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Original research
Bicycling-related concussions leading to postconcussion syndrome in adults
  1. Connor Moore1,
  2. Paria Baharikhoob1,2,
  3. Mozhgan Khodadadi1,
  4. Charles H Tator1,3
  1. 1Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
  2. 2Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Charles H Tator; Charles.Tator{at}uhn.ca

Abstract

Background Concussions among adult bicyclists are common, but little is known about the long-term effects of the consequences of these concussions such as postconcussion syndrome (PCS) including its occurrence, clinical features and recovery potential. Indeed, our study is the first to examine PCS due to bicycling in any age group.

Objectives We examined patient demographics, concussion mechanisms and persistent symptoms as factors leading to PCS in adults and the potential for recovery.

Methods We conducted a retrospective chart review of 28 patients age 18 or older who sustained a concussion while bicycling and were referred to the Canadian Concussion Centre for management of PCS.

Results Eighteen patients (64.3%) fell from their bicycles due to loss of control, attempts to avoid a crash or collision with an object. Eight patients (28.6%) were struck by a motor vehicle, and two patients (7.1%) were injured by collision with another bicycle. The mean duration of PCS was 23.7 months and at the time of the last follow-up, 23 (82.1%) patients had failed to recover completely. Patients with one or more previous concussions had a significantly longer duration of PCS (p=0.042). Bicycling concussions resulted in a greater mean duration of PCS (23.7 months) than a comparison group of patients with PCS due to collision sports (16.1 months) (p=0.07).

Conclusion Adults who sustain bicycling-related concussions and develop PCS often have long-lasting symptoms; greater attention should be given to prevention strategies such as improved bicycling infrastructure and safer bicycling practices to reduce concussions in adult bicyclists.

  • cycling
  • concussion
  • recovery
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsem-2020-000746

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    Footnotes

    • Contributors CM: Summer research assistant at the Canadian Concussion Centre, level IV Bachelor of Health Sciences (Honours) student at McMaster University. PB: Summer research assistant at the Canadian Concussion Centre, second-year MSc candidate in medical science at the University of Toronto Institute Of Medical Science. Received a bachelor's degree in Biological Sciences and Psychology (minor) from Ryerson University. MK: Clinical Research Coordinator, Canadian Concussion Centre, Krembil Brain Institute, and Toronto Western Hospital. CHT: Emeritus Scientist, Krembil Brain Institute, Toronto Western Hospital and Professor of Neurosurgery, University of Toronto. CM, PB. MK and CHT conceived and designed the study. CM and PB analysed the data and prepared the first draft of the manuscript. CM, MK and CHT made further contributions in interpreting the data, and revising the manuscript, and have given approval for the final version to be submitted.

    • Funding Funds for this study were provided by the Canadian Concussion Centre, Krembil Brain Institute, at the Toronto Western Hospital, which is funded by the Toronto General and Western Hospital Foundation.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval This study was given ethics approval by the Research Ethics Board of the University Health Network, with the approval ID: 13-6167-BE.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data can be made available upon reasonable request. The data used for this study was deidentified participant data. The information collected included patient characteristics (sex, age, previous concussions and pre-existing conditions), helmet use during the bicycling incident, radiographic findings, injury mechanisms, symptomatology and recovery. The information collected was treated confidentially and was deidentified to protect the identities of the patients. The independent variables were patient characteristics and injury mechanism. The dependent variables were the duration of symptoms and the number of persistent symptoms from the most recent bicycling-related concussion. In all cases, the concussion which brought the patient to the CCC was the bicycling-related concussion. The information was obtained retrospectively from the clinical data registry and clinical charts of patients followed at the CCC. The data can be retrieved upon reasonable request from CHT at: Charles.Tator@uhn.ca