On- and off-road motorcycling injury in Victoria€¦ · In this edition we highlight the injury toll in off-road motorcycling as this is an increasingly popular sport and recreation

VICTORIAN INJURY SURVEILLANCE UNIT HAZARD 64 page 1

Hazard(Edition No. 64)Spring 2006Victorian Injury SurveillanceUnit (VISU)

www.monash.edu.au/muarc/visu

Monash UniversityAccident Research Centre

In recent years, injury surveillance has focussed primarily on monitoring and characterising fatal and non-fatal motorcyclinginjuries that occur on-road. In this edition we highlight the injury toll in off-road motorcycling as this is an increasingly popularsport and recreation activity that poses a substantial public health problem especially for children and adolescents.

On- and off-road motorcyclinginjury in VictoriaErin Cassell, Angela Clapperton, Mary O’Hare & Melinda Congiu

139 deaths, 7,961 hospital admissionsand at least 9,550 ED presentationsfor motorcycling injury. Thisrepresents a yearly toll of 46 deaths,2,650 hospital admissions and at least3,180 ED presentations.

• 130 of the 139 motorcycling deaths(94%) occurred on-road.

• Motorcycling hospital admissionswere much more evenly split with 52%of cases (n=4,165) occurring on-roadand 43% off-road (n=3,444). AmongED presentations (non-admissions),47% occurred on-road (n=4,508) and37% occurred off-road (n=3,564).

• Comparison of the relative severity ofon-road and off-road motorcyclinghospitalisations, using length ofhospital stay as a proxy measure,

revealed that on-road cases had ahigher average length of stay thanoff-road cases (5.3 days vs. 3.2 days).Hospitalised on-road motorcyclistswere twice as likely to suffer severeinjuries (defined by a length of stay of8 days or more) than their off-roadcounterparts (16% vs 8%) but slightlyless likely to suffer moderately severeinjuries defined by a length of stay of2-7 days (35% vs. 38%).

• Males accounted for over 90%fatalities and hospital admissions and85% of ED presentations. Femaleswere more likely to be injured on-roadthan off-road.

• On-road motorcycling fatalities peakedin 20-24 year olds (18%, n=24) butthere were more than 10 fatalities in all5-year age groups from age 15-19 years

SummaryThe latest available three years of injurydata were extracted from the death,hospital admissions and emergencydepartment datasets for analysis: January1, 2002 to December 31, 2004 for fatalities;and July 1 2002 to June 30 2005 forhospital admissions and emergencydepartment presentations (non-admissions). On-road injuries are definedas transport-related injuries incurred bymotorcyclists in traffic accidents and off-road injuries as transport- or sports-related injuries incurred by motorcyclistsin non-traffic accidents.

• Over the three-year study period (2002-2004 for deaths and 2002/3 to 2004/5for hospital-treated injury) there were


to age 44-49 years. By contrast, off-road motorcycling fatalities wereclustered in age groups 15-19 and 20-24 years (66%, n=6). On-road hospital-treated injury cases (admissions andpresentations) peaked in 20-29 yearolds whereas off-road cases peakedin 10-19 year olds.

• A disproportionate number of fatalitiesoccurred in autumn (37% of cases),whereas hospital admissions and EDpresentations for motorcycling injurieswere fairly evenly spread acrosssummer, autumn and spring. Fewermotorcycling fatalities and hospital-treated injuries occurred in winter,which may reflect less participation incold and wet weather.

• Weekends were the peak period foron- and off-road motorcyclingfatalities, hospital admissions and EDpresentations.

• Injury patterns were similar in on- andoff-road cases. Most deaths werecaused by multiple internal and headinjuries. Fracture was the mostcommon injury in hospitalised cases,accounting for around 55% of on- andoff-road motorcycling hospitalisa-tions. Injuries were fairly evenlydistributed along the lower and upperlimbs with the knee and lower leg mostvulnerable to injury (25% of cases).For ED presentations, fractures (26%)and sprains and strains (23%), werethe most common injuries with theshoulder and upper arm and knee andlower leg bearing the brunt of injuries.

• The major cause of on-road motor-cycling fatalities was collision withother motor vehicles (63%), followedby collision with fixed or stationaryobject (25%) and non-collisiontransport accident (4%). By contrast,no off-road fatalities were caused by acollision with another motor vehicle.Non-collision transport accident(thrown, fell, overturned) caused two-thirds of off-road fatalities andcollision with fixed or stationaryobject caused one-third.

• Collisions with other vehicles caused34% of on-road motorcycling

hospitalisations and non-collisiontransport accidents a further 30% (thecause was unspecified in 27% of on-road hospitalisations). Consistentwith the pattern for off-road motor-cycling fatalities, the major cause ofoff-road hospitalisations was non-collision transport accidents (66%),followed by collision with fixed orstationary object (13%) (The causewas unspecified in 14% of off-roadcases).

• There were 9 deaths, 1,570 hospitaladmissions and 2,097 ED presenta-tions of motorcyclists aged less than18 years over the 3-year study period.All injured on-road drivers aged 0-17years (n= 372) must have beenunlicensed as the minimum age for amotorcycle learner permit in Victoriais 18 years. Off-road drivers aged 0-17 years would have been ridingillegally if the injury occurredanywhere other than on privateproperty. Rural youth were over-represented in on- and off-roadmotorcycling injury cases.

On-road motorcycle riders areapproximately 30 times more likely to bekilled or seriously injured per kilometretravelled than other vehicle occupants(Diamantopoulou et al., 1996). Estimationof the number of off-road motorcyclistsand the extent of their exposure tomotorcycling (e.g., frequency andduration of riding) is not known, so thecomparative risk of injury in off-road andon-road motorcycling cannot beestimated. Our analysis shows thatalthough more fatal and very severemotorcycling injuries occur on-road, off-road motorcycling is associated with aconsiderable toll of serious injuries,especially affecting children andadolescents, and warrants as muchpreventive action from government ason-road injury.

The Victorian government, through theTransport Accident Commission,VicRoads and Victoria Police, is currentlyimplementing a number of motorcyclingsafety projects included in the VictorianMotorcycle Road Safety Strategy 2002-2007 and special initiatives funded by

the Motorcycle Safety Levy introducedin October 2002. These include treatmentof blackspots for motorcyclist crashes,imposition of a more stringent graduatedlicensing scheme (in 2007), improve-ments to motorcycle rider training, re-development of the motorcycle learnerknowledge test, improved safetyenforcement, mass media safetycampaigns and new resources to educatemotorcyclists and raise awareness ofmotorcyclists among vehicle drivers.

By contrast, almost no attention has beenpaid to the safety of off-road motor-cycling, a burgeoning sport and leisureactivity. One major impediment to actionis the lack of a lead agency willing to takeprimary responsibility for reducing off-road motorcycling deaths and injuries.Currently, responsibility and safetyexpertise are distributed across severalgovernment departments and constituentdivisions/agencies including: Depart-ment of Sustainability and Environment,Department of Communities (Sport andRecreation and Local Government);Department of Human Services (PublicHealth and The Office for Children);Department of Justice (Victoria Police),VicRoads and the Transport AccidentCommission.

In these circumstances a whole-of-government response is required withone agency designated and resourcedby the Victorian government to take thelead and co-ordination role. TheVictorian Motorcycling AdvisoryCouncil (VMAC), established by govern-ment to provide strategic advice onissues relating to the management anddevelopment of (on-road) motorcyclingin Victoria, provides a good model for aconsultative body on off-road motor-cycling safety. VMAC includesrepresentatives of motorcycle ridergroups, manufacturers, retailers, ridertraining organizations, as well asresponsible government agencies andMonash University Accident ResearchCentre.

Development of strategies and measuresto reduce off-road motorcycling injuryshould include consideration of age


restrictions for off-road motorcycleriding, a special licensing, registrationand personal insurance scheme for off-road riders, the development, standard-isation and evaluation of skills and riskawareness training courses and packagesincluding internet based training, thedevelopment and evaluation of amentoring scheme for novice riders byexperienced riders delivered through off-road motorcycle organisations and clubs,encouragement and enforcement of theuse of helmets and measures toencourage wearing of protective andconspicuous clothing and the regularmaintenance of off-road motorbikes.

Consideration of ways to expand theprovision of supervised off-road ridingfacilities should be a component of anyfuture safety strategy as the lack of ridingspaces is fuelling illegal riding andcausing significant environmentaldamage, and effective safety promotionis only possible in a structured and legalenvironment.

