Bike injury monograph by yaofenji

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									Facts & Prevention Strategies

Bicyclist Injuries in
Pennsylvania

                                 1994

                                An Injury Profile Monograph




                ...in pursuit of good health
Pennsylvania Department of Health   i   Bicyclist Injuries, 1994
                               Facts & Prevention Strategies



                       Bicyclist Injuries in
                               Pennsylvania




                            An Injury Profile Monograph




                                   Injury Prevention Program
                               Pennsylvania Department of Health
                                    P.O. Box 90, Room 1003
                                   Harrisburg, PA 17108-0090
                                          (717) 787-5900




                                       September 1997



Pennsylvania Department of Health             ii                   Bicyclist Injuries, 1994
                                      Acknowledgments

This monograph was prepared by Harold Weiss, M.S., M.P.H, Samuel Forjuoh, M.B., Ch.B,
Dr.P.H, and Jeffrey Coben, M..D. from the Center for Violence and Injury Control (CVIC),
Allegheny University of the Health Sciences, One Allegheny Center, Suite 510, Pittsburgh, PA
15212-4772. Tel. (412) 330-6125 Fax (412) 330-6122.

The Pennsylvania Department of Health financed this report under a contract funded by the
Preventive Health and Health Services Block Grant. The hospitalization data were provided by the
Pennsylvania Health Care Cost Containment Council (PA HCCCC).

Many sources contributed ideas and formats for this monograph including publications from the
Johns Hopkins Center for Injury Research and Policy (formerly the Johns Hopkins Injury
Prevention Center), the Division of Health Statistics in the Pennsylvania Department of Health, the
Center for Disease Prevention and Epidemiology in the Oregon Department of Human Resources,
the National Highway Traffic Safety Administration in the U.S. Department of Transportation, the
Emergency Preparedness and Injury Control Branch of the Injury Surveillance and Epidemiology
Section in the California Department of Health Services, and the Washington State Injury
Prevention Program in the Washington State Department of Health. We also wish to thank
Stephan Strotmyer for assistance in preparing the PA HCCCC data set and Stephanie Pruszynski
for assistance in manuscript and graphics preparation.

Copies of this document may be obtained by contacting:
       Injury Prevention Program
       Division of Health Risk Reduction
       Pennsylvania Department of Health
       P. O. Box 90, Room 1003
       Harrisburg, PA 17108-0090
       (717) 787-5900




Data used in this report were provided to the Pennsylvania Department of Health by the Pennsylvania Health Care
   Cost Containment Council. The Pennsylvania Health Care Cost Containment Council specifically disclaims
                                responsibility for any interpretations or conclusions.



  This monograph was funded, in part, under a contract administered by the Pennsylvania Department of Health.
            The Department specifically disclaims responsibility for any interpretations or conclusions.
                 Contents may be republished or reproduced whole or in part, with attribution.




Pennsylvania Department of Health                    iii                                  Bicyclist Injuries, 1994
                                                            Table of Contents
Executive summary ............................................................................................................................... 1
Fact sheet ................................................................................................................................................ 2
Introduction ........................................................................................................................................... 3
Data review – an analysis of the 1994 PA HCCCC hospital inpatient database ......................... 5
          Demographics ....................................................................................................................... 5
          Diagnoses............................................................................................................................... 7
          Head injuries.......................................................................................................................... 9
          Motor vehicle related bike incidents................................................................................ 10
          Length of stay and charges ............................................................................................... 11
          Time and place.................................................................................................................... 13
Recommendations............................................................................................................................... 14
Bicycle safety tips................................................................................................................................. 15
Appendix............................................................................................................................................... 16
          Detailed supplementary reference tables ........................................................................ 17
          Technical notes and methods........................................................................................... 30
          References............................................................................................................................ 32

List of figures
1. Bicyclist injuries by single year of age (< age 40)....................................................................... 5
2. Rate of bicyclist injuries, by age group and sex.......................................................................... 6
3. Leading diagnosis groups by age .................................................................................................. 7
4. Distribution of bicycle-related fractures...................................................................................... 8
5. Percent head injury involvement by age group, bicyclist injuries............................................ 9
6. Percent of motor vehicle involvement by age group.............................................................. 10
7. Total charges (dollars) by payer source ..................................................................................... 11
8. Mean total charges for head injuries by survival status........................................................... 12
9. Bicyclist injuries, by urban status and quarter .......................................................................... 13

List of tables
1. Bicyclist injuries by age group and gender, number and rate................................................. 17
2. Bicyclist injuries by age group and gender, number and rate, white race ............................ 18
3. Bicyclist injuries by age group and gender, number and rate, black race............................. 19
4. Charges for hospitalized bicyclist injuries, by age group ........................................................ 20
5. Charges for fatal and nonfatal hospitalized bicyclist head injuriesError! Bookmark not
    defined.
6. Age group and charges by length of stay, principal diagnoses groups
         disposition, and payer source............................................................................................. 22
7. Head injury frequency and percent by survival and motor vehicle involvement ............... 23
8. Head injury frequency and percent for five diagnosis fields by survival and
          motor vehicle involvement ............................................................................................... 24
9. Summary statistics for age, length of stay, injury severity score and charges...................... 25
10. Diagnosis group by selected severity measures........................................................................ 26
11. Motor vehicle involvement by principal diagnosis group ...................................................... 27
12. Principal diagnosis group by body region for non-CNS injuries .......................................... 27
13. Admission source and disposition for hospitalized bicyclist injuries.................................... 28
14. Number and rates of hospitalized bicyclist injuries by county and gender ......................... 29


Pennsylvania Department of Health                                                iv                                                     Bicyclist Injuries, 1994
                                    Executive summary
This monograph, the first in a series, reports on the distribution and costs of injuries to bicyclists
discharged from Pennsylvania hospitals during 1994. The data are derived from statewide hospital
discharge data collected by the Pennsylvania Health Care Cost Containment Council (PA HCCCC).
The report covers bicycle rider related cases, both motor vehicle and non motor vehicle related,
derived from analysis of the cause of injury data field (E-code). Payer source is based on the most
likely payer source (not all charges are actually collected). Data on bicyclists who died before being
admitted to a hospital and patients treated and released from emergency departments are excluded
from these data.

In 1994, there were 1,435 hospital discharges related to bicycle rider injuries; ninety-four percent of
these involved Pennsylvania residents. Twenty-three of the cases died in the hospital. Eighty
percent of the cases were male. The median age for all cases was 14 years (mean = 21.3, SE = 0.45).
The hospital discharge rate for males was 19.9 per 100,000 population compared to 4.6 for females.
Males age 10 through 14 had the highest rate (81.1 per 100,000 population) accounting for 23
percent of all bicyclist injuries. For boys 5 to 14 years of age, bicycle injuries accounted for about 11
percent of all injury related hospitalizations. For females, the highest rates were observed in the
same age groups, though at a much lower level. Black children generally had higher rates than
whites. The rate among boys 10 to 14 was 101 per 100,000 population for blacks and 69.2 for
whites. Over one-third (36 percent) of all the hospitalizations were over age 19. Average injury
severity increased slightly in older age groups. Older riders (25 to 44 years of age) had a slightly
lower risk of head injury involvement compared to children 5 to 14 years of age (30 percent versus
37 percent, respectively). The day of the week that patients were admitted on did not vary. Most
injuries occurred in urban counties during the spring and summer. Motor vehicles were involved in
31 percent of the injuries.

