Bicycle Lanes Are We Running in Circles or

Bicycle Lanes: Are We Running in Circles or Cycling in the Right Direction? Juan Duchesne MD FACS FCCM FCCP The William Henderson Chair of Surgery Endowed Professor of Trauma Division Chief Acute Care Surgery Tulane School of Medicine TICU Medical Director Norman E. Mc. Swain Jr. MD Spirit of Charity Level I Trauma Center University Medical Center New Orleans

No conflicts of interest or financial disclosures to declare

Bicycle Safety in the U. S. Buehler and Pucher, TR News 280, May-June 2012.

Orleans Parish: Bike Friendly • Construction of on-street bicycle lanes in 2010 • Named as a “bicycle friendly city” in 2011 1 - www. norpc. org 2 - http: //bikeeasy. org/news/archives/151/

Orleans Parish: Bike Friendly www. norpc. org

Orleans Parish: Bike Unsafe? Department of Transportation, Census Bureau. 2012.

Street markings NOLA Bike Lanes Helmet use? Shared lanes (www. nola. com) Barriers

Bicycle Laws, Orleans Parish • Helmet required if <12 years old • State DUI laws do not apply to bicycling • Can be charged with reckless driving or drunk in public 1 - State v. Carr, 761 So. 2 d 1271 (2000) 2 -www. tripadvisor. com

Study Hypothesis Construction of bicycle lanes will decrease the incidence and severity of injuries to bicyclists in a major urban city in the United States

Methods • Retrospective chart review of trauma registry from 2007 -2017 at Level I Trauma Center • Data extracted from Louisiana Transportation Research Center and Pedestrian Bicycle Resource Initiative • All adult patients who were bicyclists injured in a motor vehicle accident • Separated into pre-bicycle lane and post-bicycle lane cohorts

Louisiana Transportation Research Center http: //datareports. lsu. edu/SHSPBike. Ped. aspx

Trauma Registry Patients 277 bicyclist vs. motorist identified 93 patients excluded: Non-bicycle accident, n=17 Non-motorist, n=65 Non-traffic accident n=11 184 patients met inclusion criteria Pre-bike lanes 32 patients Post-bike lanes 152 patients

Bicycles in Orleans Parish 7000 6000 Bicycle lanes Number of bicyclists * 5000 4000 3000 2000 1000 0 2007 2008 2009 2010 2011 2012 2013 Year *2007 vs. 2017, p<0. 0001 2014 2015 2016 2017

Bicycle Lane Use, Orleans Parish 100 Bicyclists (%) 80 60 * 40 2011 2012 2013 Year** *2010 vs. 2017, p<0. 0001 **No data available for 2016 2014 2015 2017

Bicycle Related Injuries in Orleans Parish Bicycle lanes

Helmet Use in Orleans Parish Bicycle lanes

Trauma Patient Demographics Pre-Bike Lanes N=32 Post-Bike Lanes p value N=152 Average (SEM) 40. 9 (2. 8) 39. 6+1. 3 0. 7 Male gender, n (%) 27 (84. 3) 116 (76. 3) 0. 5 Injury severity score, (SEM) 12. 7+1. 7 8. 9+0. 6 0. 01 Average systolic blood pressure in ED (SEM) 130+7 133+2 0. 5 Average heart rate in ED, (SEM) 94+4 88+2 0. 2 GCS in ED (SEM) 12. 6+0. 7 13. 9+0. 2 0. 02 Alcohol or drug use, n (%) 15 (46. 9) 74 (48. 7) 1. 00 Helmet use, n (%) 0 8 (5. 3) 0. 4

Location of Injuries: Pre-Bike Lane Polytrauma 62. 5%* Head and neck 59. 4%* Thoracic 15. 6% Spine 15. 6% Abdomen 9. 4% Extremities 56. 3%

Location of Injuries: Post-Bike Lane Polytrauma 44. 7%* Head and neck 38. 8%* Thoracic 18. 4% Abdomen 5. 3% Spine 15. 1% Extremities 44. 7% *p value <0. 0001

Trauma Patient Outcomes Clinical outcome Pre-Bike Lanes Post-Bike Lanes N=32 N=152 26 (81. 3) 104 (68. 4) 0. 2 1 (3. 1) 3 (2. 0) 0. 5 Hospital length of stay, avg days (SEM) 9. 4+2. 5 5. 9+0. 8 0. 09 ICU length of stay, avg days (SEM) 3. 0+1. 2 2. 2+0. 4 Patients requiring surgical intervention, n (%) 32 (100) 85 (55. 9) <0. 0001 Required hospital admission, n (%) Death, n (%) p value

Operative Procedures Procedure, n (%) Open reduction of fracture Pre-Bike Lanes Post-Bike Lanes N=32 N=152 p value 32 (100. 0) 12 (7. 9) <0. 0001 External fixator device placement 0 52 (34. 2) <0. 0001 Wound debridement 0 7 (4. 6) 0. 2 Skin graft/flap 5 (15. 6) 14 (9. 2) 0. 3 Exploratory laparotomy 1 (3. 1) 0 0. 3 Thoracotomy 1 (3. 1) 1 (0. 7) 0. 3 0 3 (2. 0) 0. 6 Craniotomy

Summary • Bicycle use increased significantly while overall bicycle lane use decreased in Orleans Parish • Number of bicycle-related trauma patients increased after bicycle lane implementation • No statistically significant increase in helmet use or decrease in intoxicated bicyclists

Study Limitations • Retrospective design • Single institution in one city • Smaller cohort of bicyclists pre-bicycle lanes • Reliability of data from state/city databases • No way to link on scene accidents and patients transferred to trauma center

Future Directions • What factors besides bicycle lanes could have had an effect on the severity of bicycle trauma? • How to reduce incidence of intoxicated bicyclists? • Could community outreach programs be instituted to help educate bicyclists and motorists? • How to increase the incidence of helmet use?

Thank you