Bicycle-Related traumatic brain injury in children seen in a pediatric emergency department: 1997-2003

Abstract

Study objectives: We examine differences in the occurrence of traumatic brain injury (TBI) in children who were injured while riding bicycles and were treated in a pediatric emergency department (ED) during a 6-year period. Methods: A retrospective review of patient data collected from an urban pediatric ED for children aged 0 to 16 years between 1997 and 2003 was carried out. The search tracked International Classification of Diseases, Ninth Revision (ICD-9) codes consistent with TBI as defined by Guidelines for Surveillance of Central Nervous System Injury. The external cause-of-injury codes (E-codes) linked to these ICD-9 codes were examined for those consistent with TBI that occurred while the child was riding a bicycle. The E-codes included were E-826.1 and E-810 to E-825, all with .6 as a fourth digit modifier. Patients' personal identifiers were removed, and then the remaining data were sorted according to age, sex, and admission status. The data were separated by age group: 8 years and younger, 9 to 11 years old consistent with grades 4 to 6, 12 to 14 years old consistent with middle school (grades 7 to 9), and 15 to 16 years. The 2 groups of particular interest were the 9- to 11-year-old group and the 12- to 14-year-old group. They were contrasted to determine whether there is a statistical difference in the incidence of TBI caused by injuries obtained while riding a bicycle. The incidence of TBI was also examined as it related to sex across the age groups. Results: From 1997 to 2003, there were 4,509 pediatric ED visits for TBI, with 175 (3.9%) for bicycle-related TBI. There were 42 bicycle-related TBIs in the 9- to 11-year-old group and 66 bicycle-related TBIs in the 12- to 14-year-old group, which accounted for 24% and 38%, respectively, of all bicycle-related TBI. The difference between the 2 age groups was statistically significant (χ 2 [1]=5.33; P =.02.) The difference between boys and girls was also of interest. Male patients were treated more frequently than female patients across all ages in the study. An examination of data from all children 0 to 16 years showed that male patients were nearly 5 times as likely to visit the ED because of bicycle-related TBI. Male patients accounted for 146 visits and female patients, 29. The difference was statistically significant (χ 2 [1]=78.2; P Conclusion: The study suggests that children of middle school age have an increased incidence of bicycle-related TBI, which could be due to differences in helmet use, riding styles, riding frequency, distance traveled, safety measures observed, or level of parental supervision, all of which needs to be delineated with further research. Boys were much more likely to sustain TBI than their female peers, which correlates with Centers for Disease Control and Prevention surveillance data for TBI that demonstrate that males are more likely to sustain TBI. Adolescents have been defined as particularly noncompliant in helmet use compared with younger children, which may explain increased TBI in this age group. Increased risk-taking in this age group could also have played an important role in the difference. These results identify children of middle school age to be particularly at risk for bicycle-related TBI. The study also demonstrates that males across all ages are at higher risk than females for bicycle-related TBI. Therefore, it may be useful to implement injury prevention techniques targeted toward this high-risk group.