The leading principal diagnosis category was fractures (39.2 percent) followed by central nervous
system injuries (33.4 percent), the latter made up almost exclusively of head injuries. Bicyclists
hospitalized with head injuries were about three times as likely to die as those hospitalized without
head injury. Among patients who did not have a principal diagnosis of head injury, fractures to the
extremities were the most important injury type. About two-thirds of the fractures were to the long
bones of the arms and legs. Overall, patients stayed in the hospital for a median of two days
(average = 4.4, SE = 0.22). The longest stay recorded was 132 days.

Charges associated with these hospitalizations totaled more than $15 million. The median charge for
a bicycle injury was $5,754 (average = $10,508). The maximum spent for a single case was reported
to be $197,232. The average inpatient fees for non fatal head injured bicyclists were more than
$1,800 greater than those persons hospitalized without a head injury primary diagnosis.
Government payment sources were responsible for almost $4 million, about one-fourth of the
total.

The use of approved helmets for all age groups can markedly reduce fatalities and hospitalizations
related to head injuries. Preventive measures for other injuries include protective clothing and
extremity guards, proper bicycle design and maintenance, cyclist and parent education, reduced use
of alcohol while riding and improved traffic flow designed to separate bicyclists from motor
vehicles.

Pennsylvania Department of Health                  1                                 Bicyclist Injuries, 1994
             Bicyclist Injuries in Pennsylvania - Fact Sheet
Ø      Each year in Pennsylvania about 17 bicyclists under the age of 20 are killed.1

Ø      More children under the age of 15 are killed in Pennsylvania in bicycle and pedestrian related incidents
       than as occupants in motor vehicle crashes.1

Ø      Collisions between motor vehicles and bicyclists accounted for 73 percent of bicycling deaths among
       Pennsylvania residents from 1990 through 1994.2

Ø      Most bicycle-related deaths in Pennsylvania are the result of head injuries.2

Ø      About one-half of all head injury deaths to bicyclists are children under 18 years of age.2

Ø      In 1994, more than 1,400 bicyclists were hospitalized in Pennsylvania for their injuries.

Ø      Motor vehicles were involved in 31 percent of bicyclists hospitalized in Pennsylvania for their injuries.

Ø      Sixty-four percent of persons hospitalized in Pennsylvania for bicyclist injuries were under age 20 and
       the average age for all hospitalized injured cyclists was 21.3 years.

Ø      In Pennsylvania, males had 4 times the number of bicycle-related hospitalizations injury than females.

Ø      Among those hospitalized, 23 (1.6 percent) died in the hospital and 61 percent of these had a head
       injury.

Ø      Bicyclists hospitalized in Pennsylvania with head injuries were about three times as likely to die as those
       hospitalized without head injury.

Ø      Bicyclist hospitalized injury rates in Pennsylvania in 1994 were highest at ages 10 to 14 years.

Ø      Among Pennsylvania youths age 5 to 14, bicyclist injury hospitalizations accounted for more than 11
       percent of all injury hospitalizations.

Ø      Pennsylvania 1994 inpatient bicycle-related injury charges totaled more than $15 million.

Ø      The average inpatient fees for non fatal head injured (primary diagnosis) bicyclists were more than
       $1,800 greater than those persons hospitalized without a primary head injury diagnosis.

Ø      The average length of hospital stay for an injured bicyclist in Pennsylvania in 1994 was 4.4 days.

Ø      In a 1994 statewide survey, 71 percent of the adults who had children reported that their children rode
       bicycles. In only 55 percent of these households the youngest child had a helmet and only about half of
       the respondents said their children wore their helmet all the time while riding their bikes. 2

Ø      Pennsylvania law requires the wearing of an approved bicycle helmet by children under the age of 12
       when the operator rides as a passenger on a pedalcycle or in a trailer towed by a pedalcycle.

Ø      Nationally, for every hospitalized bicycle-related injury, there are 27 emergency department visits.3




Pennsylvania Department of Health                     2                                     Bicyclist Injuries, 1994
Introduction

Overview


T        his monograph is the first in a series of injury specific papers addressing selected injury
         problems in Pennsylvania. This bicycle-related injury monograph begins with an executive
         summary and a fact sheet that summarizes information about bicycle-related injuries with both
national and Pennsylvania statistics. These parts are followed by this introduction which presents a
brief overview of bicycle injury safety issues from a public health (preventive) perspective. The next
data review section presents selected results, in both narrative and chart format, from an analysis of
the 1,435 bicycle-related injury cases found in the 1994 hospital data collected by the Pennsylvania
Health Care Cost Containment Council (PA HCCCC). The next section delineates key prevention
recommendations and a brief overview of preventive strategies. Detailed supplementary reference tables, derived
from the hospital discharge data, are presented without annotation in the next-to-last section.
Definitions and technical notes are presented next followed by a list of the resources and references used
in preparing this monograph.


The Bicycle injury problem
Bicycles are a popular and growing means of personal transportation, recreation and fitness in
Pennsylvania and the United States. In 1990, approximately 1,767 million bicycle trips were made in
the United States.1 Almost half (45 percent) of all bicycle trips are made by children age 5 to 15
years and almost three-quarters of these (72 percent) are made by males. 1

Concomitant with this large use and experience comes the burden of preventable injuries and
deaths. Between 900 and 1,000 bicyclists die each year in the United States. In a 1987-88 review,
Baker et. al. reported 64 bicycle deaths in Pennsylvania and a rate of .27 per 100,000 population.1
Bicycle deaths and injuries are known to cluster in the summer months when bike riding reaches its
zenith. Although alcohol testing is not always performed in bicycle-related deaths, in states where
testing is frequently done, 28 percent were positive for alcohol.3

In addition to deaths, bicycle crashes lead to thousands of hospitalizations and emergency
department visits. Nationally, about 25 hospital admissions occur for each bicycle-related death.1 It
has also been estimated that nationally, for every hospitalized bicycle-related injury, there are about
27 bicycle-related emergency department visits.3 In Pennsylvania, this translates to an estimated
38,700 emergency department visits based upon the 1,435 hospitalizations reported by the
Pennsylvania Health Care Cost Containment Council (the focus of this report).

Head injury is the leading cause of serious injury and death in bicycle crashes.4, 11 Nationwide, head
injuries account for almost two-thirds of the deaths and hospitalizations and one-third of the
emergency department visits from bicycle crashes.5 Non fatal head injuries can produce injuries that
are severely disabling for weeks or years and can be devastating to both individuals and families.
Fortunately, bicycle helmets, if worn properly, can have a significant impact on reducing bicycle-
related head injuries. A Seattle study showed a reduction of head injury risk while bicycling by 85
percent,4 and other studies have shown the effectiveness of helmets in many settings.6, 7 From a
cost-benefit standpoint, the Children’s Safety Network has estimated that for every dollar spent on

Pennsylvania Department of Health                     3                                   Bicyclist Injuries, 1994
bicycle helmets, two dollars in medical costs are saved.8

Regulations requiring the use of bicycle helmets, when combined with strong enforcement and
ongoing community information campaigns, can significantly increase helmet use among children
and young adults leading to significant reductions in deaths and hospitalizations. However, helmet
use rates often remain low, despite regulation, when enforcement and positive reinforcement of
their importance are lacking. The resulting injuries place a large burden on individuals, families,
communities, and state government.

