ARCHIVED - Injuries associated with Bicycles - 2006, Ages 1 year and older
Source of the Statistics
Injury data were obtained from the database of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). CHIRPP is an injury surveillance system operating in the emergency departments of 10 pediatric and 4 general hospitals in Canada. Data collection began in April 1990 at the pediatric hospitals and between 1991 and 1995 in the general hospitals. CHIRPP is a program of the Injury and Child Maltreatment Section of the Health Surveillance and Epidemiology Division, Public Health Agency of Canada.
Briefs and reports are updated when there is reason to believe the injuries or circumstances surrounding the injuries have changed. For example, the report of injuries associated with a specific product would be updated if the manufacturing regulations for the product are changed to include a new safety element. There is no need to update reports on a regular basis because the data collection sites are not a representative sample of all Canadian hospitals. Frequent updates would simply increase the number of records included in the report but not necessarily result in any change in the patterns and distributions found.
Limitations
It is important to note that the injuries described do not represent all injuries in Canada, but only those seen at the emergency departments of the 14 hospitals in the CHIRPP network. Since most of the data comes from the pediatric hospitals, which are in major cities, injuries suffered by the following people are under-represented in the CHIRPP database: older teenagers and adults, who are seen at general hospitals; native people; and people who live in rural areas. Fatal injuries are also under-represented in the CHIRPP database because the emergency department data do not capture people who died before they could be taken to hospital or those who died after being admitted.
Inclusion and Exclusion Criteria
A May 2008 search of the CHIRPP database for injuries associated with bicycles was conducted (ages 1 year and older; 1,850,948 records total). The records were retained if i) the narrative contained one of the following text strings: “BIKE”, “BICYCLE”, “TRICYCLE”, “UNICYCLE”, “CYCLE” , “BICYCLETTE”, “VELO” or “PEDALER ii) and the injury occurred in 2006. This final dataset was then reviewed manually to confirm all cases occurred outdoors, were associated with non-motorized bicycles. Cases involving exercise bikes, motocross, motorcycle, motorized dirt bikes, or toy bikes were excluded.
Recommended Citation
Injury briefs and reports and data from them may be copied and circulated freely provided that the source is acknowledged. The following citation is recommended:
Health Surveillance and Epidemiology Division (Public Health Agency of Canada). Injuries associated with bicycles: Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database, 2006, 1 year and older, 3,993 records.
For more information
Please contact the Injury and Child Maltreatment Section, Health Surveillance and Epidemiology Division, by PHONE at (613) 957-4689, by FAX at
(613) 941-9927 or visit our website.
Overall Pattern
Overall, 3,993 cases were identified where the injury was associated with a bicycle (3526.1 cases per 100 000 CHIRPP records). Among 2006 CHIRPP cases, this represents 3.4% of total cases, approximately 9% of all sports and recreation activities, and 44% of all wheeled, non-motorized activities (bikes, scooters, scooter boards, inline skates and skateboards).
There were 11% of cases admitted to hospital for treatment, compared to a 7.0% admittance rate for CHIRPP during the same timeframe for all injuries. The leading injuries reported were fractures (34.0%), lacerations (18.0%), and minor head injuries or concussions (7.3%). The majority of injuries occurred between April and October (94%), with a slightly higher proportion on the weekend (16%) than the weekdays (14%).
The analysis will be divided into cases involving children (between 1 and 10 years of age) (43.1% of cases), youth (11-15 years) (40.3% of cases) and adults (16 years and up) (16.7% of cases), to compare patterns among these groups. For all age groups combined, the median age was 11.9 and the interquartile range was 6.3 years (minimum age 1 year, maximum age 85 years). Analysis of the adult age group indicates a median age of 24 years.
Table 1 summarizes the age and sex distribution by these age groups.
Table 1. Injuries associated with bicycles, age and sex distribution, CHIRPP, ages 1 year and older, 2006.
| Age Group (Years) | # cases overall (%) | #/100,000 CHIRPP 1 | % male | % male CHIRPP 2 |
| Children (1-10 years) | 1720 (43.1) | 3,294.6 | 66.1 | 56.9 |
| Youth (11-15 years) | 1607 (40.3) | 5,289.4 | 80.7 | 63.0 |
| Adult (16 years and older) | 666 (16.7) | 2,172.1 | 76.7 | 58.8 |
| Total | 3993 (100.0) | 3,526.1 | 73.8 | 59.0 |
1Because CHIRRP collects information from ten children’s hospitals and only five of the general hospitals, there is a high number of young children in the database. Using cases per 100,000 within an age group (instead of percentage by age group) adjusts for this uneven distribution. 2The proportion of males in the entire CHIRPP database for the given age group.
