Skip to main content

Advertisement

SpringerLink
Log in

Fatal Cycling Injuries

  • Injury Clinic
  • Published:
Sports Medicine Aims and scope Submit manuscript

Summary

Cycling accidents are responsible for significant morbidity and mortality, especially in boys under the age of 16. While most cycling injuries result from simple falls from the bicycle, the majority of fatalities are caused by head injuries resulting from accidents involving motor vehicles. It is estimated that up to 85% of all cycling fatalities caused by head injuries could be prevented by the use of an appropriate cycling helmet.

Although the majority of adult cyclists wear helmets the reverse is true for children, who comprise the greatest proportion of all cyclists. Intensive educational programmes increase the number of cycling helmets that are sold, but have a lesser effect on the number used while cycling. Legislation, compassionately enforced on minors, i.e. with an understanding attitude towards their developmental stage, is the only proven technique that substantially improves rates of helmet use by young cyclists. Such legislation reduces their morbidity and mortality from head injuries.

This article reviews the epidemiological factors associated with traumatic cycling injuries and the nature of these injuries. Special attention is paid to head injuries and the evidence that these are largely preventable with the use of appropriate 3-layered cycling helmets, the features of which are detailed. Factors promoting or discouraging helmet use by children are reviewed. These include the following factors: age, since helmet use is highest in mature cyclists and lowest in children because of negative peer pressure; parental example, including an attitude of safety consciousness and parental concern; higher levels of education; access to discounted helmets; public campaigns to promote helmet use; and, most importantly, appropriate legislation.

But it is clear that appropriate legislation making helmet use compulsory for all cyclists is the only effective method for increasing helmet use, especially by young cyclists. Such legislation would reduce a mortality rate among young cyclists that has been equated to the mortality caused by some childhood infections in the pre-vaccination era. Some argue that physicians have a particular responsibility for promoting effective legislation for mandatory helmet use so that young children can be ‘vaccinated’ against the risk of the modern childhood epidemic; fatal head injury while cycling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kiburz D, Jacobs R, Reckling F, et al. Bicycle accidents and injuries among adult cyclists. Am J Sports Med 1986; 14: 416–9

    PubMed  CAS  Google Scholar 

  2. Kruse DL, McBeath AA. Bicycle accidents and injuries: a random survey of a college population. Am J Sports Med 1980; 8: 342–4

    PubMed  CAS  Google Scholar 

  3. Weiss BD. Nontraumatic injuries in amateur long distance bicyclists. Am J Sports Med 1985; 13: 187–92

    PubMed  CAS  Google Scholar 

  4. Lind MG, Wollin S. Bicycle accidents. Acta Chir Scand 1986; Suppl. 531: 1–47

    Google Scholar 

  5. Friede AM, Azzara CV, Gallagher SS, et al. The epidemiology of injuries to bicycle riders. Pediatr Clin North Am 1985; 32: 141–51

    PubMed  CAS  Google Scholar 

  6. Selbst SM, Alexander D, Ruddy R. Bicycle-related injuries. Am J Dis Child 1987; 141: 140–4

    PubMed  CAS  Google Scholar 

  7. Division of Injury Epidemiology and Control, Center for Environmental Health, Centers for Disease Control. Bicycle-related injuries: data from the National Electronic Injury Surveillance System. JAMA 1987; 257: 3334–7

    Google Scholar 

  8. Sacks JJ, Holmgreen P, Smith SM, et al. Bicycle-associated head injuries and deaths in the United States from 1984 through 1988: how many are preventable? JAMA 1991; 266: 3016–8

    PubMed  CAS  Google Scholar 

  9. Björnstig U, Näslund K. Pedal cycling accidents: mechanisms and consequences. A study from Northern Sweden. Acta Chir Scand 1984; 150: 353–9

    PubMed  Google Scholar 

  10. Maimaris C, Summers CL, Browning C, et al. Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers. BMJ 1994; 308: 1537–40

    PubMed  CAS  Google Scholar 

  11. McFarlane JP, Jones JE, Lawson JS. Injuries from bicycle accidents: the problem and recommended strategies for prevention. Aust Paed J 1982; 18: 253–4

    CAS  Google Scholar 

  12. Sgaglione NA, Suljaga-Petchel K, Frankel VH. Bicycle-related accidents and injuries in a population of urban cyclists. Bull Hosp Jt Dis Orthop Inst 1982; 42: 80–91

