Early 2007 a report was published about the developments in the number of traffic injured who are admitted to hospital (Van Kampen, 2007). It mentions two alarming developments for cyclists who are admitted to hospital after a crash: 1) their number is increasing steadily, and 2) their injury severity is hardly decreasing, contrary to that of injured car occupants.
This study has attempted to find an explanation for these developments among cyclists admitted to hospital. Data about cyclist injuries from the National Medical Registration (LMR) has been used for detailed analysis. A distinction was made between injured cyclists in crashes with a motorized vehicle as a crash opponent, the motor vehicle crashes, and those in crashes in which no motor vehicle was involved, the non-motor vehicle crashes. An estimated 70% of the crashes in the latter category are single vehicle crashes, crashes without a crash opponent, but this category also contains the bicycle-bicycle and the bicycle-pedestrian crashes.
Using the development in cyclist hospital admissions as a measure, road safety for cyclists has deteriorated over the years. Their total number has risen from almost 6,400 in 1984 to almost 8,200 in 2005. This is due to the fact that the road safety of the largest group of in-patients, injured from non-motor vehicle crashes, has deteriorated. Their number has risen from approximately 4,400 in 1984 to approximately 6,700 in 2005. The figures are better for the cyclist injured from the other group, the motor vehicle crashes: their number has decreased from approximately 2,000 in 1984 to approximately 1,500 in 2005, and their crash rate, the number of victims per kilometre travelled, has gone down. This is a positive development, also because the injury severity of cyclists injured in this crash type has become somewhat less over the years. However, the average hospital stay, the number of injuries per patient, and the percentage that die in hospital, indicate that this group of cyclists is more severely injured than those cyclists who did not have a motorized crash opponent.
Although cyclists who are not hit by a motor vehicle have sustained less severe injury and there are fewer fatalities, their number is indeed on the increase, as well as their crash rate. Furthermore, the injury severity for this group of cyclists has not decreased, as opposed to cyclists who are injured in motor vehicle crashes.
The analyses looked at the most important injury of each cyclist who was admitted to hospital. An injury pattern consisting of five categories was used: injury (of at least moderate severity) to head/skull, torso, arms, and legs, plus the category other injury, which consists of mild injury and neck injury (which is rare).
With a percentage of 45% of all injuries in the injury pattern, head/skull injury is the most important injury for cyclist in-patients from motor vehicle crashes. Leg injury takes the second position with 25%, and injury to the torso comes third with 13%.
Stichting Wetenschappelijk Onderzoek Verkeersveiligheid SWOV - Leidschendam
With 40%, leg injury is the most frequent injury for cyclist in-patients from non-motorized vehicle crashes, head/skull injury takes the second place with 30%, followed by injury to the arms with 20%.
Differentiated by age this picture changes considerably, because the proportion of head/skull injury decreases with increasing age, whereas the proportion of leg injury rises. However, in motor vehicle crashes head/skull injury remains the most important injury, in non-motor vehicle crashes leg injury takes prime position after the age of 55.
Mobility data over the period 1994-2005 shows that the number of bicycle kilometres travelled has increased by 7%. Especially the over-40s have started to cycle more, whereas youths cycle less. Nonetheless, in this period the crash rate for cyclists who are victims in motor vehicle crashes decreased by 20%. As mentioned previously, the crash rate for cyclist in non-motorized vehicle crashes went up by 12%, particularly for the age group 40-60 year olds.
The positive development for cyclist injured in motor vehicle crashes is the more remarkable because not only did bicycle mobility increase, but also that of car drivers, the most important crash opponent. It is likely that this improvement is not an autonomous development, but rather the result of measures taken. These were mainly the measures which were taken in the framework of Sustainable Safety, such as improvements to the infrastructure by the construction of roundabouts and 30km/h zones, which prevent conflicts and/or reduce injury severity.
On the other hand, however, there have hardly been any measures that could have had a positive effect on single vehicle bicycle crashes. On the contrary: the injury rate for cyclists in non-motorized vehicle crashes has increased. Where the lay-out and maintenance of the infrastructure for cyclists is concerned, an important task remains for the road authorities. Improving the bicycle's stability could be a different type of measure to benefit both the young novice cyclists and the elderly cyclists.
Considering the high proportion of head/skull injury, it is recommended to think of methods for cyclists to protect themselves against this type of injury. It can be considered to stimulate the voluntary use of bicycle helmets. Some type of leg protection could be of benefit to all cyclists, even though the elderly are most prone to sustaining leg injury. For the relatively small group of children in the ages of 5-14 wrist protection could be useful to prevent wrist fractures when they fall.
Furthermore, in line with the Sustainable Safety principle of forgivingness, the car front should be further improved to reduce cyclist's injury severity.
Finally, we recommend to accurately monitor the developments of the group cyclist injured from non-motorized vehicle crashes; also those of cyclists who are not admitted to hospital. At present, the data from the National Medical Registration (LMR) and the Injury Information System are indispensable for this purpose.