This report is based in part uponresearch conducted for VicRoads. Theresearch was the first stage in a largerresearch program endorsed by theVictorian Motorcycle AdvisoryCouncil (VMAC) investigating off-road motorcycling issues

IntroductionBoth on- and off-road motorcycling areexperiencing surges in popularity inVictoria as shown by the 21% increase inbike sales over the 5-year period 2001-4(FCAI, 2005). Off-road motorcyclesoutsold on-road bikes in all 5 years.Compared to other vehicle occupants,on-road motorcyclists are a high-riskgroup for injury. On-road motorcycleriders are approximately 30 times morelikely to be killed or seriously injured perkilometre travelled than other vehicleoccupants (Haworth & Mulvihill, 2005).The aim of this study is to compare thefrequency and pattern of injury in off-road motorcycling to on-road motor-cycling and make recommendations forpreventive action.

MethodMotorcycling injury data for Victoria areavailable for three levels of severity:deaths, hospital admissions andemergency department (E.D) presenta-tions (non-admissions). The data wereextracted from three injury datasets heldby the Victorian Injury Surveillance Unit(VISU) at Monash University AccidentResearch Centre:

• The Australian Bureau of StatisticsDeath Unit Record File (ABS-DURF)for deaths

• Victorian Admitted Episodes Data-base (VAED) for hospital admissions

• Victorian Emergency MinimumDataset (VEMD) for emergencydepartment presentations (non-admissions)

The latest available three years of datawere extracted from each dataset foranalysis: January 1, 2002 to December31, 2004 for fatalities and July 1 2002 toJune 30 2005 for hospital admissions andemergency department presentations(non-admissions).

Definitions are shown in Box 1, dataextraction methods in Box 2, andinformation on the three databases heldby VISU is included in Box 3.

Results

Deaths(n=139, annual average 46 cases)

Fatalities were extracted from theAustralian Bureau of Statistics (ABS)death unit record file (DURF) for the latestavailable 3-year period, January 2002 toDecember 2004.

FrequencyThere were 139 motorcycling fatalities inVictoria over the study period, an averageof 46 deaths per year (Table 1). Eight ofthe fatalities were pillion passengers.Ninety-four percent of the fatalitiesoccurred on-road and 6% off-road. Ratedata are not available for the purpose ofcomparing risk because there are noparticipation and exposure data for off-road motorcycling.

As shown in Table 1, there was a sharpdecrease in the frequency of on- and off-road fatalities from 2002 to 2003 thatcontinued into 2004. However, the long-term trend shows volatility (Figure 1).The ABS fatality file for 2005 was notavailable at the time of writing soTransport Accident Commission (TAC)data, based on Police and VictorianCoroners’ reports, were used to graphon-road fatalities in 2005. TAC dataindicate that fatalities increased to 48 in2005 (www.tac.vic.gov.au/jsp/statistics/roadtollannual). The TAC does notpublish data on off-road motorcyclingfatalities. ABS deaths data for period1997-2004 shows that off-road motor-cycling deaths peaked in 2001 (9 deaths)and have shown a consistent downwardtrend from that year (Figure 1).

Gender and ageGenderNinety-three percent of motorcyclingfatalities were males (n=129), comprising93% of on-road fatalities (n=121) and 89%of off-road fatalities (n=8). However, noreliable participation and exposure (time-at-risk) data of males and females areavailable, so the relative risk of


motorcycling death by gender cannot beestimated.

AgeOn-road motorcycling fatalities peakedin 20-24 year olds (18%, n=23). However,there were more than ten fatalities in all5-year age groups from late adolescence(15-19 year olds) through to late middleage (44-49 year olds) (Figure 2). Bycontrast, off-road motorcycling fatalitieswere mostly clustered in age groups 15-19 and 20-24 years (66%, n=6). Thesepatterns are likely to reflect age-relatedparticipation rates and exposure (time-at-risk) to the different forms of motor-cycling. The mean age of on-roadfatalities was 35 years (median 33 years)compared with 29 years (median 23 years)for off-road fatalities.

In Victoria, the licensing age formotorcycle riding is 18 years. Underagemotorcyclists may only ride on privateproperty. Detailed analysis of injury datafor under-age motorcycle riders isreported separately at the end of theresults section.

Seasonal variationAs shown in Table 2, seasonalvariation was evident for on-roadmotorcycling deaths with the highestproportion occurring in autumn (37%)and the lowest in winter (18%). Nopattern is discernable for off-roadfatalities due to small numbers.

Day of weekOn-road fatalities were fairly evenlyspread across the week with a small peakon Sundays (Table 3). All off-roadfatalities, except one, occurred on theweekend (88.9%, n=8).

Causes of fatalitiesThe four major causes of fatalities,accounting for 84% of all motorcyclingdeaths, were:• Motorcycle rider injured in a collision

with a car, van or pick-up truck – 64deaths (46% of cases overall; 49% ofon-road fatalities and 0% of off-roadfatalities).

Frequency of on- and off-road motorcycling fatalities, Table 1Victoria 2002-4 (n=139)

Source: ABS-DURF 2002-2004

Frequency of on- and off-road motorcycling fatalities,Victoria 1997-2005 Figure 1

Source: ABS-DURF 1997-2004. TAC 2005Notes: (1) Frequency of off-road deaths for 2005 not yet available from ABS

On- and off-road motorcycling fatalities by age group, Figure 2Victoria 2002-4 (n=139)



• Motorcycle rider injured in a collisionwith a fixed or stationary object – 36deaths (26% of cases overall; 25% ofon-road fatalities and 33% of off-roadfatalities).

• Motorcycle rider injured in a collisionwith a heavy vehicle or bus – 17 deaths(12% of cases overall; 13% of on-roadfatalities and 0% of off-road fatalities).

• Motorcycle rider injured in a non-collision accident (e.g. thrown off, fallor overturned motorcycle accident) -11 deaths (8% of cases overall; 4% ofon-road fatalities and 67% of off-roadfatalities). (Table 4)

There was a different pattern of causesfor on- and off-road fatalities. Over 60%of on-road motorcycling fatalities werecaused by collisions with other motorvehicles (including heavy vehicle andbuses), whereas no off-road motorcyclefatalities were due to this cause. Thetwo causes of off-road motorcyclingfatalities were being thrown or falling frommotorcycle (67%) and collisions with afixed or stationary objects (33%).

There is no detailed information on themechanisms and circumstances ofmotorcycling fatalities on ABS-DURF.The National Coroners InformationSystem (NCIS) provides more detailedinformation on fatalities for injuryprevention purposes.

Nature and site of main injuryMost deaths were the result of multipleinternal and head injuries. The specifictypes of injuries causing death weregenerally not well specified in ABS-DURF. Injuries sustained by the on-road fatal cases were coded as follows:‘unspecified’ injuries of multiple bodyregions (n=54, 42%); ‘other andunspecified’ injuries of the head (n=28,22%); ‘other and unspecified’ injuries ofthe thorax (n=14, 11%); multiple fracturesof the head, face and neck (n=12, 9%);multiple internal injuries includingfractures (n=9, 7%); and ‘other andunspecified’ injuries (n=13, 10%). Injuriessustained by the off-road fatal caseswere: ‘unspecified’ injuries of the head(n=3); ‘multiple internal injuries’

Distribution of on- and off-road motorcycling fatalities Table 2by season, Victoria 2002-4 (n=139)


Distribution of on- and off-road motorcycling fatalities Table 3by day of the week, Victoria 2002-4 (n=139)


Causes of on- and off-road motorcycling fatalities, Table 4Victoria 2002-4 (n=139)


including fractures (n=2); multiplefractures of the cervical spine (n=1);‘unspecified’ multiple injuries (n=1);‘unspecified’ injuries of the thorax (n=1);and ‘unspecified’ injuries of the headand thorax (n=1).

Hospital admissions(n=7,961,annual average 2,654 cases)

Data on hospital admissions wereextracted for the Victorian AdmittedEpisodes Dataset (VAED) for the three-year period 2002/3 to 2004/5. To avoiddouble counting, all deaths were


excluded from the VAED dataset beforeanalysis.

FrequencyThere were 7,961 hospital admissions formotorcycling injury in Victoria over thethree-year study period, 215 (2.7%) ofwhich were pillion passengers. Over half(52%) of the hospitalised injury casesoccurred on-road, and 43% occurred off-road. The overall frequency of motor-cycling hospitalisations in Victoriaincreased by 13% from 2002/3 to 2004/5;off-road motorcycling hospitalisationsincreased by 17% and on-road hospital-isations by 12%. (Table 5.)

