Bicycle-Related Injuries: Data from the National Electronic Injury Surveillance System

Since its inception in 1972, the U.S. Consumer Product Safety Commission (CPSC) has used its National Electronic Injury Surveillance System (NEISS) to collect data on product-related injuries treated in emergency rooms. Currently, 62 hospitals located throughout the United States contribute to this data base. Based on NEISS data, CPSC estimates that in 1985 there were nearly 10 million emergency room visits for nonoccupational, product-related injuries. Approximately 574,000 (5.7%) of these involved bicycles.

To determine whether NEISS could be expanded to cover all reported injuries, CPSC conducted a special study supported by CDC and the Bureau of Justice Statistics of the U.S. Department of Justice. From September 15-28, 1986, eight of the reporting hospitals collected data on all injured patients, whether or not consumer products were involved.

Information collected on the 3,418 injuries reported during the study period included a narrative description of all injury events. For each of the 2,232 product-related injuries, the product involved was assigned the corresponding NEISS consumer product code. The narrative descriptions were reviewed, and each injury was assigned an external cause of injury code (E-code*) in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification (1). The 120 incidents that involved noninjury conditions were excluded from further analysis.

To assess the value of the data collected during this broad, short-term study, bicycle-related injuries were analyzed. During the 2-week study period, bicycle-related injuries accounted for slightly more than 3% of the 3,298 injuries treated. Five of the 101 patients with bicycle-related injuries were hospitalized, and the remaining 96 were treated and released. There were no deaths due to bicycle-related injuries.

As in other investigations, 15% of the bicycle-related injuries resulted from collisions with motor vehicles (2,3). Sixty-nine bicyclists were injured while riding in locations other than public highways. Seventeen injuries involved bicycles being maintained or otherwise not being ridden. Compared with nonbicycle-related injuries, bicycle-related injuries were more likely to involve facial trauma but less likely to involve other head trauma (Table 3). Bicycle-related injuries accounted for approximately the same proportion of total trauma visits for both sexes (Table 4). However, there was large variation across age strata; more than half of the bicycle-related injuries occurred in the 5- to 14-year-old age group. Reported by: Div of Injury Epidemiology and Control, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Analysis of the NEISS data generated in this special 2-week study has led to several observations about the system. First, NEISS has the potential for monitoring a variety of injuries including those that are of public health concern. Second, the system can be temporarily expanded on short notice. Third, a succinct narrative description of the circumstances of injuries allows E-codes to be assigned in most instances. Finally, E-coding in areas such as bicycle-related injuries can be effectively supplemented by NEISS product codes (19 of the injuries were identified and two erroneous ones were excluded on the basis of the product code).

In the special NEISS study reported here, bicycle-related injuries accounted for slightly more than 3% of the 3,298 injuries treated. The difference between this percentage and the 1985 CPSC national average of 5.7% is, for the most part, attributable to the inclusion of occupational and nonproduct-related injuries in the special study. These inclusions increased the denominator by almost 33% while adding no additional bicycle-related injuries to the numerator. In addition, the study was carried out during a time when the rate of bicycle-related injuries is lower than the yearly average.

The number of injuries reported during this study did not provide sufficient data to completely evaluate the range of seriousness of bicycle-related injuries. In this short time period, there were no deaths and only 5 of the 101 patients with bicycle-related injuries required overnight hospitalization. Other investigations have shown that the most serious bicycle-related injuries involve head trauma resulting from crashes with automobiles (4,5).

Measures to prevent bicycle-related injuries can be categorized under 1) proper road design and maintenance, 2) improvement in bicycle manufacture, and 3) dissemination of safety information (2). The need for improvements in the manufacturing of bicycles was identified through analysis of NEISS data. In response to this need, CPSC issued safety standards in 1974 for bicycle frames, brakes, steering systems, and wheels and required a standardized road test for bicycles (6). Dissemination of safety information includes education regarding safe riding practices, bicycle maintenance, and use of appropriate head gear (7). Sample copies of bicycle safety information for children are available to health professionals from the American Academy of Pediatrics, Publications, 141 Northwest Point Blvd., Elk Grove Village, IL 60009-0927.

References

1. Commission on Professional and Hospital Activities. Annotated international classification of diseases, ninth revision, clinical modification. Ann Arbor: Commission on Professional and Hospital Activities, 1986.

2. Lind MG, Wollin S. Bicycle accidents. Acta Chir Scand 1986; suppl 531:1-47.

3. Selbst SM, Alexander D, Ruddy R. Bicycle-related injuries. Am J Dis Child 1987;141:140-4.

4. Guichon DMP, Myles ST. Bicycle injuries: one-year sample in Calgary. J Trauma 1975;15:504-6.

5. Fife D, Davis J, Tate L, et al. Fatal injuries to bicyclists: the experience of Dade County, Florida. J Trauma 1983;23:745-55.

6. Consumer Product Safety Commission. Hazardous substances and articles; administration and enforcement regulations: banning of hazardous bicycles. Federal Register 1974;39(Jul 16):26100.

7. Weiss BD. Childhood bicycle injuries: what can we do ? Am J Dis Child 1987;141:135-6. *A shorthand notation for classifying the circumstance or event preceding an injury (1).

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