Child Bicyclists Research Articles

Child cyclists: A study of factors affecting their safety.

To study various factors that contribute to a child cyclist's risk of having, or being injured in the event of, an accident. All children aged 8-12 years, attending four primary schools, who had access to a bicycle were invited to participate. The study consisted of: a questionnaire; a helmet and bicycle check (by professional cycle shop staff) and a practical assessment. Two hundred and ninety-three children participated in one or more parts of the study. Of the 214 helmets checked, 41% were deemed 'unsafe'. Forty-one percent of 205 bicycles checked were not considered roadworthy. Of the 127 children who usually ride their bicycle to school, 59% had either a bicycle that was not considered roadworthy or a helmet that was judged 'unsafe'. Of the 200 children, 91% knew the correct hand signals for a right and left turn. Eleven- and 12-year-olds were significantly better at performing the practical assessment than 8- to 10-year-olds (P < 0.0001). Parents cannot assume that simply providing a cycle helmet and ensuring it is worn means a child will have maximum protection in the event of an accident. Calculations that base the safety benefits of cycle helmets on observation studies are likely to be underestimates. Regular checking of the roadworthiness of a child's bicycle is advised as simple things such as underinflated tyres or worn brake pads can adversely affect handling. There is no specific age at which it can be said a young child is 'safe' to ride unaccompanied on public roads.

How safe are children when transported by bicycle?

ABSTRACTObjectives: With the increasing popularity of cycling generally and availability of new bicycle child carriers, there is an emerging interest in the safety of child bicycle passengers and riders. However, very little is known about the nature and extent of injuries to child bicycle riders and passengers. The aim of this study was to enhance our understanding of child safety in bike transportation and to identify injury patterns and outcomes.Method: Analyses of Victorian hospital data (emergency department presentations and hospital admissions) were undertaken to describe and compare injury outcomes among children aged 0–3 years, 4–6 years, and 7–10 years on bicycles. Data over the 15-year period, July 1, 1999, to June 30, 2014, were examined.Results: A total of 17,859 emergency department presentations and 4,794 hospitalizations were reported for child cyclists under the age of 10 years. The rate of emergency department presentations and hospital admissions per 100,000 population decreased by 1.5% (−2.8 to −0.2%) and 5.0% (−6.5 to −3.4%), respectively. For emergency department presentations, the most commonly injured body parts included the head (34.9%), elbows and forearms (14.6%), and wrist and hands (16.3%). For hospital admissions, the head was again the most commonly injured body region (36.5%), followed by the elbow and forearm (26.7%) and shoulder and upper arm (9.1%). Comparisons of injured body regions between age groups revealed that children aged 3 and under were significantly more likely to sustain injuries to the head that required hospital admissions compared to older age groups. In contrast, older children, between the ages of 7 and 10 years, were significantly more likely to sustain injuries to either the arms, wrists, or hands. Further analysis of the nature of injury revealed that children aged 3 and under had a significantly higher number of open wound injuries compared to older children.Conclusion: This article provides an exploratory and broad overview of the magnitude and severity of injuries among child bike riders and passengers and highlights that younger children are more likely to sustain head injuries compared to older children. This is likely the result of very young children being passengers on bicycles who are constrained in a seat or trailer with little protection or opportunity to mitigate injuries.Highlights:• Analyses of injury data to understand the nature and extent of injuries to children on bikes as passengers and riders.• Child cyclist injuries as a significant safety issue within Victoria, Australia.• Young children aged 0–3 years experienced significantly more head injuries compared to older children.

