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Alarming Cycle of Head Injury in the UK

Medico Legal

According to the Department of Transport, the number of cyclists killed or seriously injured on UK roads has increased 11% in the past three years.

Head injuries, ranging from fatal skull fractures and brain damage to minor concussion and cuts, are very common injuries to cyclists. Hospital data shows that over 40% of cyclists, and 45% of child cyclists, suffer head injuries.

 

A study of 116 fatal cyclist accidents in London and rural areas found over 70% of the cyclist fatalities in London had moderate or serious head injuries in London, and over 80% of those killed in collisions on rural roads.

Cyclist Casualties 2013 [1]

                                 Child           Adult          All

Killed                           6             103           109

Seriously Injured        276          2,867        3,143

Slightly Injured         1,676        14,510      16,186

Total                        1,958        17,480      19,438 

The alarming fact is that every year in this country around 19,000 cyclists are killed or injured in reported road accidents, including around 3,000 who are killed or seriously injured.

According to RoSPA, these figures only include cyclists killed or injured in road accidents that were reported to the police. Many cyclist casualties are not reported to the police, even when the cyclist is inured badly enough to be taken to hospital. The figures also exclude cycling accidents that occur away from the road. Although the number of deaths is accurate, there could be two or three times as many seriously injured cyclists and double the number of slightly injured.

Cyclist casualties have risen in recent years as the amount of cycling has increased. The majority of cyclist casualties are adults, with less than one fifth being children. Cycling accidents increase as children grow older, with 10 to 15 year old riders being more at risk than other age groups, including adults until about the age of 60 years.

To some extent, this reflects increased cycling as children grow older followed by a switch to motorised transport from the late teens onwards. It also coincides with the age when children attend Secondary school, and may indicate riskier behaviour by this age group.

Males are far more likely to be involved in cycling accidents than females; four out of five cyclist casualties are male.

Most cycling accidents happen in urban areas where most cycling takes place. Almost two thirds of cyclists killed or seriously injured were involved in collisions at, or near, a road junction, with T junctions being the most commonly involved. Roundabouts are particularly dangerous junctions for cyclists. Not surprisingly, the severity of injuries suffered by cyclists increases with the speed limit, meaning that riders are more likely to suffer serious or fatal injuries on higher speed roads. Almost half of cyclist deaths occur on rural roads.

Around 80% of cycling accidents occur in daylight which is when most cycling takes place. For child cyclists, 90% of their accidents occur during the day. The most dangerous hours for cyclists are 3.00 to 6.00 p.m. and 8.00 to 9.00 a.m. on weekdays. However, cycling accidents in the dark are more likely to be fatal

More cycle accidents occur during the Spring and Summer months (May to September) than the Autumn and Winter months (October to April). However, the casualty rate in terms of miles travelled is higher over the Autumn and Winter period.

Cycling Accidents

Around 75% of fatal or serious cyclist accidents occur in urban areas [2]

Around half of cyclist fatalities occur on rural roads

75% happen at, or near, a road junction

80% occur in daylight

80% of cyclist casualties are male

Almost one quarter of the cyclists killed or injured are children

Around three quarters of cyclists killed have major head injuries.

Types of Accident

Accidents involving child cyclists are often the result of the child playing, doing tricks, riding too fast or losing control. For teenage and adult cyclists, accidents are more likely to involve collisions with motor vehicles, but about 16% of fatal or serious cyclist accidents reported to the police do not nvolve a collision with another vehicle, but are caused by the rider losing control of their bicycle.

In collisions involving a bicycle and another vehicle, the most common key contributory factor recorded by the police is 'failed to look properly' by either the driver or rider, especially at junctions. 'Failed to look properly' was attributed to the car driver in 57% of serious collisions and to the cyclist in 43% of serious collisions at junctions.

Other common contributory factors attributed to drivers are 'poor turn/manoeuvre' (in 17% of serious accidents involving a cyclist) and 'careless, reckless, in a hurry (17%). Cyclists are more likely to suffer serious injuries when a driver is judged to be 'impaired by alcohol', exceeding the speed limit' or 'travelling too fast for the conditions'.

