Bicycle-related Injuries Research Articles

Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors

Introduction Children ages 5-14 years have the highest rate of bicycle-related injuries in the country. Bicycle helmets can prevent head and brain injuries, which represent the most serious type of bicycle-related injury. Objectives This paper compares children's bicycle helmet use to that estimated from an earlier study, and explores regional differences in helmet use by existing helmet legislation. Methods This study was a cross-sectional, list-assisted random-digit-dial telephone survey. Interviews were completed by 9,684 respondents during 2001-2003. The subset with at least one child in the household age 5-14 years (2,409 respondents) answered questions about bicycle helmet use for a randomly selected child in their household. Results Almost half (48%) of the children always wore their helmet, 23% sometimes wore their helmet, and 29% never wore their helmet. Helmet wearing was significantly associated with race, ethnicity, and child age but was not associated with the sex of the child. Other significant predictors of use included household income, household education, census region, and bicycle helmet law status. Statewide laws were more effective than laws covering smaller areas. The proportion of children who always wore a helmet increased from 25% in 1994 to 48% in 2001-2002. Significant increases in helmet use from 20% to 26% were seen among both sexes, younger (5-9 years) and older (10-14 years) children, and in all four regions of the country. Conclusions While there has been substantial progress in the number of children who always wear their helmets, more than half do not. Further progress will require using a combination of methods that have been shown to successfully promote consistent helmet use. Impact on industry: minimal.

Bicycle-related injuries in children: Disturbing profile of a growing problem

Bicycle-related injuries in children: Disturbing profile of a growing problem

Letter: Children's bicycle safety education does not reduce injuries

Learning to ride a bicycle is a common and joyful experience of childhood (up to 68% of children reported riding a bicycle in a two-week period) that has many health benefits. However, children have the highest bicycle-related injury rates compared to other age groups. In NSW, bicycle injury-related hospitalisations in people aged 5-14 years account for approximately half of all bicycle injury-related hospitalisations. A typical bicycle education program for children will involve a one-session program focusing on safe cycling information, with some time allocated to practising safe cycling skills. However, these programs have not been well documented or evaluated. We conducted a pilot study investigating the effectiveness of a bicycle education program in increasing safe cycling knowledge and behaviour in the Macarthur area of south-west Sydney.

Characteristics of bicycle-related head injuries among school-aged children in Taipei area

Background Bicycle-related head injury is an important public health issue. A paucity of statistical data on bicycle accidents exists in Taiwan. The purpose of this study was to report the characteristics of bicycle-related head injuries among school-aged children in Taipei, Taiwan. Methods Between 2001 and 2002, basic patient information of those with bicycle-related head injuries was collected from the Trauma Data Registry in 5 hospitals of the Taipei area. Telephone interviews were conducted to collect specific information surrounding bicycle accidents. Results Of 324 patients with bicycle-related head injuries, 90 (27.8%) had severe head injuries. Boys compared with girls had a higher proportion of severe head injuries (34.1% vs 23.4%; P = .048). Children aged 5 to 9 years had a higher proportion of severe head injuries compared with ages 10 to 14 years (65.2% vs 6.4%; P = .043). Bicycles without reflectors had a higher proportion of severe head injuries compared to bicycles with reflectors (69.0% vs 5.7%; P = .004). Bicyclists carrying goods (such as backpacks or weighted toward the road) and speeding were associated with severe head injury ( P < .05). Collisions with vehicles of a larger size resulted in a higher rate of severe head injury compared with collisions with pedestrians (76.9% vs 3.6%; P = .043). Conclusions For children whose main mode of transport is bicycles, the enforcement of helmet legislation, educational programs in bicycling safety and equipment, and improving the infrastructure for bicycling in urban areas are needed in Taiwan to reduce potentially debilitating or life-threatening injuries.

