Introduction: This study aimed to examine difference in trauma injuries between bicycle users in winter months compared to summer months. Behavioral variables were also examined to assess seasonal variability, as well as associations with traumas. Methods: This was a retrospective cohort study of all bicycle related traumas presenting to a level I trauma center between the years 1998-2018. All data was collected through a standardized trauma database. Seasonal differences were examined by comparing trauma severity and behavior patterns between patients arriving in the months May-September (summer) and those arriving in November-March (winter). Outcome measures included: Injury Severity Scale, GCS, type of accident, helmet use, demographics and alcohol level. Groups were compared using t-tests and Chi-square analysis as appropriate. Results: A total of 980 bicycle related traumas were analyzed. There were a significantly greater number of injuries in the summer as compared to winter months (879 in summer vs. 101 in winter). While most injuries in both groups were rated in the severe range of the Injury Severity Scale, there were no differences in injury severity, initial GCS, deaths, or head injuries between the two seasons. There were also no differences in drug, alcohol, or helmet use. The only significant difference between seasons was that winter riders were more likely to be male. Overall, helmet use was associated with lower injury severity, less head trauma, and a higher initial GCS. Use of alcohol was associated with less likelihood of wearing a helmet. Conclusion: In conclusion, bicycle use in winter does not appear to be associated with worse outcomes than summer. Public health interventions can continue to encourage winter bicycle use, with the encouragement of helmet use and avoidance of alcohol when cycling as an important protective factor in both seasons.

Introduction: We seek to characterize unhelmeted injured cyclists presenting to the emergency department (ED): demographics, cycling behaviour, and attitudes towards helmet use. Methods: This was a prospective cohort study in a downtown teaching hospital, from May 2016 - Sept 2019. Injured cyclists presenting to the ED were recruited if they were not wearing a helmet at time of injury and over age 18. Exclusion criteria included intoxication, inability to consent, or admission to hospital. A standardized survey was administered by a research coordinator. Descriptive statistics were used to summarize the data, and survey responses reported as percentages. Results: We surveyed a convenience sample of 68 unhelmeted injured cyclists (UICs) with mean age of 33.6 years (range 18 to 68, median 29.5 years). Ratio of males to females was 1:1. The majority of UICs cycled most days per week or every day in non-winter months (89.6 %, n = 60). Cycling in Toronto was perceived as somewhat dangerous (45.6%, n = 31) or very dangerous (5.9%, n = 4) by most, and very safe (2.94 %, n = 2) or somewhat safe (19.12%, n = 13) by few. Almost a third (29.4 %, n = 20) had been in a cycling accident in the prior year, some of these (15.0%, n = 3) prompting an ED visit. All cyclists were riding their personal bike (100 %, n = 68) at time of injury, and most (98.5%, n = 67) had planned to cycle when they departed home that day. Purpose of trip was primarily for commuting to work (50%, n = 34), social activities (19.1%, n = 13), school (7.4%, n = 5), and recreation (7.4%, n = 5). Bicycle helmet ownership was low (41.2 %, n = 28). UICs reported rarely (10.3%, n = 7) or never (64.7%, n = 44) wearing a helmet when cycling. Reported factors discouraging helmet use included inconvenience (33.8%, n = 23), lack of ownership (32.4%, n = 22), discomfort (29.4%, n = 20), and ‘messed hair’ (14.7%, n = 10). Few characterized helmets as unnecessary (10.3%, n = 7) or ineffective (1.5%, n = 1). The majority had a college diploma or more advanced education (77.9%, n = 53), and spoke English at home (85.3%, n = 58). Conclusion: Unhelmeted injured cyclists surveyed were frequent commuter cyclists who do not regard cycling as safe, yet choose not to wear helmets for reasons largely related to convenience rather than perceptions regarding safety or necessity. Initiatives to increase helmet use in this subgroup should address the reasons given for not wearing a helmet, potentially using principles of adult education and behavioral economics.

Objective: To determine if health outcomes and demographics differ according to helmet status between persons with cycling-related traumatic brain injuries (TBI).Methods: This is a retrospective study of 128 patients admitted to the Montreal General Hospital following a TBI that occurred while cycling from 2007-2011. Information was collected from the Quebec trauma registry and the coroner’s office in cases of death from cycling accidents. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated were length of stay (LOS), extended Glasgow outcome scale (GOS-E), injury severity scale (ISS), discharge destination and death.Results: 25% of cyclists wore a helmet. The helmet group was older, more likely to be university educated, married and retired. Unemployment, longer intensive care unit (ICU) stay, severe intracranial bleeding and neurosurgical interventions were more common in the no helmet group. There was no significant association between the severity of the TBI, ISS scores, GOS-E or death and helmet wearing. The median age of the subjects who died was higher than those who survived. Conclusion: Cyclists without helmets were younger, less educated, single and unemployed. They had more severe TBIs on imaging, longer LOS in ICU and more neurosurgical interventions. Elderly cyclists admitted to the hospital appear to be at higher risk of dying in the event of a TBI.