Learning game for training child bicyclists’ situation awareness

Encouraging more children to bicycle would produce both environmental and health benefits, but bicycling accidents are a major source of injuries and fatalities among children. One reason for this may be children’s less developed hazard perception skills. We assume that children’s situation awareness could be trained with a computer based learning game, which should also improve their hazard perception skills. In this paper, we present a prototype for such a game and pilot it with 8–9year old children.The game consisted of videos filmed from a bicyclist’s perspective. Using a touchscreen, the player's task was to point out targets early enough to gain points. The targets were either overt (other visible road users on a potentially conflicting course) or covert (occlusions, i.e. locations where other road users could suddenly emerge). If a target was missed or identified too late, the video was paused and feedback was given.The game was tested with 49 children from the 2nd grade of primary school (aged 8–9). 31 young adults (aged 22–34) played the game for comparison. The effect of the game on situation awareness was assessed with situation awareness tests in a crossover design. Similar videos were used in the tests as in the game, but instead of pointing out the targets while watching, the video was suddenly masked and participants were asked to locate all targets which had been present just before the masking, choosing among several possible locations. Their performance was analyzed using Signal Detection Theory and answer latencies.The game decreased answer latency and marginally changed response bias in a less conservative direction for both children and adults, but it did not significantly increase sensitivity for targets. Adults performed better in the tests and in the game, and it was possible to satisfactorily predict group membership based on the scores. Children found it especially difficult to find covert targets. Overall, the described version of the learning game cannot be regarded as an effective tool for situation awareness/hazard perception training, but ways to improve the game are discussed.

Hazard perception in young cyclists and adult cyclists

Child bicyclists are at greater risk to get involved in a traffic accident. Although hazard perception tests between inexperienced and experienced car drivers revealed significant differences in perceptual-cognitive skills, a similar test for bicyclists is not yet existent. Therefore this study aimed to compare visual search patterns and reaction times of child bicyclists and adult bicyclists utilizing a hazard perception test for cyclists. Seventy-five children and forty-one adults were presented with eleven video clips filmed from the perspective of the bicyclist. The participants were required to press a response button whenever they detected a hazardous situation. Children were found to have significantly delayed reaction times and time until the first fixation on the latent covert hazards compared to adults. The inefficient visual search patterns in children may be attributed to an immature visual system. However, the finding that children fixated later on the hazards and only responded to the covert latent hazards when they became salient indicate difficulties with identifying possible hazards. Altogether, the findings of this study suggest that children’s situation awareness is dependent upon experience too, and not just maturation. Therefore, implications for training young bicyclists will be discussed.

Statistical Analysis of Bicyclists’ Injury Severity at Unsignalized Intersections

Objectives: This study investigated factors correlated with the severity of injuries sustained by bicyclists in bicycle–motor vehicle crashes at unsignalized intersections to develop site-specific countermeasures and interventions to improve bicycle safety.Method: Crash data were extracted from accident reports entered into the Kentucky State Police's Kentucky Collision Database in 2002–2012. A partial proportional odds model was developed for data analysis.Results: According to our modeling results, stop-controlled intersections, one-lane approaches, helmet usage, and lower speed limits were associated with decreased injury severity, whereas uncontrolled intersections, older (age > 55) drivers and bicyclists, child (age < 16) bicyclists, foggy and rainy weather, inadequate use of lights in dark conditions, and wet road surfaces were linked with increased injury severity.Conclusions: Based on these results, we suggest the development of educational programs focused on the following groups: child bicyclists, older bicyclists, and older drivers. Investigating and modifying street lighting could improve bicycle safety. Implementing road diets/traffic calming methods could create a safer traffic environment. Certain traffic control strategies (e.g., stop control) could be considered for uncontrolled intersections with high bicycle exposure, and helmet campaigns should be launched to increase helmet awareness and use. The study also suggests some interesting future research directions, including examining driver/bicyclist behaviors at uncontrolled intersections and studying the riding behaviors of child bicyclists in Kentucky.

Adult headform impact tests of three Japanese child bicycle helmets into a vehicle

