Cooke, who turned 60 earlier this month, was hoping to repeat the gold medal she earned in Rio 2016.

But she was caught in a collision with two other riders early in the race, which was marred by poor, slippery conditions.

Canada's Marie-Eve Croteau crashed and the rider behind her, Germany's Jana Majunke, braked - with Cooke then going into the back of Majunke, and crashing badly herself.

Majunke pedalled away but neither Cooke nor Croteau completed the race.

Cooke, who claimed silver in the women's time trial on Tuesday, got back on her tricycle but was unable to finish.

"Well at least I got two firsts today - first ever race crash and the first time I have not finished a race," she said from her hospital bed.

Cooke has a collapsed left lung and doctors have inserted a chest drain.

"I feel better than I did an hour ago," she said.

She will undergo further tests to see if she has any rib fractures and it is unclear how long she will need to stay in hospital.

"I'm made of concrete. I spoke to my sister and she told me it's alright, I still have three years to come back and redeem myself (in Paris)," Cooke said.

The Victorian won the mixed time trial T1-2 in London 2012 and both the T1-2 time trial and the T1-2 road race in Rio 2016.

Australian Associated Press