    PubMed  CAS  Google Scholar 

  13. Walter JA. Bicycle ownership, use, and injury patterns among elementary school children. Pediatrics 1971; 47: 1042–50

    Google Scholar 

  14. Lindqvist C, Sorsa S, Hyrkas T, et al. Maxillofacial fractures sustained in bicycle accidents. Int J Oral Maxillofac Surg 1986; 15: 12–8

    PubMed  CAS  Google Scholar 

  15. Weiss BD. Preventing bicycle-related head injuries. NY State J Med 1987; 87: 319–20

    CAS  Google Scholar 

  16. Weiss BD. Bicycle-related head injuries. Clin Sports Med 1994; 13: 99–112

    PubMed  CAS  Google Scholar 

  17. Rivara FP. Traumatic deaths of children in the United States: currently available prevention strategies. Pediatrics 1985; 75: 456–62

    PubMed  CAS  Google Scholar 

  18. Armson CJ, Pollard CW. Child cyclist injuries: a prospective study. Med J Aust 1986; 144: 144–6

    PubMed  CAS  Google Scholar 

  19. Ballham A, Absoud EM, Kotecha MB, et al. A study of bicycle accidents. Injury 1985; 16: 405–8

    PubMed  CAS  Google Scholar 

  20. Gonski L, Southcombe W, Cohen D. Bicycle accidents in childhood. Med J Aust 1979; 2: 270–1

    PubMed  CAS  Google Scholar 

  21. Grundill WL, Muller R. Bicycle accident injuries. S Afr Med J 1986; 70: 413–4

    PubMed  CAS  Google Scholar 

  22. Guichon DMP, Myles ST. Bicycle injuries: one-year sample in Calgary. J Trauma 1975; 15: 504–6

    PubMed  CAS  Google Scholar 

  23. Jackson RH. Hazards to children in traffic. Arch Dis Child 1978; 53: 807–13

    PubMed  CAS  Google Scholar 

  24. Nixon J, Clacher R, Pearn J, et al. Bicycle accidents in childhood. BMJ 1987; 294: 1267–9

    PubMed  CAS  Google Scholar 

  25. Thomas S, Acton C, Nixon J, et al. Effectiveness of bicycle helmets in preventing head injury in children: case-control study. BMJ 1994; 308: 173–6

    PubMed  CAS  Google Scholar 

  26. Pellegrino EA. Cycle injuries: a comparative study. Wis Med J 1968; 67: 413–7

    PubMed  Google Scholar 

  27. Ruderman S. Bicycle injuries in a suburban community. NJ Med 1987; 84: 629–31

    CAS  Google Scholar 

  28. Sage MD, Cairns FJ, Koelmeyer TD, et al. Fatal injuries to bicycle riders in Auckland. NZ Med J 1985; 98: 1073–4

    CAS  Google Scholar 

  29. Williams AF. Factors in the initiation of bicycle-motor vehicle collisions. Am J Dis Child 1976; 130: 370–7

    PubMed  CAS  Google Scholar 

  30. Hanson PG. Road traffic casualties in a surgical department. Acta Chir Scand 1974; Suppl. 442: 1–471

    Google Scholar 

  31. Kraus JF, Fife D, Conroy C. Incidence, severity, and outcomes of brain injuries involving bicycles. Am J Public Health 1987; 77: 76–8

    PubMed  CAS  Google Scholar 

  32. Mackay G. Pedestrian and cyclist road accidents. J Forensic Sci 1975; 15: 7–15

    CAS  Google Scholar 

  33. McKenna S, Borman B, Fleming H. Pedal cycle accidents. NZ Med J 1984; 97: 657–8

    CAS  Google Scholar 

  34. Fife D, Davis J, Tate L, et al. Fatal injuries to bicyclists: the experience of Dade County, Florida. J Trauma 1983; 23: 745–55

    PubMed  CAS  Google Scholar 

  35. Clarke AJ, Sibert JR. Why child cyclists should wear helmets. Practitioner 1986; 230: 513–4

    PubMed  CAS  Google Scholar 

  36. SDM Court. In: RH Jackson, editor. Children, the Environment and Accidents. Tunbridge Wells: Pitman Medical, 1977; 155

