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Huffman WH, Gupta R, Ayotte SR, Lawrence JTR. Pediatric Fractures Associated With Riding Bicycles: A National 20-year Analysis. J Pediatr Orthop 2024; 44:e1-e6. [PMID: 37798855 DOI: 10.1097/bpo.0000000000002522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Biking is a popular childhood activity with an intrinsic risk of injury. While advocacy groups have promoted protective equipment to help mitigate these risks, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth. METHODS The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged 18 years or below with fractures presenting to US emergency departments associated with riding bicycles. The patient narratives were analyzed to exclude patients not actively riding bicycles and to note helmet use and collisions with motor vehicles (MVs). RESULTS A total of 33,955 fractures were identified in the database, representing an estimated 1,007,714 fractures from 2001 to 2020, or 50,331 fractures annually. Linear regression noted a significant decrease in fractures over the period ( R2 =0.899; P <0.001). Most fractures occurred in patients who were male (71.8%, 95% CI: 70.4% to 73.2%), White (53.1%, 46.0% to 60.0%), and aged 10 to 12 (30.6%, 29.6% to 31.7%) or 13 to 15 years (24.8%, 23.4% to 26.2%). Fractures occurred most frequently in the forearm (25.2%, 22.8% to 27.8%), wrist (21.2%, 19.5% to 22.9%), and shoulder (10.5%, 9.7% to 11.3%). Patients who sustained fractures after being struck by a MV were >6 times more likely to be admitted to the hospital (36.0%, 28.6% to 44.2%) compared with patients not struck by a MV (5.4%, 4.3% to 6.8%). When helmet use was recorded in patients with skull fractures, most patients were not wearing helmets at the time of injury (85.7%, 74.6% to 92.5%). CONCLUSIONS Although the national burden of fractures associated with riding bicycles in pediatric populations has steadily decreased, it remains a significant cause of injury for children. Fractures involving MV more often require hospitalization, and an alarming number of skull fractures are noted in children not wearing helmets. These data support continued efforts to promote consistent helmet use and safer riding environments around MV in all children, but especially among 10- to 15-year-old males. LEVEL OF EVIDENCE Level III-prognostic.
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Affiliation(s)
| | - Radhika Gupta
- Perelman School of Medicine at the University of Pennsylvania
| | - Steven R Ayotte
- Perelman School of Medicine at the University of Pennsylvania
| | - J Todd R Lawrence
- Perelman School of Medicine at the University of Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Lee LK, Flaherty MR, Blanchard AM, Agarwal M. Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports. Pediatrics 2022; 150:188764. [PMID: 35965276 DOI: 10.1542/peds.2022-058878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Bicycling, snow sports, and other recreational activities and sports are important activities to keep children and youth active as part of a healthy lifestyle. These activities can be associated with serious and fatal head and facial injuries. Helmets, when worn correctly, are effective in decreasing head injuries and fatalities related to these activities. Legislation for helmet use is effective in increasing helmet use in children and, ultimately, in decreasing deaths and head and facial injuries. A multipronged strategy employing legislation, enforcement of laws, and medical clinicians and community programs is important for increasing helmet use to decrease deaths and injuries from recreational sports.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michael R Flaherty
- Division of Pediatric Critical Care Medicine, Mass General for Children, Boston, Massachusetts
| | - Ashley M Blanchard
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Maneesha Agarwal
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Lee LK, Flaherty MR, Blanchard AM, Agarwal M. Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports. Pediatrics 2022; 150:188762. [PMID: 35965284 DOI: 10.1542/peds.2022-058877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Recreational activities and sports are a common and popular way for youth to enjoy physical activity; however, there are risks related to physical injury. Injuries can potentially result in death and long-term disability, especially from traumatic brain injury. Helmet use can significantly decrease the risk of fatal and nonfatal head injury, including severe traumatic brain injury and facial injuries when participating in recreational sports. The most robust evidence of helmet effectiveness has been demonstrated with bicycling and snow sports (eg, skiing, snowboarding). Despite this evidence, helmets are not worn consistently with all recreational sports. A multipronged approach is necessary to increase helmet use by children and youth participating in recreational sports. This approach includes legislation and enforcement, public educational campaigns, child education programs, and anticipatory guidance from clinicians. This policy statement guides clinicians, public health advocates, and policymakers on best practices for increasing helmet use in recreational sports, including bicycling and snow sports.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michael R Flaherty
