Bicycle-Related Traumatic Brain Injuries and Emergency Room Visits

It’s clear – if a car or truck comes barreling down the road and strikes a bicycle rider, the cyclist will be lucky to survive. Even when vehicles are traveling slowly, the bike rider is usually pitched off the bike and often strikes the ground with his/her head. Bicycles lack protective frames for the rider. Bicycle helmets, if worn properly, provide some protection for scalp and skull, but they provide minimal protection from brain injuries.

A 2021 study from the Centers for Disease Control and Prevention (CDC) analyzed ER care for bicycle accident victims who suffered head trauma, and were treated by an ER department, for the decade 2009 to 2018. The study estimates that emergency departments (EDs) examined nearly 600,000 bicycle-related TBIs during that period. The rates of bicycle-related TBI victims were highest among adult men and minors aged 10-14 years. The good news is that the yearly numbers declined as the decade wore on. The overall implications of the analysis are that some of the key factors in avoiding bicycle-related TBIs include better traffic laws, better bicycle infrastructure, and more helmet use, along with targeted interventions.

The study was implemented due to the following concerns, among others:

• Bicycle riding is the leading cause of sport and recreation-related emergency department (ED) visits for TBIs.
• The CDC examined data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). The NEISS-AIP is operated by the S. Consumer Product Safety Commission, which keeps “data on patients treated in hospital EDs drawn from a nationally representative, stratified probability sample of hospitals, and weighted by the inverse probability of selection to provide national estimates.”
• The examination reviewed ER care if the head was the primary body part that was injured and the principal diagnosis was an internal organ injury or a concussion. The rates of bicycle-related TBIs per 100,000 population were “calculated by using U.S. Census Bureau population estimates as the denominator, stratified by sex and age group.”
• In 2018, 857 adult bicyclists died from traffic-related crashes in the United States, the highest number in two decades
• Male bicycle riders were three times as likely as women to need ED care for a traumatic brain injury.

Some of the leading discussion points from the CDC study

The CDC discussion of their review highlighted the following:

• Some of the reasons why the rate of adult bicycle-related TBIs increased compared to child bicycle-related TBIs may be that more adults and fewer children are riding bicycles, more adult cyclists use roadways to get to work, and because much of the education about safe bicycle riding focuses on children, not adults. More parents may be involved with the safety education of their children, too.
• “Policies that recommend the use of bicycle helmets have achieved long-term sustained helmet use rates and a 20%–55% reduction in bicycle-related head injuries, including TBIs.” The analysis emphasized that “bicycle helmets are not designed to prevent a concussion, which occurs after linear and rotational forces cause extreme brain movement inside the skull.”
• Some of the strategies for reducing bicycle-related TBIs include:
  • Building roads and paths that focus on bicycling safety – such as bicycle lanes and safer intersections.
  • Reducing the rate of distracted driving on the roads.
  • Better bicycle lights.
  • Better visibility in nighttime driving conditions.
  • Focusing more on educating men about bicycle safety.
  • Better use of signage on public transit and better use of social media about the risks and dangers of unsafe driving and riding.

The study also includes some caveats about its reliability:

• The rate of ER visits reported is likely much less than the number of visits that occurred due to underreporting. ER doctors focus on risks of imminent death or disability and are often distracted by orthopedic or bleeding injuries, and often overlook subtle signs of brain injury.
• Many bicycle-related TBI victims don’t seek help or see their primary doctor.
• Incidents where the TBI was a secondary diagnosis instead of a primary diagnosis may not have been included.
• The study didn’t focus on various factors that might affect bicycle safety infrastructure, such as race, ethnicity, and socioeconomic status.
• The data doesn’t include critical background information, including where the bicycle accident happened, how often the rider rides his/her bicycle, and other factors.

What are common head and brain injuries from bike accidents?

Some of the common types of head trauma from a Phoenix bicycle accident include:

• Traumatic brain injuries (TBIs). These refer to any forceful trauma to the brain either due to a direct impact or to secondary forces as the brain rattles around in the skull. Victims of TBIs often suffer physically, emotionally, and cognitively. While some TBI victims may recover, victims with moderate or severe TBIs may suffer and may require medical care for the rest of their lives.
• Skull fractures. If a car accident, truck accident, construction accident, or other accident causes enough force, the skull can fracture, causing various medical issues in addition to the fracture, like the bleeding or tearing of brain tissues.
• A concussion is a type of TBI. According to the Mayo Clinic, a concussion is a traumatic brain injury that affects the ability of the brain to function. Symptoms include headaches and difficulties with coordination, balance, memory, and concentration. Concussions can cause a loss of consciousness, though most do not.
• Many people with a head injury develop cranial hematomas (bleeding and clotting in the brain) that may be life-threatening.
• Shearing forces. When the skull is rapidly accelerated or decelerated, even if there is no physical impact to the skull, the movement of the brain within the skull can cause stretching or tearing of tissue. This can create bleeding which will show up on a CT scan but may cause damage to the axons (the “wires” that connect the neurons). Axonal damage can cause the brain to be less efficient and make thinking slower and harder, among other things. Axonal damage is almost never recognized in the ER.

Other head injuries that may be due to an crash include fractures and damage to the eye sockets, jaw, nose, cheekbones, and forehead.

Anyone who experiences an accident and blow to the head should seek immediate medical care at the closest emergency room. If the police are called to investigate the accident, they will often arrange for an ambulance or an emergency medical transport to the ER.

At Plattner Verderame, P.C., our Phoenix bicycle accident lawyers seek compensation from careless drivers and other liable defendants for all your damages. While some brain injury victims may be released after an examination, many others may require surgery and extensive rehabilitative care. The cost of all medical care for a TBI can be quite expensive. The pain and suffering can affect every part of your life, including your ability to work, take care of your family, and enjoy your life. To speak with our experienced and respected bicycle accident lawyers, call our offices in Phoenix or Tempe or complete our contact form to schedule a free consultation today.