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International Journal of Injury Control and Safety

Promotion

ISSN: 1745-7300 (Print) 1745-7319 (Online) Journal homepage: http://www.tandfonline.com/loi/nics20

Road accidents involving bicycles: configurations


and injuries

Chiara Orsi, Cristina Montomoli, Dietmar Otte & Anna Morandi

To cite this article: Chiara Orsi, Cristina Montomoli, Dietmar Otte & Anna Morandi (2017): Road
accidents involving bicycles: configurations and injuries, International Journal of Injury Control
and Safety Promotion, DOI: 10.1080/17457300.2016.1278239

To link to this article: http://dx.doi.org/10.1080/17457300.2016.1278239

Published online: 24 Jan 2017.

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Download by: [FU Berlin] Date: 25 January 2017, At: 03:41


INTERNATIONAL JOURNAL OF INJURY CONTROL AND SAFETY PROMOTION, 2017
http://dx.doi.org/10.1080/17457300.2016.1278239

Road accidents involving bicycles: configurations and injuries


Chiara Orsia, Cristina Montomolia, Dietmar Otteb and Anna Morandia
a
Centre of Study and Research on Road Safety, Section of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and
Forensic Medicine, University of Pavia, Pavia, Italy; bAccident Research Unit, Medical University Hanover, Hanover, Germany

ABSTRACT ARTICLE HISTORY


This study analyzed the most common types of accident involving bicycles and compared the frequency Received 29 September 2016
of injuries. The data source was the database of German In-Depth Accident Study (GIDAS). Cases consist Accepted 12 December 2016
of bicycles and their riders involved in accidents between 2000 and 2010. In most collisions, the bicycle KEYWORDS
impacted with a car. The percentage of injured bicyclists was higher in collisions with a heavy vehicle and Road accident; bicycle;
decreased when the bicycle impacted with lighter vehicles. A high percentage of injured bicyclists in accident configuration;
single accidents was observed; the most severe injury was more frequently to head and extremities. injury; prevention
Accidents involving a car and a bicycle with the right of way in a bicycle path represented about 20% of
involved and injured bicyclists. The ten most frequent configurations represented about 60% of involved
and injured bicyclists. These results contribute to understand the dangerous scenarios for bicyclists and
to suggest preventive actions.

Introduction injured (2013: 71,066). In 2013, the amount of fatally injured


bicyclists per million inhabitants was 4.4; the percentage of
Road traffic deaths, disabilities, and injuries are a major global
bicycle fatalities with respect to all road fatalities was slightly
public health issue. According to The Global Status Report of
over 10%, and 19% of those severely injured in traffic accidents
the World Health Organization, which includes data from 180
were bicyclists (Bogerd et al., 2015). German national statistics
countries, 1.25 million people are killed each year due to road
show a slightly increasing trend for slightly injured bicyclists in
traffic accidents (World Health Organization, 2015).
all accident configurations. For seriously injured bicyclists,
In 2014, almost 26,000 road fatalities were reported in the
there is a slightly decreasing trend, and for fatally injured ones
European Union, representing a decrease of around 1% com-
a strongly decreasing trend (Johannsen, Otte, & Urban, 2015).
pared to 2013, and of 18% compared to 2010. The EU road
Fortunately, the number of bicyclists killed in traffic accidents
fatality rate in 2014 was 51 dead per one million inhabitants.
has steadily decreased by about 75% over the past 35 years,
Vulnerable road users – in particular bicyclists – play an
from 1,338 in 1980, while the total number of injured and
important role in this context: overall, bicyclists make up 8% of
killed bicyclists rose from 54,583 in 1980 to 78,296 in 2014
road fatalities in the European Union. The number of such
(Otte, Facius, & J€ansch, 2014).
fatalities has decreased by only 3%, which is much lower than
The major problem for bicyclists worldwide is that our
the total fatality decrease of 18% from 2010 (European Com-
modern traffic system is designed mainly from a car-user’s
mission, 2015a). One possible reason for the slow reduction in
point of view, which results in a lack of coherent develop-
the number of cycling victims is that the total number of bicy-
ment of route networks for bicyclists. Thus, as the system
clists has increased in the European Union as cycling, being
does not take into account the peculiar characteristics of
easy, inexpensive and healthy, is becoming one of the most
bicyclists, bicyclists rank among the most exposed partici-
popular means of transport throughout the world (K€ uster,
pants in traffic, and are therefore more likely to suffer inju-
2013). The number of bicyclists and the share of cycling road
ries in case of an accident: bicyclists, being less protected,
deaths in total road deaths differ substantially among coun-
less visible, flexible in behaviour, and more unstable, have a
tries. For instance, the share of cycling deaths is especially high
greater chance of suffering more severe consequences from
in Denmark and the Netherlands: 17% and 24%, respectively
road accidents than do users of motorized vehicles (Verster,
(European Commission, 2015b).
van Herwijnen, Volkerts, & Olivier, 2009; Wegman, Zhang,
Data reported by DESTATIS (https://www.destatis.de/EN)
& Dijkstra, 2012).
show that in the Federal Republic of Germany, in 2015,
In this context, the aim of the present study was to evaluate
2,507,881 accidents were registered by the police (2014:
the most common types of accident involving bicycles and to
2,406,685), 393,744 people were seriously or slightly injured
compare the frequency of injuries, in order to understand
(C1.1% compared to 2014), and 3475 people died on the roads
which are the most dangerous scenarios for bicyclists and to
(C2.9% compared to 2014). As regards bicyclists, in 2014, a
suggest appropriate preventive actions.
total of 396 bicyclists were killed (2013: 354) and 77,900