Rural residents (defined as personsresiding in all areas of Victoria except theMelbourne Statistical Division andGreater Geelong Statistical Sub Division)comprised 27% of on-road motorcyclinghospital admissions and 42% of off-roadadmissions. Rural residents appear tobe over-represented in off-roadadmissions because they accounted for24% of Victoria’s population over thestudy period, but off-road motorcycle usemay be higher in rural areas.

Gender and ageGenderOver 90% of on- and off-road motorcyclinghospital admissions were males (Figure 3).

AgeAs shown in Figure 4, the majordifference in the age structure of on- andoff-road motorcycling hospitalisationswas the much higher proportion of 10-19year olds among off-road motorcyclinghospitalisations (31% vs. 14%). Children(aged <15 years) formed a higherproportion of off-road motorcyclingcases than on-road cases (19% vs. 6%).The mean age of on-road motorcyclinghospitalisations was 33 years (median 31years) compared with 27 years (24 years)for off-road motorcycling cases.

Seasonal variationMotorcycling-related hospital admissionswere spread fairly evenly across the finer

Frequency of on- and off-road motorcycling hospital Table 5admissions, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5

On- and off-road motorcycling hospital admissions Figure 3by gender, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5

On- and off-road motorcycling hospital admissions by Figure 45-year age groups, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5


seasons of the year (summer, autumnand spring) with a small downturn in thewinter months, which may reflect lessparticipation in motorcycling in wet andcold conditions (Table 6).

Day of weekThere was a marked upsurge in motor-cycling-related hospital admissions onweekends with over half of both on- andoff-road hospital admissions occurringon Saturdays and Sundays (Table 7).Admissions were higher on Mondaysthan the other weekdays but there maybe some delayed admissions for injuriesthat occurred on the weekend (Table 7).

Location of injury eventOverall, one-third (n=2,598) of motor-cycling injury hospitalisations were notcoded for place of occurrence of injury(location). As would be expected, theroad/street/highway was the mostcommon location of on-road motor-cycling injury (70%, n=2,917) (Table 8).Location data for off-road motorcyclinghospitalisations was unreliable: 41% ofcases were coded to ‘unspecified’location and a further 12% were coded tothe road, street and highway. Ofspecified cases, the main locations foroff-road injury were: sports and athleticsareas (14%, mostly racetracks andracecourses), farms (11%), the home (4%),forests (4%) and other specifiedcountryside (4%).

Causes of injuryAs shown in Table 9 the major causes ofall motorcycling hospitalisations were:

• Non-collision transport accident suchas being thrown or falling from amotorcycle (44% of all motorcyclinghospital admissions)

• Motorcyclist injured in a collision witha car, pick-up truck or van (16%)

• Motorcyclist injured in a collision witha fixed or stationary object (10%).

There were a number of obviousdifferences in the pattern of causes ofon- and off-road hospitalisations:

Distribution of on- and off-road motorcycling hospital Table 6admissions by season, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5

Distribution of on- and off-road motorcycling hospital Table 7admissions by day of week, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5

On- and off-road motorcycling hospital admissions Table 8by location of injury event, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5

• On-road motorcycling injury incidentswere much more likely to involve acollision with a car, pick up truck orvan (30% cf. <1%)

• Two-thirds (66%) of all off-road injuryincidents were non-collision eventscompared with 30% of on-road injuryincidents

• A higher proportion of off-road injuryincidents were caused by a collisionwith a fixed or stationary object (13%

cf. 9%) and by collisions with 2 or 3wheeled motor vehicles (4% cf. 2%)

• A higher proportion of on-roadhospital admissions were coded to‘unspecified’ cause (27% cf. 14%).

Nature of main injuryTable 10 shows that the type of injuriessustained by on- and off-road motor-cyclists were broadly similar, indicatingthat similar injury mechanisms may apply.Fracture was the most common injury


accounting for 56% of on-road motor-cycling cases and 60% of off-road cases,followed by open wounds (8% and 9%,respectively).

Further analyses of data on the moresevere injury cases showed that therewere only small differences in theproportion of on-road and off-road caseswho sustained traumatic amputations(0.3% and 0.4% respectively), intracranial

injuries (6.9% and 7.4%) and nerve/spinalcord injuries (1.7 % and 1.0%).

Injury siteThe pattern of injured body sites wasvery similar for on- and off-road motor-cycling cases (Figure 5 and Table 11).Overall, and for both groups, the lowerextremity was the most common site ofinjury followed closely by the upperextremity. A slightly higher proportionof on-road than off-road motorcyclinginjuries were to the trunk (16% cf 14%)and a correspondingly lower proportionwere to the head/face/neck (15% cf 17%)(Figure 5)

The most commonly injured body sitesfor both on-road and off-road caseswere: the knee and lower leg (~25%),elbow and forearm (~13%), shoulder andupper arm (~13%), and the head and face(~12%) (Table 11).

Injury severity(length of hospital stay)Comparison of the relative severity ofon-road and off-road motorcyclinghospitalisations, using length of hospitalstay as a proxy measure, revealed thaton-road cases had a higher average(mean) length of stay than off-road cases(5.3 days vs. 3.2 days). Around half ofon- and off-road motorcycling hospital-ised cases were discharged from hospitalin less than two days and a further one-third in 2-7 days (Table 12). However,on-road motorcyclists were twice as likelyto suffer severe injuries (defined by alength of stay of 8 days or more) thanoff-road motorcyclists (16% vs. 8%).

The pattern of injury in severe cases wassimilar for both groups. Fractures, mostlyof the lower limb, were the most commoninjury (62% of on-road cases and 65% ofoff-road cases), followed by injury tointernal organs (8% and 10%),intracranial injuries (10% and 8%) andinjury to the nerve and spinal cord (both5%). Twenty-one percent of severelyinjured off-road motorcyclists were aged10-19 years compared with 8% of theiron-road counterparts.

Causes of on- and off-road motorcycling hospital Table 9admissions, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5

On- and off-road motorcycling hospital admissions by Figure 5broad body region injured, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5Note: The ‘other and unspecified’ category includes multiple body regions, body region not

relevant, unspecified and missing body region.


On- and off-road motorcycling hospital admissions by nature of injury, Table 10Victoria 2002/03 to 2004/05 (n=7,961)

Source: VAED 2002/3-2004/5 Victoria 2002/3 to 2004/5 (n=7,961)

On- and off-road motorcycling hospital admissions by specific body site injured, Table 11Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5


Gender and ageGenderOverall, males accounted for 85% of EDpresentations for motorcycling injuries.A higher proportion of females wereinjured in on-road riding (19% of all cases)than off-road riding (10%) but thisdifference may reflect their lowerparticipation in off-road motorcycling.

Gender participation and exposure datawere not available so it was not possibleto determine whether males are at higherrisk of ED presentation for motorcyclinginjury per se than females.

AgeAs shown in Figure 6, the major differ-ence in the pattern of ED presentationsfor motorcycling injury by age was themuch higher proportion of 5-19 year oldspresenting to ED with injuries thatoccurred off-road than on-road (36% vs.15%). At the other end of the age scale,18% of on-road motorcycling injury EDpresentations were age 45 years and olderwhereas 11% of off-road presentationsfell into this age bracket. The mean ageof on-road motorcycling ED presenta-tions was 31 years (median 29 years),

compared with 23 years (median 21 years)for off-road presentations

Seasonal variationMotorcycling ED presentations were lessfrequent in winter than the other seasonsof the year, probably reflecting lowerparticipation in wet and cold conditions(Table 14). For on-road motorcycling,ED presentations peaked in summer (27%of cases), whereas for off-road motorc-ycling, presentations peaked in autumn(29% of cases).

Day of weekThere was a marked upsurge in both on-and off-road motorcycling EDpresentations on weekends, followed bya decline until mid-week (Table 15).Motorcycling presentations were higheron Mondays than other weekdays, butsome cases presenting on a Monday maybe delayed presentations for injuries thatoccurred on the weekend.

Location of injury eventBy definition, all on-road cases occurredon the road, street or highway (Table16). Over one-third (38%) of off-roadinjuries occurred in a place for recreation,almost one-quarter (24%) occurred in thehome (garage, driveway, yard), 22%occurred on farms and 13% at sport andathletics areas.

Causes of injuryCase narrative data were analysed toidentify the causes of injury for on- andoff-road motorcycling ED presentations.A cause could be identified in half of thecases overall (50%, n=4,809) — 53% ofon-road cases (n=2405) and 48% of off-road cases (n=1695). For the remainingcases there was either no informationavailable (n=25, <1%) or the onlyavailable information was whether theinjured person was the driver of themotorcycle (n=4,364, 92%) or a pillionpassenger (n=355, 8%).