The second most common contributory factor attributed to cyclists was 'cyclist entering the road from the pavement' (including when a cyclist crosses the road at a pedestrian crossing), which was recorded in about 20% serious collisions (and over one third of serious collisions involving child cyclists)

The most common vehicle involved in collisions with cyclists is a car or taxi, with the rider usually being hit by the front of the vehicle. In a quarter of fatal cyclist accidents, the front of the vehicle hit the rear of the bicycle.

However, heavy goods vehicles (HGVs) present a particular danger for cyclists, especially in London where around 20% of cyclist fatalities occur involve an HGV. These often occur when an HGV is turning left at a junction'. About one quarter of accidents resulting in serious injury to a cyclist involved an HGV, bus or coach 'passing too close' to the rider.

Common Cycling Accidents

Motorist emerging into path of cyclist

Motorist turning across path of cyclist Cyclist riding into the path of a motor vehicle, often riding off a pavement

Cyclist and motorist going straight ahead

Cyclist turning right from a major road and from a minor road

Child cyclist playing or riding too fast

Injury Patterns

Limb Injuries

Limb injuries are common in cyclist casualties, with over 40% suffering arm injuries and around 25% suffering leg injuries.

Chest/Abdomen Injuries Chest and abdomen injuries occur much less frequently (5%), but are often serious. When they do occur they are often accompanied by head injuries.

Head Injuries

Head injuries, ranging from fatal skull fractures and brain damage to minor concussion and cuts, are very common injuries to cyclists. Hospital data shows that over 40% of cyclists, and 45% of child cyclists, suffer head injuries. A study of 116 fatal cyclist accidents in London and rural areas found over 70% of the cyclist fatalities in London had moderate or serious head injuries in London, and over 80% of those killed in collisions on rural roads.

Key cycle helmet fact

Headway, the charity that works to improve life after brain injury, states as its mission to promote understanding of all aspects of brain injury and to provide information, support and services to people with a brain injury, their families and carers. In addition, it campaigns to reduce incidence of brain injury. Here we reproduce its key cycle helmet facts as well as its bigger head injury picture.

• The number of cyclists killed or seriously injured on UK roads has increased 11% in the past three years. (DoT)

• Cyclist casualty and KSI rates per 100,000 people are highest for 12-15 year olds. For this age group, 1 in every 5 casualties in a road accident is a pedal cyclist. (DoT)

• 22% of all UK cycling casualties are under 16. The figure for child casualties in all forms of road traffic accident is only 10%. (DoT)

• It is estimated that 90,000 on-road and 100,000 off-road cycling accidents occur every year in the UK, of which 53%(100,000) involve children under 16 (Bicycle Helmets 1 - Does the dental profession have a role in promoting their use? (Chapman HR, Curran ALM. British Dental Journal 2004;196(9):555-560)

• The number of pedal cyclists killed or seriously injured (KSI) in road accidents in 2007 was 2,564. This included 136 deaths. 522 children were among the KSI total. (Cycle Helmets, Lee AJ, Mann NP, Arch Dis Child 2003)

• A Cochrane review considering five case-control studies from the UK, Australia and the USA illustrates a large and consistent protective effect from cycle helmets, reducing the risk of brain injury by up to 88% and injury to the upper and mid face by 65% . (Helmets for preventing head and facial injuries in bicyclists, Thompson et al.. Cochrane Database Syst Rev. 2000)

• After introducing a helmet law for children under 14, the US state of New Jersey reported that bicycle-related fatalities for that group fell by 60%. For riders over 14, who were not required to wear helmets, the reduction was a mere 5% in the same period. (Trends in Pediatric and Adult Bicycling Deaths Before and After Passage of a Bicycle Helmet Law, Wessen et al)

Cyclist’s life-changing brain damage

In January 2015 the Manchester evening News reported that a cyclist who suffered severe brain injuries when he was thrown from his bicycle has won a £2million compensation payout. John Wellock, 65, from Greater Manchester, was left in a coma after a motorist pulled out in front of him on the A62 Huddersfield Road in Delph, Oldham in September 2010.

