Accident Analysis and Prevention 65 (2014) 97–104
Contents lists available at ScienceDirect
Accident Analysis and Prevention journal homepage: www.elsevier.com/locate/aap
Alcohol consumption, helmet use and head trauma in cycling collisions in Germany Chiara Orsi a,∗ , Ottavia E. Ferraro a , Cristina Montomoli a , Dietmar Otte b , Anna Morandi a a Centre of Study and Research on Road Safety, Section of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy b Accident Research Unit, Hannover Medical University, Germany
a r t i c l e
i n f o
Article history: Received 9 July 2013 Received in revised form 25 November 2013 Accepted 27 December 2013 Keywords: Bicycle Road accident Collision Alcohol Helmet Injury
a b s t r a c t Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions. The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany and to identify risk factors related to head trauma sustained in cycling accidents. The source used for the present analysis was the database of the German in-depth accident study (GIDAS). All cyclists who had been involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected. Logistic regression analyses were carried out to evaluate various aspects: alcohol consumption, helmet use, head trauma, and cyclist/accident characteristics. Female riders were less likely to have consumed alcohol (OR = 0.23, 95% CI: 0.08–0.66); cyclists who did not wear a helmet were more likely to have consumed alcohol (OR = 2.41, 95% CI: 1.08–5.38); cyclists who were not responsible for the collision were less likely to have consumed alcohol than those who were partially responsible for the accident (OR = 0.22, 95% CI: 0.08–0.61). Cyclists involved in collisions with another vehicle, motorised or not, had a lower risk of suffering a head injury compared with those involved in single-vehicle accidents (OR = 0.27, 95% CI: 0.12–0.62, and OR = 0.08, 95% CI: 0.03–0.22, respectively). The prevention or limiting of alcohol consumption among cyclists and the corresponding testing of cyclists must be improved. Training initiatives on helmet protection should be encouraged. © 2014 Elsevier Ltd. All rights reserved.
1. Introduction Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport the world over. The cyclist population is growing in Europe (Küster, 2013a; Van Hout, 2008) and, in particular, in Germany (Küster, 2013b). Cyclists, however, are among the most vulnerable road users in traffic collisions. Indeed, cyclists, being less protected, less visible and more unstable, are likely to suffer more severe consequences of road accidents than users of motorised vehicles (Verster et al., 2009). The number of cyclist injuries and deaths, which is already high, increases year by year (NHTSA’s National Center for Statistics, 2012; European Road Safety Observatory, 2011). Factors known to be associated with the risk of accidents and accident-related injures
∗ Corresponding author at: Centre of Study and Research on Road Safety, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy. Tel.: +39 0382 987552; fax: +39 0382 987183. E-mail address: [email protected] (C. Orsi). 0001-4575/$ – see front matter © 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.aap.2013.12.019
are: rider age, rider experience, the time and day of the week on which the accident occurred, and the environmental conditions; helmet use and alcohol and drug consumption are also important factors (Ministry of Transport of New Zealand, 2012; Crocker et al., 2012; Bacchieri et al., 2010; Berg and Westerling, 2007; Andersson and Bunketorp, 2002). Road accidents involving cyclists have widely varying consequences, ranging from minor abrasions to fractures and death (Scheiman et al., 2010; Schwellnus and Derman, 2005). Different parts of the body can be involved (Abbas et al., 2011; Stranges et al., 2012; Abu-Zidan et al., 2007), but the most serious injuries are those that involve the head and the spinal cord. These injuries have been found to be more frequent among cyclists who had abused alcohol and/or drugs and who were not wearing a protective helmet at the time of the accident (Crocker et al., 2012; Airaksinen et al., 2010; Javouhey et al., 2006; Andersson and Bunketorp, 2002; Li et al., 1996, 2000, 2001). The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany, and to identify risk factors related to head trauma sustained in cycling accidents.