As shown in Table 17 the major causesof all motorcycling ED presentationswere:

Emergency departmentpresentations(non-admissions) (n=9,553,annual average 3,184 cases)Data on emergency department presenta-tions were extracted from the VictorianEmergency Minimum Dataset (VEMD) forthe three-year period 2002/3 to 2004/5.Only non-admissions were included inanalyses.

FrequencyThere were 9,553 motorcycling injuryE.D. presentations (non-admissions)recorded on the VEMD over the 3-yearperiod, 47% of which occurred on-roadand 37% off-road (Table 13). Ninepercent of presentations were pillionpassengers. Residents of rural Victoriawere over-represented in off-road cases(49%) but not in on-road cases (23%).

The overall frequency of motorcyclingE.D. presentations increased by 35% overthe 3-year study period, largely due tothe 66% increase in off-road motor-cycling ED presentations. On-roadmotorcycling ED presentations increasedby a comparatively modest 11%. (Table13)

On- and off-road motorcycling hospital admissions Table 12by length of hospital stay, Victoria 2002/3 to 2004/5 (n=7,961)

Source: VAED 2002/3-2004/5

Frequency of on- and off-road motorcycling hospital Table 13ED presentations, Victoria 2002/3 to 2004/5 (n=9,553)

Source: VEMD 2002/3-2004/5


• Falling or being thrown from a motor-cycle (67% of all motorcycling EDpresentations where a cause could bedetermined)

• Motorcyclist injured in a collision witha car, pick-up truck or van (25%).

There were a number of obviousdifferences in the pattern of causes ofon- and off-road ED presentations:

• As expected, on-road motorcyclinginjury incidents were much more likelyto involve a collision with a car, pickup truck or van (46% cf. 4%)

• Eighty-seven percent of all off-roadinjury incidents were falls from themotorcycle compared with 48% of on-road injury incidents

Other potential contributory factors toinjury could not be characterised morecompletely because data on variablessuch as type of motorcycle, helmet use,motorcycling speed at the time of injury,alcohol use or riding experience were notconsistently reported in case narrativedata.

Nature of main injuryThe rank order of the most commoninjuries was identical for on- and off-road motorcycling ED presentations(Table 18). The four most frequentlyoccurring injuries among both on andoff-road presentations were: fractures(22% and 29% of injuries respectively);sprains and strains (22%, 23%); super-ficial injuries (16%, 10%); and openwounds (8%, 10%).

Injury siteThe overall pattern of body sites injuredwas similar among on- and off-roadmotorcycling ED presentations in thatmost injuries were to the extremities, 58%and 75% respectively (Figure 7).However, higher proportions of on-roadthan off-road motorcycling injuries wereto multiple body sites (15% cf 7%), thehead/face/neck (11% cf 7%) and the trunk(10% cf 7%) (Table 19).

The five most common specific bodysites injured in on-road and off-roadmotorcycle injury cases presenting to ED

On- and off-road motorcycling hospital ED Figure 6presentations by 5-year age group, Victoria 2002/3 to 2004/5(n=9,553)

Source: VEMD 2002/3-2004/5

Distribution of on- and off-road motorcycling Table 14hospital ED presentations by season, Victoria 2002/3 to 2004/5(n=9,553)

Source: VEMD 2002/3-2004/5

Distribution of on- and off-road motorcycling Table 15hospital ED presentations by day of presentation,Victoria 2002/3 to 2004/5 (n=9,553)

Source: VEMD 2002/3-2004/5


On- and off-road motorcycling hospital ED presentations by location Table 16of injury event, Victoria 2002/3 to 2004/5 (n=9,553)

Source: VEMD 2002/3-2004/5

Causes of on- and off-road motorcycling ED presentations, Table 17Victoria 2002/3 to 2004/5 (n=4,809)

Source: VEMD 2002/3-2004/5


On- and off-road motorcycling hospital ED presentations by nature Table 18of main injury, Victoria 2002/3 to 2004/5 (n=9,553)

Source: VEMD 2002/3-2004/5

On- and off-road motorcycling hospital ED presentations by body Figure 7site injured, Victoria 2002/3 to 2004/5 (n=9,553)

Source: VEMD 2002/3-2004/5. Note: The ‘other and unspecified’ category includes body region not required, unspecified and missing body region.


On- and off-road motorcycling hospital ED presentations by specific Table 19body site injured, Victoria 2002/3 to 2004/5 (n=9,553)

Source: VEMD 2002/3-2004/5

were very similar, but ranking byfrequency was different (Table 19). Thetop five injury sites for on-roadmotorcycling ED presentations were:injuries to multiple sites (15% of cases);shoulder and upper arm (14%); knee andlower leg (14%); wrist and hand (12%);and ankle and foot (11%). For off-roadmotorcycling ED presentations, the topfive injured body sites were: shoulderand upper arm (18% of cases); knee andlower leg (17%); wrist and hand (16%);ankle and foot (14%) and elbow andforearm (8%).

On- and off-roadmotorcycling injury inchildren and adolescentsaged0-17 yearsThere were 9 deaths, 1,570 hospitaladmissions and 2,097 ED presentationsof motorcyclists aged less than 18 yearsover the 3-year study period. All injuredon-road drivers aged 0-17 years (n= 372)must have been unlicensed as theminimum age for a motorcycle learnerpermit in Victoria is 18 years. Off-roaddrivers aged 0-17 years would have beenriding illegally if the injury occurredanywhere other than on private property.

Over the study period, 27% of Victorianchildren and adolescents aged 0-17 yearslived in rural areas yet rural residentsaccounted for 52% of on-road and 53%of off-road motorcycling hospital

admissions, and 33% of on-road and 58%of off-road motorcycling ED presenta-tions. Although exposure to motorcycleriding may be higher in rural than urbanareas, these figures suggest that ruralyouth are over-represented in motor-cycling injury cases.

Table 20 summarises the data on deaths,hospital admissions and presentationsfor on- and off-road motorcycling injuryin persons aged 0-17 years, excludinghospital-treated cases that occurred in‘other and unspecified locations’ (6%,n=88 hospital admissions and 17%, n=365ED presentations).

Seven of the nine deaths occurred on-road (78%), two of whom were pillionpassengers. By contrast, most hospital-treated motorcycling injury casesoccurred off-road, 73% of admissions(n=1,055) and 81% of ED presentations(n=1,324). Deaths and hospital treated


On- and off-road motorcycling deaths, hospital admissions and hospital ED Table 20presentations in persons aged 0-17 years (excluding cases that occurredin ‘other and unspecified’ locations)

Source: ABS 2002-2004, VAED 2002/3-2004/5 & VEMD 2002/3-2004/5

injuries peaked in 15-17 year olds for bothon- and off road motorcycling. Fatalitiesand hospital-treated injury cases weremostly males, but females formed a higherproportion of cases with less severeinjuries (ED presentations), especiallycases that occurred on-road. Sevenpercent of on-road cases and 5% of off-road cases were severe injuries thatrequired more than 8 days hospital stay.

In two-thirds of on-road motorcyclinghospital admissions the position of therider on the motorcycle was unspecified.This is not surprising, given that the riderwould have been breaking the law if

identified as the driver and may not havevolunteered this piece of information tomedical staff.

DiscussionOn-road motorcycle riders are approxi-mately 30 times more likely to be killed orseriously injured per kilometre travelledthan other vehicle occupants (Diaman-topoulou et al., 1996). Our analysisshows that although more fatal and verysevere motorcycling injuries occur on-road, off-road motorcycling is associatedwith a considerable toll of serious injuries,

especially affecting children andadolescents, and warrants as muchpreventive action from government ason-road injury. Estimation of the numberof off-road motorcyclists and the extentof their exposure to motorcycling (e.g.,frequency and duration of riding) is notknown, so the comparative risk of injuryin off-road and on-road motorcyclingcannot be estimated.

Emergency Department presentationsdata indicate that a large proportion(~40%) of off-road riding occurs onpublic land. There are no reliable data onlegal and illegal participation in off-road


motorcycling on the public land roadnetwork and illegal tracks in State forestsand National Parks, state Parks and otherreserves. In a recent report, theDepartment of Sustainability andEnvironment estimated that 50% of the106,700 motorbikes registered in Victoriain 2004 ride on the public land roadnetwork and a further 37,000 unregisteredtrailbikes ride illegally on public land(DSE, 2005). Federal Chamber of Auto-motive Industries (FCAI) sales figuresshow that off-road motorbike sales haveoutstripped road bike sales every yearfrom 2000 to 2004 and comprised 65% ofthe 72,392 motorcycle sales over the 5-year period (DSE, 2005). It is likely thatthe injury toll from off-road motorcyclingwill continue to grow unless steps aretaken to deal with the issue.