Circumstances
Table 2 describes the circumstances at the time of injury. Overall, the circumstances which led to the injury can be classified broadly into either Loss of Control (81.0%) or Collision (14.6%). The percentage of injuries associated with loss of control decrease significantly between children (82.7%) and adults (78.7%) ( X2(1, N=2386) = 5.09, p<.05). The percentage of injuries involving collisions do not differ between children (13.4%) and adults (16.4%) when tested (X2 (1, N=2386) = 3.53, p>.05).
Table 2. Circumstances, injuries associated with bicycles, CHIRPP, by age group, 2006.
| Circumstance | Total | Children | Youth | Adult |
| # cases (%) | # cases (%) | # cases (%) | # cases (%) | |
| Loss of Control | 3,234 (81.0) | 1,422(82.7) | 1,288 (80.1) | 524 (78.7) |
| Fell from bike, NFS | 1365 | 637 | 470 | 258 |
| Loss of control, no additional detail | 571 | 310 | 184 | 77 |
| Fell doing tricks/stunts | 375 | 101 | 237 | 37 |
| Fell due to hill or excessive speed | 183 | 94 | 71 | 18 |
| Distracted/chased and fell while biking* | 181 | 82 | 70 | 29 |
| Rough terrain (e.g. gravel, mud, sand) | 164 | 54 | 87 | 23 |
| Hit obstacle (e.g. rock, pothole), fell | 152 | 68 | 58 | 26 |
| Braking suddenly | 83 | 22 | 46 | 15 |
| Something caught in wheel/chain and fell | 83 | 29 | 43 | 11 |
| Racing (formal or informal) | 35 | 11 | 15 | 9 |
| Fell while getting on or off bike | 25 | 14 | 6 | 5 |
| Impaired (alcohol or drugs) | 17 | 0 | 1 | 16 |
| Collision | 583 (14.6) | 230 (13.4) | 244 (15.2) | 109 (16.4) |
| With motor vehicle | 260 | 67 | 120 | 73 |
| With fixed object (e.g. curb, tree, sign) | 164 | 73 | 71 | 20 |
| With bicyclist | 76 | 43 | 25 | 8 |
| With a parked car | 59 | 32 | 21 | 6 |
| With a pedestrian | 24 | 15 | 7 | 2 |
| Other | 176 (4.4) | 68 (3.9) | 75(4.7) | 33 (4.9) |
| Bike mechanical failure | 104 | 28 | 51 | 25 |
| Unintended use of bike** | 56 | 38 | 16 | 2 |
| Injured while repairing bike | 8 | 0 | 4 | 4 |
| Unknown | 8 | 2 | 4 | 2 |
| Total | 3,993 (100.0) | 1,720 (100.0) | 1,607 (100.0) | 666 (100.0) |
*Includes being chased by an animal.
**Unintended includes cases such as where more than one patient on bike, riding in inappropriate place.
Injuries
There are up to 3 injuries recorded for each patient. For this analysis, there were a total of 5,075 injuries associated with 3,993 patients. Table 3 lists the nature of injury by body part for only the first, most serious injury. Overall, fractures were the most frequently occurring injury (34.0%) (upper extremity comprised 80% of all fractures), followed by lacerations (17.5%) and soft tissue injuries (15.3%). This pattern is consistent across all 3 age groups.
Table 3. Nature of injury, associated with bicycles, CHIRPP, by age group, 2006.
