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Thoracic trauma is the third most common cause of death in multi-trauma patients. One of the most frequent mechanism is road traffic accident (RTA). The objective of the present study was to investigate the influence of severe (abbreviated injury scale, AIS≥3) injuries in each body region on the mortality of multi-trauma patients with a particular attention to thoracic trauma. We also described the epidemiology and injury pattern of these patients when presenting with at least one AIS ≥2 thoracic injury (AISThorax≥2). Patients included in the Rhône RTA registry between 1997 and 2016, with at least one AIS ≥2 injury in any body region were included. Two subgroups were defined according to whether patients presented at least one AISThorax≥2 injury or not. Multivariate regression analysis with mortality as outcome was performed. A total of 46,526 patients had at least one AIS≥2 injury, among them 6,382 (13.7%) had at least one AISThorax≥2 injury. Severe thoracic injuries (OR=12.2, 95%CI [8.4;17.7]) were strongly associated with death, second to severe head injuries were (OR=26.8, 95%CI [20.4;35.2]). Chest wall injuries were the most frequent thoracic injury (62.1%, n=5,419) and 52.4% of these were multiple rib fractures. Severe thoracic injury is a priority in multi-trauma patients; both in the detection but also in the management.

BackgroundThoracic trauma is the third most common cause of death in multi-trauma patients and is associated with poor short-term outcomes since it is responsible for up to 25% of trauma-related deaths. One of the most frequent mechanism is road traffic accident (RTA), affecting particularly young patients. The primary objective of the present study was to investigate the influence of severe injuries in each body region on the mortality of multi-trauma patients with a particular attention to thoracic trauma. Secondary objectives were to investigate risk factors for mortality in multi-trauma patients but also to describe the epidemiology and injury pattern of these patients when presenting with at least one abbreviated injury scale (AIS) ≥2 thoracic injury (AISThorax≥2).MethodsRetrospective study that included RTA occurring from January 1997 to December 2016. Patients of all ages included in the Rhône RTA registry, with at least one AIS ≥2 injury in any body region were included. Two subgroups were defined according to whether patients presented at least one AISThorax≥2 injury or not. Multivariate regression analysis with mortality as outcome was performed. ResultsA total of 46,526 patients had at least one AIS≥2 injury, among them 6,382 (13.7%) had at least one AISThorax≥2 injury. In the AISThorax≥2 group, the median [IQR] ISS was 14 [6-7] and 16.2% (n=1,031) patients died. Severe (AIS≥3) head (OR=26.8, 95%CI [20.4;35.2]) and thoracic (OR=12.2, 95%CI [8.4;17.7]) injuries were associated with death; as was age [40-59 years (OR=1.3, 95%CI [1.1;1.5]), 60-79 years (OR=2.1, 95%CI [1.7;2.6]), and ≥80 years (OR=5.5, 95%CI [4.2;7.3])], male sex (OR=1.5, 95%CI [1.3;1.7]), RTA occurring in a highway (OR=1.9, 95%CI [1.5;2.4]) or in a rural road (OR=1.8, 95%CI [1.5;2.1]). The most frequent thoracic injury was that of the chest wall (62.1%, n=5,419). The most frequent concomitant AIS≥2 injuries affected the head (29.1%), upper extremities (26.8%), and lower extremities (25.8%).ConclusionsThe present study found that the severity of thoracic trauma was an independent and significant risk factor for death in multi-trauma patients as was age, being a car occupant and having a crash in a rural road or a highway.