The head is the body region that most frequently incurs fatal and serious injuries of cyclists in collisions against vehicles. Many research studies investigated helmet effectiveness in preventing head injuries using accident data. In this study, the impact attenuation characteristics of three Japanese child bicycle helmets were examined experimentally in impact tests into a concrete surface and a vehicle. A pedestrian adult headform with and without a Japanese child bicycle helmet was dropped onto a concrete surface and then propelled into a vehicle at 35km/h in various locations such as the bonnet, roof header, windshield and A-pillar. Accelerations were measured and head injury criterion (HIC) calculated. In the drop tests using the adult headform onto a concrete surface from the height of 1.5m, the HIC for a headform without a child helmet was 6325, and was reduced by around 80% when a child helmet was fitted to the headform. In the impact tests, where the headform was fired into the vehicle at 35km/h at various locations on a car, the computed acceleration based HIC varied depending on the vehicle impact locations. The HIC was reduced by 10–38% for impacts headforms with a child helmet when the impact was onto a bonnet-top and roof header although the HIC was already less than 1000 in impacts with the headform without a child helmet. Similarly, for impacts into the windshield (where a cyclist’s head is most frequently impacted), the HIC using the adult headform without a child helmet was 122; whereas when the adult headform was used with a child helmet, a higher HIC value of more than 850 was recorded. But again, the HIC values are below 1000. In impacts into the A-pillar, the HIC was 4816 for a headform without a child helmet and was reduced by 18–38% for a headform with a child helmet depending on the type of Japanese child helmet used. The tests demonstrated that Japanese child helmets are effective in reducing accelerations and HIC in a drop test using an adult headform onto a relatively rigid hard surface, i.e., simulating a road surface or concrete path. However, when the impact tests are into softer surfaces, the child helmet’s capacity to decrease accelerations is accordingly reduced. Impacts into the windshield, while below the critical HIC value of 1000, indicated higher HIC values for a headform with a child helmet compared to an adult headform without a child helmet. The unpredictable nature of the results indicates further research work is required to assess how representative the stiffness of an adult headform is when compared to an actual head.

Spatial Analysis of Child Pedestrian and Bicycle Crashes

Pedestrian and bicycle safety for school-aged children is a particular concern as traffic crashes continue to be a leading cause of death for children 5 to 14 years old. For this concern to be addressed, Safe Routes to School (SRTS) programs have been implemented in communities across the country, with one of the primary objectives being to provide safe and convenient routes for children to walk or bike to school. Unfortunately, SRTS programs allocate limited funding for such projects. Consequently, it is imperative that programs are implemented at locations where they are likely to have the greatest impact. The primary focus of this study was to develop a safety Performance function (SPF) for use in prioritizing candidate schools for SRTS programs. Traffic crashes over a 5-year analysis period were examined and linked to data that included the school enrollment, the socioeconomic and demographic data for each school district, and the functional class of the roadway on which each school was located. Schools on local roads were found to experience more crashes than those located on other, higher-class road facilities. Crashes also varied with average family size, number of parents per household, population density, and median family income. Crashes were less frequent in school districts that exhibited greater ethnic diversity. The SPF developed as a part of this research can be used for prioritization of candidate schools as well as to assess the efficacy of SRTS programs on a longitudinal basis and thus provide a valuable tool for school administrators and others involved in child pedestrian and bicycle safety.

Trends in head injuries associated with mandatory bicycle helmet legislation targeting children and adolescents

BackgroundBicycling related head injuries (HIs) can be severe. Helmet use reduces head injury risk; however, there are few controlled studies of the effect of helmet legislation. We conducted this study to investigate changes in HIs after bicycle helmet legislation targeting those <18 in Alberta, Canada in 2002. MethodsBicyclist and pedestrian (control) HI rates and HIs as a proportion of all injuries were compared for the three years (1999–2001) before and four years (2003–2006) after bicycle helmet legislation in three age groups (children: <13, adolescents: 13–17, and adults: 18+). ResultsThere were 41,270 ED visits and 2782 hospitalizations for bicyclists and 9836 ED visits and 2029 hospitalizations for pedestrians (excluding the legislation year 2002). The rate of ED HIs declined for child bicyclists and child pedestrians, while the rate of non-HIs declined in adult bicyclists and child pedestrians. The rate of hospitalized HIs declined in child bicyclists and all ages of pedestrians while non-HI rates declined for child and adult pedestrians. Non-HI rates for adolescent and adult bicyclists increased. After adjusting for sex and location, the proportion of ED bicycle HIs declined by 9% (APR=0.91; 95% CI: 0.86, 0.95) in children, was unchanged among adolescents and increased in adults (APR=1.08; 95% CI: 1.01, 1.15). The proportion of bicycle HI related hospitalizations decreased by 30% (APR=0.70; 95% CI: 0.55, 0.90) in children, 36% (APR=0.64; 95% CI: 0.49, 0.84) in adolescents and 24% (APR=0.76; 95% CI: 0.63, 0.91) in adults. There were no observed changes in the proportion of pedestrian HIs resulting in ED visits or hospitalizations. InterpretationOur data indicate significant declines in the proportion of child bicyclist ED HIs and child, adolescent and adult bicyclist HI hospitalizations. This is in contrast to no significant trends in the proportion of ED or hospitalized HIs among pedestrians and the unexpected increases in the proportion of ED HIs for adult bicyclists. Comparing bicyclist and pedestrian trends in the proportion of child and adolescent HIs suggests a bicycle helmet legislation effect.