The exact nature and patterns of this burden, though, is hard to garner from mortality statistics
alone. It was fortunate, therefore, that in 1993 the Pennsylvania Health Care Cost Containment
Council (PA HCCCC) began requiring the use of external cause of injury codes (E-codes) in their
statewide hospital discharge data collection system. With the addition of this data element it became
possible to track, for the first time in Pennsylvania, large scale patterns of injury related morbidity.
After the 1993 startup period, the much-improved availability of E-codes in the PA HCCCC data
has made the production of this monograph possible and with it, a much better understanding and
tracking of the characteristics of bicycle rider injuries in the Commonwealth.




Pennsylvania Department of Health                 4                                 Bicyclist Injuries, 1994
Analysis of Bicycle Injuries in the 1994
PA HCCCC Hospital Inpatient Database

This monograph describes the distribution and costs of the 1,435 bicyclist injuries treated and
discharged in Pennsylvania hospitals for 1994. The case are derived from statewide hospital
discharge data collected and distributed by the Pennsylvania Health Care Cost Containment Council
(PA HCCCC). The Council compiles data on inpatient discharges from all non-federal hospitals in
Pennsylvania. This report covers bicycle rider related cases, both motor vehicle and non-motor
vehicle related, derived from analysis of the data from all hospitals in the data set. These data
contain a rich array of information about hospitalized cases including demographics, diagnoses,
injury causes, disposition, total charges and payer source, among other variables. This data set does
not, however, contain information on helmet use or other safety-related behaviors, nor does it
include bicyclists who died before being admitted to a hospital.


Demographics
In 1994, there were 1,435 hospital discharges related to bicycle-rider injuries reported by
Pennsylvania hospitals. Ninety-four percent of these occurred to Pennsylvania residents. Among

                                                                    Bicyclist Injuries

                                                     By Single Year of Age (< 40)

                                             Hospital Discharges, Pennsylvania, 1994
                   100

                   80

                   60

                   40

                   20
           Count




                    0
                         0       2       4       6       8       10 12 14 16 18 20 22 24 26 28 30 32 34 36 38
                             1       3       5       7       9    11 13 15 17 19 21 23 25 27 29 31 33 35 37 39


                         Age in Years

                                                                                             Source: PA HCCCC


Figure 1

Pennsylvania Department of Health                                         5                          Bicyclist Injuries, 1994
                                           Rate of Bicyclist Injuries
                                             By Age Group and Sex
                                     Hospital Discharges, Pennsylvania, 1994
                          90

                          80

                          70

                          60

                          50
           Rate/100,000




                                                                        Male
                          40
                                                                        Female
                          30

                          20

                          10

                           0
                               0-4   5-9   10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54   55+

                                                                        Source: PA HCCCC




Figure 2
the hospitalized cases, 23 died in the hospital. Other bicycle-related deaths occurred, but the victims
died before being admitted, and thus, were not part of the hospital discharge data set. Eighty
percent of the cases were male. Most cases occurred to children and adolescents (Figure 1). The
median age for all cases was 14 years (mean = 21.3, SE = 0.45).

The hospital discharge rate for males was 19.9 per 100,000 population compared to 4.6 for females
(Figure 2). Males ages 10 through 14 had the highest rate (81.1 per 100,000 population) accounting
for 23 percent of all bicyclist injuries. For boys 5 to 14 years of age, bicycle injuries themselves
accounted for about 11 percent of all injury related hospitalizations. For females, the highest rates
were observed in the same age groups, though at a much lower level.

Black children generally had higher rates than whites. For example, the rate among boys ages 10-14
was 101 per 100,000 population for blacks and only 69.2 per 100,000 for whites.

More than one-third (36 percent) of all persons hospitalized in Pennsylvania for bicyclist injuries
were age 20 and older. Considering that older age groups are less likely to ride, these numbers are
important.



Pennsylvania Department of Health                            6                              Bicyclist Injuries, 1994
                    Leading Diagnosis Groups by Age

                              Bicyclists Injuries

                    Hospital Discharges, Pennsylvania 1994
                   400


                   300                                                    Principal Diagnosis

                                                                              Superficial
                   200

                                                                              Internal Injury
                   100
                                                                              CNS Injury
           Count




                     0                                                        Fracture
                         U
                         5- der
                         10 yrs yr
                         15 14
                         20 19 rs
                         25 24 rs
                         30 29 rs
                         35-34 rs
                         40 39 rs
                         45 44 rs
                         50 49 rs
                         55 54 rs
                         60 59 rs
                         65 64 rs
                         70 69 rs
                         75 74 rs
                         80-79 rs
                         85 84 rs
                           n
                           9 5
                            -
                            - y
                            - y
                            - y

                            - y
                            - y
                            - y
                            - y
                            - y
                            - y
                            - y
                            - y

                            - y
                             yr yrs
                               s+
                                y




                                y
                                    s




                                                       Source: PA HCCCC

Figure 3




 Diagnoses
 The leading principal diagnosis category (Figure 3) was fractures (39.2 percent) followed by central
 nervous system injuries (33.4 percent), the latter made up almost exclusively of head injuries.
 Bicyclists hospitalized with head injuries were about three times more likely to die as those
 hospitalized without head injury. Among patients that did not have a principal diagnosis of head
 injury, fractures to the extremities were the most important injury type. About two-thirds of the
 fractures were to the long bones of the arms and legs (Figure 4). For most riders, the extremities
 have little or no protective equipment.

 Average injury severity increased slightly in older age groups. Older riders (25 to 44 years of age)
 had a slightly lower risk of head injury involvement than children 5 to 14 years of age (30 percent
 versus 37 percent, respectively).




 Pennsylvania Department of Health                 7                                Bicyclist Injuries, 1994
                     Distribution of Bicycle-Related Fractures
                                Primary Diagnoses
                     Hospital Discharges, Pennsylvania, 1994




                                                        Face Bones
                                                        54 (9.6%)

                                Scapula
                                5 (.9%)                       Clavicle
                                                              11 (2.0%)
                              Ribs
                              21 (3.7%)
                                                               Humerus
                                                               57 (10.1%)

                                                                     Vertabral column
                                                                     16 (2.8%)
                           Pelvis
                           19 (3.4%)
                                                                     Radius and Ulna
                                                                     98 (17.4%)
                           Carpal
                           4 (.7%)                                     Metacarpal
                                                                       1 (.2%)




                            Phalanges                        Femur
                            7 (1.2%)                         109 (19.4%)
                                     Patella
                                     6 (1.1%)


                                                          Tibia and Fibula
                                                          91 (16.2%)


                            Tarsal and Metatarsal
                            3 (.5%)                          Ankle
                                                             58 (10.3%)
                                                         Toes
                                                         1 (.2%)


                          Figure 4
                                                              Source PA HCCCC




Pennsylvania Department of Health                   8                                   Bicyclist Injuries, 1994
             Percent Head Injury Involvement

              By Age Group, Bicyclist Injuries

             Hospital Discharges, Pennsylvania, 1994
   100%
                 74       63        67      70           81      91         72
     90%
     80%
     70%
     60%
     50%
     40%
                                                                                    Head Injury
     30%                  37
                                    33
                                            30                              28
     20%         26                                                                     No Head Injury
                                                         19
     10%
      0%                                                          9                     Head Injury
            Under 5 yrs        15-24 yrs         45-64 yrs                75 yrs+
                      5-14 yrs           25-44 yrs            65-74 yrs

                                                              Source: PA HCCCC


Figure 5

Head injuries

Among all possible outcomes other than death, head and central nervous system injuries are the
                           most serious and devastating. There were 469 bicycle-related injury
                           discharges with a primary diagnosis of head injury. An additional 94
                           cases of head injury were identified from secondary diagnoses (see
                           Tables 7 and 8). Among persons under age 44, more than one out of
                           four bicycle-related injuries were head injuries. The 5 to 14-year age
                           group had the highest rate of head injury involvement (37 percent)
                           (Figure 5). Bicyclists hospitalized with head injuries were about three
                           times more likely to die than those hospitalized without head injury.