CONTACT Chiara Orsi chiara.orsi@unipv.it


© 2017 Informa UK Limited, trading as Taylor & Francis Group
2 C. ORSI ET AL.

Previous research has addressed some of these issues. division, higher speed limits, heavy vehicle involvement and
For example, some studies highlighted that road accidents older bicyclists.
involving bicyclists have widely varying consequences, ranging This paper analyzes the frequency and severity of the most
from minor abrasions to fractures and death (Scheiman, Mog- common accident configurations in order to understand and
haddas, Bj€ ornstig, Bylund, & Saveman, 2010; Schwellnus & Der- quantify the situations that result in accidents on which to pay
man, 2005). Although different parts of the body can be involved more attention.
(Abbas, Hefny, & AbuZidan, 2011; AbuZidan, Nagelkerke, &
Rao, 2007; Stranges, UscherPines, & Stocks, 2012), the majority Materials and methods
of bicycle-related injuries are head injuries (Lustenberger et al.,
 Data sources and data collection
2010; Styrke, Stalnacke, Sojka, & Bj€ornstig, 2007) and fractures to
the extremities (Eid, Bashir, Muhammed, & Abu-Zidan, 2007; The data source was the German In-Depth Accident Study
Lustenberger et al., 2010; Richter, Pape, Otte, & Krettek, 2005; (GIDAS) database.
Richter et al., 2007; Rosenkranz & Sheridan, 2003). Within the GIDAS study (http://www.gidas.org/en), a sam-
Previous studies conducted in Europe and North America ple of accidents in which at least one person involved was
have evaluated the role of accident type as a risk factor for the injured or killed occurring in areas of Hannover and Dresden
consequences of bicycles accidents. was investigated. Therefore, the sample includes both accidents
Reynolds, Harris, Teschke, Cripton, and Winters (2009) occurring in urban and rural areas in the regions of Hannover
reviewed studies of the impact of transportation infrastructure and Dresden.
on bicyclist safety. The evidence to date suggest that purpose- In both areas, the police, rescue services, and fire department
built bicycle-only facilities (e.g. bicycle routes, bicycle lanes, headquarters report all accidents continuously to the GIDAS
bicycle paths, bicycle tracks at roundabouts) reduce the risk of research team. The team then selects accidents based on a strict
crashes and injuries compared to cycling on-road with traffic selection process, investigating these cases following detailed pro-
or off-road with pedestrians. cedures contained in a handbook and coding manual.
Schepers and Wolt (2012), in a study conducted in the Neth- Accident investigation takes place daily during two six-hour
erlands, developed a categorization of single-bicycle crash types. shifts following a 2-week cycle in order to cover all periods of
The results indicated that about half of all single-bicycle crashes the day throughout the whole year:
are related to infrastructure: the bicyclist collided with an obsta-
cle, rode off the road, the bicycle skidded due to a slippery road  first week: from 12:00 am to 06:00 am and from 12:00 am
surface, or the bicyclist was unable to stabilize the bicycle or to 6:00 pm
stay on it because of an uneven road surface. The first two cate-  second week: from 6:00 am to 12:00 pm and from 6:00
gories occur because the bicyclist inadvertently takes a danger- pm to 12:00 pm
ous riding line, while the last two happen under more direct
influence of the road surface conditions. Other types related to During each shift, a team consisting of two technical team
the bicyclist are loss of control at low speed, due to forces on members, a medical team member and a coordinator is on
the front wheel, or poor or risky riding behaviour. Bicycle duty, equipped with special emergency vehicles. When an acci-
defects contribute to a small group of crashes. Finally, some dent occurs, the team goes to the accident site and collects
bicyclists fall because of an external force, such as a gust of wind. information on environmental conditions, road design, traffic
In a study conducted Sin North Carolina (USA), Kim, Kim, control, accident details, crash information, vehicle damage
Ulfarsson, and Porrello (2007) found that head-on collisions and deformation, impact contact point for bicyclists, passen-
greatly increase the probability of fatal injury in accidents. gers and pedestrians, technical vehicle data, and information
Rivara, Thompson, and Thompson (1997) conducted about the people involved.
research in the Seattle area (USA) aimed at determining the The information collected ‘on the scene’ is supplemented by
risk factors for serious injury to bicyclists; they found that risk more detailed measurements of the vehicle (usually collected
of serious injury was increased by collision with a motor vehi- the following day), further medical information about injuries
cle and risk of neck injury was increased in bicyclists struck by and treatment, and an extensive accident reconstruction gener-
motor vehicles. ated from evidence collected at the accident scene. The acci-
Teschke et al. (2012) conducted a study in Toronto and dent is then reconstructed using an in-depth approach,
Vancouver (Canada), comparing cycling injury risks of 14 reconstruction methodologies, and ad hoc software (http://
route types and other route infrastructure features. They found www.dsd.at/index.php?langDen).
that, of 14 route types, bicycle tracks had the lowest risk; risks Both teams – Hannover and Dresden – function in the same
on major streets were lower without parked cars and with bicy- manner using the same system and procedures, collecting data
cle lanes; local streets also had lower risks. Other infrastructure in a common database. Each year, in every investigation region,
characteristics were associated with increased risks: streetcar or approximately 1000 traffic accidents are documented.
train tracks, downhill grades, and construction. Moreover, a
research conducted in Beijing by Yan, Ma, Huang, Abdel-Aty,
The sample
and Wu (2011) found that the severity level of bicyclist injuries
could be elevated by specific crash patterns and risk factors Cases consist of bicycles and their riders that were involved in
including head-on and angle collisions, the running over of accidents that occurred from 2000 to 2010, stored in the
bicyclists, no streetlights at night, roads without median/ GIDAS database.
INTERNATIONAL JOURNAL OF INJURY CONTROL AND SAFETY PROMOTION 3

