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Significant increase in ED visits for bike-related injuries during the pandemic

Hospital Healthcare Europe
4 November, 2021  

An increased popularity of bike riding in Canada in 1990 led to a 60% increase in the number of emergency department (ED) visits that were attributable to carelessness or poor bike control.1 Five years later, a report by the US, the Centers for Disease Control and Prevention, noted how nearly 1000 people die from injuries caused by bicycle crashes and that 550,000 people are treated in an ED for bike-related injuries.2 Despite the propensity for accidents, the COVID-19 pandemic led to a boom in sales of bicycles, with a report from the Bicycle Association in the UK noting that between April and June 2020, bicycle sales increased by 63% year-on-year.3

But whether increased sales led to a higher incidence of accidents among children during the pandemic is uncertain and this was the question posed by a team from the Department of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.4 They conducted a cross-sectional study of ED visits to their children’s hospital between March and October 2020 and compared the level of visits with the same time period for two previous years: 2018 and 2019. 

The researchers included all patients younger than 18 years of age and who presented at the ED with a bicycle-related injury from pedal bicycles, bicycle trailers and E-Bikes. However, they excluded cases where a pedestrian was injured and motorised bicycle-related injuries (e.g., dirt bikes). Data collected from hospital injury records included demographics, chief complaint, triage acuity at presentation and the use of helmets. Acuity was assessed using the Canadian Emergency Department Triage and Acuity Scale (CTAS), which ranges from 1 (critical) to 5 (non-urgent). Outcomes were classed as “admission to hospital”, “left without being seen” or “discharged home from the ED”. Among those admitted, the researchers further categorised patients as admitted to the floor, requiring immediate surgery or admission to the intensive care unit. 


In terms of the number of visits, there were 1215 bike-related visits during the study period; 234 in 2018, 305 in 2019 and 676 in 2020. The mean age of all children was 9.5 years (67% male) and the median CTAS score was 3. The most common injury was a fracture (38.8%) and while this was numerically higher during the COVID-19 period (41.9% vs 37.5%, COVID vs pre-COVID), the difference was not statistically significant but there were significantly more bike injuries per month during the COVID-19 period compared to other times (p = 0.041). A comparison of pre-COVID-19 and COVID-19 time periods also revealed how there was a higher incidence of soft tissue bike-related injuries (28.4% vs 38.6%, p < 0.001). In contrast, there was a lower incidence of lacerations (24.3% vs 19.2%, pre vs COVID-19, p = 0.03) and multi-trauma injuries (4.3% vs 1.3%, pre vs COVID-19, p = 0.001). However, there were no significant differences for severe injuries or any other injury category.

Despite the increased rates of injury, the authors maintained that the benefits of cycling outweighed the risks and concluded that bike-related injuries increased during the pandemic and while soft tissue injuries were the most common reason, there was no difference in severe injuries compared to previous years.

  1. Cushman R et al. Bicycle-related injuries: a survey in a pediatric emergency department. CMAJ 1990;143(2):108–12.
  2. Anon. Injury-control recommendations: bicycle helmets. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. MMWR Recomm Rep 1995;44(RR-1):1–17. 
  3. Reid C, Bike sales increased 63% during lockdown reveals UK’s Bicycle Association. Forbes. 
  4. 22130aef7e12 (accessed October 2021).
  5. Shack M et al. Bicycle injuries presenting to the emergency department during COVID-19 lockdown. J Paediatr Child Health 2021. doi: 10.1111/jpc.15775.