Pennsylvania Department of Health                    9                                Bicyclist Injuries, 1994
                                           Percent of Motor Vehicle Involvement
                                                in Bicyclist Injuries, By Age Group
                                                  Hospital Discharges, Pennsylvania, 1994
                                  40%
    % Motor Vehicle Involvement




                                  30%




                                  20%




                                  10%
                                  Under 5 yrs               15-24 yrs               45-64 yrs                  75 yrs+
                                                 5-14 yrs               25-44 yrs                65-74 yrs

                                                                                                Source: PA HCCCC


Figure 6


 Motor vehicle-related bike incidents

                             When bicycle riders are hit by a motor vehicle the outcome is often
                             much worse than bicycle crashes unrelated to motor vehicles. So even
                             though motor vehicles are involved in only 31 percent of bicyclists
                             hospitalized in Pennsylvania for their injuries, their impact is
 disproportionately greater. Adolescent and young adult bicycle-related injuries more frequently
 involved motor vehicles than persons age 45 to 74 (Figure 6).




 Pennsylvania Department of Health                                      10                             Bicyclist Injuries, 1994
                                    Bicylist Injuries

                   Hospital Discharges, Pennsylvania, 1994




                                                                      Source: PA HCCCC

Figure 7


Length of Stay and Charges
Overall, patients stayed in the hospital for a median of two days (average = 4.4 days, SE = 0.22).
The longest patient stay recorded was 132 days. For persons hospitalized with primary diagnoses of
fractures the median length of stay was two days. In contrast, the median stay of persons with
central nervous system injuries was 11 days.

Charges associated with these hospitalizations totaled more than $15 million. The median charge for
a bicycle injury was $5,754 (average = $10,508). The maximum spent for a single case was reported
to be $197,232. The median inpatient charge for non fatal head injured bicyclists ($4,356) was more
than $1,900 greater than those persons hospitalized without a head injury primary diagnosis
($6,272). For persons hospitalized with primary diagnoses of fractures, the median charge was about
$6,800. In contrast, the median charge for persons with central nervous system injuries was more
than $20,000. Among fatal cases, the median costs for head injury deaths were over three times
those for non-head injury deaths. The median was $26,225 per fatal head injured case compared to
a median of $8,976 per fatal non head injured case. For all bicyclist injuries, government payment
sources were responsible for almost four million dollars, about one fourth of the total.

Pennsylvania Department of Health              11                               Bicyclist Injuries, 1994
                                Median Charges for Bicyclist

                                 Head Injuries, By Survival

                           Hospital Discharges, Pennsylvania, 1994
                      $30,000




                      $20,000
     Median Charges




                      $10,000                                          Head Injury

                                                                           Head Injury

                          $0                                               No Head Injury
                                     Fatal            Nonfatal

                                                    Source: PA HCCCC


Figure 8




 Pennsylvania Department of Health             12                         Bicyclist Injuries, 1994
                          Bicyclist Injuries

                   By Urban Status and Quarter

             Hospital Discharges, Pennsylvania, 1994
             800



             600


             400
                                                                     Urban/Rural Status
             200
                                                                           Rural
     Count




               0                                                           Urban
                      Jan-Mar Apr-Jun Jul-Sept Oct-Dec


                                     Quarter
                                               Source: PA HCCCC


Figure 9




Time and place
The rate of bicycle-related hospitalizations in the state was 11.6 per 100,000 persons. Most bicycle
crashes leading to hospitalization in Pennsylvania also occur in urban counties (Figure 9) where
most trips are taken and the most bicycle riders live. Among Philadelphia residents 223 cases were
reported (rate = 14.6), and 161 cases were reported in Allegheny County (rate = 12.2). A detailed
county breakdown is shown in Table 14 in the appendix.

Given the marked change in seasons in Pennsylvania, it is not surprising that most bicycle injuries
occur in the spring and summer months (Figure 9). The day of the week that patients were
admitted did not vary appreciably. Information on the exact time and location of these incidents
was not available from the PA HCCCC data set.




Pennsylvania Department of Health               13                                 Bicyclist Injuries, 1994
Recommendations

From the Centers for Disease Control9
Bicycle helmets should be worn by all persons (i.e., bicycle operators and
passengers) at any age when bicycling.

Bicycle riders should wear helmets whenever and wherever they ride a bicycle.

Bicycle helmets should meet the standards of the American National Standards
Institute (ANSI), the Snell Memorial Foundation or ASTM.

To effectively increase helmet-use rates, states and communities must
implement programs that include legislation, education and promotion,
enforcement and program evaluation.


From the Johns Hopkins Injury Prevention Center:3
No age group should be exempt from helmet requirements or other preventive
measures.

Bicyclists should be separated from motorized traffic wherever possible.

Alcohol regulations for motor vehicle operators should be extended to include
bicyclists. Bicyclists who die within four hours of injury should be tested for
alcohol.

Attention should be given to visibility of bicycles and bicyclists.

Head protection is needed even in the absence of exposure to motorized traffic.

A broad approach to bicyclist injuries and deaths is recommended, including
strategies designed to protect other parts of the body and strategies that
operate in the pre-impact and post-impact phases.




Pennsylvania Department of Health       14                            Bicyclist Injuries, 1994
                                    Bicycle Safety Tips10

1.   The first step in avoiding bicycle injury is selecting the right equipment. This includes a helmet
     and a bike of the correct size.
      How to fit a bike:
       • Lay your arm along the top bar with the elbow touching the seat. The finger tips should
            just reach the handlebars.
       • Straddle the bike. There should be about one inch between the top bar and the rider’s
            crotch.
       • Adjust the seat so you can sit on the seat and balance on your toes.
2. Once you have the right bike, keep it properly maintained. Bicycle inspection should include:
     • Adjusting the handlebars and bicycle seat to the right height and securing them tightly.
     • Checking the tires for proper inflation. Tires should be firm to the touch. Examine the
         tires for cuts and cracks. Replace tires when the tread is worn.
     • Routinely tighten nuts and bolts and oil moving parts.
     • Check your brakes. Brakes should tighten and release smoothly and quickly.
     • Check that all reflectors are clean and positioned correctly.
     • Check your wheels for loose and broken spokes. These cause the wheel to wobble.
3. Protect your head – Always wear an ANSI/ANELL/ASTM approved bicycle helmet.
    How to fit a helmet:
      • Place helmet level on the head. It should be snug and cover the forehead.
      • Adjust the helmet straps so when buckled it cannot move from side to side or back and
           forth.
      • There should be about one finger width of space between the chin and the chin strap.
4. See and be seen – wear bright light colored clothing. Equip your bike with reflectors: white in
   front; read in rear; and wheel and pedestal reflectors. Also equip your bike with a white front
   headlight.
5. Avoid riding at night – dusk or night riding is extremely dangerous even with reflective clothing.
    As an adult, use extreme caution when riding at night. Be a defensive bicycle driver, especially
   at night, and be as visible as possible. Children should walk their bike home at night or call
   someone to pick them up.
6. Be predictable – a bike is a vehicle.
      • Ride with trafic.
      • Use hand signals to communicate with other drivers.
      • Obey traffic signs and signals.
7. Be alert – stop, look left, right, and left again before entering the road. Enter traffic only when
   the road is clear.
8. Ride with supervision – children under age 9 must never ride in the street without adult
   supervision – even on streets that do not have a lot of traffic.