Analysis of injuries severely injured bicyclists and fatally injured bicyclists – was
evaluated.
The injury situation was described based on the Abbreviated
Injury Scale (AIS). The AIS is an anatomically based global
severity scoring system that classifies each injury by body Results
region according to its relative importance, based on a six-
Sample description
point ordinal scale (from 1 D minor to 6 D maximal) devised
by the American Association of Automotive Medicine (http:// In total, the crashes of 4928 bicyclists involved in an accident
www.aaam.org/about-ais.html). For each bicyclist, all injures during the years 2000–2010 were analyzed. Most bicyclists
were classified according to body region (head, face, neck, tho- (59.4%) were male, with a mean age of 38.3 (SD §20.1) (data
rax, abdomen, spine, upper extremities, lower extremities) and not shown). In the majority of the accidents (63.8%), the bicy-
AIS score. The whole-body injury score (maximum AIS, cle impacted with a passenger car; 13.6% of cases involved sin-
MAIS) is defined as the severity of injury of the most injured gle accidents; in the other cases, the bicycle impacted with
part of the body. All bicyclists with MAIS  3 were classified as another bicycle (11.0%), a heavy vehicle (truck, bus, tram)
severely injured bicyclists. (6.6%), or a motorcycle (1.2%) (Figure 1).