  37. Sandels S. Young children in traffic. Br J Educ Psychol 1970; 40: 111–6

    PubMed  CAS  Google Scholar 

  38. Avery JG, Avery PJ. Scandinavian and Dutch lessons in childhood road traffic accident prevention. BMJ 1982; 285: 621–6

    PubMed  CAS  Google Scholar 

  39. Davis MW, Litman T, Crenshaw RW, et al. Bicycling accidents. Physician Sports Med 1980; 8: 88–96

    Google Scholar 

  40. Olkkonen S, Honkanen R. The role of alcohol in nonfatal bicycle injuries. Accid Anal Prev 1990; 22: 894–96

    Google Scholar 

  41. Thorson J. Pedal cycle accidents. Scand J Soc Med 1974; 2: 121–8

    PubMed  CAS  Google Scholar 

  42. Watts CK, Jones D, Crouch D, et al. Survey of bicycling accidents in Boulder, Colorado. Physician Sports Med 1986; 14 Mar: 99–104

    Google Scholar 

  43. Illingworth CM, Noble D, Bell D, et al. 150 bicycle injuries in children: a comparison with accidents due to other causes. Injury 1981; 13: 7–9

    PubMed  CAS  Google Scholar 

  44. Cass DT, Gray AJ. Paediatric bicycle injuries. Aust NZ J Surg 1989; 59: 719–24

    CAS  Google Scholar 

  45. Walter JPW Bicycle accidents. BMJ 1979; 1: 265

    PubMed  CAS  Google Scholar 

  46. McDermott FT, Klug GL. Head injury predominance: pedal-cyclists vs motor-cyclists. Med J Aust 1985; 143: 232–4

    PubMed  CAS  Google Scholar 

  47. McDermott FT, Klug GL. Injury profile of pedal and motor cyclist casualties in Victoria. Aust NZ J Surg 1985; 55: 477–83

    CAS  Google Scholar 

  48. McDermott FT, Klug GL. Differences in head injuries of pedal cyclist and motorcyclist casualties in Victoria. Med J Aust 1982; 2: 30–2

    PubMed  CAS  Google Scholar 

  49. Waters EA. Should pedal cyclists wear helmets? A comparison of head injuries sustained by pedal cyclists and motorcyclists in road traffic accidents. Injury 1986; 17: 372–5

    PubMed  CAS  Google Scholar 

  50. Hoffman M, Moshel M, Mendes DG. Bicycle spoke injuries. J Trauma 1980; 20: 325–6

    Google Scholar 

  51. Viljanto J. Bicycle and moped spoke injuries in children: analysis of 103 consecutive cases. Ann Chir Gynaecol Fenn 1975; 64: 100–7

    PubMed  CAS  Google Scholar 

  52. Subrahmanyam M. Bicycle injury pattern among children in rural India. Trop Geogr Med 1984; 36: 243–7

    PubMed  CAS  Google Scholar 

  53. Furnas DW. Ten speed bicycles and shoulder bags: hazard to fair faces. JAMA 1976; 236: 2318–9

    PubMed  CAS  Google Scholar 

  54. Spemon AL, Ford WD. Bicycle handlebar injuries in children. J Pediatr Surg 1986; 21: 118–9

    Google Scholar 

  55. Rohatgi M, Gupta DK. Isolated complete transection of common bile duct following blunt bicycle handlebar injury. J Pediatr Surg 1987; 22: 1029–30

    PubMed  CAS  Google Scholar 

  56. Stanton PE, Brown R, Rosenthal D, et al. External iliac artery occlusion by bicycle handle injury. J Cardiovasc Surg 1986; 27: 728–30