Pennsylvania Department of Health                15                                Bicyclist Injuries, 1994
                                    Appendix




Pennsylvania Department of Health     16       Bicyclist Injuries, 1994
                    Detailed Supplemental Tables
                         for Bicyclist Injuries
              Pennsylvania Hospital Discharge Data - 1994
Table 1

                            Hospitalized Bicyclist Injuries
                     By Age Group and Gender, Number and Rate
                                Pennsylvania, 1994
                                                  Sex
                          Male                   Female                     Total
                     Number    Rate*         Number   Rate*            Number     Rate*
         Under 5            26        6.3              8       2.0          34        4.2
         5-9               238       57.7             81      20.7         319       39.7
         10-14             324       81.1             80      21.1         404       51.9
         15-19             143       33.7             24       5.8         167       19.9
         20-24              61       14.5             12       2.9          73        8.8
         25-29              81       19.4              7       1.7          88       10.6
         30-34              48       10.6             14       3.0          62        6.8
         35-39              61       13.2             13       2.7          74         7.9
         40-44              43        9.9             11       2.4          54         6.1
         45-49              42       11.3             9        2.3          51         6.6
         50-54              19        6.2             5        1.5          24         3.8
         55-59              18        6.8             3          .          21         3.8
         60-64               5        2.0             2          .           7         1.3
         65-69              13        5.3             6        2.0          19         3.4
         70-74               9        4.3             4          .          13         2.6
         75-79               8        5.3             1          .           9         2.3
         80-84               7        7.9             4          .          11         4.3
         85+                 3           .            2           .          5         2.3
         All
                         1,149       19.9          286         4.6       1,435       11.9
         Ages
        * Per 100,000 population, 1994, totals exclude missing data.
        . = Not calculated for n<5.
        Source: PA HCCCC.




Pennsylvania Department of Health                17                               Bicyclist Injuries, 1994
Table 2


                             Hospitalized Bicyclist Injuries
                 By Age Group and Gender, Number and Rate, White Race,
                                  Pennsylvania, 1994
                                                        Sex
                               Male                    Female                     Total
                          Number    Rate*          Number   Rate*            Number     Rate*
             Under 5                19      5.4            7         2.1          26           3.8
             5-9                192        54.2          60         17.9         252         36.5
             10-14              240        69.2          59         18.0         299         44.3
             15-19              106        28.7          16          4.4         122         16.7
             20-24               48        13.1          10          2.8          58          8.0
             25-29               63        17.3           6          1.6          69          9.5
             30-34               33         8.2          11          2.7          44          5.4
             35-39               47        11.3           8          1.9          55          6.6
             40-44                  35      8.9            9         2.2          44           5.5
             45-49                  30      8.8            7         2.0          37           5.3
             50-54                  15      5.4            5         1.7          20           3.5
             55-59               15         6.2           2            .          17          3.3
             60-64                4           .           2            .           6          1.2
             65-69               13         5.7           6          2.1          19          3.7
             70-74                9         4.6           3            .          12          2.6
             75-79                8         5.7           1            .           9          2.5
             80-84                7         8.4           4            .          11          4.6
             85+                  3           .           2            .           5          2.5
             All Ages           887        17.2         218          3.9       1,105         10.3
             * Per 100,000 population, 1994, totals exclude missing data..
             . = Not calculated for n<5.
             Source: PA HCCCC.




Pennsylvania Department of Health                 18                                Bicyclist Injuries, 1994
Table 3
                                Hospitalized Bicyclist Injuries
                    By Age Group and Gender, Number and Rate, Black Race,
                                     Pennsylvania, 1994
                                                             Sex
                                   Male                     Female                      Total
                              Number    Rate*           Number   Rate*             Number     Rate*
               Under 5                4            .           0       -                 4            .
               5-9                   21        41.7            9        18.2            30         30.1
               10-14                 46       100.8           13        29.1            59         65.3
               15-19                 18        38.7            3           .            21         22.7
               20-24                  6        12.8            1               .         7             7.5
               25-29                 11        24.5            0       -                11         12.1
               30-34                 10        23.0            3               .        13         14.2
               35-39                  9        22.4            4               .        13         14.9
               40-44                  4           .            2               .         6          7.8
               45-49                  9        32.5            0       -                 9         14.3
               50-54                  1           .            0       -                 1            .
               55-59                  3           .            1               .         4            .
               60-64                  0        -               0       -                 0         -
               65-69                  0        -               0       -                 0         -
               70-74                  0        -               0       -                 0         -
               75-79                  0        -               0       -                 0         -
               80-84                  0        -               0       -                 0         -
               85+                    0        -               0       -                 0         -
               All Ages             142         26.3          36           5.9         178          15.5
               * Per 100,000 population, 1994, totals exclude missing data..
               . = Not calculated for n<5.
               - = No observation to compute rate.
               Source: PA HCCCC.




Pennsylvania Department of Health                  19                                 Bicyclist Injuries, 1994
Table 4




                                    Charges for Hospitalized
                                       Bicyclist Injuries
                                      Pennsylvania, 1994
                                                    Total Charges
                                                  Count      Sum
                               Under 5 yrs           34      $183,644
                               5-9 yrs              319     $2,382,743
                               10-14 yrs            404     $3,366,928
                               15-19 yrs            167     $1,868,258
                               20-24 yrs             73      $966,469
                               25-29 yrs             88      $923,088
                               30-34 yrs             62      $701,800
                               35-39 yrs             74     $1,054,532
                               40-44 yrs             54     $1,111,338
                               45-49 yrs             51      $562,447
                               50-54 yrs             24      $428,129
                               55-59 yrs             21      $501,095
                               60-64 yrs              7        $37,011
                               65-69 yrs             19      $279,756
                               70-74 yrs             13      $232,901
                               75-79 yrs              9      $125,884
                               80-84 yrs             11      $288,989
                               85 yrs+                5       $64,084
                               Total               1,435   $15,079,094
                              Source: PA HCCCC




Pennsylvania Department of Health            20                          Bicyclist Injuries, 1994
Table 5




                             Charges for Fatal and Nonfatal
                           Hospitalized Bicyclist Head Injuries
                                   Pennsylvania, 1994

                                                                    Group
                                       Fatal         Nonfatal       Total
                  No        Count             9             957           966
                  Head      Sum         $98,150      $9,215,501    $9,313,651
                  Injury    Median       $8,976          $6,272        $6,277
                            Mean        $10,906          $9,630        $9,641
                  Head      Count            14             455           469
                  Injury    Sum        $550,149      $5,215,294    $5,765,443
                            Median      $26,225          $4,356        $4,443
                            Mean        $39,296         $11,462       $12,293
                  Group     Count            23           1412          1435
                  Total     Sum        $648,299     $14,430,795   $15,079,094
                            Median      $22,496         $5,681        $5,754
                            Mean        $28,187        $10,220       $10,508
                  Source: PA HCCCC.




