Multicentre study of hospitalised patients with sports- and recreational cycling–related traumatic brain injury in Hong Kong

Abstract

Introduction:Cycling is associated with a greater risk of traumatic brain injury (TBI) than other recreational activities. This study aimed to investigate the epidemiology of sports-related TBI in Hong Kong and to examine predictors for recreational cycling-induced intracranial haemorrhage. Methods: This retrospective multicentre study included patients diagnosed with sports-related TBI in public hospitals in Hong Kong from 2015 to 2019. Computed tomography scans were reviewed by an independent assessor. The primary endpoint was traumatic intracranial haemorrhage. The secondary endpoint was an unfavourable Glasgow Outcome Scale (GOS) score at discharge from hospital. Results: In total, 720 patients were hospitalised with sports-related TBI. The most common sport was cycling (59.2%). The crude incidence of cycling-related TBI was 1.1 per 100 000 population. Cyclists were more likely to exhibit intracranial haemorrhage and an unfavourable GOS score, compared with patients who had TBI because of other sports. Although 47% of cyclists had intracranial haemorrhage, only 15% wore a helmet. In multivariate analysis, significant predictors for intracranial haemorrhage were age ≥60 years, antiplatelet medication, moderate or severe TBI, and skull fracture. Among 426 cyclists, 375 (88%) had mild TBI, and helmet wearing was protective against intracranial haemorrhage, regardless of age, antiplatelet medication intake, and mechanism of injury. Of 426 cyclists, 31 (7.3%) had unfavourable outcomes on discharge from hospital. Conclusions: The incidence of sports-related TBI is low in Hong Kong. Although cycling-related

A Review of Cyclist Head Injury, Impact Characteristics and the Implications for Helmet Assessment Methods

“…15/187 had unknown helmet status. The vast majority (88%) of cyclists with TBI were suffering from mild TBI Alfrey et al 2 Admissions to Marin County Level III Trauma Center in California, USA 2007–2015 In helmeted riders there were significantly fewer facial fractures 67/701, 9.5%, vs. 35/205, 17.0% (), skull fractures and serious head injuries 701 (77%) wore helmets and 205 (23%) did not wear helmets Woo et al 120 Hospitalised recreational cyclists in Hong Kong 2015–2019 Helmets protected significantly against skull fracture, extradural haematoma and subdural haematoma regardless of injury mechanism, age or antiplatelet medication intake 361 (84.7%) cyclists were not wearing a helmet. Although 47% of cyclists had intracranial haemorrhage, only 15% wore a helmet Major Trauma Centre / Intensive Care Unit Admissions Forbes et al 35 St Mary’s Hospital London (UK) admissions 2011–2015 Helmet use protected against subdural haematoma, skull fracture (down 80%) and intracranial injury (down 80%) 97 known helmet status (27 with, 70 without) Sethi et al 101 One New York (USA) major trauma centre admissions Feb. 2012–Aug.…”

“… 61 Woo et al . 120 assessed TBI in hospitalised cyclists in Hong Kong. 120 They also found that helmets protected significantly against skull fracture, extradural haematoma and subdural haematoma regardless of age, antiplatelet medication intake, or mechanism of injury.…”

“…Motor vehicle involvement was the most frequent cause of fatal injuries. Falls only: 24 (7.16%) 335 311 92.8 24 7.2 Forbes et al 35 Motorized vehicle 63 (48.7%) 129 63 48.7 43 33.0 Park et al 88 Fall alone (46.8%), MVC (42.0%), Obstacle (11.2%) 205 86 42.0 96 46.8 Leo et al 57 Only includes cyclist-car collisions 15,650 15,650 100.0 – – Carone et al 16 15/22 vehicle, 6/22 falls, 1/22 obstacle 22 15 68.2 6 27.3 Baschera et al 8 More than half of cases sustained their injuries in a self-accident and about 40% in a collision with another vehicle, mainly in collision with cars and trucks 1019 408 40.0 510 50.0 Feler 34 MVC: 7,196/16,181 (38.7%), information about falls not given 16,181 6262 38.7 – – Woo et al 120 4.0% MVC, 66.6% falls. Among the mTBI cohort: 12/353 involved MVs 426 17 <...…”