Context and objective Among the different products and protective gear used by riders of two-wheeled motorized vehicles, back protectors that are designed to prevent damage to the spinal column are widely used today compared other protections. However, few studies measure their effectiveness. Can their effectiveness be measured? How do they help decrease or change the nature of thoracolumbar traumas that occur? To address these questions and remedy the lack of objective data regarding these products, an epidemiological, clinical, and biomechanical analysis of motorcycle riders who were admitted to a French trauma center after an accident was performed. So, this study investigates the effectiveness of back protectors, including their ability to prevent specific mechanisms of thoracic and lumbar spinal injuries related to TWMV accidents. Method A questionnaire was administered to victims of accidents involving two-wheeled motorized vehicles who were admitted to the trauma room at the Marseille trauma center over the course of 2016. Collect data are related to the victim, the accident scenario, and a detailed description of the observed injuries using AIS (Abbreviated Injury Scale) coding and Magerl classification. Univariate analyses and Fisher tests were performed for victims who were or were not wearing back protectors. Results This study collected data from 124 victims. Almost half of the victims were wearing a back protector at the time of the accident (53 victims, thus 43% of riders). Collectively, twenty-nine victims who were wearing back protectors had 57 thoracolumbar injuries, and twenty eight victims who were not wearing back protectors had 75 thoracolumbar lesions. The results from this study show that there is no significant difference in the nature and mechanism of thoracolumbar injuries as a function of back protection. The majority of the thoracolumbar injuries were not severe. They were primarily bone injuries, essentially compression fractures, regardless of whether a back protector was worn. Conclusion This study shows that the use of back protection does not decrease the number, type, or mechanism of thoracolumbar injuries associated with accidents involving two-wheeled motorized vehicles. However, it suggests that lumbar vertebral injuries are deflected towards the thoracic vertebrae when back protectors are worn. Finally, it suggests that the design of back protectors should be reconsidered to better protect riders from what are referred to as compression fractures (craniocaudal force), which remain the primary form of fracture regardless of the rider’s characteristics, based on the data analyzed.

Road traffic accidents (RTAs) are the first cause of abdominopelvic injuries (APIs). The objective of this study was to describe the characteristics and severity of APIs due to traffic accidents in a large French trauma registry and to identify risk factors for API.All victims from the French Rhône registry of victims of RTAs were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments. All APIs, defined as an injury between the diaphragm and the pelvic bone, were extracted and studied.Among 162,695 victims, 10,165 had an API (6.7%). Accidents frequently involved young men and 2 cars. Mean Injury Severity Score (ISS) was 8.7. Mortality rate was 5.6%. Soft tissue injuries largely predominated (n = 6,388; 54.4% of patients). Overall, 2,322 victims had a pelvic bone injury. Internal abdominal organs were involved in 2,425 patients; the most frequent were the spleen, liver, and kidney. Wearing of the seat belt appeared to be a significant protective factor in API, including serious injuries. A partial analysis over the past 2 years among the most severe patients hospitalized in the intensive care unit indicated that nonoperative management was carried out in two thirds of the wounded. In uni- or multivariate analysis, sex, age, type of user, antagonist, time of occurrence, associated severe lesions, or wearing of the seat belt were statistically associated with the occurrence of API, highlighting a more dangerous user profile.Abdominopelvic injuries concern a minority of road traffic injuries, but they are responsible for significant mortality. Large solid organs are the most frequently affected. Women drivers wearing a seat belt and driving in town during the day appear to be more protected against API.

Objective: This study assesses the effectiveness of protective clothing (motorcycle jacket, trousers, gloves, knee-high or ankle boots, back protection) for motorized 2-wheeler (MTW) riders. Methods: This retrospective observational study used injury data from the Rhône Registry of Road Accident Victims, plus a postal survey conducted in 2016. Seven thousand one hundred forty-eight MTW riders involved in accidents between 2010 and 2014 were identified from the Registry and were invited to complete a questionnaire. Nine hundred seventy-nine individuals returned the questionnaire with relevant information; 951 with complete injury descriptions and clothing information were included in the study. The impact of protective clothing on injury risk was estimated using Poisson regression, with weighting for nonrespondents. Results: Sixty-seven percent of MTW riders sustained upper limb injuries and 47% sustained lower limb injuries. Gloves were the most frequent gear worn (76%), followed by jackets (59%) and knee-high or ankle boots (37%). Only 23% had back protection and 0.3% had an airbag. Wearing protective clothing was associated with a lower risk of soft tissue injury to upper and lower limbs: For upper limbs, the risk was lower when one of 2 items (a motorcycle jacket or gloves) was worn (relative risk [RR]=0.36; 95% confidence interval [CI], 0.18-0.75) and was lowest when both were worn (RR = 0.28; 95% CI, 0.12-0.69); for lower limbs, risk was reduced by wearing both motorcycle trousers and boots (RR = 0.60; 95% CI, 0.40-0.91) but was not significantly reduced when only one of these items was worn (RR = 0.90; 95% CI, 0.67-1.21). This protective effect was mainly due to a reduction in abrasions/lacerations rather than contusions. However, protective clothing did not reduce the risk of fracture, dislocation, or sprain, except for knee-high or ankle boots, which were associated with lower risk of ankle or foot fracture (RR = 0.43; 95% CI, 0.24-0.75). No effect of back protectors was shown. Conclusions: This study confirms the potential for motorcycle clothing to protect users from injury, in particular abrasions and lacerations. However, it did not show any significant protective effect against more serious injuries, such as fracture, dislocation, or sprain, except for knee-high or ankle boots, which reduced foot and ankle fracture risk. Our results argue for more widespread use of protective clothing by MTW users.