Accident configurations analysis Accident consequences


Each accident was jointly reconstructed and analyzed by a team The accident consequences for 4770 bicyclists were known.
of experts. Based on the results of the reconstruction, all the Among these, 92.8% reported injuries following the acci-
accidents were classified into different configurations, depend- dent; among the injured bicyclists, 5.5% were severely
ing on the situation which led to the accident. injured (Table 1) and 44 (0.9%) died following the accident.
The type of vehicle that the bicycle impacted was also con- The percentage of injured bicyclists from an impact with
sidered, as this is an important factor for the health consequen- heavy vehicles is higher than that from lighter ones: more
ces of the bicyclist. than 99% when the bicycle impacted a four-wheeled motor
vehicle (passenger car or heavy vehicle), 85.7% in accidents
with a motorcycle, 67.2% in accidents with another bicycle,
Statistical analysis
and 51.4% in accidents with a pedestrian. A similar trend
All the study variables were described using the usual descrip- is observed for severe injuries: the percentage of severely
tive statistics: mean and standard deviation for continuous var- injured bicyclists is higher (9.2%) in accidents with a heavy
iables and percentages for categorical ones. In particular, vehicle than in accidents with a car (4.9%), motorcycle
frequencies of the collision partner, of the maximum AIS body (4.2%), bicycle (3.6%), or involving a pedestrian (0.6%). In
region, and of the accident configuration were calculated. Acci- single accidents, 93.3% of bicyclists were injured, 8.5% of
dent consequences – percentage of injured, severely injured them severely (Table 1).
and fatally injured bicyclists – for the collision partner and Figure 2 shows the distribution of the maximum AIS by
accident configurations were also calculated. Finally, the body region: the most severe injuries were more frequent to
impact of the most frequent accident configurations – in terms the head (29.2% of bicyclists) and the extremities (26.8% upper
of the percentage of involved bicyclists, injured bicyclists, extremities and 20.1% lower extremities).

Figure 1. Accident collision partners.


4 C. ORSI ET AL.

Table 1. Accident consequences by collision partner. (8) Conflict between a car turning off to the left and a bicy-
Collision Injured MAIS  3 cle from a special path/track going in the same or
partner N (total) N % (among total) N % (among injured) opposite direction (3.0%).
Passenger car 3042 3019 99.2 147 4.9 (9) Conflict between a bicycle and a car: a vehicle turning
Heavy vehicle 311 305 99.1 28 9.2 off to the left (either the car or the bicycle) and oncom-
Motorcycle 56 48 85.7 2 4.2
Bicycle 534 359 67.2 13 3.6 ing traffic (2.6%).
Pedestrian 181 93 51.4 1 0.6 (10) Conflict because of a car door opening (2.4%).
Single accident 646 603 93.3 51 8.5
Total 4770 4427 92.8 242 5.5

Consequences by accident configuration


In the most common configuration (accident between a non-
Accident configurations
priority car and a bicyclist with priority coming from a bicycle
In Table 2, the ten most frequent accident configurations are path), the percentage of injured bicyclists was 99.5%, 3.1% of
reported. For each of these, the absolute number of accidents which were severely injured and 0.1% that died following the
and the percentage with respect to the total number of acci- accident (Table 2).
dents are shown. The 10 most frequent configurations are: The configurations accounting for the highest percentages
of severely injured bicyclists, higher than the average (5.5%),
(1) Conflict between a non-priority car and a bicycle with were (Table 2):
priority coming from a bicycle path (19.8%).
(2) Conflict between a car and a bicycle coming from a  accident between a car and a bicycle from a parallel bicy-
parallel bicycle path where the bicycle is turning into or cle path which is turning into or crossing the road (8.9%);
crossing the road (6.7%).  single accident on a straight road, not influenced by road
(3) Conflict between a bicycle and a car: one non-priority width or lateral gradient (8.6%);
(either the car or the bicycle) and the other priority  accident between a bicycle and a car: one non-priority
from the left, not overtaking (6.5%). (either the car of the bicycle) and the other priority from
(4) Conflict between a bicycle and a car: one non-priority the right, not overtaking (8.3%);
(either the car or the bicycle) and the other priority  conflict because of a car door opening (6.1%).
from the right, not overtaking (5.7%).
(5) Conflict between a car turning off to the right and a The configurations accounting for the highest percentages
bicycle from a special path/track going in the same or of bicyclist fatalities, higher than the average (1.0%), were:
opposite direction (5.0%).
(6) Conflict between two bicycles meeting head-on (3.4%).  accident between a bicycle and a car: one non-priority
(7) Single accident on a straight road, not influenced by (either the car or the bicycle) and the other priority from
road width or lateral slope (3.1%). the right, not overtaking (2.3%);
 accident between a bicycle and a car: one non-priority
(either the car or the bicycle) and the other priority from
the left, not overtaking (1.7%);
 conflict because of a car door opening (1.7%);
 single accident on a straight road, not influenced by road
width or lateral gradient (1.4%).

