title: Major trauma and urban cyclists: physiological status and injury profile.
abstract: BACKGROUND
  Pedal cycling in cities has the potential to deliver significant health and economic benefits for individuals and society. Safety is the main concern for potential cyclists although the statistical risk of death is low. Little is known about the severity of injuries sustained by city cyclists and their outcome.
  
  
  OBJECTIVE
  The aim of this study was to characterise the physiological status and injury profile of cyclists admitted to our urban major trauma centre (MTC).
  
  
  METHODS
  Database analysis of cyclist casualties between 2004 and 2009. The physiological parameters examined were admission systolic blood pressure (SBP), admission base deficit and prehospital Glasgow Coma Scale.
  
  
  RESULTS
  265 cyclists required full trauma-team activation. 82% were injured during a collision with a motorised vehicle. The majority (73%) had collided with a car or a heavy goods vehicle (HGV). These casualties formed the cohort for further analysis. Cyclists who collided with an HGV were more severely injured and had a higher mortality rate. Low SBP and high base deficit indicate that haemorrhagic shock is a key feature of HGV casualties.
  
  
  CONCLUSIONS
  Collision with any vehicle can result in death or serious injury to a cyclist. Injury patterns vary with the type of vehicle involved. HGVs were associated with severe injuries and death as a result of uncontrollable haemorrhage. Awareness of this injury profile may aid prehospital management and expedite transfer to MTC care. Rapid haemorrhage control may salvage some, but not all, of these casualties. The need for continued collision prevention strategies and long-term outcome data collection in trauma patients is highlighted.
authors.affiliation: Research Fellow, Trauma Clinical Academic Unit, The Royal London Hospital, London E1 1BB, UK. joanna.manson@gmail.com
authors.forename: Joanna
authors.initials: J
authors.lastname: Manson
authors.forename: Sian
authors.initials: S
authors.lastname: Cooper
authors.forename: Anita
authors.initials: A
authors.lastname: West
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Foster
authors.forename: Elaine
authors.initials: E
authors.lastname: Cole
authors.forename: Nigel R M
authors.initials: NR
authors.lastname: Tai
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001642:Bicycling; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014505:Urban Population; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology