title: Injury incidence and predictors on a multiday recreational bicycle tour: The Register's Annual Great Bike Ride Across Iowa, 2004 to 2008.
abstract: OBJECTIVE
  The "Register's Annual Great Bike Ride Across Iowa" (RAGBRAI) is a 7-day recreational bicycle ride with more than 10,000 participants covering 500 miles. The heat and humidity of late July in Iowa, the prevalence of amateur riders, and the consumption of alcohol can combine creating the potential for a significant number of injuries. The purpose of this study is to determine the type, quantity, and severity of injuries on RAGBRAI and gather data on the factors related to these incidents.
  
  
  METHODS
  This retrospective chart review examined ambulance "run sheets" for patients requiring transport to the hospital from the bike route between 2004 and 2008. These run sheets included name, age, chief complaint, anatomic location of injuries, medications administered, procedures performed, and a full narrative describing the initial scene, patient's account of the incident, services provided, and ongoing condition of the patient while en route to the hospital. Chi-square tests, Pearson's correlation tests, and t tests were applied to determine significant statistical outcomes.
  
  
  RESULTS
  From 2004 to 2008, Care Ambulance Inc provided on-route medical services for 419 RAGBRAI participants. Of these participants, 190 (45.3%) required transport to a local hospital by Care Ambulance Inc. Females were more likely to require transport, as they comprised 46.3% of transported patients while only representing 35% of all RAGBRAI participants (P = .001). For men, increasing age was a significant predictor of transport, particularly males between the ages of 60 and 69 years old (P = .01). Of the 148 run sheets where mechanism of incident was documented, 114 incidents were caused by rider factors (77.0%), 29 by road factors (19.6%), and 5 by bicycle factors (3.4%). Higher heat indexes were correlated with an increased number of dehydration cases (r = 0.979, P = .02). Of participants who reported with minor injuries to a mobile first aid station and did not require transport, 90.1% had not imbibed any alcohol. Bony injuries were more common above the waistline as 39/45 (86.7%) fractures occurred to the clavicle, shoulder/proximal humerus, hand, or head. The most common bony injury each year of RAGBRAI was a clavicle fracture, which represented 44.4% of all recorded fractures from 2004 to 2008. Lacerations and abrasions were also more common above the waist, as 63.5% (127/200) of soft tissue injuries requiring treatment were either to the head or upper extremities. No specific event day showed any correlation with increased injury (P >.05).
  
  
  CONCLUSIONS
  This study suggests that females and older males are more likely to require transport for injuries sustained on RAGBRAI, the majority of injuries occur around the head and upper extremities, dehydration case load is correlated with heat index, and that incidents are usually caused by rider factors. This research could be used by multiday recreational bicycle tour organizers to continue educating riders on riding carelessness and etiquette and prepare medical services for certain quantities and types of injuries.
authors.affiliation: Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. paul-boeke@uiowa.edu
authors.forename: Paul S
authors.initials: PS
authors.lastname: Boeke
authors.forename: Hans R
authors.initials: HR
authors.lastname: House
authors.forename: Mark A
authors.initials: MA
authors.lastname: Graber
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001265:Athletic Injuries / Q000453:epidemiology* / Q000209:etiology*; D001642:Bicycling / Q000293:injuries*; D002648:Child; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D014187:Transportation of Patients / Q000706:statistics & numerical data; D055815:Young Adult