Over the 3-year period(s) studied, off-road motorcycling contributed 6% of allmotorcycling fatalities, and 43% and 37%of all hospital admissions and EDpresentations (non-admissions) formotorcycling injuries, respectively.Injured off-road motorcyclists tend to beyounger than their on-road counterparts,with off-road fatalities and hospital-treated injury cases concentrated in the15-24 year age group. Very severe injuries(defined in our study as those requiringeight or more days hospital stay) weremore likely to occur in on-road than off-road riding. The major difference betweenthe two motorcycling activities in termsof injury causation was that off-roadmotorcyclists were more likely than theiron-road counterparts to be killed orinjured in single vehicle (non-collision)events such as falls/thrown from/overturns, and less likely to be killed orinjured in collisions with other vehicles.

Causal patterns reflect the different injuryhazards faced by off-road and on-roadmotorcyclists (Newstead & Cameron,MUARC report, undated; CDC, 2006).For example, although off-road motor-cyclists usually travel at lower speedsthey generally negotiate rugged andunpredictable terrain strewn withobstacles on trails that are generallypoorly maintained and susceptible to

deterioration in bad weather conditions,and they execute inherently riskymanoeuvres such as jumping overobstacles. Conversely, on-road motor-cycles must share the road with manyand much larger vehicles, such as carsand trucks, increasing the possibility ofadverse mass ratio accidents.

The gender and injury profiles of off-and on-road hospital-treated cases were

similar. Injured motorcyclists wereoverwhelmingly male and, in both kindsof motorcycling, the major types of injurywere fractures, open wounds and sprains/strains and the most vulnerable bodysites were the knee and lower leg, elbowand forearm and shoulder and upper arm.

Our results are broadly similar to thosereported from an earlier in-depth Victorianstudy on motorcycle injuries to childrenand adolescents (Haworth et al., 1994), arecent report on road injuries amongyoung adults in Queensland (QISU, 2006)and descriptive studies on motorcyclinginjuries conducted in the 1990s in NewZealand (Begg et al., 1994; Langley et al.,1994).

Case-control and cohort studies ofvarying quality have identified severalrisk factors for on-road (traffic) motor-cycle crashes and related injury: youngerage (age 15-19 years/age under 25 years);unlicensed riding; riding an unregisteredor unfamiliar/borrowed motorcycle;alcohol consumption in the previous 12hours; BAC>.00 and BAC>.05; notwearing a helmet; inconspicuous ridinggear (non-wearing of reflective/fluorescent clothing and wearing a blackhelmet); no daytime headlight operation;carrying a pillion passenger; riding amotorcycle with engine capacity of 750ccand above compared to one of 260cc orbelow (after adjusting for licence status);riding on non-work related tripscompared with work-related trips; lowsocio-economic status for youngerdrivers (Haworth et al., 1997; Wells et al.,2004; Liu et al., 2003; Mullin et al., 2000;Zambon & Hasselberg, 2006a; Zambon& Hasselberg 2006b).

Several studies have reported that ridingexperience protects against motorcyclinginjury but a more recent population basedcase-control study by Mullin et al. (2000)found no evidence of a protective effectafter results were adjusted for age andother potential confounders. In thisstudy, the only measure of experiencefound to be protective was familiaritywith the motorcycle - drivers who haddriven their current motorcycle 10,000kms or more had a 48% reduced riskcompared to those who had driven theirmotorcycle less than 1000 km (Mullin etal., 2000).

There is sparse information in theVictorian injury surveillance datasets onboth the contributory factors to off-roadinjury and the specific mechanisms ofinjury. Also, our literature search foundno analytic studies investigating the riskfactors for off-road motorcycling crashes/injuries. A descriptive study conductedin Victoria in 1994 followed up 174seriously injured on- and off-road ridersand pillion passengers aged under 21years, of whom 160 were admitted tohospital and 25 were killed (Haworth etal., 1994). Most of the motorcyclists under


licensing age were injured in off-roadcrashes. The authors identified a numberof potential risk factors for injury fromthe in-depth investigation of the 99 off-road motorcycling cases including:young age (riding under licensing age);body weight of rider (rider weighing lessthan 50 kg riding a motorcycle with anengine capacity of more than 100cc); lackof formal motorcycling training; lack offamiliarity with the motorcycle beingridden (in 20% of cases riders were ridingthe crash vehicle for the first or secondtime); and non-wearing of a helmet.

Of grave concern is the number of injuredoff-road motorcyclists who were drivingillegally (i.e. they were aged under 18years and injured outside the bounds ofprivate property) and injured on-roadmotorcycle drivers who were underlicensing age (18 years for learner’s andprobationary licences). It is also probablethat the motorcycles used by theunlicensed drivers were unregisteredbecause, in Victoria, registration ofmotorcycles is restricted to operatorswho are at least 17 years and 9 months ofage, and the holder of a motorcycle learnerpermit must be at least 18 years of age.In response to the growing number ofoff-road motorcycle injuries amongchildren and teens in the United States,the American Academy of Pediatricsrecommended in 2000 that parents notallow children aged less than 16 years toride off-road motorcycles, and that Statesprohibit their use by children and teensin that age group (AAP, 2000).

The lesser vehicle requirements forregistration of recreational motorcyclesin Victoria may be a contributory factorto off-road motorcycling injury.However, riding of these vehicles isrestricted to roads that are not declaredas freeways or arterial roads and areoutside built up areas.

Findings from risk factor research havesupported the development of a range ofcountermeasures to on-road crashes/injury, although few have as yet beenformally evaluated for effectiveness.There is strong support for the effective-ness of helmet wearing (Liu et al. 2003)

and preliminary evidence from NewZealand and Quebec for the effectivenessof a Graduated Licensing Scheme fornovice motorcyclists that encompass thecontrol of several of the established riskfactors for on-road crashes outlinedabove (time of day restrictions; non-carrying of pillion passengers; zeroBlood Alcohol Content limit etc.)(Mayhew & Simpson, 2001).

The Victorian government, through theTransport Accident Commission,VicRoads and Victoria Police, is currentlyimplementing a number of motorcyclingsafety projects included in the VictorianMotorcycle Road Safety Strategy 2002-2007 and special initiatives funded bythe Motorcycle Safety Levy introducedin October 2002. These include treatmentof blackspots for motorcyclist crashes,improvements to motorcycle ridertraining, re-development of the motor-cycle learner knowledge test, improvedsafety enforcement, mass media safetycampaigns and new resources to educatemotorcyclists and raise awareness ofmotorcyclists among vehicle drivers.Funded research projects includeinvestigations into: the causes of seriouscrashes; the contribution of fatigue tomotorcycle crashes; rider skills develo-pment including hazard perception andresponse; and ways to improveconsumer awareness/understanding ofprotective clothing and the protectiverating of different items.

By contrast, almost no attention has beenpaid to the safety of off-road motor-cycling, a burgeoning sport and leisureactivity. One major impediment to actionis the lack of a lead agency willing to takeprimary responsibility for reducing off-road motorcycling deaths and injuries.Currently, responsibility and safetyexpertise are distributed across severalgovernment departments andconstituent divisions/agencies includ-ing: Department of Sustainability andEnvironment, Department ofCommunities (Sport and Recreationand Local Government); Departmentof Human Services (Public Health andThe Office for Children); Department

of Justice (Victoria Police), VicRoads andthe Transport Accident Commission.

In these circumstances a whole-of-government response is required withone agency designated and resourcedby the Victorian government to take thelead and co-ordination role. TheVictorian Motorcycling AdvisoryCouncil (VMAC), established bygovernment to provide strategic adviceon issues relating to the managementand development of (on-road) motor-cycling in Victoria, provides a goodmodel for a consultative and advisorybody on off-road motorcycling safety.VMAC includes representatives ofmotorcycle rider groups, manufacturers,retailers, rider training organizations, aswell as responsible government agencies(VicRoads, Victoria Police, TransportAccident Commission) and MonashUniversity Accident Research Centre.