Bicycle-related injuries in children: Disturbing profile of a growing problem

Context We observed a changing pattern of bicycle-related injuries in children, with the focus changing from head trauma to thoracic and abdominal injuries, and a trend to increasingly severe injuries. Objective To assess the changing injury pattern, and investigate the development of preventive measures to improve safety. Design, setting, and participants Retrospective record review of 142 paediatric patients admitted to our Department of Paediatric Surgery between 1996 and 2005 following bicycle-related injuries. Clinical, laboratory, diagnostic, and therapeutic aspects were analysed. Additional information concerning children's bicycle-related injuries in Israel was obtained from the Gertner Institute (Israel National Center for Trauma and Emergency Medicine Research) and from Beterem (The National Center for Children's Safety & Health, the Safe Kids Israeli Chapter) National Report on Child Injuries in Israel 2006. Main outcome measures The nature and severity of injuries were reviewed, and two 5-year periods compared—from 1996 to 2000 (53 children—Group 1), and from 2001 to 2005 (89 children—Group 2). Results Head trauma was more common in the Group 1 patients (52.6% vs. 45.2%), but skull fractures and intracranial haemorrhage occurred more frequently in Group 2 (28.5% vs. 16.7%; 21.3% vs. 8.3%, respectively). Injury to the stomach or duodenum, kidneys and liver were all more common in Group 2. Splenic injury occurred with equal frequency in both groups, but more severe injuries were seen in Group 2. More children in Group 2 required intensive care (31% vs. 19.3%). Conclusions There is a changing pattern of bicycle-related injuries in children, with chest and abdominal injuries dominating, and an increasing incidence of more severe injury. These findings are important in decision-making regarding preventive measures.

Myopia, Spectacle Wear, and Risk of Bicycle Accidents Among Rural Chinese Secondary School Students

To study the effect of myopia and spectacle wear on bicycle-related injuries in rural Chinese students. Myopia is common among Chinese students but few studies have examined its effect on daily activities. Data on visual acuity, refractive error, current spectacle wear, and history of bicycle use and accidents during the past 3 years were sought from 1891 students undergoing eye examinations in rural Guangdong province. Refractive and accident data were available for 1539 participants (81.3%), among whom the mean age was 14.6 years, 52.5% were girls, 26.8% wore glasses, and 12.9% had myopia of less than -4 diopters in both eyes. More than 90% relied on bicycles to get to school daily. A total of 2931 accidents were reported by 423 participants, with 68 requiring medical attention. Male sex (odds ratio, 1.55; P < .001) and spectacle wear (odds ratio, 1.38; P = .04) were associated with a higher risk of accident, but habitual visual acuity and myopia were unassociated with the crash risk, after adjusting for age, sex, time spent riding, and risky riding behaviors. These results may be consistent with data on motor vehicle accidents implicating peripheral vision (potentially compromised by spectacle wear) more strongly than central visual acuity in mediating crash risk.

A systematic review of correct bicycle helmet use: how varying definitions and study quality influence the results

Background:Bicycle helmets effectively reduce the risk of bicycle-related head injuries and trauma; however, they must fit properly to be effective. Little is known about the prevalence of correctly worn helmets...

Discrepancy in bicycle helmet use among college students between two bicycle use purposes: Commuting and recreation

Objectives The purpose of the study was to examine associations between bicycle helmet use and attitudes among U.S. college students. Bicycle helmet use was assessed for two different bicycle use purposes: commuting to school and recreation. Materials and methods Student bicycle riders were recruited on the campus of a large public university in Colorado. Questionnaire development was guided by the Theory of Reasoned Action and Health Belief Model. Bicycle use and helmet use for the two purposes, attitudes toward helmet use and bicycle helmet regulations on campus, perceived risk of bicycle-related injury, subjective norms were asked. Bicycle helmet use was defined by current behaviors and intentions for the future, based on the Stages of Change model. Results A total of 192 questionnaires collected from students who rode bicycles for both commuting and recreation was used for the analysis. Bicycle helmet use differed depending on purposes of bicycle riding: 9.4% of bicycle riders wore bicycle helmets every time for commuting, while 36.5% did so for recreation. Different variables were associated with bicycle helmet use for commuting and recreation in logistic regression models, suggesting that psychosocial structures behind bicycle helmet use behaviors might differ between two bicycle use purposes, commuting and recreation.

