title: Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics.
abstract: OBJECTIVE
  To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics.
  
  
  METHODS
  Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics.
  
  
  RESULTS
  Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission).
  
  
  CONCLUSIONS
  In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians.
authors.affiliation: Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cripton
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Brubacher
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Chipman
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Canada University Health Network, Toronto, Canada.
authors.forename: Steven M
authors.identifier: http://orcid.org/0000-0002-7871-3583
authors.initials: SM
authors.lastname: Friedman
authors.affiliation: School of Occupational and Public Health, Ryerson University, Toronto, Canada.
authors.forename: M Anne
authors.initials: MA
authors.lastname: Harris
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
authors.forename: Meghan
authors.initials: M
authors.lastname: Winters
authors.affiliation: Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, Canada.
authors.forename: Conor C O
authors.initials: CC
authors.lastname: Reynolds
authors.affiliation: Division of Neurosurgery and Injury Prevention Research Office, Keenan Research Centre, St. Michael's Hospital, Toronto, Canada Departments of Surgery and Education and Public Health, University of Toronto, Toronto, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, Canada.
authors.forename: Shelina
authors.initials: S
authors.lastname: Babul
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Kay
authors.initials: K
authors.lastname: Teschke
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000367:Age Factors; D001642:Bicycling; D002170:Canada; D002947:Cities; D004779:Environment Design; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D014186:Transportation; D014218:Triage; D014505:Urban Population; D014947:Wounds and Injuries / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
keywords: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; PUBLIC HEALTH