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CHIRPP INJURY BRIEF - Canadian Hospitals Injury Reporting and Prevention Program

ARCHIVED - Injuries associated with Bicycles - 2006, Ages 1 year and older PDF

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Source of the Statistics

Injury data were obtained from the database of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). CHIRPP is an injury surveillance system operating in the emergency departments of 10 pediatric and 4 general hospitals in Canada. Data collection began in April 1990 at the pediatric hospitals and between 1991 and 1995 in the general hospitals. CHIRPP is a program of the Injury and Child Maltreatment Section of the Health Surveillance and Epidemiology Division, Public Health Agency of Canada.

Briefs and reports are updated when there is reason to believe the injuries or circumstances surrounding the injuries have changed. For example, the report of injuries associated with a specific product would be updated if the manufacturing regulations for the product are changed to include a new safety element. There is no need to update reports on a regular basis because the data collection sites are not a representative sample of all Canadian hospitals. Frequent updates would simply increase the number of records included in the report but not necessarily result in any change in the patterns and distributions found.

Limitations

It is important to note that the injuries described do not represent all injuries in Canada, but only those seen at the emergency departments of the 14 hospitals in the CHIRPP network. Since most of the data comes from the pediatric hospitals, which are in major cities, injuries suffered by the following people are under-represented in the CHIRPP database: older teenagers and adults, who are seen at general hospitals; native people; and people who live in rural areas. Fatal injuries are also under-represented in the CHIRPP database because the emergency department data do not capture people who died before they could be taken to hospital or those who died after being admitted.

Inclusion and Exclusion Criteria

A May 2008 search of the CHIRPP database for injuries associated with bicycles was conducted (ages 1 year and older; 1,850,948 records total). The records were retained if i) the narrative contained one of the following text strings: “BIKE”, “BICYCLE”, “TRICYCLE”, “UNICYCLE”, “CYCLE” , “BICYCLETTE”, “VELO” or “PEDALER ii) and the injury occurred in 2006. This final dataset was then reviewed manually to confirm all cases occurred outdoors, were associated with non-motorized bicycles. Cases involving exercise bikes, motocross, motorcycle, motorized dirt bikes, or toy bikes were excluded.

Recommended Citation

Injury briefs and reports and data from them may be copied and circulated freely provided that the source is acknowledged. The following citation is recommended:

Health Surveillance and Epidemiology Division (Public Health Agency of Canada). Injuries associated with bicycles: Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database, 2006, 1 year and older, 3,993 records.

For more information

Please contact the Injury and Child Maltreatment Section, Health Surveillance and Epidemiology Division, by PHONE at (613) 957-4689, by FAX at

(613) 941-9927 or visit our website.

Overall Pattern

Overall, 3,993 cases were identified where the injury was associated with a bicycle (3526.1 cases per 100 000 CHIRPP records). Among 2006 CHIRPP cases, this represents 3.4% of total cases, approximately 9% of all sports and recreation activities, and 44% of all wheeled, non-motorized activities (bikes, scooters, scooter boards, inline skates and skateboards).

There were 11% of cases admitted to hospital for treatment, compared to a 7.0% admittance rate for CHIRPP during the same timeframe for all injuries. The leading injuries reported were fractures (34.0%), lacerations (18.0%), and minor head injuries or concussions (7.3%). The majority of injuries occurred between April and October (94%), with a slightly higher proportion on the weekend (16%) than the weekdays (14%).

The analysis will be divided into cases involving children (between 1 and 10 years of age) (43.1% of cases), youth (11-15 years) (40.3% of cases) and adults (16 years and up) (16.7% of cases), to compare patterns among these groups. For all age groups combined, the median age was 11.9 and the interquartile range was 6.3 years (minimum age 1 year, maximum age 85 years). Analysis of the adult age group indicates a median age of 24 years.

Table 1 summarizes the age and sex distribution by these age groups.

Table 1. Injuries associated with bicycles, age and sex distribution, CHIRPP, ages 1 year and older, 2006.

