Full length articlePredictors of recovery in cyclists hospitalised for orthopaedic trauma following an on-road crash
Introduction
Cycling has been demonstrated as a sustainable, healthy and cost-effective mode of transport, (Grabow et al., 2012, Oja et al., 2011, OECD, 2013) and governments and cycling-bodies continue to advocate for increased cycling participation globally. (Australian Bicycle Council, 2010, German Federal Ministry, 2012, United Kingdom Department, 2014) However, cyclists are recognised as vulnerable road users and serious injury rates are on the rise globally. (Henley and Harrison, 2012, Sikic et al., 2009, Sanford et al., 2015, Weijermars et al., 2016a, Tin et al., 2010) Furthermore, these injuries result in significant economic costs. (Hitchens and Palmer, 2012)
While long-term outcomes, such as return to work and functional outcomes, have been investigated in the road transport population as a whole (Gabbe et al., 2016, Holtslag et al., 2007, Vles et al., 2005, Hours et al., 2010), comparatively little is known about the outcomes of injured cyclists. Our work has previously demonstrated that while return to work rates were high in an injured cycling cohort (94%), less than 40% of patients had returned to their pre-injury level of function at 12 months post injury;(Beck et al., 2016) a finding that is consistent with international literature on functional outcomes in all road user groups. (Hours et al., 2010) Given this, there is a need to further identify crash characteristics and patient-level factors that are associated with long-term outcomes. Such information could be used to guide prioritisation of injury prevention efforts, as well as inform the delivery of health and disability services.
The aims of this study were to investigate the demographic, crash and injury characteristics as predictors of return to work and functional outcomes in a cohort of cyclists hospitalised for orthopaedic trauma following an on-road crash.
Section snippets
Study design
A retrospective analysis of data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) was conducted for patients who were hospitalised following a cycling crash between 1st July 2007 and 30th June 2015.
The Victorian Orthopaedic Trauma Outcomes Registry
The VOTOR is a sentinel site registry collecting data from four hospitals in Victoria; two adult level 1 equivalent trauma centres, one regional trauma centre and one metropolitan trauma centre. All adult patients (≥16 years) admitted for an orthopaedic injury via the emergency
Results
Over the 8 year study period, 1787 injured cyclists were admitted at the participating hospitals following on-road crashes. The median (IQR) age of participants was 44 (33–55) years and 79% were male (Table 1). Most patients had no pre-existing conditions and resided in major cities. Forty-one percent were compensated for their injury by a third-party insurer (ie. TAC or WorkSafe). Fifty-two percent were in the highest quintile (most advantaged) for Index of Relative Socio-economic Advantage and
Discussion
Our study investigated factors that were associated with outcomes in a cohort of cyclists hospitalised for orthopaedic trauma following an on-road crash. The majority of crashes were either non-collisions or impacts with a car, pick-up truck or van. Most cyclists had returned to work at 12 months post-injury, but less than half had returned to their pre-injury level of function. Cyclists who had collisions with motor vehicles generally had poorer outcomes compared to cyclists with other crash
Conclusion
In this study of cyclists hospitalised for orthopaedic trauma, we demonstrated that for crashes occurring on-road, the majority of injured cyclists had returned to work at 6 months post injury, but less than half of our sample had returned to pre-injury levels of function. Cyclists who collided with motor vehicles were more commonly classified as major trauma and a smaller proportion had returned to work and had returned to pre-injury functional levels at 12 months post-injury when compared to
Funding
The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) is funded by the Transport Accident Commission via the Institute for Safety Compensation and Recovery Research (ISCRR). Ben Beck received salary support from the National Health and Medical Research Council (NHRMC)(NHMRC) Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre of Research Excellence (#1029983). Christina L. Ekegren is supported by a National Health and Medical Research Council of Australia Early Career Fellowship
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