Pennsylvania Department of Health              21                               Bicyclist Injuries, 1994
    Table 6
                                       Age Group and Charges by
                 Length of Stay, Principle Diagnosis Group, Disposition, and Payer Type
                                     Bicyclist Injury Hospitalizations
                                            Pennsylvania, 1994
                                                                Age into 3 Categories         Total          Total Charges

                                                                                                          Mean
                                                             Under         16-64                         Charge       Sum of
                                                             15 yrs         yrs     65 yrs+                of          Group
                                                             Count         Count    Count     Count      Group        Charges
Length of         1 Day                                          334          223         3       560      $4,469    $2,502,454
Stay              2-3 Days                                       239          205        12       456      $6,870    $3,132,893
Category          3-7 Days                                       111          105        20       236     $12,211    $2,881,727
                  8-14 Days                                       32           55         9        96     $25,679    $2,465,176
                  > 2 Weeks                                       40           33        12        85     $48,175    $4,094,875
Total                                                            756          621        56     1,433     $10,521   $15,077,124
Principal         Non-injury                                      53           45        16       114      $8,257     $941,253
Diagnosis         Fracture                                       277          258        27       562     $10,293    $5,784,393
Group             Central Nervous System Injury                  279          190        10       479     $12,786    $6,124,551
                  Open Wound                                      22           17         1        40      $5,709     $228,369
                  Internal Injury                                 47           28         2        77     $11,408     $878,399
                  Superficial/Contusion                           45           26         0        71      $4,525     $321,291
                  Other Injury                                    34           57         1        92      $8,705     $800,837
Total                                                            757          621        57     1,435     $10,508   $15,079,094
Patient           Outpatient                                       1            0         0         1      $3,114        $3,114
Discharge         Discharged to home/self-care (routine)         710          550        38     1,298      $8,745   $11,350,855
Status            Dis/trans to short-term gen hosp                10           10         2        22      $8,864     $195,001
                  Dis/trans to skilled nurse fac (SNF)             1            0         5         6     $27,837     $167,023
                  Dis/trans to intermed care fac (ICF)             1            0         0         1     $12,742       $12,742
                  Dis/trans to other instit in/outpt srvcs        14           25         7        46     $44,130    $2,029,967
                  Dis/trans to home under care of hhso            10           15         4        29     $20,532     $595,438
                  Left AMA/discontinued care                       0            9         0         9      $8,517       $76,656
                  Expired                                          6            8         1        15     $40,256     $603,835
                  Expired in a medical facility                    4            4         0         8      $5,558       $44,465
Total                                                            757          621        57     1,435     $10,508   $15,079,094
Payor Type        Patient Direct Bill (Self)                      32           25                  57      $6,869     $391,530
&                 Medicare                                         1           16        44        61     $16,088     $981,363
Identification    Medicare HMO/PPO                                 0            0         1         1     $14,736       $14,736
                  Medicaid                                       123          132         0       255     $11,510    $2,935,132
                  Medicaid HMO/PPO                                 2                      0         2      $6,362       $12,723
                  Blue Cross                                     140          133         3       276      $7,907    $2,182,396
                  Blue Cross HMO/PPO                               3            1         0         4      $5,970       $23,880
                  Blue Cross - Union Health/Welfare Fund           1            1         0         2      $4,526        $9,052
                  Blue Cross Association                           1            0         0         1      $7,349        $7,349
                  Commercial                                     195          174         7       376     $13,827    $5,198,862
                  Commercial HMO/PPO                              37           20         1        58      $9,601     $556,879
                  Commercial - Union Hlth/Welfare Fund             0            1         0         1      $6,067        $6,067
                  Commercial - Workers' Compensation               0            1         0         1      $2,966        $2,966
                  Commercial - Auto                               44           18         0        62     $11,324     $702,098
                  Employer Direct Bill                             1            2         0         3     $17,987       $53,962
                  Other Government                                 3            3         0         6      $8,913       $53,479
                  Other - Unknown                                 93           73         0       166     $10,525    $1,747,112
Total                                                            676          600        56     1,332     $11,171   $14,879,585
Source: PA HCCCC.


    Pennsylvania Department of Health                                 22                                Bicyclist Injuries, 1994
Table 7



                         Head Injury Frequency and Percent
                             For Primary Diagnosis Field
                      By Survival and Motor Vehicle Involvement
                            Hospitalized Bicyclist Injuries
                                  Pennsylvania, 1994
                                                     No
                                                   Head       Head       Group
                                                   Injury     Injury     Total
                 Fatal       MV        Count             1           6        7
                             Related   Row %          14%          86%    100%
                                       Col %           0%          1%       0%
                             Non-MV    Count             8           8      16
                             Related   Row %          50%          50%    100%
                                       Col %           1%          2%       1%
                             Group     Count             9          14      23
                             Total     Row %          39%          61%    100%
                                       Col %           1%          3%       2%
                 Nonfatal MV           Count          284          148      432
                          Related      Row %          66%          34%    100%
                                       Col %          29%          32%     30%
                             Non-MV    Count          673          307      980
                             Related   Row %          69%          31%    100%
                                       Col %          70%          65%     68%
                             Group     Count          957          455    1,412
                             Total     Row %          68%          32%    100%
                                       Col %          99%          97%     98%
                Percents may not add up to 100% due to rounding.




Pennsylvania Department of Health            23                             Bicyclist Injuries, 1994
Table 8

                           Head Injury Frequency and Percent
                                  for 5 Diagnosis Fields
                        By Survival and Motor Vehicle Involvement
                              Hospitalized Bicyclist Injuries
                                    Pennsylvania, 1994
                                                       No
                                                     Head        Head       Group
                                                     Injury      Injury     Total
                  Fatal        MV        Count              0          7          7
                               Related   Row %         -          100%       100%
                                         Col %         -              1%       0%
                               Non-MV    Count              8          8        16
                               Related   Row %          50%          50%     100%
                                         Col %             1%         1%       1%
                               Group     Count              8          15       23
                               Total     Row %          35%          65%     100%
                                         Col %             1%        3%        2%
                  Nonfatal MV            Count             229       203       432
                           Related       Row %          53%          47%     100%
                                         Col %          26%          36%      30%
                               Non-MV    Count           635          345      980
                               Related   Row %          65%          35%     100%
                                         Col %          73%          61%      68%
                               Group     Count           864          548    1,412
                               Total     Row %          61%          39%     100%
                                         Col %          99%          97%      98%
                  Percents may not add up to 100% due to rounding.




Pennsylvania Department of Health             24                              Bicyclist Injuries, 1994
       Table 9




                                    Statistics for Continuous Variables
                                         Age, LOS, ISS, & Charges
                                      Hospitalized Bicyclist Injuries
                                             Pennsylvania, 1994
                                                  N                                                            Range
                                     Valid            Missing             Mean             Median        Low        High
                                                                                 Std.
                                   Statistic          Statistic    Statistic     Error     Statistic   Statistic     Statistic
Age in Years                               1435              0         21.3          .45         14             0          93
Length of Stay                             1433              2           4.4         .22          2             1         132
Injury Severity Score (ISS)                 938            497           6.7         .22          5             1          75
Total Charges                              1435              0      $10,508        $449      $5,754            $0    $197,232
Source: PA HCCCC.




