Pediatric Fractures Associated with Riding Bicycles: A National Twenty-Year Analysis

Abstract

Biking is a popular childhood activity that has an intrinsic risk of injury. While multiple advocacy groups have pushed for protective equipment to help mitigate these risks, to date, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth. The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify fractures presenting to U.S. Emergency Departments associated with riding bicycles in patients aged ≤ 18 years. Analysis of the annual incidence over time was performed with linear regression to determine the significance of trends observed in the number of bicycle-related fractures. A total of 34,722 fractures were identified in the database, representing an estimated 1,019,509 fractures from 2001-2020, or 50,975 fractures annually. The average age was 10.15 years, and most patients were male (70.7%). Linear regression noted that the overall trend was significant for decreasing fractures over the time period (R2=0.9011; P<0.001). Patients struck by a motor vehicle were more likely to be hospitalized (27.1% vs. 5.3%; P<0.001) and more likely to sustain injuries to the axial skeleton (19.0% vs. 5.0%; P<0.001). The majority of patients who sustained a skull fracture were not wearing helmets at the time of injury (85.7%). Fractures in males were more likely to be at the shoulder (M: 12.5%, F: 5.4%; P<0.001) or hand (M: 5.0%, F: 2.6%; P<0.001), and fractures in females were more likely to be at the elbow (M: 7.6%, F: 9.5%; P<0.001) or wrist (M: 20.5%, F: 22.9%; P<0.001). The national burden of fractures associated with riding bicycles in pediatric populations has shown a steady decrease for many years. However, our research demonstrates alarming results regarding motor vehicle involvement and helmet use in pediatric bicycle fractures, as well as several differences across sex in injury patterns.