Age Group (Years) # cases overall (%) #/100,000 CHIRPP 1 % male % male CHIRPP 2
Children (1-10 years) 1720 (43.1) 3,294.6 66.1 56.9
Youth (11-15 years) 1607 (40.3) 5,289.4 80.7 63.0
Adult (16 years and older) 666 (16.7) 2,172.1 76.7 58.8
Total 3993 (100.0) 3,526.1 73.8 59.0

1Because CHIRRP collects information from ten children’s hospitals and only five of the general hospitals, there is a high number of young children in the database. Using cases per 100,000 within an age group (instead of percentage by age group) adjusts for this uneven distribution. 2The proportion of males in the entire CHIRPP database for the given age group.

Circumstances

Table 2 describes the circumstances at the time of injury. Overall, the circumstances which led to the injury can be classified broadly into either Loss of Control (81.0%) or Collision (14.6%). The percentage of injuries associated with loss of control decrease significantly between children (82.7%) and adults (78.7%) ( X2(1, N=2386) = 5.09, p<.05). The percentage of injuries involving collisions do not differ between children (13.4%) and adults (16.4%) when tested (X2 (1, N=2386) = 3.53, p>.05).

Table 2. Circumstances, injuries associated with bicycles, CHIRPP, by age group, 2006.

Circumstance Total Children Youth Adult
# cases (%) # cases (%) # cases (%) # cases (%)
Loss of Control 3,234 (81.0) 1,422(82.7) 1,288 (80.1) 524 (78.7)
Fell from bike, NFS 1365 637 470 258
Loss of control, no additional detail 571 310 184 77
Fell doing tricks/stunts 375 101 237 37
Fell due to hill or excessive speed 183 94 71 18
Distracted/chased and fell while biking* 181 82 70 29
Rough terrain (e.g. gravel, mud, sand) 164 54 87 23
Hit obstacle (e.g. rock, pothole), fell 152 68 58 26
Braking suddenly 83 22 46 15
Something caught in wheel/chain and fell 83 29 43 11
Racing (formal or informal) 35 11 15 9
Fell while getting on or off bike 25 14 6 5
Impaired (alcohol or drugs) 17 0 1 16
Collision 583 (14.6) 230 (13.4) 244 (15.2) 109 (16.4)
With motor vehicle 260 67 120 73
With fixed object (e.g. curb, tree, sign) 164 73 71 20
With bicyclist 76 43 25 8
With a parked car 59 32 21 6
With a pedestrian 24 15 7 2
Other 176 (4.4) 68 (3.9) 75(4.7) 33 (4.9)
Bike mechanical failure 104 28 51 25
Unintended use of bike** 56 38 16 2
Injured while repairing bike 8 0 4 4
Unknown 8 2 4 2
Total 3,993 (100.0) 1,720 (100.0) 1,607 (100.0) 666 (100.0)

*Includes being chased by an animal.

**Unintended includes cases such as where more than one patient on bike, riding in inappropriate place.

Injuries

There are up to 3 injuries recorded for each patient. For this analysis, there were a total of 5,075 injuries associated with 3,993 patients. Table 3 lists the nature of injury by body part for only the first, most serious injury. Overall, fractures were the most frequently occurring injury (34.0%) (upper extremity comprised 80% of all fractures), followed by lacerations (17.5%) and soft tissue injuries (15.3%). This pattern is consistent across all 3 age groups.

Table 3. Nature of injury, associated with bicycles, CHIRPP, by age group, 2006.

