What is more dangerous: road cycling or mountain biking?

What is more dangerous: road cycling or mountain biking?

A year-long study shows road cyclists suffer more serious injuries than mountain bikers, with older riders most at risk, changing the way doctors and health experts view cycling safety.

In a study recently published in the journalScientific reportsResearchers examined the specific risk associations of the two most popular cycling disciplines, road cycling and mountain biking. The prospective study used data from 149 cyclists who were treated at a trauma center over a one-year period.

Study results showed that mountain biking accidents were more than twice as common, but cycling accidents resulted in significantly more severe injuries as measured by the Injury Severity Score (ISS). Road cyclists suffered more severe head injuries and the only death in the cohort occurred in a road cyclist with head trauma. Collisions with motor vehicles were also more common among road cyclists. Additionally, the study found a positive association between age and injury severity (older riders suffer more severe injuries), particularly among road cyclists, highlighting an important risk factor for this growing population.

background

Cycling has been scientifically proven to provide multiple health and environmental benefits, including improved cardiovascular fitness, reduced carbon emissions and reduced traffic congestion. As a result, cycling has seen a significant surge in popularity worldwide, especially after the recent COVID-19 pandemic.

However, as bicycles become more common, so do concerns about safety and injury prevention. Cycling's two main disciplines, mountain biking and road cycling, offer different environments and challenges. The former involves driving on unpaved paths with technical obstacles such as stones and roots at lower speeds. Road cycling, on the other hand, involves riding on paved roads at higher speeds and often alongside car traffic.

While previous research has identified common injury patterns in general cycling, few studies have directly compared the frequency and severity of injuries between these two very different cycling styles. Understanding these differences is critical to tailoring medical responses to specific injuries, improving safety protocols on roads and trails, and educating a rapidly growing driver community.

About the study

The present study fills these knowledge gaps by conducting a prospective observational study (one year) between November 2020 and October 2021 in Barcelona, ​​Spain. The study included all adult cyclists (18 to 77 years of age) who presented to their emergency trauma department with a cycling-related injury. The result was a final study cohort of 149 samples (12% women; mean age 44.8 years).

Study data collection included each participant's sociodemographic data, medical health records, and cycling information. The cycling information included detailed reports on the type of cycling sub-discipline (road or mountain cycling), the mechanism and events of the accident, and the use of safety equipment (helmet, lights). At the same time, the ISS, a standardized anatomical scoring system ranging from 0 (no injury) to 75 (fatal), was used to clinically quantify the severity of each participant's injuries.

Statistical analyzes were performed according to the principles of the International Conference on Harmonization (ICH) Topic E9 (CPMP/ICH/363/96) and included both descriptive statistics (for quantitative variables) and multivariate regression models.

Study results

The study results showed a clear, subtype-specific divergence in both injury frequency and injury severity. Looking only at injury frequency, mountain biking accidents were far more common, accounting for 67.1% (100) of the 149 cases, more than double the 32.9% (49) for road cycling.

When examining injury severity, the results were reversed: analyzes estimated the median ISS for road cyclists at 6 (interquartile range 3-10), which is statistically higher than the median ISS of 4 (interquartile range 2-7.5) for mountain bikers (p = 0.039). Taken together, these results demonstrate that while more mountain bike injuries are reported at this trauma center, when they actually occur, road biking can cause significantly more harm than trail riding.

Finally, the study highlights a positive relationship between age and injury severity, particularly among racing cyclists. These variables showed a positive correlation, meaning older drivers suffered more severe injuries. With each additional year of life, a road cyclist's ISS increased by an average of 0.20 units, more than double the 0.09 unit increase seen in mountain bikers.

There were no significant differences between the two groups in triage level, need for surgery, or length of stay in the emergency department. The upper extremities were the most frequently injured body region in both groups.

Conclusions

The present study helps inform emergency responders, clinicians, and the growing cycling community about the specific associations observed in the two most popular sub-disciplines of cycling and illustrates that while more mountain bike injuries were observed at this center, they were rarely as damaging or life-threatening as the rarer but more serious road cycling accidents.

The results highlight the importance of recognizing the different profiles of different cycling disciplines in emergency medicine and public health. The positive association between older age and injury severity in road cyclists is a particularly important finding and highlights the vulnerable and growing group of cyclists.

For clinicians in particular, the present study highlights the need for a higher index of suspicion and increased investigation of major trauma in road cyclists, particularly in the elderly, to ensure that this high-risk group receives the appropriate level of care.

These results represent associations from a single-center study without exposure data and may not be generalizable to other populations. No comparative risk between cycling disciplines can be derived from this data set.

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