       Pennsylvania Department of Health                      25                                Bicyclist Injuries, 1994
  Table 10


                                               Diagnosis Group by
                                           Selected Severity Measures
                                    Bicyclist Non-Head Injury Hospitalizations
                                                Pennsylvania, 1994
                                                               Principal Diagnosis Group
                                                                     Open     Internal Superficial                 Other
                                        Non-injury      Fracture    Wound      Injury  Contusion                   Injury        Total
Length of Stay                Mean                 6              4           2           5                  2              2             4
                              Valid N   N=114           N=562         N=40        N=77         N=71               N=92          N=956
1 Day                         Count               45            171          23           6                 44           41             330
                              Col %              39%           30%        58%          8%                  62%        45%           35%
2-3 Days                      Count                32           201         11          26                   20         38           328
                              Col %              28%           36%        28%         34%                  28%        41%           34%
3-7 Days                      Count                16           120          6          27                    5         10           184
                              Col %              14%           21%        15%         35%                   7%        11%           19%
8-14 Days                     Count                8             37         0           14                   2          2             63
                              Col %               7%            7%       -            18%                   3%         2%            7%
> 2 Weeks                     Count                13            33           0          4                   0           1            51
                              Col %              11%            6%       -             5%             -                1%            5%
Total                         Count               114           562         40          77                   71         92           956
                              Col %             100%          100%       100%        100%                 100%       100%          100%
Injury Severity Score (ISS)   Mean                  3             6          2            11                  1          3             6
Minor (1-3)                   Count                30            22         21             3                 49         38           163
                              Col %              68%            6%        64%            5%                96%        58%           26%
Moderate (4-7)                Count                 8           210         11            30                  2         22           283
                              Col %              18%           54%        33%         54%                   4%        33%           44%
Serious (8-15)                Count                3            150         1           11                   0          6            171
                              Col %               7%           39%         3%         20%             -                9%           27%
Severe to Critical (16+)      Count                 3             4           0         12                   0              0         19
                              Col %               7%            1%       -            21%             -              -               3%
Total                         Count                44           386         33          56                   51         66           636
                              Col %             100%          100%       100%        100%                 100%       100%          100%
Total Charges                 Mean          $8,257    $10,293           $5,709     $11,408         $4,525           $8,705     $9,367
                              Sum         $941,253 $5,784,393         $228,369    $878,399       $321,291         $800,837 $8,954,543
Source: PA HCCCC.




  Pennsylvania Department of Health                      26                                           Bicyclist Injuries, 1994
      Table 11



                               MV Involvement by Principal Diagnosis Group
                                      Hospitalized Bicyclist Injuries
                                          Pennsylvania, 1994
                                                 Motor Vehicle (MV) Relatedness              Table Total
                                               Non-MV Related        MV Related
                                               Count    Col %     Count     Col %         Count         Col %
     Principal       Fracture                     412      41%        150        34%          562         39%
     Diagnosis       Central Nervous System       318      32%        161        37%          479         33%
     Group           Non-injury                    71       7%         43        10%          114             8%
                     Other Injury                  66       7%         26         6%            92            6%
                     Internal Injury               61       6%         16         4%            77            5%
                     Superficial/Contusion         40       4%         31         7%            71            5%
                     Open Wound                    28       3%         12         3%            40            3%
     Table Total                                  996     100%        439        100%        1435        100%
     Source: PA HCCCC




Table 12
                                 Principal Diagnosis Group by Body Region
                                  for Non-Central Nervous System Injuries
                                        Hospitalized Bicyclist Injuries
                                             Pennsylvania, 1994
                                                                            Columns

                                                           Principal Diagnosis Group
                                                          Open    Internal Superficial               Other         Group
                                               Fracture   Wound     Injury   Contusion               Injury        Total
  Injury           Head and neck                      7           3          0              0             3           20
  Severity         Face                              42           9          0              4             0           55
  Score Body       Chest                             13           0         15              0             1           30
  Region for
                   Abdominal/pelvic contents          2           2         40              0             2           47
  Primary
  Diagnosis        Extremities/pelvic girdle        322           0          0              2            34          363
                   External                           0          19          1             45            26          121
  Group Total                                       386          33         56             51            66          636
 Source: PA HCCCC



      Pennsylvania Department of Health             27                                  Bicyclist Injuries, 1994
Table 13

                         Admission Source and Disposition
                           Hospitalized Bicyclist Injuries
                               Pennsylvania, 1994
                                                                          Count       Col %
  Admission          Emergency room                                         1,100          77%
  Source             Physician referral                                       176          12%
                     Transfer from hospital                                   86            6%
                     Transfer from other health care facility                 25            2%
                     Clinic referral                                          24            2%
                     HMO referral                                              9            1%
                     Transfer from skilled nursing facility                       8         1%
                     Transfer from rural primary care facility                    7         0%
  Group Total                                                               1,435         100%
  Patient            Discharged to home/self-care (routine)                 1,298          90%
  Discharge          Discharged/transferred to other institution
                     in/outpatient services
                                                                              46            3%
  Status
                     Discharged/transferred to home under care of
                     home health service organization
                                                                              29            2%
                     Discharged/transferred to short-term general
                     hospital
                                                                              22            2%
                     Expired                                                  23            2%
                     Left against medical advice(AMA)/discontinued
                     care
                                                                                  9         1%
                     Discharged/transferred to skilled nursing facility           6         0%
                     Outpatient                                                   1         0%
                     Discharged/transferred to intermediate care
                     facility
                                                                                  1         0%
  Group Total                                                               1,435         100%
  Source: PA HCCCC.




 Pennsylvania Department of Health               28                           Bicyclist Injuries, 1994
Table 14

                                Number and Rates of Hospitalized
                             Bicyclist Injuries by County and Gender
                                      Per 100,000 Population
                                        Pennsylvania, 1994



                     Gender       Group                                            Gender                 Group
                Males    Females  Total                                      Males    Females              Total
County         No. Rate No. Rate No. Rate                   County           No. Rate No. Rate           No. Rate

Adams                4    *     1     *     5      *        Lackawanna          31   30.7    12   10.4    43      19.9
Allegheny         136 21.9     25   3.6   161   12.2        Lancaster           47   21.8    10    4.4    57      12.9
Armstrong            9 25.1     1     *    10   13.4        Lawrence             9   19.6     4      *    13      13.5
Beaver             12 13.3      2     *    14    7.4        Lebanon             16   28.2     3      *    19      16.3
Bedford              4    *     3     *     7   14.3        Lehigh              20   14.0    10    6.5    30      10.1
Berks              28 16.6      3     *    31    8.9        Luzerne             35   22.5    10    5.8    45      13.7
Blair              17 27.2      6   8.6    23   17.4        Lycoming             9   15.4     3      *    12       9.9
Bradford             5    *     0     -     5      *        McKean               3      *     1      *     4         *
Bucks              48 17.2     12   4.2    60   10.6        Mercer               7   11.7     1      *     8       6.5
Butler               3    *     4     *     7    4.3        Mifflin              1      *            -     1         *
Cambria            22 28.5     10 12.0     32   19.9        Monroe              11   19.8     7   12.4    18      16.1
Cameron              0    -     0     -     0      -        Montgomery          38   11.3    11    3.0    49       7.0
Carbon               9 31.6     2     *    11   18.7        Montour              2      *     1      *     3         *
Centre               7 10.4     4     *    11    8.5        Northampton         27   21.7     9    6.9    36      14.1
Chester            33 16.9      4     *    37    9.3        Northumberland      15   33.0     3      *    18      18.8
Clarion              8 39.4     1     *     9   21.4        Perry                2      *     0      -     2         *
Clearfield           5    *     1     *     6    7.6        Philadelphia       178   25.1    45    5.5   223      14.6
Clinton              4    *     2     *     6   16.0        Pike                 0      -     2      *     2         *
Columbia             8 26.4     1     *     9   14.1        Potter               4      *     0      -     4         *
Crawford             7 16.3     1     *     8    9.1        Schuylkill          12   16.2     2      *    14       9.1
Cumberland         13 13.1      4     *    17    8.3        Snyder               3      *     0      -     3         *
Dauphin            23 19.6      7   5.5    30   12.2        Somerset             4      *     2      *     6       7.6
Delaware           62 23.6     12   4.2    74   13.5        Sullivan             0      -     0      -     0         -
Elk                  4    *     1     *     5      *        Susquehanna          2      *     0      -     2         *
Erie               28 20.7      7   4.8    35   12.5        Tioga                5      *     0      -     5         *
Fayette            13 18.6      2     *    15   10.2        Union                2      *     0      -     2         *
Forest               4    *     0     -     4      *        Venango              4      *     0      -     4         *
Franklin             1    *     1     *     2      *        Warren               3      *     0      -     3         *
Fulton               4    *     0     -     4      *        Washington          15   15.0     4      *    19       9.1
Greene               1    *     0     -     1      *        Wayne                2      *     0      -     2         *
Huntingdon           2    *     0     -     2      *        Westmoreland        32   17.7    10    5.1    42      11.2
Indiana              8 18.3     2     *    10   11.0        Wyoming              2      *     0      -     2         *
Jefferson            2    *     1     *     3      *        York                43   24.5     6    3.3    49      13.7
Juniata              4    *     1     *     5      *        State Total      1,122   19.4   277    4.4 1,399      11.6
* = rate not computed
- = no observations to compute rate
Source: PA HCCCC




