Cycling the single biggest activity for referrals to brain unit

Sports and exercise accidents account for a third of all referrals to the State’s main centre for treating traumatic brain injury, according to a newly published study.

Cycling was most common single activity leading to referral to the national neurological centre in Beaumont Hospital, and for transfer to its specialist care unit.

Over a 30-month period, 463 traumatic brain injuries were referred to the centre, of which 35 per cent related to sports and exercise activities.

The most commonly referred activity was cycling, with 86 incidents, followed by Gaelic football with 30, horse-riding with 23 and rugby with 13. Other referrals arose from soccer, hurling, golf and mixed martial arts.

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Of 26 patients with cycling-related head injuries who were transferred to the unit, only two were recorded as wearing a helmet at the time of injury. Eighteen did not have helmets and no information about helmet status was available for the other six cases.

The two patients with helmets suffered minor injuries while two-thirds (67 per cent) of those not wearing a helmet suffered intercranial haemorrhage, with five requiring surgical intervention.

The four patients who died were all cyclists, two of whom were involved in collisions with cars.

Contact sports

Gaelic football accounted for the most referrals of all contact sports, “most likely reflecting higher participation rates”. The study refers to a “significant disconnect” between players, coaches and administration on head injuries, with less than half of all coaches accessing online material supplied by the GAA.

Rugby accounted for 13 referrals and six transfers to the unit, giving it the highest ratio of transfers for sports-related brain injuries.

“This could be explained by the high-impact nature of the collisions and possibly a higher awareness of the potential for brain injury in rugby football among the players, coaches and referring physicians.”

Lead author Dr Philip O’Halloran said it was encouraging to see so many people engaging in sport regularly. But while most brain injuries were mild, moderate severe injuries can be life-threatening or life-changing for patients and their families.

“We need to do more to protect players across many sports at all levels. It’s inexcusable to leave a player on the pitch after a traumatic brain injury at this stage. When is a traumatic brain injury ‘just’ a concussion?”

Lack of data

The study, published in the Journal of Clinical Neuroscience, says widespread media coverage around cycling, rugby and soccer injuries had led to difficulties deciphering real risk from perceived risk. It highlights the “emerging evidence” of cognitive disorders due to repetitive head injuries and the “paucity” of information about traumatic brain injuries arising from these pursuits.

"Despite cycling being considered the healthiest and most environmentally sustainable means of transport in urban areas as well as having significant health benefits, a cyclist is one of the most vulnerable road users in Ireland, " the study states.

Dublin’s cycling infrastructure is inferior to many other European cities, “leading to an increased risk of injury” and there is no law compelling the wearing of bike helmets, it adds.

“Strong evidence exists illustrating the protective nature of helmets on brain injuries internationally and within an Irish cohort. Our study demonstrated that 69 per cent of cyclists transferred to our service were not wearing a helmet, and all four mortalities were associated with cycling.”

“Making helmet use mandatory may be associated with high-risk behaviour as well as reducing the overall number of cyclists, thereby increasing the risk to the remaining cyclists.

“The current debate regarding helmet legislation should not be used in isolation but in conjunction with a concerted effort to significantly improved the cycling infrastructure.”