Originally Posted by
I-Like-To-Bike
The data for some bicycle safety "studies" does not come from hospital ER visits but rather from self reporting of "crashes" from non-random samples of bicyclists; some of the infamous "studies" oft used to allegedly substantiate the safety claims of Vehicular Cycling advocates were just that type. In these "crash" studies, there was no filtering out of minor injuries or even no injury crashes.
And even ER visits may involve no injury/slight injury "crashes" of the getting checked out, just in case variety. Especially if a helmet or head got scratched.
Originally Posted by
I-Like-To-Bike
And even ER visits may involve no injury/slight injury "crashes" of the getting checked out, just in case variety. Especially if a helmet or head got scratched.
On top of which, it is not uncommon for an ER doctor to "upcode" an injury to ensure insurance coverage for a procedure.
For example:
S: The patient, a 27-year-old male presents with headache and tenderness on the right side of his head after falling from his bicycle when jumping the curb from street to sidewalk one hour previously. Patient reports no nerve-like radiation of pain nor tingling or numbness of the extremities. The patient denies any recent changes in vision, one-sided weakness, dysphagia or dysarthria. No recent changes in balance or ability to walk. No pain or numbness in any of the extremities is noted. Patient reports no LOC. Patient was not wearing a helmet.
O: PERLA. Skin: no lesions observed. Pulse within normal limits and regular. Respiration normal and unlabored. Muscle tone normal. Mental status: normally responsive. active range of the affected area(s) was pain-free and within normal limits. mild edema with localized tenderness to palpation noted superior to right supraorbital ridge. Cranial Nerves II-XII normally responsive bilaterally. Musce stretch reflex wnl bilaterally. upper and lower extremity muscle strength +5 bilaterally.
*OK. So what we have here is the situation I-Like-To-Bike described. Some guy whacked himself upside the head; he didn't lose consciousness, he shows no sign of neurolgical damage or even significant musculoskeletal damage. EVEN SO, I don't want this coming around and biting me in the ass. So here's what I'm going to do. I'm going to order a CT scan, just to make sure there is no fracture or bleed, for which the insurance company is going to say "screw off, ER doc" if I code him with a contusion. So I'm going to give him a concussion (unspecified) diagnosis code of 850.9, which is a billable diagnosis, and which certainly supports my orders.
Assessment: 850.9 (primary) E8xxx.xx (secondary; external causes of injury involving pedal cyclist)
Plan: CT
Now, researcher Dr. Ilovehelmets PhD comes along with his database sniffing tools, and this gets culled into the "unhelmeted cyclist, MTBI" category.
Which is bullhockey, as we can see from the notes. The guy got a headache, a bump and a bruise, and probably went home to nurse it better with a Guinness.
But you know what? Across the country, this exact scenario plays out. Every. Single. Day. Thus, these types of studies are horribly skewed from the outset.