The former salesman spent nine months in hospital going through intensive rehabilitation. His life-changing brain injuries mean he is now dependent on the care of his wife, Elaine, 58, and has been unable to work since.

Following a long legal battle John has now been awarded a £2m out-of-court settlement after the driver’s insurers admitted liability. The money will allow John to continue with his rehabilitation

Elaine, who was also forced to give up work following the crash, said: “The settlement is a massive relief and a weight off our shoulders.

"We can now look to the future as we know that John’s care needs will be taken care of for the rest of his life. We know nothing will ever be the same again but at least now we have some comfort in knowing that we have the security provided by the settlement.”

John, who used to work for an interior design company, believes he would have been killed had he not been wearing a bike helmet and is now campaigning to make the safety gear compulsory.

He said: “I believe wearing a cycle helmet saved my life, I’ve been campaigning to try and make them compulsory for all. Anything that can be done to improve safety for cyclists is extremely important.”

The driver pleaded guilty to driving without due care and attention at Oldham Magistrates Court in 2011. Geraldine McCool, who represented John for Irwin Mitchell solicitors, said the case should be a warning to motorists of the life-changing effects of careless driving. She said: “John’s life will never be the same again but at least now we have secured the settlement he will be able to access the expert support, care and rehabilitation he needs to help with his recovery.

Brain injury: the bigger picture

Here we reproduce Headway’s key facts and statistics in relation to the bigger brain injury picture.

Acquired brain injury

This includes all admissions for head injuries, strokes, brain tumours, meningitis, encephalitis, hydrocephalus, anoxia, CO poisoning, abscess and hyponatraemia.

1 million - Minimum estimate of people in the UK living with long-term effects of brain injury

558 - UK residents per 100,000 sustaining a brain injury

Every 90 seconds - Someone is admitted to hospital in the UK with acquired brain injury

353,059 - UK admissions to hospital with acquired brain injury in 2011-12

661 - Northern Ireland residents per 100,000 sustaining an acquired brain injury in 2011-12, the highest rate in the UK

Head injury

These indicate traumatic brain injury, ranging from minor brain injuries to severe injuries causing long-term disability.

213,752 - Total UK admissions to hospital for head injury in 2011-12

169,673 - UK admissions to hospital with a non-superficial head injury in 2011-12

33.5% - Increase in UK head injury admissions in the last decade

10,000 - 20,000 - Number of severe traumatic brain injuries per year in the UK

2x - More likely for men to sustain a traumatic brain injury than women - 15-24 year old males and over 80 year olds - Groups most at risk of traumatic brain injuries

Effects

Behaviour and personality Anxiety, depression, loss of motivation, difficulty controlling anger, and impulsivity

Cognitive

Problems with memory, attention and concentration, low tolerance of noisy or stressful environments, loss of insight and initiative

Physical

Loss of co-ordination, muscle rigidity, paralysis, epilepsy, difficulty in speaking, loss of sight, smell or taste, fatigue, and sexual problems Initial diagnosis of severity of injury is not a reliable indicator of long-term problems Relationships with family and friends can be placed under immense strain Relatives report that the ten most difficult problems are personality changes, slowness, poor memory, irritability, bad temper, tiredness, depression, tension and anxiety, rapid mood changes, and threats of violence. ?

For more detailed information, visit RoSPA at www.rospa.com and Headway at www.headway.org

References

[1] “Reported Road Casualties Great Britain: 2013: Main Results”, Department for Transport, 2014

[2] “Collisions Involving Cyclists on Britain's Roads: Establishing the Causes”, TRL Report PPR 445, 2009

All Headway incidence statistics: NHS Health and Social Care Information Centre (England); Information Services Division (Scotland); NHS Wales Informatics Service; Hospital Inpatient System (Northern Ireland)