How similar are two-unit bicycle and motorcycle crashes?

This paper explores the similarities and differences between bicycle and motorcycle crashes with other motor vehicles. If similar treatments can be effective for both bicycle and motorcycle crashes, then greater benefits in terms of crash costs saved may be possible for the same investment in treatments. To reduce the biases associated with under-reporting of these crashes to police, property damage and minor injury crashes were excluded. The most common crash type for both bicycles (31.1%) and motorcycles (24.5%) was intersection from adjacent approaches. Drivers of other vehicles were coded most at fault in the majority of two-unit bicycle (57.0%) and motorcycle crashes (62.7%). The crash types, patterns of fault and factors affecting fault were generally similar for bicycle and motorcycle crashes. This confirms the need to combat the factors contributing to failure of other drivers to yield right of way to two-wheelers, and suggest that some of these actions should prove beneficial to the safety of both motorized and non-motorized two-wheelers. In contrast, child bicyclists were more often at fault, particularly in crashes involving a vehicle leaving the driveway or footpath. The greater reporting of violations by riders and drivers in motorcycle crashes also deserves further investigation.

Pediatric Pancreatic Trauma: Trending toward Nonoperative Management?

Pancreatic trauma is rare in children and optimal care has not been defined. We undertook this study to review the cumulative experience from three centers. After obtaining Institutional Review Board approval at each site, the trauma registries of three institutions were searched for pancreatic injuries. The charts were reviewed and data pertaining to demographics, hospital course, and outcome were obtained and analyzed. During the study period, a total of 79 pancreatic injuries were noted. The most common mechanism of injury was motor vehicle crash (44%) followed by child abuse (11%) and bicycle crashes (11%). Computed tomographic (CT) scans were obtained in 95 per cent with peripancreatic fluid the most common finding. Median Injury Severity Score (ISS) was 9, whereas median organ injury score was 2, and a higher grade correlated with need for operation (P = 0.001). Pancreatic operations were performed in 32 patients, whereas nonoperative management was noted in 47 cases. We noted no differences in length of stay, age, ISS, or initial blood pressure in operative versus nonoperatively managed cases. Pancreatic injuries were rare in children with trauma. CT scans were the most common method of diagnosis. Nonoperative management appeared to be safe and was more common, especially for the lower grade injuries.

Googling for Health Information

Googling for Health Information

Risk Factors for Child and Adolescent Occupants, Bicyclists, and Pedestrians in Motorized Vehicle Collisions

Objective: The aim was to use similar population data to examine the relative risk of collision injury among children of different ages and adolescents involved in various collision types and to elucidate the possible risk factors related to road collisions involving children and adolescents in a large, 2-wheeled vehicle environment. Methods: We used data from a society with a large population of motorcyclists to examine the relative risk of injury among children and adolescents aged 0 to 6, 7 to 9, 10 to 12, 13 to 15, and 16 to 17 years old who were involved in single motorized vehicle, multiple motorized vehicle, bicycle-to-vehicle, and pedestrian-to-vehicle collisions. Police reports for 73,232 collision injuries between the years 2003 and 2009 were analyzed using multicategory logit models of the 4 collision types. Results: Young (particularly 0- to 6-year-old) child bicyclists and pedestrians were the most sensitive to several factors. In collisions, young child bicyclists making U-turns or being struck by forward-moving or right-turning motorized vehicles, on local roads, during the daytime, or at locations without traffic signals had the greatest risk of injury. Similarly, young child pedestrians running, during the daytime, or at locations without traffic signals had a significant risk of injury. After controlling for other factors, we found that 4-wheeled motorized vehicles, not motorcycles, presented a higher risk for injury to child passengers, bicyclists, and pedestrians. Conclusions: The risk of collision injury varied for the different groups of children in the 4 collision types. To reduce the risk of injury for young children, we recommend the development of road-crossing training tools for parents. In addition, the behaviors of children should be taken into consideration when developing in-vehicle assistance systems.

