Evidence map›Paper›PMID 41137112›Full record

ArticleInjury epidemiology2025

Safe system approach to preventing cyclist fatalities: safety by design for urban and rural environments.

Tanya Charyk Stewart, Allison Pellar, Moheem Halari, Kevin McClafferty, Pascal Verville, Michael Pickup, Douglas Fraser, Jason Gilliland, Michael Shkrum

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Injury epidemiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Canadian journal of surgery. Journal canadien de chirurgie
    Article
  2. What trauma from commercial vehicle crashes is telling us.Canadian journal of surgery. Journal canadien de chirurgie
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Tanya Charyk StewartDepartment of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. tanya.charykstewart@lhsc.on.ca.ORCID http://orcid.org/0009-0002-3875-2235
Allison PellarMotor Vehicle Safety Research Team, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Moheem HalariDepartment of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Kevin McClaffertyMotor Vehicle Safety Research Team, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Pascal VervilleTransport Canada, Toronto, ON, Canada.
Michael PickupOntario Forensic Pathology Service, Forensic Services and Coroner's Complex, Toronto, ON, Canada.
Douglas FraserDepartment of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Jason GillilandDepartment of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Michael ShkrumDepartment of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

Funding

Transport Canada Transport Canada
6 · The paper itself

Abstract

backgroundCyclists are vulnerable road users, with preventable deaths increasing by 48% over the past decade. This study aimed to review the epidemiology of cyclist fatalities to identify risk factors for targeted interventions through a safe system approach, with a focus on urban and rural environments.

methodsData on fatal cyclist and motor vehicle collisions (CMVC) and injuries were collected from the Office of the Chief Coroner (2013-19), including selected crash investigations and expert reviews by a multidisciplinary team. Descriptive analyses were conducted, and urban vs. rural CMVC were compared using Pearson chi-square and Mann-Whitney U tests.

resultsThere were 83 fatal cyclist collisions (81% male), with 6% children, 13% youth, 69% adults, and 12% seniors (median age = 48, ISS = 75). The head was the most severely injured body region across all age groups (median AIS = 5), except for children, whose thoracic injuries were more severe. Overall, 62% of cyclists were not wearing helmets, and 24% were impaired. Expert review found that 60% of child cyclist fatalities were run over, all of whom were ≤ 6 years. Distractions from cell phones (1%) or headphones (8%) may have contributed to CMVC. Urban collisions (49 cyclists; 59%) accounted for all child deaths and had significantly more collisions involving intersections (57% vs. 6%; p < 0.001), low-speed crashes (33% vs. 0%; p < 0.001), bike lanes (29% vs. 0%; p < 0.001), and heavy vehicles (31% vs. 6%; p = 0.006). Rural collisions were associated with higher speeds (> 50 km/h, 94% vs. 49%; p < 0.001), dark lighting (44% vs. 4%; p < 0.001), and riding on the roadway with traffic (56% vs. 16%; p < 0.001). No rural CMVCs had sidewalks or bike lanes (0% vs. 84%; 0% vs. 33%; p < 0.001).

conclusionCyclists face severe injury and death risks in both urban and rural settings. A safe system approach recognizes human vulnerability and the inevitability of mistakes. Engineering countermeasures, such as road separation, better lighting in rural areas, traffic calming, and vehicle safety features (i.e., guard rails, advanced headlights, and cyclist detection), support CMVC prevention. Public health campaigns and legislative action, along with equitable implementation across urban and rural areas, facilitate improving cyclists' safety.

Indexed as

CyclistsFatalitiesInjury preventionMotor vehicle collisionsRoad safetyRural environmentUrban environment

Identifiers

PMID41137112
PMCPMC12553174

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.