Development of strategies and measuresto reduce off-road motorcycling injuryshould include consideration of agerestrictions for off-road motorcycleriding, a special licensing, registrationand personal insurance scheme for off-road riders, the development, standard-isation and evaluation of skills and riskawareness training courses and packagesincluding internet based training, thedevelopment and evaluation of a mentor-ing scheme for novice riders byexperienced riders delivered through off-


road motorcycle organisations and clubs,encouragement and enforcement of theuse of helmets and measures toencourage wearing of protective andconspicuous clothing and regular main-tenance of off-road motorbikes.

Consideration of ways to expand theprovision of supervised off-road ridingfacilities should be a component of anyfuture safety strategy as the lack of ridingspaces is fuelling illegal riding andcausing significant environmentaldamage, and effective safety promotionis only possible in a structured and legalenvironment.

Data strengths and limitationsStrengthsThe three databases utilised for thisanalysis provide a statewide compilationof injury data that cover three levels ofinjury severity: deaths, hospitaladmissions and emergency departmentpresentations (non-admissions). Thesedatasets provide the most compre-hensive and complete data on motorcycleinjury in Australia because Victoria isthe only Australian state that has anEmergency Department injury sur-veillance system that covers all hospitalswith 24-hour staffed emergency services(from 2004). Further, the hospital-basedinjury surveillance data systemsseparately identify off-road (non-traffic)and on-road (traffic) cases overcomingthe shortcoming of police data that onlycovers on-road crashes, as injurious off-road crashes are not required to bereported to police. Also, police-reporteddata underestimate the number of on-road motorcycling injuries as not allinjurious on-road crashes are attendedby or reported to police, particularlycrashes that do not involve anothermotor vehicle and those that involveunlicensed riders and/or unregisteredvehicles (Rosman & Knuiman, 1994).

Limitations

Completeness of dataABS-DURF (fatalities data): ABSfatalities data are complete for 2002 and

2003 but are underestimated by 5-10% in2004 due to non-registrations of somedeaths that occurred late in that year.

VAED: Injury case capture on the VAEDis not known as no validation study ofVAED (injury surveillance) has beenundertaken. A small validation study ofVEMD conducted in four hospitals inthe late 1990s found that, on average,injury case ascertainment was 83%. Allinjury hospital admissions are processedthrough hospital emergency departmentsalthough injury cases not identified inthe ED may be noted in the medical recordafter the patient has been admitted. It isestimated that 10% of injury admissionsrecorded on the VAED are doublecounted due to the transfer of patientswithin and between hospitals for variousepisodes of care.

Trained hospital medical records staffenter data on the VAED (coded to ICD-10AM) utilising information recorded inthe patient’s medical record (electronicand paper). There may have been somemisclassification of cases to the on- andoff- road categories as there was anapparent lack of consistency in thecoding of off-road cases by cause andlocation. For this study, all off-road caseswere defined as such by their assignationto a ‘non-traffic’ transport injury cause(i.e. they were caused by a vehicleaccident that occurred in a place otherthan a public highway) yet 12% of theoff-road motorcycling hospitaladmissions selected using the ‘non-traffic’ cause codes were assigned thelocation code ‘road/street/highway’.ICD-10AM has no specific code for dirttrails/tracks so if these injury casesoccurred off-road they should have beenassigned to the location code ‘otherspecified location’.

Another limitation of the VAED data isthat the usefulness of the location andactivity codes was affected by lack ofspecificity – in 74% of off-road cases theactivity at the time of injury was codedto other or unspecified and in 38% ofcases the place where the injuryhappened (location) was unspecified.

VEMD: VEMD data are entered byuntrained ED medical and clerical staff attriage and/or later from patient self-reports, electronically recorded informa-tion and/or patient medical records. Onlypublic hospitals that offer a 24-hour EDservice contribute to the VEMD datasetso the frequency of motorcycling injuryhospital ED presentations reported heremay be an underestimate as some privatehospitals and rural public hospitalsprovide limited daytime ED services. Aspreviously mentioned, injury caseascertainment on the VEMD is estimatedat 83%. As for hospital admissions, theremay be some misclassification of on- andoff-road motorcycling injury cases assome ED presentations were coded asoccurring on a ‘road, street or highway’yet information in case narrativesindicated that the injury occurred on adirt bike track.

Recommendations

Prevention• Appointment by the Victorian

government of one governmentdepartment/agency to take the leadand co-ordination role for off-roadmotorcycling safety and establish-ment of a consultative body to adviseon state-wide and local injuryprevention and control measures.

• Consider age restrictions for riding anoff-road motorcycle and a speciallicensing, vehicle registration andpersonal injury insurance scheme.

• Develop, standardise and evaluateskills and risk awareness trainingcourses and packages, includinginternet-based training.

• Develop and evaluate a mentoringscheme for novice riders byexperienced riders delivered throughoff-road motorcycle organisations andclubs.

• Encourage and enforce the use ofhelmets by off-road motorcyclists.

• Encourage wearing of protective andconspicuous clothing by off-roadmotorcyclists.


• Encourage regular maintenance of off-road motorbikes.

Research• Improve the utility of current hospital-

based injury surveillance databasesfor monitoring and surveillance of on-and off-road motorcycle injury forinjury prevention and researchpurposes, especially the use oflocation code and quality of narrativedata.

• Link emergency presentations,hospital admissions and police recordsdatasets to improve accuracy andrepresentativeness of motorcyclinginjury data.

• Investigate off- and on-road motor-cycling fatalities in Victoria utilisingdata from the National CoronersInformation System (NCIS).

• Investigate off-road motorcyclinginjury risk and protective factors.

• Conduct an exposure study to collectparticipation and time-at-risk data toallow the determination of thecomparative risk of on- and off-roadmotorcycling.

• Investigate the minimum age at whichchildren have the physical andcognitive skills to safely ride amotorcycle off-road, and the minimumrider: motorcycle weight ratio for safemanipulation of the various styles andsizes of off-road motorcycles marketedto children.

Box 1: Definitions

Deaths and hospital admissionsDefinitions of terms used in the on and off road motorcycling deaths and hospital admissions sections of this report were drawnfrom the WHO ICD-10 coding manual:Motorcycle rider: ‘Any person riding on a motorcycle or in a sidecar or trailer attached to such a vehicle’. A motorcycle wasdefined as any road bike, dirt bike (or trail bike), moped, motorscooter or minibike. (Excluded from our analysis, to the extentpossible, were cases involving three-wheeled and four wheeled all-terrain vehicles.)Transport accident: ‘Any accident involving a device designed primarily for, or being used at the time primarily for, conveyingpersons or goods from one place to another’.Public highway [trafficway] or street: ‘The entire width between property lines (or other boundary lines) of land open to thepublic as a matter of right or custom for purposes of moving persons or property from one place to another. A roadway is that partof the public highway designed, improved and customarily used for vehicular traffic’.Traffic accident: ‘Any vehicle accident occurring on the public highway (or originating on, terminating on, or involving a vehiclepartially on the highway]. A vehicle accident is assumed to have occurred on the public highway unless another place isspecified, except in the case of accidents involving only off-road motor vehicles, which are classified as nontraffic accidentsunless the contrary is stated’.Non-traffic accident: ‘Any vehicle accident that occurs entirely in any place other than a public highway’.Using the above definitions, all injury data included in our analyses of deaths and hospital admissions were assigned to one ofthese two groups:On-road: cases of motorcycling injury that occurred in a traffic accident.Off-road: cases of motorcycling injury that occurred in a non-traffic accident.

ED presentations (non-admissions)Definitions were drawn from the VEMD coding manual.On-road: If the motorcycle injury case occurred on a ‘road, street or highway’.Off-road: If the motorcycle injury case occurred at any other location – ‘place for recreation’, ‘athletics and sports area’, ‘farm’‘home’, ‘residential institution’, ‘school, day care centre, public administration area’, ‘medical hospital’, trade or service area’,industrial or construction area’, ‘mine or quarry’ and ‘other specified place’. According to the VEMD manual, the category ‘otherspecified place’ includes such locations as mountain, beach, prairie, parking lot etc.

ReferencesAmerican Academy of Pediatrics Committee onAccident and Poisoning Prevention. All terrainvehicle injury prevention: two-, three-, and four-wheeled unlicensed motor vehicles. Pediatrics2000;105:1352-4.

Begg DJ, Langley JD, Reeder AI. Motorcyclecrashes In New Zealand resulting in death andhospitalisation. 1: Introduction, methods andoverview. Accident Analysis and Prevention1994; 26(2):157-64.