Table 3 shows the impact of the first most frequent, the five
most frequent and the ten most frequent configurations, in
terms of percentage of bicyclists involved, injured bicyclists,
severely injured bicyclists and fatally injured bicyclists. The
accident between a car and a bicycle with priority from a bicy-
cle path alone represented 19.8% of involved bicyclists and
21.5% of injured bicyclists. The five most frequent configura-
tions represented 43.7% of involved bicyclists and 46.7% of
injured bicyclists. The ten most frequent configurations repre-
sented 58.2% of involved bicyclists, 61.0% of injured bicyclists,
55.4% of severely injured bicyclists, and 43.2% of fatally injured
bicyclists.

Discussion and conclusions


Figure 2. Maximum AIS body region. For the GIDAS study, accidents were collected based on a sta-
tistical random plan, and the annual sample of cases was
Table 2. Frequency of accidents and consequences by accident configuration.
% among all Injured % severe injured % of fatalities
Accident type N cases N % (among injured) (among injured)
A non-priority car and a bicycle with priority coming 977 19.8 955 97.2 3.1 0.1
from a bicycle path

A car and a bicycle coming from a parallel bicycle 331 6.7 320 95.2 8.9 0.6
path which is turning into or crossing the road

A bicycle and a car: one non-priority and the other 318 6.5 302 94.3 6.7 1.7
priority from the left, not overtaking

A bicycle and a car: one non-priority and the other 281 5.7 267 94.7 8.3 2.3
priority from the right, not overtaking

A car turning off to the right and a bicycle from a 248 5.0 240 94.8 0.9 0.0
special path going in the same or opposite
direction

Two bicycles meeting head-on 169 3.4 164 69.2 2.6 0.0

Single accident on a straight road, not influenced by 152 3.1 143 92.1 8.6 1.4
road width or lateral gradient
INTERNATIONAL JOURNAL OF INJURY CONTROL AND SAFETY PROMOTION
5

(continued)
6 C. ORSI ET AL.

Table 3. Impact of most frequent accident configurations.

(among injured)
% of fatalities % of % of % of % of
involved injured severely fatally

0.7

0.0

1.7
riders riders injured injured
riders riders
First most frequent 19.8 21.5 12.0 2.3
configuration
% severe injured

Five most frequent 43.7 46.7 41.7 31.8


(among injured)

configurations
Ten most frequent 58.2 61.0 55.4 43.2
5.0

3.3

6.1
configurations
144 95.3

121 95.2

115 98.3
weighted based on data from all registered accidents in the
%
Injured

national statistics database. A scientific research team consist-


N

ing of technicians and physicians equipped with special emer-


% among all

gency vehicles drives to the sites of accidents and documents


cases

the damages to the vehicles, the injuries and the accident


3.0

2.6

2.4

traces. The injured person is inspected in the hospital where


the initial treatment was performed. The accidents are reported
148

126

117
N

by the police in cases of traffic accidents with personal injury


based on a special sampling process. The proportion of bicy-
clists corresponds to the general accident statistics of the inves-
tigated areas of Hannover and Dresden; the results can be
applied representatively to all of Germany after the data sets
are statistically weighted (Otte, Krettek, Brunner, & Zwipp,
2003).
The main findings of the present research can be summa-
rized as follows:

 in most collisions, the bicycle impacted with a passenger


car, followed by single accidents;
 the percentage of injured bicyclists was higher if the bicy-
Accident type

cle impacted with a heavy vehicle and decreased when


the bicycle impacted with cars, two-wheeled vehicles,
bicycles or pedestrians;
 a high percentage of injured and severely injured bicy-
clists in single accidents was observed;
 the most severe injuries were more frequently to the head
and the extremities;
 the ten most frequent configurations represented about
60% of involved bicyclists and more than 60% of injured
bicyclists;
 the five most frequent configurations represented 44% of
involved bicyclists and 47% of injured bicyclists;
 accidents between a car and a bicycle with priority from a
bicycle path alone represented almost 20% of involved
bicyclists and more than 20% of injured bicyclists.
A bicycle and a car: a vehicle turning off to the left
A car turning off to the left and a bicycle from a
special path going in the same or opposite