    Google Scholar 

  57. Spamon T, Moretti K, Sach RP BMX handlebars: a threat to manhood? Med J Aust 1982; 2: 587–8

    Google Scholar 

  58. Gourdie AL. Penetrating rectal wound from a bicycle. Injury 1985; 16: 409–10

    PubMed  CAS  Google Scholar 

  59. Jackson RH, Craft AW. Bicycle saddles and torsion of the testis. Lancet 1978; 1: 983–4

    PubMed  CAS  Google Scholar 

  60. Goodfellow RC. Bicycle saddles and torsion of the testis. Lancet 1978; 1: 1149

    Google Scholar 

  61. Gibson OB. Bicycle saddles and torsion of the testis. Lancet 1978; 1: 1149

    Google Scholar 

  62. Illingworth CM. BMX compared with ordinary bicycle accidents. Arch Dis Child 1985; 60: 4614–4

    Google Scholar 

  63. Bouvier R. Bicycle accidents in childhood. Aust Fam Physician 1984; 13: 287–9

    PubMed  CAS  Google Scholar 

  64. Worrell J. BMX bicycles: accident comparison with other models. Arch Emerg Med 1985; 2: 209–13

    PubMed  CAS  Google Scholar 

  65. Craft AW, Shaw DA, Cartlidge NEE. Bicycle injuries in children. BMJ 1973; 4: 146–7

    PubMed  CAS  Google Scholar 

  66. Faigel HC. Bicycles and safety revisited. Clin Pediatr 1977; 53: 807–13

    Google Scholar 

  67. Howell TR. Accidents and those bizarre bicycles. Pediatrics 1968; 42: 214

    PubMed  CAS  Google Scholar 

  68. Sibert JR, Newcombe RG. Bicycle injuries in children. BMJ 1977; 1: 613–4

    PubMed  CAS  Google Scholar 

  69. Pfeiffer RP. Off-road bicycle racing injuries — the Norba Pro/Elite category: care and prevention. Clin Sports Med 1994; 13: 207–18

    PubMed  CAS  Google Scholar 

  70. Greensher J. Non-automotive vehicle injuries in adolescents. Pediatr Ann 1988; 17: 114–21

    PubMed  CAS  Google Scholar 

  71. Belongia E, Weiss H, Bowman M, et al. Severity and types of head trauma among adult bicycle riders. Wis Med J 1988; 87: 11–4

    PubMed  CAS  Google Scholar 

  72. Pitt WR, Thomas S, Nixon J, et al. Trends in head injuries among child bicyclists. BMJ 1994; 308: 177

    PubMed  CAS  Google Scholar 

  73. Wasserman RC, Buccini RV. Helmet protection from head injuries among recreational bicyclists. Am J Sports Med 1990; 18: 96–7

    PubMed  CAS  Google Scholar 

  74. Dorsch MM, Woodward AJ, Somers RL. Do bicycle safety helmets reduce severity of head injury in real crashes? Accid Anal Prev 1987; 19: 183–90

    PubMed  CAS  Google Scholar 

  75. Editorial. When are cyclists going to wear helmets? Lancet 1988; 1: 2

  76. Simpson AHRW, Unwin PS, Nelson IW. Head injuries, helmets, cycle lanes, and cyclists. BMJ 1988; 296: 1161–2

    PubMed  CAS  Google Scholar 

  77. Thompson R, Rivara F, Thompson D. A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med 1989; 320: 1361–7

    PubMed  CAS  Google Scholar 

  78. Ivan LP, Choo SH, Ventureyra ECG. Head injuries in childhood: a 2-year survey. Can Med Assoc J 1983; 128: 281–4

    PubMed  CAS  Google Scholar 

  79. Gallagher SS, Finison K, Guyer B, et al. The incidence of injuries among 87,000 Massachusetts children and adolescents: results of the 1980–81 Statewide Childhood Injury Prevention Program Surveillance System. Am J Public Health 1984; 74: 1340–6

    PubMed  CAS  Google Scholar 

  80. Klauber MR, Barrett-Connor E, Marshall LF, et al. The epidemiology of head injury: a prospective study of an entire community — San Diego County, California, 1978. Am J Epidemiol 1981; 113: 500–9

    PubMed  CAS  Google Scholar 

  81. O’Rourke NA, Costello F, Yelland JDN, et al. Head injuries to children riding bicycles. Med J Aust 1987; 146: 619–21

    PubMed  Google Scholar 

  82. Wang C-c, Schoenberg BS, Li S-c, et al. Brain injury due to head trauma: epidemiology in urban areas of the People’s Republic of China. Arch Neurol 1986; 43: 570–2

    PubMed  CAS  Google Scholar 

  83. Weiss BD, Duncan B. Bicycle helmet use by children: knowledge and behaviour of physicians. Am J Public Health 1986; 76: 1022–3

    PubMed  CAS  Google Scholar 

  84. Wasserman RC, Waller JA, Monty MJ, et al. Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness. Am J Public Health 1988; 78: 1220–1