Centre for Disease Control. Nonfatal injuriesfrom off-road motorcycle riding among childrenand teens–United States, 2001-4. MMWRWeekly June 9,2006:55(22);621-624

Department of Sustainability and Environment.Trailbike project options paper. December 2005.(www.dse.vic.gov.au)

Diamantopoulou K, Skalova M, Cameron M.(1996) Casualty crash risks for motorcycleriders in Victoria: 1994. Melbourne: MonashUniversity Accident Research Centre.


Box 2: Case selection procedure

Deaths (ABS-DURF) and hospital admissions (VAED)• Cases were selected for analysis utilising ICD-10 external cause of injury codes V20-V29, ‘Motorcycle rider injured in transport

accident’. Within these codes, subcategories were selected that separated non-traffic from traffic cases.

• Extracted cases were initially aggregated and assigned to four groups: off-road (‘non-traffic’), on-road (‘traffic’), other (‘casesin which injuries were sustained whilst boarding or alighting the motorcycle’ and unspecified (all cases coded to ‘unspecified’).The other and unspecified categories were combined for most detailed analysis.

Hospital ED presentations• Cases were selected if the cause of injury was coded as 3 (‘motorcycle driver’) or 4 (‘motorcycle passenger’).

• Cases were then assigned as on-road or off-road using the location (place of occurrence of injury) variable. All cases in whichthe location of the injury event was coded to ‘road, street or highway’ were assigned to the ‘on-road’ category. Cases withother locations (‘place for recreation’, ‘athletics and sports area’, ‘farm’ etc) were assigned to the ‘off-road’ category.

• As there were large groups of cases coded under the location variable as ‘other specified’ and ‘unspecified’, a check of eachcase narrative was made for information on place of occurrence. If information on location was given, the case was re-assignedaccordingly.

In addition, a text search was made of all other case narratives on the VEMD for the study years using the words ‘dirt bike’, ‘trailbike’, ‘mini bike’, ‘motocross’, ‘enduro bike’, and ‘off-road bike’ and spelling variations of these search words. Cases where thebikes were described as three- and four-wheeled motorcycles were excluded from the sub-set by a hand search. Identified eligiblecases were added to the off-road data sub-set.

Haworth, N. & Mulvihill, C. (2005). Review ofmotorcycling licensing and training (Report No.240). Melbourne: Monash University AccidentResearch Centre.

Haworth N, Ozanne-Smith J, Fox B, Brumen I.(1994) Motorcycle-related injuries to childrenand adolescents. Melbourne: MonashUniversity Accident Research Centre. ReportNo 56.

Haworth N, Smith R, Brumen I, Pronk N.(1997) Case-control study of motorcycle crashes.Federal Office of Road Safety (FORS) ReportCR174770X. ISBN 0 642 25501 6.

Langley JD, Begg DJ, Reeder AI. Motorcyclecrashes resulting in death and hospitalisation. 11:Traffic crashes. Accident Analysis andPrevention 1994; 26 (2):165-171.

Liu B, Ivers R, Norton R et al. Helmets forpreventing injury in motorcycle riders (CochraneReview). The Cochrane Database of SystematicReviews 2003, Issue 4. Art. No.: CD04333.DOI.10.1002/14651858.CD004333

Mayhew DR, Simpson HM. (2001) Graduatedlicensing for motorcyclists. Traffic InjuryResearch Foundation.(www.trafficinjuryresearch.com)

Rosman D, Knuiman W. A comparison ofhospital and police road injury data. AccidentAnalysis and Prevention 1994;26:215-22.

Shepherd M, Hockey R, Barker R et al. Youngadults on the road. Injury Bulletin No 94,November 2006. Queensland Injury SurveillanceUnit.

Transport Accident Commission. Statistics:Annual Road Toll (www.tac.vic.gov.au/jsp/statistics/roadtollannual).

VicRoads. Victorian motorcycle road safetystrategy. Publication 01088

Wells S, Mullin B, Norton R et al. Motorcyclerider conspicuity and crash related injury: casecontrol study. British Medical Journal 2004Apr 10:328:857.

Zambon F, Hasselberg M. Factors affecting theseverity of injuries among young motorcyclists –a Swedish nationwide cohort study. TrafficInjury prevention 2006;7(2):143-9.


Box 3: VISU databases

The Australian Bureau of Statistics Death Unit Record File (ABS-DURF)This file contains information supplied by the State Registrar of Births, Deaths and Marriages from death certificates to theAustralian Bureau of Statistics (ABS). Each death registered in Australia is classified according to the World Health Organisation(WHO) International Classification of Diseases (ICD), Version 10 (ICD-10). Death data for the calendar years 1970, 1975, 1980,and 1990–2004 are held by VISU. The current file consists of 149,363 injury-related death records, 34,329 of which are Victorian.Year 2004 data may be underestimated by 5–10% due to a delay in registration of some deaths that occurred late in the year.Timeliness of data is an issue. The ABS provides VISU with a unit record file of data annually, usually in the December of thefollowing year.

The Victorian Admitted Episodes Database (VAED)The VAED is a state-wide collection of data on all admissions to Victorian hospitals (both public and private) compiled by theDepartment of Human Services. The injury surveillance subset is supplied annually to VISU. Injury data are coded to the WHOInternational Classification of Diseases Version 10 with Australian Modifications (ICD10-AM) by trained hospital personnelutilising information recorded by medical and ancillary staff in patient records (paper-based and electronic).

When integrating the injury data onto the VEMD dataset held by VISU, cases readmitted to the same hospital within 30 days areexcluded to minimise the possibility of double counting. Each record in the database represents an episode of care, and notnecessarily one incident. A patient may be transferred within and between hospitals for various episodes of care and thesetransfers cannot be tracked so that they may be represented by more than one record. This double counting is estimated toaccount for 10% of cases on the database.

The VAED (Injury Surveillance) subset held by VISU contains in excess of 2 million records for the 18-year period 1987/88 to2004/05.

The Victorian Emergency Minimum Dataset (VEMD)The VEMD records details of injury cases treated at hospitals with 24-hour Emergency Department services in Victoria compiledby the Department of Human Services and supplied quarterly to VISU. Data are supplied to DHS from the participating hospitals.At the hospital level, injury surveillance data are entered onto an electronic database by Emergency Department medical staff orclerks at triage when the patient explains the reason for presentation or later based on the information on the presenting problemrecorded electronically at triage or in the paper-based patient record. A validation study conducted by VISU has shown that 80%of injury cases are captured on the VEMD but data quality varies by hospital and by individual staff member.

Both admitted and non-admitted cases are recorded on the dataset but only non-admissions were analysed for this report(admissions data for this report were extracted from the VAED). Currently, 38 hospitals contribute data to the VEMD (InjurySurveillance). From January 2004 onwards, 100% statewide coverage applied. The total number of cases on the VISU-held VEMDdataset is in excess of 2,115,000 records. In addition to the standard injury surveillance variables —age, sex, injury cause,location, activity, nature of main injury, body region injured, and human intent— the VEMD also contains a free text description(narrative) describing the injury event in more detail. The quality of narrative data varies between hospitals and ranges from poorto excellent.


Summary Table: On- and off-road motorcycle injury cases, Victoria Table 21

Sources: Deaths - ABS-DURF 2002-2004; Hospital admissions - VAED 2002/3-2004/5;Emergency Department presentations (non-admissions) - VEMD 2002/3-2004/5Note: (1) ‘All’ includes other and unspecified


Summary Table: On- and off-road motorcycle injury cases, Victoria Table 21 (cont)



Summary Table: On- and off-road motorcycle injury cases, Victoria Table 21 (cont)



- INDEX -ubjectition Pages

Subject ..................................................................................................................................................... Edition ...................................... PagesAsphyxia........................................................................................................................................................60........................................ 1-13Babywalkers, update.........................................................................................................................16,20,25,34............... 1-4,12-13,7-8,7-8Baseball .................................................................................................................................................................................. 30 ............................................ 10-12Boating-related recreational injury ................................................................................................................................... 56 .............................................. 1-16Bunkbeds ............................................................................................................................................................................... 11 .................................................. 12Bicycles - Bicycle related ............................................................................................................................... 6,31,34,44 .......... 1-8,9-11,8-12,7-8,10-11

- Cyclist head injury study ................................................................................................................... 2,7,8,10 ....................................... 2,8,13,9Burns - Scalds, Burns prevention .................................................................................................................... 3,12,25 ............................... 1-4,1-11,4-6

