Record-high gasoline prices, the slowdown in the economy, and increasing environmental sensitivity are leading more people to bike to work or for play. But an adequate infrastructure may not be in place to protect cyclists from serious injury according to surgeons who presented a new study on the issue during a scientific paper session at the 2009 Clinical Congress of the American College of Surgeons.

The researchers found that the severity of injury and hospital length-of-stay for bicycle injuries at one trauma center has increased significantly over the past 11 years. Despite the wide-spread attention paid to the importance of wearing helmets, helmet use did not change during the time period of the study, and more than 33 percent of 329 bicycle injury victims had a significant head injury. Even more alarming, the number of chest injuries increased by 15 percent and abdominal injuries rose three-fold over the last five years. “We were astounded by that data,” said Jeffry Kashuk, MD, FACS, associate professor of surgery at the University of Colorado School of Medicine and senior attending surgeon at the Rocky Mountain Regional Trauma Center at Denver Health Medical Center, Denver. “We’re talking about injured spleens and livers, internal bleeding, rib fractures, and hemothorax [blood in the chest]. Those kinds of injuries are reflected by an increase in injury severity score,” he added.

The study was conducted in Denver, which has one of the most well-developed bicycle path networks in the country. “Denver is very much a bicycle community. If we are seeing an increase in injuries in a metropolitan area that has fairly mature bike infrastructure from the standpoint of bike pathways, there’s reason for concern about what’s happening in metropolitan areas that don’t have that level of maturity. There seems to be a significant increase nationally in the use of the bicycle for urban transportation. If our data is a microcosm of what is going on nationally, we may be on the cusp of an injury epidemic,” Dr. Kashuk said.

Researchers at the University of Colorado hope to obtain funding so they can expand the study nationally and generate data that will support better safety standards and raise community awareness about the lack of cycling infrastructure. “On a local and national level, people need to be aware of the fact that a push for bike transportation for the sake of health, the environment, and lower transportation costs has real potential to raise medical costs because our infrastructure may not be ready for it,” Dr. Kashuk said. “Look at all the safety factors that have been incor-porated in automobiles and streets and highways. If even a percentage of that kind of investment went into safety vis-a-vis bike paths and community infrastructure, we would protect people from major injury.”

Zachary Hartman, BA; Ernest E. Moore, Jr., MD, FACS; Walter L. Biffl, MD, FACS; Catherine C. Cothren, MD, FACS; Jeffrey L. Johnson, MD, FACS; Carlton C. Barnett, Jr., MD, FACS; and Angela Sauaia, MD, participated in the study.