title: Comparison of the injury severity and medical history of disease-related versus trauma-related bicyclist fatalities.
abstract: The objective of this study was to clarify the relationship between injury severity and mechanism of death in bicycle fatalities resulting from trauma compared with those resulting from disease, to propose effective measures to prevent fatal bicyclist accidents. Autopsy and accident records were reviewed for bicyclist fatalities who had undergone forensic autopsy at the Dokkyo Medical University School of Medicine between September 1999 and March 2014. Victims' health histories, blood alcohol levels, causes of death, mechanisms of injury, Abbreviated Injury Scale (AIS) scores and Injury Severity Scores (ISSs) were determined. Fifty-five bicyclists (43 male and 12 female) with a mean age of 62.5±17.3 years were included in this study. Sixteen victims had driven under the influence of alcohol (mean blood concentration of 1.8±0.7 mg/ml). Mean ISS was 32.4 and the chest had the highest mean AIS score (2.6), followed by the head (2.1) and the neck (1.8). Thirty-nine victims (70.9%) had died of trauma and 16 had died of disease. The disease-death victims had significantly higher prevalence of having diabetes mellitus, hyperlipidemia, hypertension, heart disease or cerebrovascular diseases (50.0% vs. 22.2%, p=0.03) and a lower rate of drunk driving (6.3% vs. 41.0%, p=0.01) than the trauma-death group. All victims who were affected by disease, and 33.3% of trauma-death victims, had fallen on the road without a vehicle collision (p<0.001). The mean ISS of the trauma-death group was significantly higher than that of the disease-death group (44.0 vs. 4.2, p<0.001). Except for facial injuries, the AIS scores were significantly higher in trauma-death victims than in the disease-death group (p<0.005). To effectively reduce bicyclist fatalities, the authors strongly advocate efforts that will increase compliance with drunk driving prohibitions. For victims of fatal bicycle accidents with a medical history of diseases, a forensic autopsy should be performed to establish a disease-related death while bicycle riding. We must also put into effect preventative safety measures, which take into consideration the physical condition of bicyclists, to reduce the incidence of these types of accidents.
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan. Electronic address: hitosugi@belle.shiga-med.ac.jp.
authors.forename: Masahito
authors.initials: M
authors.lastname: Hitosugi
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Koseki
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
authors.forename: Genta
authors.initials: G
authors.lastname: Miyama
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Furukawa
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
authors.forename: Satomu
authors.initials: S
authors.lastname: Morita
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic / Q000401:mortality*; D001642:Bicycling / Q000293:injuries*; D000067401:Blood Alcohol Content; D002423:Cause of Death; D016009:Chi-Square Distribution; D002908:Chronic Disease / Q000401:mortality*; D005260:Female; D049429:Forensic Pathology / Q000379:methods; D006304:Health Status; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality*
chemical_list: D000067401:Blood Alcohol Content
keywords: Aging; Bicyclist; Illness; Injury severity; Safety; Traffic accident