This study proposed to broadly examine vehicle use by pregnant women in order to improve realism of accident simulations involving these particular occupants. Three research pathways were developed: the first consisted in a questionnaire survey examining the driving habits of 135 pregnant women, the second obtained measurements of 15 pregnant women driving position in their own vehicle from the 6th to the 9th month of pregnancy by measuring distances between body parts and vehicle parts, and the third examined car accidents involving pregnant occupants. Results obtained indicate that between 90% and 100% of pregnant women wore their seat belts whatever their stage of pregnancy, although nearly one third of subjects considered the seat belt was dangerous for their unborn child. The measurements obtained also showed that the position of the pregnant woman in her vehicle, in relation to the various elements of the passenger compartment, changed significantly during pregnancy. In the studied accidents, no correlation was found between the conditions of the accident and the resulting fetal injury. Results reveal that pregnant women do not modify significantly the seat setting as a function of pregnancy stage. Only the distance between maternal abdomen and steering wheel change significantly, from 16 cm to 12 cm at 6 and 9 month respectively. Pregnant women are mainly drivers before 8 months of pregnancy, passengers after that. Car use frequency falls down rapidly from 6 to 9 months of pregnancy. Real crashes investigations indicate a low rate of casualties, i.e. 342 car accidents involving pregnant women for a period of 9 years in an approximately 1.7 million inhabitants area. No specific injury was found as a function of stage of pregnancy.

BACKGROUNDTraffic accidents are the most frequent cause of genitourinary injuries (GUI). Kidney injuries after trauma have been well described. However, there exists a paucity of data on other traumatic GUI after traffic accidents. The objective of this study was to analyze the frequency and type of all GUI, by user category, after traffic accidents.METHODS: Patient cases were extracted from the trauma registry of the French department of Rhone from 1996 to 2013. We assessed the urogenital injuries presented by each of road user’s categories. Severity injuries were coded with the Abbreviated Injury Scale and the Injury Severity Score. Kidney trauma was mapped with the classification of the American Association for the Surgery of Trauma. Multivariate prediction models were used for analysis of data.RESULTS: Of 162,690 victims, 963 presented with GUI (0.59%). 47% were motorcyclists, 22% were in a car, 18% on bicycles, and 9% were pedestrians. The most common organ injury was kidney (41%) followed by testicular (23%). Among the 208 motorists with a GUI, kidney (70%), bladder (10%), and adrenal gland (9%) were the most frequent lesions. Among the 453 motorcyclist victims with GUI, kidney (35%) and testicular (38%) traumas were the most frequent and 62% of injuries involved external genitalia. There were 175 cyclists with GUI, 70% of injuries involved external genitalia; penile traumas (23%) were the most frequent. In total, there were 395 kidney injuries, most being low grade. According to the American Association for the Surgery of Trauma kidney injuries were grade I, 59%; grade II, 11%; grade III, 16%; grade IV, 9%; grade V, 3%; and indeterminate, 2%.CONCLUSION: GUI is an infrequent trauma after traffic accidents, with kidneys being the most commonly injured. Physicians must maintain a high awareness for external genitalia injuries in motorcyclists and cyclists.LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.; Les accidents de la route sont la cause la plus fréquente de blessures génito-urinaires, représentant 48 % à 66 % de tout le trauma de reins (1-3). Néanmoins, l'épidémiologie de trauma de système génito-urinaire après des accidents de la route n'a pas été bien étudiée. Seulement quelques études ont rapporté l'épidémiologie de blessures génito-urinaires dans une grande base de données.

