Two-wheel vehicular trauma: an age-based analysis.

We retrospectively reviewed a series of 516 patients with motorcycle (n=353) and bicycle (n=162) injuries; 384 patients (74%) were younger than age 50 years and 132 (26%) were older. No significant differences by age group were seen in gender, helmet use, substance use, complications, or mortality. Older patients had more severe (Injury Severity Score [ISS] greater than 15) injuries (35 vs 18%; P<0.001), longer intensive care unit stay (1.8 vs 0.9 days; P=0.03), and more frequent discharge to subacute facilities (27 vs 10%; P<0.001). When analyzed by vehicle type, fewer older bicyclists used helmets (63 vs 99%; P<0.001) and more sustained severe head injuries (42 vs 16%; P=0.002) and critical (ISS greater than 25) overall injuries (19 vs 6%; P=0.033). Among older patients, independent predictors of mortality included emergent intubation (P<0.001), critical injury (P=0.006), severe head/neck injury (P=0.027), tachycardia at presentation (P=0.014), and female gender (P=0.026). We conclude that motorcycle and bicycle accidents cause major injuries in older patients with substantial use of hospital and posthospital resources. Older bicyclists are vulnerable to head injury and to greater functional decline. Helmet use among older bicyclists should be a direct target for a public health campaign.