| Body part Nature of injury | Total | Children | Youth | Adult |
| # cases (%) | # cases (%) | # cases (%) | # cases (%) | |
| Upper extremities | 1797 (45.0) | 714 (41.5) | 790 (49.2) | 293 (44.0) |
| fracture | 1077 | 459 | 485 | 135 |
| soft tissue | 286 | 109 | 132 | 45 |
| abrasion | 203 | 65 | 78 | 60 |
| sprain/strain | 96 | 32 | 46 | 18 |
| laceration | 91 | 39 | 33 | 19 |
| amputation -finger | 3 | 2 | 1 | 0 |
| other | 41 | 8 | 15 | 16 |
| Lower extremities | 838 (21.0) | 308 (17.9) | 376 (23.4) | 154 (23.1) |
| laceration | 236 | 93 | 117 | 26 |
| fracture | 191 | 60 | 91 | 40 |
| soft tissue | 181 | 71 | 79 | 31 |
| abrasion | 130 | 51 | 48 | 31 |
| sprain/strain | 72 | 24 | 32 | 16 |
| other | 27 | 9 | 9 | 10 |
| Face (including eye and mouth) | 528 (13.2) | 328 (19.1) | 122 (7.6) | 78 (11.7) |
| laceration | 298 | 198 | 60 | 40 |
| abrasion | 79 | 52 | 20 | 7 |
| dental | 68 | 45 | 20 | 3 |
| fracture | 41 | 11 | 12 | 18 |
| soft tissue/bruise | 24 | 12 | 5 | 7 |
| other | 18 | 10 | 5 | 3 |
| Head | 399 (10.0) | 192 (11.2) | 165 (10.3) | 42 (6.3) |
| minor closed head injury | 176 | 94 | 67 | 15 |
| concussion | 115 | 49 | 57 | 9 |
| scalp laceration | 38 | 22 | 11 | 5 |
| intracranial | 30 | 7 | 17 | 6 |
| abrasion | 18 | 8 | 4 | 6 |
| skull fracture | 14 | 5 | 8 | 1 |
| other | 8 | 7 | 1 | 0 |
| Trunk | 298 (7.5) | 128 (7.4) | 110 (6.9) | 60 (9.0) |
| soft tissue | 101 | 55 | 31 | 15 |
| abrasion | 90 | 40 | 28 | 22 |
| internal injuries | 43 | 13 | 26 | 4 |
| laceration | 36 | 18 | 16 | 2 |
| fracture | 20 | 0 | 6 | 15 |
| other | 8 | 2 | 3 | 2 |
| Neck and spine | 41 (0.1) | 14 (0.8) | 16 (1.0) | 11 (1.7) |
| soft tissue | 15 | 6 | 5 | 4 |
| fracture | 10 | 1 | 6 | 3 |
| sprain/strain | 8 | 5 | 2 | 1 |
| other | 8 | 2 | 3 | 3 |
| Other or unknown | 92 (2.3) | 36 (2.1) | 28 (1.7) | 28 (4.2) |
| Total | 3,993 (100.0) | 1,720 (100.0) | 1,607 (100.0) | 666 (100.0) |
Treatment in Emergency Department
Table 4 reports what treatment the patient received in the emergency department (ED). Children were admitted at a rate of 8.7%, increasing to 11.6% in youth (X2(1, N=3,327) =8.09, p<.01) and further increasing to 15.3% in the adult age group (X2 (1, N=2,273) =5.74, p<.05). The 2 fatalities followed impact by a motor vehicle.
Table 4. Treatment received in emergency departments, injuries associated with bicycles, CHIRPP, by age groups, 2006.
| Treatment in Emergency Department | Total | Children | Youth | Adult |
| # cases (%) | # cases (%) | # cases (%) | # cases (%) | |
| Left without being seen | 55 (1.4) | 25 (1.5) | 16 (1.0) | 14 (2.1) |
| Advice | 364 (9.1) | 214 (12.4) | 136 (8.5) | 14 (2.1) |
| Treated, medical follow-up if necessary | 1,426 (35.7) | 585 (34.0) | 505 (31.4) | 336 (50.4) |
| Treated, medical follow-up required | 1,576 (39.5) | 693 (40.3) | 695 (43.3) | 188 (28.2) |
| Short stay, observed in ED | 131 (3.3) | 53 (3.1) | 66 (4.1) | 12 (1.8) |
| Admitted to hospital | 438 (11.0) | 149 (8.7) | 187 (11.6) | 102 (15.3) |
| Fatal | 2 (0.05) | 1 (0.06) | 1 (0.06) | 0 (0.0) |
| Total | 3,993 (100.0) | 1,720 (100.0) | 1,607 (100.0) | 666 (100.0) |
Helmet Use
There were 2,993 cases where helmet status was reported (75%); and among these cases, nearly 63% reported wearing a helmet. Analysis by helmet use demonstrated riders who were not wearing a helmet experienced an admittance rate of 12%, compared to 7% of riders who did. Table 5 illustrates helmet use, where status was reported, decreased as age increased.
Table 5. Helmet use, injuries associated with bicycles, CHIRPP, by age groups, 2006.
| Helmet use while bicycling | Total | Children | Youth | Adult |
| # cases (%) | # cases (%) | # cases (%) | # cases (%) | |
| No helmet while bicycling | 1116 (37.3) | 404 (30.1) | 506 (39.2) | 206 (57.1) |
| Wore a helmet while bicycling | 1877 (62.7) | 937 (69.9) | 785 (60.8) | 155 (42.9) |
| Total cases of helmet status reported | 2,993 (100.0) | 1,341 (100.0) | 1,291 (100.0) | 361 (100.0) |
Handle Bar Impact
Cases associated with handlebar impact were identified as they are typically serious, often resulting in internal injuries. 3,4 There were 193 cases (4.8%) were the rider made contact with the handlebars and 15% of these were admitted to hospital, compared with an overall admittance rate of 11%. Of admitted cases, 73% were for treatment of internal injuries; of these 78% were associated with loss of control and 15% with a collision.
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