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Introduction Cycling is increasing in some cities. Bicycle injuries are often overlooked, partly because police crash data largely under-report them. Method A road trauma registry in a French area (Rhne county, population=1.6 Million) includes both in- and out-patients, with injuries coded with the Abbreviated Injury Scale (AIS). Over 1996–2006, 14 437 people were recorded as injured (or killed) while cycling. Type of cyclists is approximately defined by crash location and age: in or out of town, or children (0–10 years old). A multivariate logistic regression is performed to quantify risk factors of injury severity. Results Incidence peaks at 7–8 years old in females and at 12 in males; the sex-ratio (M/F) is 2.2 among injured children, 3.5 among in town injured cyclists and 5.7 among out of town. Most cyclists are injured on their own: 85% in children, 62% among in-town cyclists and 73% among out-of-town. Proportion of MAIS3+ is 4.6% in children, 7.3% among in-town and 10.6% among out-of-town. Adjusted risk factors for injury severity (Max.AIS3+) are as follows: being male, aged 45 or older, not wearing a helmet, crashing in a rural place, at night, on 90 km/h roads and colliding with a motorised vehicle. MAIS1 cyclists are mostly injured at the limbs (75% of them) and at the face (27%), MAIS2 cyclists at the upper limbs (58%) and head (22%), MAIS3 at the upper limbs (58%). Finally MAIS4+ cyclists (ie, with possibly fatal injuries) are mostly injured at the head (73%) and at the thorax (24%).

Introduction Several case–control studies have assessed the effectiveness of the bicycle helmet against head and face injuries. This is the first case–control study in a non anglo-saxon setting; it is based on recent years, when foam helmets are the most common helmets. Material and Methods The study is based on a road trauma registry that covers both in and outpatients. Some 14 000 injured cyclists are included. Helmet wearing is routinely collected as part of the registry notification form. All injuries are recorded and coded with the Abbreviated Injury Scale (AIS). Cases are respectively defined as being AIS3+ head injured, AIS1+ head injured, AIS1+ face injured, AIS2+ neck injured and AIS1+ neck injured. A first analysis is similar to the analyses selected in the Cochrane review, adjusting for age, sex, motorised antagonist (yes/no). A second analysis restricts the dataset to cyclists who are at least injured in a body region other than head, face or neck (n=11 889), to sidestep the bias due to missing crash-involved but non-injured cyclists. This analysis moreover adjusts for more crash-force related variables. Results Fully adjusted OR on the restricted dataset for wearing a helmet is 0.29, 95% CI=[0.13 to 0.56] for AIS3+ head injuries, 0.75, CI=[0.62 to 0.91] for AIS1+ head injuries, 0.71, CI=[0.58 to 0.86] for AIS1+ face injuries, 1.51, CI=[0.56 to 3.82] for AIS2+ neck injuries and 1.34, CI=[1.01 to 1.77] for AIS1+ neck injuries. The Cochrane-like analyses lead to the same conclusions except for the risk of AIS1+ neck injuries. Conclusions The bicycle helmet protects against head and face injuries.