Since 2002, France has been strengthening legislation on road traffic. This study is intended to evaluate the changes in Traumatic Brain Injury (TBI) incidence and mortality resulting from Road Traffic Collision (RTC) in the two 6-year periods before and after 2002. We used a Registry of all RTC casualties in the RhoÃne Department of France. Each casualty was coded according to the Abbreviated Injury Scale (AIS). The study describes changes in demographic variables, TBI (AIS 2) incidence and mortality, other body lesions (AIS 3)associated with TBI, road user types, seatbelt and helmet wearing. - RTC casualty occurrences decreased by 21% (from 64,312 to 50,746) during the period after 2002. TBI occurrence accounted for 8.6% and 6.7% of all RTC in both periods. This corresponds to a reduction of TBI casualty incidence (-42%), which was much more pronounced than RTC casualty incidence (-25%) (p < 0.0001). Severe and critical TBI (AIS-4and -5) incidences were reduced by half as much (-21%), compared to TBI incidence. TBI mortality rate (among population) and lethality (among TBI related to RTC casualties) decreased 56% and 23%, respectively. This reduction particularly affected car occupants and victims who deceased. TBI incidence decreased 43% in all 10-year age classes until 60 on average, this decrease declining with age in the period after 2002. After adjustment for age, sex, road user types, and severity of lesions at the head and other body regions, logisticregression analysis displayed a protective effect of the period following 2002, on the risk of death after RTC-related TBI.; Une analyse effectuée à partir des données du Registre du Rhône des victimes du Rhône d'accidents de la circulation routière, porte sur les évolutions dans l'épidémiologie des traumatismes crâniens consécutifs à un accident de la route. En 2002, le Président de la République a décidé d'ériger la sécurité routière en grande cause nationale. Dans ce cadre, une mesure importante est mise en place, « le contrôle sanction automatisé » (CSA). L'objectif de cette analyse est d'étudier les changements dans l'incidence et la mortalité des traumatismes crâniens, sur deux périodes de six années autour de l'année 2002. La définition retenue pour le traumatisme crânien (TC) est « une atteinte à la tête de niveau AIS 2 ou plus ». Le registre observe une diminution de 21% de la fréquence des accidents de la route entre les deux périodes 1996-2001 et 2003-2008 (de 64 312 victimes à 50 746) et de 25 % de l'incidence, toutes gravités confondues (de 6 804/1 000 000 à5 095/1 000 000). Pour les traumatismes crâniens, la réduction de l'incidence est encore plus prononcée : -42% entre les deux périodes (de 588/1 000 000 à 339/1 000 000). Cette étude montre que la diminution d'incidence est moins marquée chez les traumatisés crâniens séÏres (AIS 4-5), où elle n'est que de 21%. Le taux de mortalité consécutif à un traumatisme crânien a baissé de 56%. La réduction du nombre de victimes présentant un traumatisme crânio-encéphalique a surtout concerné les occupants de voitures et les victimes qui décèdent. L'incidence a diminué de 43% en moyenne pour toutes les tranches d'âge de 10 ans inférieures à 60 ans. La baisse est plus faible pour les victimes âgées de 60 ans et plus. Après ajustement sur l'âge, le sexe, le type d'usager et la séÎrité des lésions à la tête et sur les autres régions, un modèle de régression logistique a mis en évidence un effet protecteur de la période récente sur le risque de décès après un traumatisme crânien. Les réductions importantes de l'incidence, de la gravité et de la mortalité des TC comparées à l'ensemble des victimes, ont principalement concerné les occupants de voiture. Ces résultats sont à attribuer à l'amélioration des standards de soin, de la sécurité primaire des voitures et des infrastructures. Cependant, les diminutions importantes obserÎes en France comparées aux autres pays développés sur les mêmes périodes, suggèrent que les effets sont grandement attribuables aux changements de comportement des usagers sur les routes, induits par les renforcements législatifs. Les groupe à risque de TC sont maintenant les utilisateurs de deux-roues (motorisés ou non) et les personnes de plus de 60 ans.