Body part Nature of injury Total Children Youth Adult
# cases (%) # cases (%) # cases (%) # cases (%)
Upper extremities 1797 (45.0) 714 (41.5) 790 (49.2) 293 (44.0)
fracture 1077 459 485 135
soft tissue 286 109 132 45
abrasion 203 65 78 60
sprain/strain 96 32 46 18
laceration 91 39 33 19
amputation -finger 3 2 1 0
other 41 8 15 16
Lower extremities 838 (21.0) 308 (17.9) 376 (23.4) 154 (23.1)
laceration 236 93 117 26
fracture 191 60 91 40
soft tissue 181 71 79 31
abrasion 130 51 48 31
sprain/strain 72 24 32 16
other 27 9 9 10
Face (including eye and mouth) 528 (13.2) 328 (19.1) 122 (7.6) 78 (11.7)
laceration 298 198 60 40
abrasion 79 52 20 7
dental 68 45 20 3
fracture 41 11 12 18
soft tissue/bruise 24 12 5 7
other 18 10 5 3
Head 399 (10.0) 192 (11.2) 165 (10.3) 42 (6.3)
minor closed head injury 176 94 67 15
concussion 115 49 57 9
scalp laceration 38 22 11 5
intracranial 30 7 17 6
abrasion 18 8 4 6
skull fracture 14 5 8 1
other 8 7 1 0
Trunk 298 (7.5) 128 (7.4) 110 (6.9) 60 (9.0)
soft tissue 101 55 31 15
abrasion 90 40 28 22
internal injuries 43 13 26 4
laceration 36 18 16 2
fracture 20 0 6 15
other 8 2 3 2
Neck and spine 41 (0.1) 14 (0.8) 16 (1.0) 11 (1.7)
soft tissue 15 6 5 4
fracture 10 1 6 3
sprain/strain 8 5 2 1
other 8 2 3 3
Other or unknown 92 (2.3) 36 (2.1) 28 (1.7) 28 (4.2)
Total 3,993 (100.0) 1,720 (100.0) 1,607 (100.0) 666 (100.0)

Treatment in Emergency Department

Table 4 reports what treatment the patient received in the emergency department (ED). Children were admitted at a rate of 8.7%, increasing to 11.6% in youth (X2(1, N=3,327) =8.09, p<.01) and further increasing to 15.3% in the adult age group (X2 (1, N=2,273) =5.74, p<.05). The 2 fatalities followed impact by a motor vehicle.

Table 4. Treatment received in emergency departments, injuries associated with bicycles, CHIRPP, by age groups, 2006.

Treatment in Emergency Department Total Children Youth Adult
# cases (%) # cases (%) # cases (%) # cases (%)
Left without being seen 55 (1.4) 25 (1.5) 16 (1.0) 14 (2.1)
Advice 364 (9.1) 214 (12.4) 136 (8.5) 14 (2.1)
Treated, medical follow-up if necessary 1,426 (35.7) 585 (34.0) 505 (31.4) 336 (50.4)
Treated, medical follow-up required 1,576 (39.5) 693 (40.3) 695 (43.3) 188 (28.2)
Short stay, observed in ED 131 (3.3) 53 (3.1) 66 (4.1) 12 (1.8)
Admitted to hospital 438 (11.0) 149 (8.7) 187 (11.6) 102 (15.3)
Fatal 2 (0.05) 1 (0.06) 1 (0.06) 0 (0.0)
Total 3,993 (100.0) 1,720 (100.0) 1,607 (100.0) 666 (100.0)

Helmet Use

There were 2,993 cases where helmet status was reported (75%); and among these cases, nearly 63% reported wearing a helmet. Analysis by helmet use demonstrated riders who were not wearing a helmet experienced an admittance rate of 12%, compared to 7% of riders who did. Table 5 illustrates helmet use, where status was reported, decreased as age increased.

Table 5. Helmet use, injuries associated with bicycles, CHIRPP, by age groups, 2006.

Helmet use while bicycling Total Children Youth Adult
# cases (%) # cases (%) # cases (%) # cases (%)
No helmet while bicycling 1116 (37.3) 404 (30.1) 506 (39.2) 206 (57.1)
Wore a helmet while bicycling 1877 (62.7) 937 (69.9) 785 (60.8) 155 (42.9)
Total cases of helmet status reported 2,993 (100.0) 1,341 (100.0) 1,291 (100.0) 361 (100.0)

Handle Bar Impact

Cases associated with handlebar impact were identified as they are typically serious, often resulting in internal injuries. 3,4 There were 193 cases (4.8%) were the rider made contact with the handlebars and 15% of these were admitted to hospital, compared with an overall admittance rate of 11%. Of admitted cases, 73% were for treatment of internal injuries; of these 78% were associated with loss of control and 15% with a collision.