Relative Socio-economic Advantage and

Discussion

Our study investigated factors that were associated with outcomes in a cohort of cyclists hospitalised for orthopaedic trauma following an on-road crash. The majority of crashes were either non-collisions or impacts with a car, pick-up truck or van. Most cyclists had returned to work at 12 months post-injury, but less than half had returned to their pre-injury level of function. Cyclists who had collisions with motor vehicles generally had poorer outcomes compared to cyclists with other crash

Conclusion

In this study of cyclists hospitalised for orthopaedic trauma, we demonstrated that for crashes occurring on-road, the majority of injured cyclists had returned to work at 6 months post injury, but less than half of our sample had returned to pre-injury levels of function. Cyclists who collided with motor vehicles were more commonly classified as major trauma and a smaller proportion had returned to work and had returned to pre-injury functional levels at 12 months post-injury when compared to

Funding

The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) is funded by the Transport Accident Commission via the Institute for Safety Compensation and Recovery Research (ISCRR). Ben Beck received salary support from the National Health and Medical Research Council (NHRMC)(NHMRC) Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre of Research Excellence (#1029983). Christina L. Ekegren is supported by a National Health and Medical Research Council of Australia Early Career Fellowship

References (35)

  • Australian Bicycle Council

    The Australian National Cycling Strategy 2011–2016

    (2010)
  • S. Boufous et al.

    Single-versus multi-vehicle bicycle road crashes in Victoria

    Aust. J. Prev.

    (2013)
  • P.A. Cameron et al.

    Developing Australia's first statewide trauma registry: what are the lessons?

    ANZ J. Surg.

    (2004)
  • B.J. Gabbe et al.

    Is the Charlson Comorbidity Index useful for predicting trauma outcomes?

    Acad. Emerg. Med.

    (2005)
  • B.J. Gabbe et al.

    The relationship between compensable status and long-term patient outcomes following orthopaedic trauma

    Med. J. Aust.

    (2007)
  • B.J. Gabbe et al.

    Population-based capture of long-term functional and quality of life outcomes after major trauma: the experiences of the Victorian State Trauma Registry

    J. Trauma Acute Care Surg.

    (2010)
  • B.J. Gabbe et al.

    Comparison of measures of comorbidity for predicting disability 12-months post-injury

    BMC Health Serv. Res.

    (2013)
  • Cited by (17)

    View all citing articles on Scopus
    View full text