We often refer to road fatalities without knowing exactly what injuries are responsible for them. Based on the Rhône Road Trauma Registry this paper sets out to describe the topography, nature and frequency of the fatal injuries sustained by car drivers. Mean annual mortality at the wheel of a car, computed by dividing the total number of drivers killed (n=383) by the population of the Rhône Département (1.6 million) during the period 1996-2004 was 5.41 males per 100,000 and 1.41 females per 100,000, with 78% of the casualties residing in the Département. A reduction has been observed since 2003. Three-quarters of the casualties died at the scene of the crash. The results confirm the effectiveness of seat belts. The observed lethality was 0.43% for unbelted drivers and 2.7% for belted drivers (RR=0.16 [0.12; 0.21]). The injuries were analyzed for the 287 killed drivers whose deaths could be explained by the described injuries (at least one AIS 4+ injury). Of these, 41% had an ISS of 75 (at least one AIS 6 injury), 21% had an ISS of between 40 and 74, 33% an ISS of between 25 and 40, and 6% an ISS of between 16 and 24. In the case of all the AIS 4+ injuries, the three most frequent locations for injuries were the thorax only (30% of casualties), the head only (23%) and a combination of the two (18%). Abdominal injuries occurred in only 10% of casualties and spinal injuries in 9% of casualties. In the thorax, the most common injury was flail chest with haemothorax or pneumothorax. In the case of the head, the most frequent injuries were to the brain (haemorrhage, haematoma and axonal injuries). Complex fractures of the base of the skull were the second most common craniocephalic injuries. In spite of the use of restraint devices, the thorax and head are still the priority vital areas for protection in the case of car drivers. For one in four of the fatalities, death cannot be explained by any of the injuries we know about. As road traffic accidents are considered to be a cause of death in their own right, autopsies are rarely performed in France on such fatalities. This means we do not know about any injuries that cannot be detected by an external examination of the cadaver.

OBJECTIVE: To analyse the frequency and type of injury to the genitourinary system, by user category, after traffic accidents. PATIENTS AND METHODS: The register which forms the basis of this study is unique in Europe and includes 43,056 victims of road traffic accidents, and was compiled between 1996 and 2001. The categories of road users included: motorists, motorcyclists, cyclists, pedestrians, van and bus users, and roller skaters. The urological complication rate was analysed for each category. RESULTS: In all, 199 cases of trauma of the genitourinary system (0.46%) were recorded. The most frequent urological complications were renal (43%) and testicular trauma (24%), the former most frequent in motorists (65%) and pedestrians (29%), and the latter in motorcyclists (41%). CONCLUSIONS: An analysis of this register provides better knowledge of the urogenital injuries after traffic accidents. Renal and testicular injuries are the most frequent. Language: en

Traumatic spinal cord injuries (SCI) are rare but extremely costly. In order to improve the modelling of inclusion criteria for studies of SCI it is necessary to determine what epidemiological trends affect SCI. Using the Rhone Registry, which contains all the casualties resulting from road crashes in the Rhône département of France and codes their injuries using the Abbreviated Injury Scale (AIS), we describe the epidemiological trends that affect spinal cord injury (SCI), major spinal trauma (MST) and severe injuries (AIS4+) to other body regions between two periods 1996-2001 and 2003-2008. Although there has been a marked decrease (35%) in the incidence of casualties after a road traffic crash, and reductions of 22% in the incidence of MST and 33% in that of severe injuries (AIS4+) (p

Objective: The aim of this study was to examine the selfreported health status of road traffic accident victims and the predictors of self-assessed recovery 1 year after major trauma in a French population. Design: A follow-up study. Methods: The cohort comprised 276 seriously injured victims of road traffic accidents, aged > 16 years from the Rhone administrative department, France. Victim characteristics at the time of the crash and self-reported health status 1 year after trauma were collected. Predictive factors for self- assessed recovery were examined using a Poisson regression approach. Results: The majority of victims were male (76%); most had severe injuries (76%), involving mainly the lower limbs and the head (68% and 55%, respectively). At 1-year follow-up, 80% reported being not fully recovered. Self-reported health status was not significantly associated with age, gender, being in employment, type of road user, or health status during the year preceding the accident, but rather with low socioeconomic status, high injury severity, and presence of lower limb injury. Conclusion: Care for subjects who are at high risk of not fully recovering (manual workers, the very seriously injured, and those with lower limb injury) needs to be extended and improved. Longer follow-up studies on the risk factors for not fully recovering are needed in order to reduce harmful consequences for victims.