    PubMed  CAS  Google Scholar 

  85. Tucci JJ, Barone JE. A study of urban bicycling accidents. Am J Sports Med 1988; 16: 181–4

    PubMed  CAS  Google Scholar 

  86. Worrell J. Head injuries in pedal cyclists: how much will protection help? Injury 1987; 18: 5–6

    PubMed  CAS  Google Scholar 

  87. Williams M. The protective performance of bicyclists’ helmets in accidents. Accid Annal Prev 1991; 23: 119–31

    CAS  Google Scholar 

  88. Wood T, Milne P. Head injuries to pedal cyclists and the promotion of helmet use in Victoria, Australia. Accid Ann Prev 1988; 20: 177–85

    CAS  Google Scholar 

  89. Ozanne-Smith J, Sherry K. Bicycle related injuries: head injuries since legislation. Hazard 1990; 6: 1–8

    Google Scholar 

  90. Heilman DR, Weisbuch JA, Blair RW, et al. Motocycle-related trauma and helmet usage in North Dakota. Ann Emerg Med 1982; 11: 659–64

    PubMed  CAS  Google Scholar 

  91. Gisolfi CV, Rohlf DP, Navarude SN, et al. Effects of wearing a helmet on thermal balance while cycling in the heat. Physician Sports Med 1988 Jan; 16: 139–46

    Google Scholar 

  92. Jane JA, Steward O, Gennarelli T. Axonal degeneration induced by experimental noninvasive minor head injury. J Neurosurg 1985; 62: 96–100

    PubMed  CAS  Google Scholar 

  93. Gronwall D, Wrightson P. Delayed recovery of intellectual function after minor head injury. Lancet 1974; 2: 605–9

    PubMed  CAS  Google Scholar 

  94. Rutherford WH, Merrett JD, McDonald JR. Sequelae of concussion caused by minor head injuries. Lancet 1977; 1:1–4

    PubMed  CAS  Google Scholar 

  95. Rimel RW, Giordani B, Barth JT, et al. Disability caused by minor head injury. Neurosurgery 1981; 9: 221–8

    PubMed  CAS  Google Scholar 

  96. McCarty M. Do cycle helmets prevent serious head injury: cycling without helmets. BMJ 1992; 305: 881–2

    Google Scholar 

  97. Trippe HR. Helmets for pedal cyclists: they reduce the number of head injuries. BMJ 1992; 305: 843–4

    PubMed  CAS  Google Scholar 

  98. Weiss BD. Bicycle helmet use by children. Pediatrics 1986; 77: 677–9

    PubMed  CAS  Google Scholar 

  99. Coté T, Sacks JJ, Lambert-Huber DA, et al. Bicycle helmet use among Maryland children: effects of legislation and education. Pediatrics 1992; 89: 1216–20

    PubMed  Google Scholar 

  100. Burke ER. Safety standards for bicycle helmets. Physician Sports Med 1988 Jan; 16: 148–53

    Google Scholar 

  101. Mills NJ. Protective capabilities of bicycle helmets. Br J Sports Med 1990; 24: 55–60

    PubMed  CAS  Google Scholar 

  102. Pendergrast RZ, Ashworth CS, DuRant RH, et al. Correlates of children’s bicycle helmet use and short-term failure of school-level interventions. Pediatrics 1992; 90: 354–8

    PubMed  CAS  Google Scholar 

  103. Towner P, Marvel MK. A school-based intervention to increase the use of bicycle helmets. Family Med 1992; 24: 156–8

    CAS  Google Scholar 

  104. DiGuiseppi CG, Rivara FP, Koepsell TD, et al. Bicycle helmet use by children: evaluation of a community-wide helmet campaign. JAMA 1989; 262: 2256–61

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Science Institute of South Africa incorporating the Liberty Life Chair of Exercise and Sports Science and the MRC/UCT Bioenergetics of Exercise Research Unit, Department of Physiology, University of Cape Town Medical School, Observatory, South Africa

    Timothy David Noakes

Authors
  1. Timothy David Noakes
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Noakes, T.D. Fatal Cycling Injuries. Sports Med 20, 348–362 (1995). https://doi.org/10.2165/00007256-199520050-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199520050-00006

Keywords

Search

Navigation