An Application of the Principles of Projectile Motion to a Homicide Investigation

Biomechanics testimony was sought to assess the feasibility of a claim made by the defendant that a fatal head injury sustained by the victim arose as a result of the defendant throwing a child's bicycle a horizontal distance of 7 m which accidentally struck the victim. The method of projection was claimed to involve pushing the bicycle from the chest equally with both hands from a stationary upright standing position in a manner similar to a chest pass in basketball. A further consideration in the case was that the maximum height of the projectile during flight was constrained by the presence of an overhead ceiling. Using equations for uniform motion and based on measurements made at the crime scene, it was determined that the theoretical release speed of the projectile could not have been less than 10.0-11.0 m/s and was probably closer to 14 m/s. These estimated release speeds are substantially higher than the release speeds associated with a comparable movement pattern, namely, the maximal two-handed bench throw (∼2.5 m/s), and instead approximate the release speeds recorded by the best three throwers in the Men's Shot Put at the 2004 Athens Olympic Games (13.60- 13.95 m/s). It therefore seems highly unlikely that the defendant could have thrown the projectile a horizontal distance of 7 m as claimed.

Handlebar Injuries in Children: Should We Raise the Bar of Suspicion?

Injury prevention strategies for child bicyclists have focused on helmet use to prevent head trauma. Handlebars are another source of injury. A retrospective review from 2005 identified 385 admissions to a Level 1 pediatric trauma center of which 23 (5.9%) were pedal cyclists. Four cases (<1.0%) of handlebar injuries were identified. Three children (two bicyclists, one riding a scooter) sustained handlebar impact to the neck. All children with neck injuries had subcutaneous emphysema. Two of the children had pneumomediastinum, which after work-up was managed nonoperatively. One child had a tracheal injury requiring operative intervention. Another child was struck in the upper abdomen resulting in a traumatic abdominal wall hernia requiring emergent exploration and hernia repair. Discordance exists between the apparently minor circumstances of handlebar trauma and the severity of injury sustained by bicyclists. Recognizing the mechanism of handlebar-related injuries and maintaining a high index of suspicion for visceral injuries aids in the diagnosis. The incidence of these injuries is underestimated due to insufficient documentation of the circumstances of injury events and a lack of applicable E-codes specific for handlebar injury.

Changing pattern of child bicycle injury in the Bay of Plenty, New Zealand.

To determine if helmet laws and safety campaigns have had an impact on bicycle injuries in children. A comparison of the number of bicycle injuries presented to Whakatane Hospital's Emergency Department in the period 1982-1986 to the period July 1998-December 2005. In the first period there were 597 per 100,000 presentations per annum which increased to 890 per 100,000 per annum in the later period (P<0.01). Fractures increased from 115 to 234 per 100,000 per annum respectively (P=0.02). Injuries from a collision with a moving motor vehicle decreased from 72 to 30 per 100,000 per year and of those the proportion of serious head injuries dropped from 65% to 33%. There were four deaths in the earlier period but none in recent years. Injuries from bicycle use have increased but there has been a marked reduction in collisions with motor vehicles. This is a result of the changing use of bicycles by children.

Bicycle Helmets: Overcoming Barriers to Use and Increasing Effectiveness

Bicycle riding is a popular recreational activity among children, yet it is not without potential severe consequences such as traumatic brain injury and death. Despite available information attesting to the benefits of the use of bicycle safety helmets, many children still do not wear them. There are several promoting and discouraging factors that influence wearing bicycle helmets. The purposes of this article are to (1) explore current research and discuss these promoting and obstructing factors to child bicycle helmet use and to (2) provide recommendations for improving the compliance of bicycle helmet use among children. Results of the literature review have significant implications for improving the safety of children.