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C. Orsi et al. / Accident Analysis and Prevention 65 (2014) 97–104
2. Materials and methods
2.3. Statistical analysis
2.1. Data sources and data collection The source used for the present analysis was the database of the German in-depth accident study (GIDAS, 2012), which is the largest study of this kind in Germany. The research institutes involved in GIDAS, which is supported by the Federal Highway Research Institute (BASt) and the German Association for Research in Automobile Technology (FAT), are the Medical University of Hannover and the Dresden Technical University. GIDAS is designed to investigate a sample of accidents occurring in the municipal areas of Hannover and Dresden. Whenever an accident occurs in either of these areas, the local police, rescue services, and fire department headquarters immediately inform the research team. Accidents to be investigated are selected using a random sample method which leads to a statistical selection plan and thus constitutes a good approximation of the actual accident situation (Pfeiffer and Schmidt, 2006). In order to cover all periods of the day throughout the year, the accident investigators operate two 6-h shifts daily, which are organised in two-week cycles as follows: • first week: from midnight to 6.00 a.m. and from noon to 6.00 p.m. • second week: from 6.00 a.m. to noon and from 6.00 p.m. to midnight. During each shift, a team of experts is on call. Whenever an accident occurs, these experts go directly to the scene of the accident and collect a wide range of information and data: information on the environmental conditions, road design and traffic control, accident details, details of any vehicle damage/deformation and of impact contact points, technical vehicle data, information about the causes of the accident, and the injuries sustained, and the personal data of the people involved. In addition to this information, collected “at the scene”, the researchers subsequently collect more detailed measurements of the vehicle (usually the following day) and further medical information about the injuries sustained and treatments administered. Specific computer-based reconstruction methodologies with ad-hoc software are then used to reconstruct the accident in order to determine its cause. Accidents are investigated following detailed procedures contained in a handbook and coding manual (Otte et al., 2003; Otte, 2009). Each year approximately 2000 traffic accidents are documented in this way (GIDAS, 2012). 2.2. Study population All cyclists from the GIDAS database who were involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected for the present study. According to the limit set by German law, alcohol tests were classed as positive if the blood alcohol concentration (BAC) was equal to or greater than 0.05 mg/l. It is important to note that cyclists involved in traffic accidents are not routinely submitted to an alcohol test by the German police. Only those suspected of having consumed alcohol or drugs (i.e. those seeming mentally confused or unsteady or having alcoholsmelling breath, watery or bloodshot eyes, slow or slurred speech, etc.) are tested. In the years 2000–2010, a total of 4928 cyclists were involved in road accidents. Of these, 299 underwent an alcohol test following the collision. Alcohol test results were available for 242 cyclists, who were thus included in the present analysis; the 57 cyclists whose alcohol test results were not known were excluded from the analysis.
The following variables were included in the analysis: • • • • • • •
• • • • • • • •
BAC: over the limit (≥0.05 mg/l) or under the limit (
Contents lists available at ScienceDirect
Accident Analysis and Prevention journal homepage: www.elsevier.com/locate/aap
Alcohol consumption, helmet use and head trauma in cycling collisions in Germany Chiara Orsi a,∗ , Ottavia E. Ferraro a , Cristina Montomoli a , Dietmar Otte b , Anna Morandi a a Centre of Study and Research on Road Safety, Section of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy b Accident Research Unit, Hannover Medical University, Germany
a r t i c l e
i n f o
Article history: Received 9 July 2013 Received in revised form 25 November 2013 Accepted 27 December 2013 Keywords: Bicycle Road accident Collision Alcohol Helmet Injury
a b s t r a c t Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions. The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany and to identify risk factors related to head trauma sustained in cycling accidents. The source used for the present analysis was the database of the German in-depth accident study (GIDAS). All cyclists who had been involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected. Logistic regression analyses were carried out to evaluate various aspects: alcohol consumption, helmet use, head trauma, and cyclist/accident characteristics. Female riders were less likely to have consumed alcohol (OR = 0.23, 95% CI: 0.08–0.66); cyclists who did not wear a helmet were more likely to have consumed alcohol (OR = 2.41, 95% CI: 1.08–5.38); cyclists who were not responsible for the collision were less likely to have consumed alcohol than those who were partially responsible for the accident (OR = 0.22, 95% CI: 0.08–0.61). Cyclists involved in collisions with another vehicle, motorised or not, had a lower risk of suffering a head injury compared with those involved in single-vehicle accidents (OR = 0.27, 95% CI: 0.12–0.62, and OR = 0.08, 95% CI: 0.03–0.22, respectively). The prevention or limiting of alcohol consumption among cyclists and the corresponding testing of cyclists must be improved. Training initiatives on helmet protection should be encouraged. © 2014 Elsevier Ltd. All rights reserved.