Bicycle related injuries presenting to a trauma centre in Hong Kong

Background Bicycle riding is a popular leisure activity and an important means of transportation in Hong Kong. Young cyclists’ riding behaviour causes injury patterns which may differ from older riders. The aim of this study is firstly to describe bicycle related injuries presenting to a regional trauma centre in Hong Kong, and secondly to compare patients aged >15 years with those patients aged ≤15 years. Methods This retrospective observational study examined all bicycle related injury patients presenting to the ED of the Prince of Wales Hospital (PWH) in 2006. Results Results showed that bicycle helmet use was low in Hong Kong suggesting that the wearing of helmets when cycling should be promoted. Bicycle related injuries were common in children but the injuries in adults were more serious. Head and limb injuries were common and limbs on the left side were 2.5 times more likely to be injured than those on the right. The older group were more likely to be involved in a motor vehicle collision and sustained more severe injuries than the younger group. They had more serious head and neck, face, thorax and abdominal injuries compared to the younger group. Conclusion Prevention strategies should include more widespread helmet use and increasing bicycle lane provision to enable traffic separation in Hong Kong. The three ‘E’ approaches (education, enforcement and environment) should be implemented to prevent bicycle injuries in Hong Kong.

Bicycle-Related Injuries Among Children and Adolescents in the United States

Bicycle-Related Injuries Among Children and Adolescents in the United States

Bicycle-Related Injuries Among Children and Adolescents in the United States

Bicycle-Related Injuries Among Children and Adolescents in the United States

IS P-1 Characteristics of bicycle-related head injuries among school-aged children in Taiwan(International Poster 1,Science and Art for Sick Children)

IS P-1 Characteristics of bicycle-related head injuries among school-aged children in Taiwan(International Poster 1,Science and Art for Sick Children)

Bicycle-related severe head injury in Japan

Bicycle-related severe head injury in Japan

What is lost when searching only one literature database for articles relevant to injury prevention and safety promotion?

Objective:To assess what is lost if only one literature database is searched for articles relevant to injury prevention and safety promotion (IPSP) topics.Method:Serial textword (keyword, free-text) searches using multiple synonym...

Bicycle-Related Injuries Among Children and Adolescents in the United States

The objective of this study is to describe the epidemiology of bicycle-related injuries among children and adolescents 18 years and younger on a national level. This is a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients 18 years and younger who were seen in emergency departments (EDs) between January 1, 1990, and December 31, 2005, for injuries received while operating a bicycle. During the 16-year study period, there were an estimated 6 228 700 individuals 18 years and younger treated in US EDs for bicycle-related injuries. Children with head injuries were more than 3 (relative risk, 3.63) times as likely to require hospitalization and were almost 6 (relative risk, 5.77) times more likely to have their injuries result in death. The large number of annual bicycle related-injuries is evidence that prevention of these injuries should remain an important area of bicycle safety research and practice.

Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries

Evidence exists to suggest that bicycle helmets may reduce the risk of head injuries to cyclists, however helmets are not uniformly worn by all bicycle users. Legislation has been enacted in some countries to mandate helmet use by cyclists, however the issue remains controversial with opponents arguing that this may inhibit people from bicycle riding and thus from gaining the associated health benefits, or that other countermeasures may have been responsible for decline in head injuries. To assess the effects of bicycle helmet legislation on bicycle-related head injuries and helmet use, and the occurrence of unintended adverse consequences. We searched CENTRAL, the Cochrane Injuries Group's specialised register, MEDLINE, EMBASE, TRANSPORT and other specialist electronic databases, up to February 2006. In addition we searched government websites, handsearched selected journals and examined the reference lists of selected publications. We included studies that reported changes in either the number of head injuries, helmet use or bicycle use post- versus pre-legislation. Only studies that included a concurrent control group and which reported on the effect of legislation implemented at either the country, state or province wide level were included. Two authors independently extracted data and assessed methodological quality. The data were not appropriate for meta-analysis, thus the results of the included studies have been reviewed narratively. Five studies, all from North America, met the inclusion criteria. For each of the studies, bicycle helmet legislation had been enacted for children only. Adults were used as controls in four of the studies, whilst jurisdictions with no helmet legislation were used as controls in the fifth. Three of the studies reported on changes in head injury rates and three reported on changes in helmet use. There were no included studies reporting change in bicycle use or other adverse consequences of legislation. In two studies, statistically significant decreases in head injuries were reported following the implementation of helmet legislation compared with controls, whilst one reported a non-statistically significant decline. Bicycle helmet use increased statistically significantly post-legislation in all three of the studies reporting on helmet use. Bicycle helmet legislation appears to be effective in increasing helmet use and decreasing head injury rates in the populations for which it is implemented. However, there are very few high quality evaluative studies that measure these outcomes, and none that reported data on an possible declines in bicycle use.