Safety and accessibility effects of code modifications and traffic calming of an arterial road

The European Road E12 through the community center of Storuman, Sweden was reconstructed in 1999 and 2000. Pedestrian walkways, traffic islands, chicanes of a type referred to as “Danish buns”, a roundabout and a two-directional cycle track along the E12 were installed. The purpose of the reconstruction was to improve safety for pedestrians and bicyclists, primarily for children, the elderly and the disabled, and to reduce the barrier effect of the E12 thoroughfare. In May 2000, the code governing the conduct of drivers at marked crosswalks in Sweden became stricter to improve safety and mobility for pedestrians. The combined effect of reconstructions and change of code was analyzed. Traffic behavior was studied at the intersection where the roundabout was constructed. Yield behavior towards pedestrians changed significantly. The difference was even greater with respect to yielding to child bicyclists – from 6% before to 84% after – even though the code change only related to pedestrians. Crash data analysis suggests a minor increase in fall injuries after reconstructions and change of code. Measures of speed, behavioral studies, questionnaires, face-to-face interviews and crash data analysis suggest that safety has increased not only along the E12 but also along adjacent roads. The final conclusion is that a bypass is not needed in a case like Storuman. Traffic calming of the main arterial through the town seems sufficient.

Child and family safety device affordability by country income level: an 18 country comparison

Objective: To compare availability, urban price, and affordability of child/family safety devices between 18 economically diverse countries. Design: Descriptive: urban price surveys by local safety organisations or shoppers. Setting: Retail...

34. Traffic Safety for Diverse Populations

Injuries continue to be a serious health problem worldwide and account for more lives lost than any disease entity. In accordance with Healthy People 2010 objectives, efforts to reduce deaths and nonfatal injuries can be directed towards increasing usage of safety belt and child restraint devices for all occupants involved in motor vehicle crashes. US Census data reveal that immigration accounts for more than 31% of the shift in demographics of people within the United States since 1990. The projected impact on racial/ethnic groups is a rise of 15% within those electing to reside in the United States. Since 1998, Massachusetts has seen a steady rise in overall crash-related fatalities. A gap exists in the educational materials available to diverse populations or emerging linguistic groups within our state. Grant funding was provided through the National Highway Traffic Safety Administration to Beth Israel Deaconess Medical Center, in Boston, Massachusetts, to develop traffic safety materials for diverse populations. Identification of the existing diversity with the state was conducted using 2000 US Census data. Of the state's total population of 6.3 million residents, there were positive gains in the following racial/ethnic groups: 16% Black, 49% Latino, and 70% Asian or Pacific Islander. Utilizing reports of hospital discharge data from the Massachusetts Division of Health Care Finance and Policy, as well as crash data from the Governor's Highway Safety Bureau, the incidence and mechanisms of injuries were examined. The project coordinator conducted online and telephone queries of state and national traffic safety organizations and outreach programs looking at prevention topics, languages available, and medium (such as brochures, cards, or other materials) to steer the project. The steady rise of traffic-related injuries and fatalities, coupled with the historically low safety belt use within the state, indicated a need for educational materials focused on the following 4 traffic topics: child passenger, restraint use, pedestrian, and bicycle safety. The languages selected were Haitian Creole, Khmer, Portuguese, Russian, and traditional Chinese. Based on the findings from the environmental scan, educational materials on the 4 priority topics were developed in each of the 5 languages identified. The educational materials are available in portable document format at http://bidmc.harvard.edu/injuryprevention. Accurate data regarding race and ethnicity of those injured in traffic-related events is very limited. Injury prevention programs may begin to identify populations at risk through the examination of readily available census data.

Promotion of Safety Helmets for Child Bicyclists: 2002 Update

Current research continues to show that bicycle helmets prevent serious injury and death in cyclists of all ages. Children are at special risk for head injury. The purpose of this review was to update information on the use and protective effect of bicycle helmets for child cyclists. Legislation, combined with community education and helmet promotion campaigns, remains the most cost-effective approach for increasing helmet use. Nineteen states and the District of Columbia have passed helmet legislation. Modest gains in helmet-wearing rates have been documented, with the greatest gains in young children, compared with adolescents. Nurses remain in strategic positions to encourage helmet use by educating children and parents. Nurses can participate in community-based education and advocacy programs. Nurse researchers can carry out descriptive studies that increase community awareness of bicycle injuries and examine factors such as parental rules and adolescent risk-taking.