Emerg Med J doi:10.1136/emermed-2011-200966
  • Original article

Major trauma and urban cyclists: physiological status and injury profile

  1. Nigel R M Tai2
  1. 1Trauma Sciences, The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
  2. 2Trauma Clinical Academic Unit, The Royal London Hospital, London, UK
  3. 3London Helicopter Emergency Medical Service, The Royal London Hospital, London, UK
  1. Correspondence to Joanna Manson, Research Fellow, Trauma Clinical Academic Unit, The Royal London Hospital, London E1 1BB, UK; joanna.manson{at}
  1. Contributors JM and NT conceived the idea. JM and SC collected the data and performed the analysis. Data were contributed by AW and EF. The manuscript was written by JM with contribution from EC and NT. NT is the guarantor of the article. The work for this study was conducted by the authors. All authors are keen cyclists.

  • Accepted 26 January 2012
  • Published Online First 22 February 2012


Introduction Pedal cycling in cities has the potential to deliver significant health and economic benefits for individuals and society. Safety is the main concern for potential cyclists although the statistical risk of death is low. Little is known about the severity of injuries sustained by city cyclists and their outcome.

Aim The aim of this study was to characterise the physiological status and injury profile of cyclists admitted to our urban major trauma centre (MTC).

Methods Database analysis of cyclist casualties between 2004 and 2009. The physiological parameters examined were admission systolic blood pressure (SBP), admission base deficit and prehospital Glasgow Coma Scale.

Results 265 cyclists required full trauma-team activation. 82% were injured during a collision with a motorised vehicle. The majority (73%) had collided with a car or a heavy goods vehicle (HGV). These casualties formed the cohort for further analysis. Cyclists who collided with an HGV were more severely injured and had a higher mortality rate. Low SBP and high base deficit indicate that haemorrhagic shock is a key feature of HGV casualties.

Conclusion Collision with any vehicle can result in death or serious injury to a cyclist. Injury patterns vary with the type of vehicle involved. HGVs were associated with severe injuries and death as a result of uncontrollable haemorrhage. Awareness of this injury profile may aid prehospital management and expedite transfer to MTC care. Rapid haemorrhage control may salvage some, but not all, of these casualties. The need for continued collision prevention strategies and long-term outcome data collection in trauma patients is highlighted.


  • Funding JM is supported in part by the RCS/Philip King Charitable Settlement Trust. EC is supported by the Trauma Outcomes Grant & Barts and The London Charity.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Further information can be obtained from Joanna Manson via joanna.manson{at}

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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