Bicycle-related head injury: a study of 86 cases.
Within the framework of a bicycle helmet research program, we have set up a database of bicycle accident victims, containing both accident and clinical data. The database consists of a consecutive series of 86 victims of bicycle accidents who underwent a neurosurgical intervention in our hospital between 1990 and 2000. Data were obtained from police files, medical records, computed tomography head scans and a patient questionnaire. In only three victims, the wearing of a helmet was documented. In this study, the head injuries are analysed and the relation between the different types of head injuries and outcome is assessed. Forty-four accidents were collisions with a motor vehicle and 42 accidents were falls. Most impacts occurred at the side (57%) or at the front (27%) of the head. The most frequent injuries were skull fractures (86%) and cerebral contusions (73%). Age was negatively correlated with outcome (P = 0.0002 ) and positively correlated with the number (P = 0.00002) and volume (P = 0.00005) of contusions and the presence of subdural haematomas (P = 0.000001). The injuries with the strongest negative effect on outcome were: subarachnoid haemorrhage (P = 0.000001), multiple (P = 0.000005) or large ( P 0.0007) contusions, subdural haematoma (P = 0.001) and brain swelling (P = 0.002). A significant coexistence of these four injuries was found. We hypothesise that in many patients the contusions may have been the primary injuries of this complex and should therefore be considered as a main injury determining outcome in this study. We believe that such findings may support a rational approach to optimising pedal cyclist head protection.
Depreitere
Bart
B
Department of Neurosurgery, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. bart.depreitere@uz.kuleuven.ac.be
Van Lierde
Carl
C
Maene
Sigrid
S
Plets
Christiaan
C
Vander Sloten
Jos
J
Van Audekercke
Remy
R
Van der Perre
Georges
G
Goffin
Jan
J
D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D001642:Bicycling / Q000293:injuries*; D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D023261:Glasgow Outcome Scale; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged