London study shows different nature of injuries suffered by cyclists in collision with cars and HGVs

A study of admissions of seriously injured cyclists at a major London hospital has revealed that those involved in a collision with an HGV were more than three times as likely to die as those in an incident involving a car, and provides new insight into the different nature of injuries that collisions with each type of vehicle are likely to lead to.

The study, believed to be the first to analyse admissions of cyclists to hospital by the type of vehicle involved and the nature and severity of injuries, has been published online by the Emergency Medical Journal.

It was conducted by researchers from the Trauma Clinical Academic Unit at the Royal London Hospital, Queen Mary University and the London Helicopter Emergency Unit, analysed the records of 265 cyclists admitted during the six-year review period, an average of 44 a year.

Those admissions made up 4 per cent of cases necessitating the involvement of the hospital’s full trauma team, 3 per cent of the deployments of the London Air Ambulance and 5 per cent of fatalities, noted the study.

While cyclists involved in a collision with a car were more likely to survive, with a fatality rate of 6 per cent compared to 21 per cent of those where the incident involved an HGV, they were more likely to sustain head injuries, while collisions wih lorries were more likely to lead to serious injuries to the pelvis, torso and limbs.

According to the study, patients seriously injured collisions with HGVs also spent longer in the hospital, with an average stay of 12 days; however, many of those were subsequently transferred to another hospital, suggesting the injuries were of a long-term nature, and this area will be the subject of further research.

The study also highlighted that blood loss is a major cause of death among cyclists involved in road traffic incidents, highlighting the need to rapidly transfer them to a major trauma unit where surgeons could work to get bleeding under control, although it added that taking steps to prevent collisions in the first place remained a priority.

Generally, uncontrolled blood loss was said to be a factor in around half of deaths taking place shortly after serious injury, while one in four patients suffer a malfunction in their body’s ability to clot blood, an issue that is a key focus in trauma research at Queen Mary.

Dr Joanna Manson, Trauma Research Fellow at Queen Mary and Surgery Registrar at the Barts and The London NHS Trust, said: "Patients are more likely to survive severe injury if they are treated in a major trauma centre, such as The Royal London Hospital, but the injuries caused by colliding with a car or an HGV can be very serious and some patients cannot be saved.

"Overall, increasing cycling in our cities is beneficial both to the individual and to the city but the risk of injury remains a major deterrent. Exactly how to improve the safety for people cycling in urban environments is unclear and we need more evidence to guide policy making in this area," she added.

According to the study, admissions of seriously injured cyclists rose from 24 in 2004, a year in which no fatalities were recorded at the hospital, to 69 plus eight fatalities in 2009.

While The Times, which last month launched its Cities Fit For Cycling campaign, focused on those figures, which show that admissions of seriously injured cyclists increased nearly three-fold during the period in question, that upwards trend is not reflected in official London-wide statistics, and moreover comes in the latter half of a decade in which cycling on London’s roads more than doubled.

According to Transport for London (TfL) figures, eight cyclists died and 332 were seriously injured on the capital’s roads in 2004, rising to 13 killed and 420 seriously injured – the latter reflecting a 26.5 per cent increase on the earlier figure – in 2009.

Comparing those figures with the ones in the Royal London study suggests that as a proportion of the cyclists seriously injured in London, admissions to the hospital more than doubled from 7.2 per cent to 16.4 per cent between 2004 and 2009.

However, it should be noted that 2004 saw the lowest recorded levels of both death and serious injuries among cyclists in London over the past two and a half decades. In the five previous years, 1999-2003, TfL data show an average of 17 fatalities and 430 serious injuries, while for 2005-09, the respective figures are 17 and 404.

While the vast majority of patients admitted to the hospital are brought there by the London Ambulance Service or London’s Helicopter Emergency Medical Service, often deployed in major trauma cases, it also admits a small proportion who number of patients who arrive via the Essex & Herts or Kent & Surrey air ambulances.

In terms of admissions, the Royal London has by far the busiest accident & emergency department in London. A study, London’s Trauma Workload, conducted over three weeks in March 2009, showed that during the period it had around double the admissions of the next closest major trauma unit, at King’s College Hospital in South London, with nearly half the Royal London’s patients brought there by air ambulance.