Pennsylvania Department of Health                      29                              Bicyclist Injuries, 1994
Technical Notes and Methods

Definitions
Bicyclist related injury – A bicyclist related injury was defined as a crash in which the bicycle rider
or bike passenger was injured during a collision with a motor vehicle or was injured from a non-
motor vehicle related incident such as fall from a bicycle, collision with other bicyclist, pedestrian or
other object. Bicyclist injuries were identified from the external cause of injury (E-code) field and
grouped according to motor vehicle relatedness by including the following codes.11

E-code                   Description                E-code                    Description
Motor vehicle traffic (MVT)
Injured person is a pedalcyclist involving:
E810.6 MVT involving collision with train          E819.6      MVT unspecified nature
E811.6 MVT involving re-entrant collision          E822.6      Other motor vehicle nontraffic accident
            with another vehicle                               involving collision with moving object
E812.6 MVT involving collision with                E823.6      Other motor vehicle nontraffic accident
            motor vehicle                                      involving collision with stationary object
E813.6 MVT involving collision with other          E824.6      Other motor vehicle nontraffic accident
            vehicle                                            while boarding or alighting
E814.6 MVT involving collision with                E825.6      Other motor vehicle nontraffic accident
            pedestrian                                         of other and unspecified nature
E815.6 Other MVT involving collision on            Non motor vehicle
            highway
E817.6 Noncollision MVT accident while             E826.1-      Pedalcycle accident
            boarding or alighting                  E826.9
E818.6 Other noncollision MVT

Bicyclist related head injury – A bicyclist-related head injury was defined as a patient with a
principal diagnosis of skull fracture, brain lesion or intracranial bleeding.

The Injury Severity Score (ISS) – The ISS ranks injury severity mainly in terms of threat to life.
The ISS was computed from the primary and secondary diagnosis fields. In this report the ISS was
derived by automated translation of the ICD-9 diagnoses using Trianalytics’ Tricode software.

Charges – Hospital charges are defined as the total hospital charges associated with the hospital
stay. Because actual payments are made after the hospital discharge the payer source is actually the
expected payer source and not all charges are actually collected.

Rural/urban – If at least half the residents of a county lived in a municipality with less than 2,500
persons that was not contiguous to a built up urbanized area, the county was defined as
“predominately rural.”12

Median – In a sample of observations ordered from lowest to highest, the median is the middle
observation if n is odd and the average of the two middle observations if n is even.

SE – Standard error, the standard deviation of an estimate computed by taking the square root of

Pennsylvania Department of Health                 30                                  Bicyclist Injuries, 1994
the variance divided by the sample size. It is a measure of how widely dispersed the observed values
are around the point of central tendency.

Limitations of the data
The 1994 hospital discharge database includes those persons discharged in the year under study.
Persons may have been injured in 1994 but not discharged until later. Conversely, some persons
may have been injured in 1993 and discharged in 1994. Because of the offsetting nature of these
temporal situations, no adjustment was made.

The hospital discharge database includes non-Pennsylvania residents hospitalized for injury in
Pennsylvania hospitals. Because we have not sought records of Pennsylvania residents hospitalized
in other states for bicycle-related injuries, it is assumed that the numbers gained and lost through
this assumption are about equal.

The hospital discharge database includes persons who may have been admitted to one hospital and
discharged to another hospital and discharged again in the same calendar year. This double counting
probably results in an inflation of the incidence count of less than 5 percent (based on reports of
multiple hospitalizations in other studies). Because the E-coding completeness by which bicycle-
related hospitalizations could be identified was about 90 percent complete, this means that perhaps
as many as 10 percent of the bike-related hospitalizations could not be identified from the PA
HCCCC database.

There was no verification of the cause of injuries reported by hospitals in the PA HCCCC data.
While it is possible that some reports of bicycle-related injuries may have been miscoded (false
positives), it is also possible that a number of actual bicycle-related injuries may not have been
properly identified and coded correctly (false negatives).

Because the data was derived from hospital billing data, there was no information on whether the
injured person was wearing a helmet and no information about other risks and behaviors during the
injury event.

Information regarding Hispanic or non-Hispanic origin was available, but the numbers were too
small for meaningful analysis (40 cases). Similarly, other racial categories existed, but the frequency
of any subgroup other than white or blacks were quite low (4 “Asian or Pacific Islanders,” 4
“Native American or Eskimo” and 119 unknown).




Pennsylvania Department of Health                 31                                 Bicyclist Injuries, 1994
                                  ...in pursuit of good health




                      For additional information, call toll-free
                                            1-800-692-7254




Tom Ridge                                                                                    Daniel F. Hoffmann
Governor                                                                                             Secretary of Health



    The Pennsylvania Department of Health is an equal opportunity provider of grants, contracts, services, and employment.
                                           References

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 Commonwealth of Pennsylvania, Department of Health, Division of Health Statistics and
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1996.
3
 Baker SP, Guohua LI, Fowler C, and Dannenberg AL. Injuries to Bicyclists: A National Perspective.
Johns Hopkins University Injury Prevention Center. 1993.
4
 Bicycle Helmets. American Academy of Pediatrics Committee on Injury and Poison Prevention.
Pediatrics. 1995;95:609-610
5
 Dannenberg AL, Gielen AC, Beilenson PL, Wilson MH, Joffe A. “Bicycle helmet laws and
educational campaigns: an evaluation of strategies to increase children’s helmet use.” Am J Pub
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    Thompson RS, Rivara FP, Thompson DC. “A case-control study of the effectiveness of bicycle
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 Williams M. “The protective performance of bicyclists’ helmets in accidents.” Accid Anal Prev 1991;
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 “Building safe communities: state and local strategies for preventing injury and violence.” Prepared
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 Centers for Disease Control and Prevention. “Injury-control recommendations: bike helmets.”
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     Pennsylvania Traffic Injury Prevention Program.
11
  Emergency Preparedness and Injury Control Branch of the Injury Surveillance and Epidemiology
Section in the California Department of Health Services. Personal communication. Draft report on
“Bicycle Injuries.” 1997.
12
     Center for Rural Pennsylvania. Personal communication. December, 1995.




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