- Unintentional burns and scalds in vulnerable populations ..................................................................... 57 .............................................. 1-17Child care settings ................................................................................................................................................................ 16 .............................................. 5-11Client survey results ............................................................................................................................................................ 28 .................................................. 13Cutting and piercing (unintentional) asasultive ....................................................................................................... 52, 55 .................................. 1-17,14-17Data base use, interpretation & example of form ............................................................................................................ 2 ................................................ 2-5Deaths from injury (Victoria) ....................................................................................................................................... 11,38 .................................... 1-11,1-13Dishwasher machine detergents - Update ....................................................................................................................... 18 .................................................. 11DIY maintenance injuries ................................................................................................................................................... 41 .............................................. 1-12Dog bites, dog related injuries ........................................................................................................................ 3,12,25,26,34 .................... 5-6,12,13,7-13,2-5Domestic architectural glass ..................................................................................................................................... 7,22,25 ................................. 9-10,1-5,12Domestic Violence .......................................................................................................................................................... 21,30 ......................................... 1-9,3-4Drowning/near drowning, including updates ............................................................................................... 2,5,7,30,34,55 ................. 3,1-4,7,6-9,5-7,1-13Elastic luggage straps ........................................................................................................................................................... 43 ................................................ 2-6Escalator ............................................................................................................................................................................... 24 .............................................. 9-13Exercise bicycles, update ................................................................................................................................................... 5,9 ........................................ 6,13-14Falls - Child, Older Persons, Home .................................................................................................................. 44,45,48,59 ................. 1-17,1-15,1-12,1-21Farm, Tractors ..................................................................................................................................................... 30,3324,47 ......................... 4,1-13,1-8,8-10Finger jam (hand entrapment) .................................................................................................................... 10,14,16,25,59 ................ 5,5-6,9-10,9-10,1-21Fireworks ............................................................................................................................................................................... 47 ................................................ 2-7Geographic regions of injury .............................................................................................................................................. 46 .............................................. 1-17Home .......................................................................................................................................................................... 14,32,59 ......................... 1-16, 1-13,1-21Horse related ...................................................................................................................................................................... 7,23 ...................................... 1-6,1-13Infants - injuries in the first year of life ............................................................................................................................ 8 .............................................. 7-12Injury surveillance developments, includes ICD10 coding ....................................................................................... 30,43 ...................................... 1-5,8-13Intentional ............................................................................................................................................................................ 13 .............................................. 6-11Latrobe Valley - First 3 months, Injury surveillance & prevention in L-V ....................... 9, March 1992, Feb 1994 .......................... 9-13, 1-8, 1-14Ladders .................................................................................................................................................................................. 63 .............................................. 1-14Lawn mowers ........................................................................................................................................................................ 22 ................................................ 5-9Marine animals ..................................................................................................................................................................... 56 ............................................ 18-20Martial arts ........................................................................................................................................................................... 11 .................................................. 12Mobility scooters ................................................................................................................................................................. 62 .............................................. 1-12Motor vehicle related injuries, non-traffic, vehicle jack injuires ............................................................................ 20,63 .......................................... 1-9,16Needlestick injuries ................................................................................................................................................... 11,17,25 .................................. 12,8,10-11Nursery furniture ............................................................................................................................................................. 37,44 .................................. 1-13,11-13Older people ......................................................................................................................................................................... 19 .............................................. 1-13Off-street parking areas ...................................................................................................................................................... 20 ............................................ 10-11Playground equipment ................................................................................................................... 3,10,14,16,25,29,44,617-9,4,8,8-9,13,1-12,13-14,1-21Poisons - Domestic chemical and plant poisoning .................................................................................................. 28 ................................................ 1-7

- Drug safety and poisons control ................................................................................................................. 4 ................................................ 1-9- Dishwasher detergent, update .................................................................................................................. 10,6 .......................................... 9-10,9- Early Childhood, Child Resistant Closures ...................................................................................... 27,2,47 ............................... 1-14,3,11-15- Adult overview ............................................................................................................................................. 39 .............................................. 1-17

Power saws, Chainsaws ................................................................................................................................................... 22,28 .................................. 13-17,8-13Roller Blades, Skateboards ................................................................................................................................ 2,5,25,31,44 .............. 1-2,11-13,12,12 3-7,8School .................................................................................................................................................................................... 10 ................................................ 1-8Shopping trolleys ...................................................................................................................................................... 22,25,42 ............................... 10-12,8-9,12Smoking-related .................................................................................................................................................. 21,25,29,44 ................................. 10-12,6-7,8Socio-economic status and injury ...................................................................................................................................... 49 .............................................. 1-17Sports - child sports, adult sports, surf sports ......................................................................................... 8,9,44,15,51,561-6,1-8,15-16,1-10,1-25,16-18Suicide - motor vehicle exhaust gas ................................................................................................................. 11,20,25,41 ............................ 5-6,2-4,3-4,13Trail bikes ............................................................................................................................................................................. 31 ................................................ 7-9Trampolines .............................................................................................................................................................. 13,42,61 ............................. 1-5,1-11,1-21Trends in road traffic fatality and injury in Victoria ..................................................................................................... 36 .............................................. 1-13Vapouriser units ................................................................................................................................................................... 43 ................................................ 7-8Venomous bites and stings .................................................................................................................................................. 35 .............................................. 1-13VISS: How it works, progress, A decade of Victorian injury surveillance .......................................................... 1,26,40 ............................... 1-8,1-5,1-17VISAR: Celebration of VISAR's achievements, VISAR name change to VISU ..................................................... 50,61 .......................................... 1-25,1Work-related ............................................................................................................................................................. 17,18,58 ........................... 1-13,1-10,1-17


Guest EditorsDr Dale Andrea,Manager Business Strategy, Registration and Licensing Policy, VicRoads

Prof. Joan Ozanne-Smith,Monash University Accident Research Centre

VISU StaffDirector: Ms Erin CassellCo-ordinator: Ms Karen AshbyResearch Fellow: Ms Angela Clapperton

General AcknowledgementsParticipating hospitals

From October 1995Austin & Repatriation Medical CentreBallarat Base HospitalThe Bendigo Hospital CampusBox Hill HospitalEchuca Base HospitalThe Geelong HospitalGoulburn Valley Base HospitalMaroondah HospitalMildura Base HospitalThe Northern HospitalRoyal Children's HospitalSt Vincents Public HospitalWangaratta Base HospitalWarrnambool & District Base HospitalWestern Hospital - FootscrayWestern Hospital - SunshineWilliamstown HospitalWimmera Base HospitalFrom November 1995Dandenong Hospital

From December 1995Royal Victorian Eye & Ear HospitalFrankston Hospital

From January 1996Latrobe Regional Hospital

From July 1996Alfred HospitalMonash Medical Centre

From September 1996Angliss Hospital

From January 1997Royal Melbourne Hospital

From January 1999Werribee Mercy Hospital

From December 2000Rosebud Hospital

Coronial ServicesAccess to coronial data and links withthe development of the Coronial Servicesstatistical database are valued by VISU.

How to access VISU

data:VISU collects and analyses informationon injury problems to underpin thedevelopment of prevention strategiesand their implementation. VISU analysesare publicly available for teaching,research and prevention purposes.Requests for information should bedirected to the VISU Co-ordinator or theDirector by contacting them at the VISUoffice.

Contact VISU at:MUARC - Accident Research CentreBuilding 70Monash UniversityVictoria, 3800

Phone:Enquiries (03) 9905 1805Co-ordinator (03) 9905 1805Director (03) 9905 1857Fax (03) 9905 1809

Email:[email protected]

From January 2004Bairnsdale HospitalCentral Gippsland Health Service (Sale)Hamilton Base HospitalRoyal Women's HospitalSandringham & District HospitalSwan Hill HospitalWest Gippsland Hospital (Warragul)Wodonga Regional Health Group

From April 2005Casey Hospital

All issues of Hazard and other informa-tion and publications of the MonashUniversity Accident Research Centre canbe found on our internet home page:http://www.monash.edu.au/muarc/visu

National InjurySurveillance UnitThe advice and technical back-upprovided by NISU is of fundamentalimportance to VISU.


VISU is a project of the Monash University Accident Research Centre,funded by the Department of Human Services

Hazard was produced by the Victorian Injury Surveillance Unit (VISU)

with layout assistance of Glenda Cairns, Monash University Accident Research Centre

Illustrations by Debbie Mourtzios

ISSN-1320-0593

Printed by Work & Turner Pty Ltd, Tullamarine

Documents

On- and off-road motorcycling injury in Victoria€¦ · In this edition we highlight the injury toll in off-road motorcycling as this is an increasingly popular sport and recreation