Resume Introduction Les ruptures traumatiques de l’artere sous-claviere (RTASC) sont rares et de pronostic pejoratif. L’objectif de ce travail est de decrire l’epidemiologie et les caracteristiques de la prise en charge clinique des RTASC chez les victimes d’accident de la circulation. Methodes Grâce au registre des accidents de la circulation du departement du Rhone (France), toutes les victimes de RTASC ont ete identifiees a l’aide du code AIS entre 1996 et 2008. Les dossiers cliniques, biologiques, radiologiques et la survie a j60 des patients ont ete analyses retrospectivement durant les phases pre- et intrahospitalieres. Resultats Parmi les 1181 patients avec un traumatisme thoracique grave identifies dans le registre, une RTASC a ete observee chez cinq patients (0,4 %). Quatre des cinq patients sont decedes par choc hemorragique precoce et refractaire. De nombreuses similarites ont ete mises en evidence entre ces patients : 1) les victimes arrivees vivantes a l’hopital etaient toutes des motards ayant eu un accident sans antagoniste ; 2) le bilan lesionnel retrouvait un polytraumatisme severe, thoracique et 3) orthopedique ; 4) cliniquement et biologiquement, il existait des signes de choc hemorragique grave ; 5) radiologiquement, il existait toujours des signes de dissociation scapulothoracique. Conclusion Les RTASC sont des lesions rares, mais de pronostic sombre. La reconnaissance de ces lesions doit etre precoce chez un motard accidente seul, devant une triade clinique associant, un etat de choc hemorragique, un traumatisme severe du thorax et des membres superieurs. La radiographie thoracique montrant une dissociation scapulothoracique doit conduire a une prise en charge medicochirurgicale rapide dans un centre adapte.

Fatalities or injuries following motorized and non-motorized vehicle accidents (MNMVA) are reported by police or health care systems. However, limited data exist for spinal injuries. Using an epidemiological database of road accidents occurring in a defined geographic area, we measured the incidence of major spinal trauma (MST, Abbreviated Injury Scale [AIS] score 2 or more), spinal cord injury (SCI, AIS score 4 or more), and associated lesions over a 10-year period (1997-2006). Among the 97,341 victims included, 21,623 (22.2%) suffered spinal trauma, but only 1523 (1.6%) and 144 (0.2%) sustained an MST or SCI, respectively, and among those 10% and 43% died, respectively, before reaching hospital facilities. Men were more likely to have SCI and die. Cervical injuries were more frequently observed for SCI (58%) than for MST (39%; p0.001). Motorcyclists were overrepresented in SCI (33%) compared to MST (21%; p0.001), and were at significant risk for fatality. Non-restrained car occupants were at risk of MST and SCI, whereas motorcyclists wearing helmets were not. The chest was the most frequently-injured body region. Nearly half of MNMVA victims suffering SCI die quickly after the crash. Young age, male gender, a motorcyclist, and non-restrained car occupant were risk factors for serious injury. These groups should be targeted in specific programs to decrease fatalities, spinal trauma, and SCI after MNMVA.

The aim of the study was to determine the risk factors of a severe outcome for children severely injured [killed or with an Injury Severity Score (ISS) ≥16] in a road accident. Casualties that occurred between 1996 and 2001 which involved children under 14 years of age were assessed in a population-based study based on data included in a French road trauma Registry. A severe traumatic brain injury (TBI) was defined as a head injury with an Abbreviated Injury Scale (AIS) severity score ≥3. A multivariate logistic regression was performed to quantify the risk of a “severe outcome” defined as death or an expected serious impairment 1 year later. The annual incidence of an ISS of 16+ was 7.7 per 100,000 children. Among the 126 severely injured children included in this study, 40 died (including 16 immediate deaths), and a severe outcome was expected for 54 of the 86 survivors. Children with an “isolated severe TBI” and those with “multiple injuries including TBI” were more likely to have a severe outcome than those who had an “isolated severe injury without TBI” (OR: 7.91; 95%CI: 1.43–43.77 and OR: 8.37; 95%CI: 1.52–46.13, respectively). Age was inversely linked to a severe outcome. The unprotected motor vehicle occupants (MVO) had an odds ratio of 7.56 (95%CI: 1.07–53.56) compared to the protected MVO. Only 30% of children who survived a severe TBI were admitted to rehabilitation. The mechanism of the injury, an injury pattern involving the head and a young age were associated with a severe outcome following a road accident. A majority of children severely injured were not referred to inpatient rehabilitation.

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.