The results obtained lead to some considerations about road


accidents involving bicycles and some suggestions for preven-
Conflict because of a car door opening

tive actions.
The findings of this study indicate that in the majority of
collisions, the bicycle impacted with a passenger car and that
the risk of sustaining injury or death in an accident is higher if
and oncoming traffic

the vehicle partner in the accident is a heavy vehicle or a car, in


Table 2. (Continued )

line with previous findings (Orsi, Marchetti, Marinoni, & Mor-


andi, 2009; Rivara et al., 1997). These results therefore suggest
direction

that injuries to bicyclists can be reduced through a better


design of cars and heavy vehicles. Design measures include
crash-friendly car fronts and side-underrun protection on
INTERNATIONAL JOURNAL OF INJURY CONTROL AND SAFETY PROMOTION 7

lorries (European Commission, 2015c; Wittink, 2001). Lorries that several of the ten most common configurations are at
could be made much safer for the other vehicle involved by the crossings suggests that attention has to be given to the design
application of adequate protection around the vehicle, for of bicycle routes at these locations. Crossings at the intersection
example, side-underrun protection; such protection prevents of bicycle tracks and streets do not always seem well under-
the dangerous underrun of, for instance, bicyclists (European stood by drivers, particularly when environmental features do
Commission, 2015c; PROMISING, 2001a). Another important not clearly reflect the right-of-way, thus creating confusion
issue for reducing the number and severity of crashes with among drivers and bicyclists alike (European Commission,
other vehicles is the visibility of bicyclists by means of lighting 2015c; PROMISING, 2001b). Additional facilities are necessary
and reflecting devices. Bicyclists benefit from conspicuity aids at intersections in order to reduce the speed differences
such as armbands, light-coloured and retro-reflective clothing, between bicyclists and other traffic as much as possible. Prior-
and high-visibility helmets. In addition, bicycles should be ity regulations, speed humps, and raised intersections are suit-
equipped with front and rear lights and reflectors (European able to achieve this (European Commission, 2015c; SWOV,
Commission, 2015c; OECD, 2004). 2004). Finally, an educational campaign should be addressed
Another relevant aspect is the importance of transportation not only to bicyclists but also to the drivers of other vehicles, as
infrastructure on bicyclist safety, in particular bicycle lanes: all both parties can be the cause of injury (European Commission,
ten of the most frequent configurations occur when the bicy- 2015c; Phillips, Ullebergb, & Vaa, 2011). As stressed by de
clist is going or is riding outside the bicycle lane. As suggested Geus et al. (2012), ‘softer’ methods and stricter enforcement
by previous studies, bicycle tracks reduce the risk of crashes must be used together, since getting bicyclists to use lights and
and injured compared to cycling on-road (Reynolds et al., reflectors at night or to stop at stop signs and red lights may be
2009; Teschke et al., 2012). difficult without enforcement.
The danger of single accidents is in line with the results Our study has some limitations.
from previous studies, for instance, Orsi et al. (2009) and Data analyzed in this study were collected in only two geo-
Schepers and Walt (2012). Moreover, the single accident is the graphical areas in Germany (Hannover and Dresden). How-
second most frequent kind of accident, followed by crashes ever, to evaluate the representativeness of our data, we
involving a car. These results highlight the importance of single compared their distributions with those reported by DESTA-
accidents in terms of both frequency and severity. As these TIS (https://www.destatis.de/EN) for the whole Germany. The
accidents occur without the intervention of other vehicles, the number of bicyclists involved in accidents causing personal
consequences may be due to the impact with some infrastruc- injury in 2012 was 81,162; we can assume that this number is
ture. For example, Haileyesus, Annest, and Dellinger (2007) very close to the number of accidents involving bicyclists in
suggested that prevention efforts should include improvement which at least one person involved was injured or killed, as the
in the road environment along with the promotion of safe per- number of accidents involving two bicyclists in which at least
sonal behaviour and practices, while Schepers et al. (2015) one of them is injured is very low. The number of accidents
stressed that good maintenance of infrastructure and removing causing personal injury in 2012 was 299,637. Therefore, the
or improving the visibility of obstacles can help reduce the risk percentage of accidents causing personal injury involving bicy-
of single bicycle accidents and improve conditions for bicy- clists was around 27%. In our data, 4928 on a total of 21,021
clists, especially those with poor vision. Moreover, previous accidents causing personal injury involved bicyclists (the data
studies have found that some of these collisions are attributable is from the GIDAS database for the years 2000–2010), that is,
to distractions, illness and falling asleep, often brought on by more than 23%. These percentages are in line with the fact that
an excess of food, alcohol, pharmaceuticals or drugs (Boufous, the use of bicycles, and consequently the number of accidents
de Rome, Senserrick, & Ivers, 2013; Juhra et al., 2012; involving bicycles, has grown in recent years. Moreover, based
Martınez-Ruiza et al., 2013; Orsi, Ferraro, Montomoli, Otte, & on the data reported by DESTATIS (https://www.destatis.de/
Morandi, 2014). Finally, Schepers (2012) found that single EN), the percentage of bicyclists killed in a road accident with
accidents are less frequent among experienced and skilled respect to bicyclists involved in accidents causing personal
bicyclists. injury was 0.5% in 2012 (406/81,162) and the percentage of
The results of this research indicate that the most severe bicyclists injured in a road accident with respect to bicyclists
injuries were more frequently to the head and the extremities, involved in accidents causing personal injury was 92% (74,370/
in accordance with previous studies (Eid et al., 2007; Lusten- 81,162). In our sample, we found the following percentages:
berger et al., 2010; Richter et al., 2005, 2007; Rosenkranz & 0.9% of bicyclists were killed and 93% injured.
Sheridan, 2003). This evidence underlines the importance of Another important limitation of this study is that it is based
wearing a helmet as a preventive measure for accident conse- on data collected by police. Therefore, even though a strict
quences. Indeed, it is known that helmets reduce bicycle- selection process was applied, crashes that were never reported
related head injuries for bicyclists of all ages involved in all to police could not be included in the sample.
types of crashes, including those with motor vehicles (Airaksi- Stutts and Hunter (1998) reported several studies compar-
nen, L€ uthje, & Nurmi-L€ uthje, 2010; Amoros, Chiron, Martin, ing overall numbers of hospital or emergency room reported
& Laumon, 2012; Attewell, Glase, & McFadden, 2001; Thomp- cases with official crash statistics. All these studies have shown
son, Rivara, & Thompson, 2000). reporting discrepancies. In a study conducted in New Zealand,
The evidence that a few configurations cause the majority of the number of hospital admissions over a ten-year period was
injuries to bicyclists indicates that preventive actions can be compared to the number of police-reported road accident vic-
focused on the most common situations. For example, the fact tims (Morrison & Kjellstrom, 1987). The proportion of police-
8 C. ORSI ET AL.

