Identifying safety factors and patterns of bicycle trauma in a tertiary level 1 trauma center in Boston, Massachusetts

Abstract

Background: Increasing bicycle ridership is accompanied by ongoing bicycle-related accidents in many urban cities, including Boston, Massachusetts. There is a need for improved understanding of patterns and risks of urban bicycle usage. We describe the injuries and outcomes of bicycle-related trauma in Boston, Massachusetts, and determine accident-related factors and behaviors associated with injury severity. Methods: We conducted a retrospective review of bicycle-related injuries presenting to a Level 1 trauma center in Boston, Massachusetts between 2001 and 2015; of this initial group, 313 patients returned a post-injury survey regarding accident-related factors, personal safety practices, and road and environmental conditions at the time of the accident. Injury characteristics and outcomes were obtained from chart review. Results: Over half of all cyclists biked for commuting and recreational purposes (54%), used a road without a bike lane (58%), and a majority wore a helmet (91%). The most common injury pattern involved the extremities (42%) followed by head injuries (13%). Bicycling for commuting rather than recreation was significantly associated with decreased injury severity, and cycling on a road with a dedicated bicycle lane, the absence of gravel or sand, and use of bicycle lights trended strongly towards significantly decreased injury severity. After any bicycle injury, the number of miles cycled decreased significantly regardless of cycling purpose. Conclusions: Our results suggest that physical separation of cyclists from motor vehicles via bicycle lanes, regular cleaning of these lanes, and usage of bicycle lights are modifiable factors protective against injury severity. Safe bicycling practices and understanding of factors involved in bicycle-related trauma can reduce injury severity and guide public health initiatives and urban planning.