Bicycle Injury Documentation Before and After Charting Intervention

Previous studies have shown that routinely completed free-text emergency department medical records contain limited information necessary for injury surveillance. We instituted an injury documentation sheet into our emergency department records to evaluate the impact on completeness of bicycle injury documentation rates. The pretest/posttest study design used E-codes to identify bicycle-related injuries. A standardized data collection tool was utilized to review these charts. Time periods before (January 1 to December 31, 2004) and after (January 1 to June 30, 2005) institution of a standardized documentation sheet were reviewed. Data were entered into the computer program, Epistat, and scores were used for comparison. Initial review (n = 667) revealed mean age of patients 8.6 years, with 46% African American and 67% male. Helmet usage was documented in 49% of the charts (81 were wearing helmets; 245 were not wearing helmets). Mechanism of injury was documented as bicycle alone in 587, bicycle versus car in 13, and bicycle versus stationary object in 64. After implementation of an injury data sheet (n = 205), it was found that the mean age was 9.24 years, with 51% African American and 43% male. Helmet use was documented in 77% of cases (26 wearing helmets; 132 not wearing). Mechanism was documented as bicycle alone in 125, bicycle versus car in 66, and bicycle versus stationary object in 14. Helmet use was much more frequently documented after the initiation of an injury documentation reminder sheet (z = 6.97; P < 0.001; 95% confidence interval, 20.2-35.8). The use of standard injury documentation prompts increased completeness of documentation. With improved documentation, more accurate injury surveillance can be performed.

A Clinical Decision Rule for Cranial Computed Tomography in Minor Pediatric Head Trauma

To develop a sensitive clinical decision rule with a high negative predictive value for the use of cranial computed tomography (CT) in minor pediatric head trauma, to identify clinical features predictive of neurosurgical intervention, and to assess clinicians' predictive abilities to determine the presence or absence of intracranial injury based on history and physical examination alone. Prospective observational study. Four level I pediatric trauma centers. One thousand patients younger than 21 years with minor head trauma undergoing cranial CT. Intracranial injury as demonstrated by CT and neurosurgical intervention. Of 1000 patients in the study, the mean age was 8.9 years, and 64.1% were male; 6.5% (65 of 1000) had positive findings on CT, and 9.2% (6 of 65) of these required neurosurgical intervention. Recursive partitioning identified the following variables in the decision rule: dizziness, skull defect, sensory deficit, mental status change, bicycle-related injury, age younger than 2 years, Glasgow Coma Scale score less than 15, and evidence of a basilar skull fracture. For detection of intracranial injury, the decision rule had a sensitivity of 95.4% (95% confidence interval [CI], 86.2%-98.8%), a specificity of 48.9% (95% CI, 46.6%-52.1%), and a negative predictive value of 99.3% (95% CI, 98.1%-99.8%). We developed a sensitive clinical decision rule with a high NPV for detection of intracranial injury in minor pediatric head trauma. If validated, this rule could provide a useful adjunct to the physician's clinical assessment by reducing variations in practice and unnecessary cranial CT.

Bicycle-related injuries in Tehran.

Herein, we reviewed the pattern and mechanisms of injuries resulting from bicycle accidents in Tehran. During one year of trauma registry in six general hospitals, 8,000 trauma patients who had sustained injuries within a week before admission and hospitalized for more than 24 hours were studied. Bicycle injuries comprised 2.1% (n=170) of all cases admitted during the studied period. Males were injured more often than females (M:F ratio=8:1). Seventy-seven point one percent of the patients were younger than 20 years. None of the patients had used helmets while being injured. A considerable proportion of accidents occurred between 6 and 8 PM. The most common season of bicycle accidents were summer (55.2%) and spring (24.8%). Seventy-six (44.7%) patients sustained injuries in collision with other vehicles (cars, motorcycles, etc). Four patients died of severe head injuries. Thirteen (8.1%) patients had injury severity score of >16 (severe injury). The mean duration of hospital stay was 5.2 (range: 1 - 52) days. Due to the fatal nature of head injuries and high incidence of fall/overturn injuries among bicycle riders, helmets should be worn by all riders, particularly young children. In addition, allocating a separate cycle path may reduce severe bicycle injuries.

Pediatric hospitalizations for bicycle-related injuries

Objectives:To determine the incidence of bicycle-related injury hospitalizations among children and adolescents 20 years of age and younger and to examine the associated use of healthcare resources.Design:Nationally representative data from...