reported to hospital-reported road accident cases declined over Similar investigations in other areas are therefore needed in
the ten-year study period, from 0.21 to 0.15 for bicyclists. A order to establish the transferability of these findings.
similar study by Dutch researchers yielded higher proportions In conclusion, it is reasonable to assume that in-depth
(0.82 for bicyclists) (Maas & Harris, 1984). In a follow-up investigations and accident reconstructions provide the most
study, however, Harris (1990) noted that these proportions detailed data for specific research questions and decision-mak-
had declined to less than 0.70 by the late 1980s. Lower propor- ing. It is possible to infer that training education programmes
tions were also reported in two other European studies that to improve riding ability and knowledge of the risk associated
looked only at bicyclists: a German study on the under-report- with riding could protect bicyclists; for example, by helping
ing of road traffic accidents in 1993 reported proportions of them in the detection of oncoming passenger cars and other
0.30 for hospitalized bicyclists and 0.20 for bicyclists receiving road vehicles and the prediction of their manoeuvres. More-
outpatient treatment only (Hautzinger, D€ urholt, & H€ornstein, over, a visibility enhancement system is recommended for the
1993), while an earlier British study had reported 0.24 for bicy- bicycle and the bicyclist; for example, one placed on the helmet.
clists receiving either inpatient or outpatient treatment (Bull & Finally, to reduce the potential for accidents, proper road
Roberts, 1973). In addition, more recent studies have design, the use of traffic calming, mobility management, and
highlighted that bicycle statistics based on police crash reports stricter adherence to traffic laws are desirable.
disproportionately underestimate bicycle crashes (Elvik &
Mysen, 1999; Langley, Dow, Stephenson, & Kypri, 2003; Ter-
cero & Andersson, 2004). As noted by Tin Tin, Woodward, Disclosure statement
and Ameratunga (2013), this is not surprising, since many No potential conflict of interest was reported by the authors.
bicycle crashes do not come to the attention of the police or
medical personnel, and this underestimation amounted to 70%
or more of self-reported crashes in overseas studies (de Geus References
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