1. Introduction Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport the world over. The cyclist population is growing in Europe (Küster, 2013a; Van Hout, 2008) and, in particular, in Germany (Küster, 2013b). Cyclists, however, are among the most vulnerable road users in traffic collisions. Indeed, cyclists, being less protected, less visible and more unstable, are likely to suffer more severe consequences of road accidents than users of motorised vehicles (Verster et al., 2009). The number of cyclist injuries and deaths, which is already high, increases year by year (NHTSA’s National Center for Statistics, 2012; European Road Safety Observatory, 2011). Factors known to be associated with the risk of accidents and accident-related injures
∗ Corresponding author at: Centre of Study and Research on Road Safety, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy. Tel.: +39 0382 987552; fax: +39 0382 987183. E-mail address: [email protected] (C. Orsi). 0001-4575/$ – see front matter © 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.aap.2013.12.019
are: rider age, rider experience, the time and day of the week on which the accident occurred, and the environmental conditions; helmet use and alcohol and drug consumption are also important factors (Ministry of Transport of New Zealand, 2012; Crocker et al., 2012; Bacchieri et al., 2010; Berg and Westerling, 2007; Andersson and Bunketorp, 2002). Road accidents involving cyclists have widely varying consequences, ranging from minor abrasions to fractures and death (Scheiman et al., 2010; Schwellnus and Derman, 2005). Different parts of the body can be involved (Abbas et al., 2011; Stranges et al., 2012; Abu-Zidan et al., 2007), but the most serious injuries are those that involve the head and the spinal cord. These injuries have been found to be more frequent among cyclists who had abused alcohol and/or drugs and who were not wearing a protective helmet at the time of the accident (Crocker et al., 2012; Airaksinen et al., 2010; Javouhey et al., 2006; Andersson and Bunketorp, 2002; Li et al., 1996, 2000, 2001). The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany, and to identify risk factors related to head trauma sustained in cycling accidents.
98
C. Orsi et al. / Accident Analysis and Prevention 65 (2014) 97–104
2. Materials and methods
2.3. Statistical analysis
2.1. Data sources and data collection The source used for the present analysis was the database of the German in-depth accident study (GIDAS, 2012), which is the largest study of this kind in Germany. The research institutes involved in GIDAS, which is supported by the Federal Highway Research Institute (BASt) and the German Association for Research in Automobile Technology (FAT), are the Medical University of Hannover and the Dresden Technical University. GIDAS is designed to investigate a sample of accidents occurring in the municipal areas of Hannover and Dresden. Whenever an accident occurs in either of these areas, the local police, rescue services, and fire department headquarters immediately inform the research team. Accidents to be investigated are selected using a random sample method which leads to a statistical selection plan and thus constitutes a good approximation of the actual accident situation (Pfeiffer and Schmidt, 2006). In order to cover all periods of the day throughout the year, the accident investigators operate two 6-h shifts daily, which are organised in two-week cycles as follows: • first week: from midnight to 6.00 a.m. and from noon to 6.00 p.m. • second week: from 6.00 a.m. to noon and from 6.00 p.m. to midnight. During each shift, a team of experts is on call. Whenever an accident occurs, these experts go directly to the scene of the accident and collect a wide range of information and data: information on the environmental conditions, road design and traffic control, accident details, details of any vehicle damage/deformation and of impact contact points, technical vehicle data, information about the causes of the accident, and the injuries sustained, and the personal data of the people involved. In addition to this information, collected “at the scene”, the researchers subsequently collect more detailed measurements of the vehicle (usually the following day) and further medical information about the injuries sustained and treatments administered. Specific computer-based reconstruction methodologies with ad-hoc software are then used to reconstruct the accident in order to determine its cause. Accidents are investigated following detailed procedures contained in a handbook and coding manual (Otte et al., 2003; Otte, 2009). Each year approximately 2000 traffic accidents are documented in this way (GIDAS, 2012). 2.2. Study population All cyclists from the GIDAS database who were involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected for the present study. According to the limit set by German law, alcohol tests were classed as positive if the blood alcohol concentration (BAC) was equal to or greater than 0.05 mg/l. It is important to note that cyclists involved in traffic accidents are not routinely submitted to an alcohol test by the German police. Only those suspected of having consumed alcohol or drugs (i.e. those seeming mentally confused or unsteady or having alcoholsmelling breath, watery or bloodshot eyes, slow or slurred speech, etc.) are tested. In the years 2000–2010, a total of 4928 cyclists were involved in road accidents. Of these, 299 underwent an alcohol test following the collision. Alcohol test results were available for 242 cyclists, who were thus included in the present analysis; the 57 cyclists whose alcohol test results were not known were excluded from the analysis.
The following variables were included in the analysis: • • • • • • •
• • • • • • • •
BAC: over the limit (≥0.05 mg/l) or under the limit (