- Division of Pediatric Critical Care Medicine, Mass General for Children, Boston, Massachusetts
| | - Ashley M Blanchard
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Maneesha Agarwal
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Piatt J. A taxonomy of childhood pedal cyclist injuries from latent class analysis: associations with factors pertinent to prevention. Inj Epidemiol 2022; 9:5. [PMID: 35074005 PMCID: PMC8785559 DOI: 10.1186/s40621-021-00366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of pedal cyclist injuries have largely focused on individual injury categories, but every region of the cyclist's body is exposed to potential trauma. Real-world injury patterns can be complex, and isolated injuries to one body part are uncommon among casualties requiring hospitalization. Latent class analysis (LCA) may identify important patterns in heterogeneous samples of qualitative data. METHODS Data were taken from the Trauma Quality Improvement Program of the American College of Surgeons for 2017. Inclusion criteria were age 18 years or less and an external cause of injury code for pedal cyclist. Injuries were characterized by Abbreviated Injury Scale codes. Injury categories and the total number of injuries served as covariates for LCA. A model was selected on the basis of the Akaike and Bayesian information criteria and the interpretability of the classes. Associations were analyzed between class membership and demographic factors, circumstantial factors, metrics of injury severity, and helmet wear. Within-class associations of helmet wear with injury severity were analyzed as well. RESULTS There were 6151 injured pediatric pedal cyclists in the study sample. The mortality rate was 0.5%. The rate of helmet wear was 18%. LCA yielded a model with 6 classes: 'polytrauma' (5.5%), 'brain' (9.0%), 'abdomen' (11.0%), 'upper limb' (20.9%), 'lower limb' (12.4%), and 'head' (41.2%). Class membership had highly significant univariate associations with all covariates except insurance payer. Helmet wear was most common in the 'abdomen' class and least common in the 'polytrauma' and 'brain' classes. Within classes, there was no association of helmet wear with severity of injury. CONCLUSIONS LCA identified 6 clear and distinct patterns of injury with varying demographic and circumstantial associations that may be relevant for prevention. The rate of helmet wear was low, but it varied among classes in accordance with mechanistic expectations. LCA may be an underutilized tool in trauma epidemiology.
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Affiliation(s)
- Joseph Piatt
- Division of Neurosurgery, Nemours/A I duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA. .,Departments of Neurological Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Ali A, Friedman J, Tatum D, Jones G, Guidry C, McGrew P, Schroll R, Harris C, Duchesne J, Taghavi S. The Association of Payer Status and Injury Patterns in Pediatric Bicycle Injuries. J Surg Res 2020; 254:398-407. [PMID: 32540507 DOI: 10.1016/j.jss.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Bicycle injuries continue to cause significant morbidity in the United States. How insurance status affects outcomes in children with bicycle injuries has not been defined. We hypothesized that payer status would not impact injury patterns or outcomes in pediatric bicycle-related accidents. METHODS The National Trauma Data Bank was used to identify pediatric (≤18 y) patients involved in bicycle-related crashes admitted in year 2016. Patients with private insurance were compared with all others (uninsured, Medicaid, and Medicare). RESULTS There were 5619 patients that met study criteria. Of these, 2500 (44%) had private insurance. Privately insured were older (12 y versus 11, P < 0.001), more likely to be white (77% versus 56%, P < 0.001), and more likely to wear a helmet (26% versus 9%, P < 0.001). On multivariate analysis, factors associated with traumatic brain injury included age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.06-1.08; P < 0.001) and helmet use (OR, 0.64; 95% CI, 0.55-0.74; P < 0.001). Patients without private insurance were significantly less likely to wear a helmet (OR, 0.52; 95% CI, 0.44-0.63; P < 0.001). Uninsured patients had significantly higher odds of a fatal injury (OR, 4.43; 95% CI, 1.52-12.92; P = 0.006). CONCLUSIONS Uninsured children that present to a trauma center after a bicycle accident are more likely to die. Although helmet use reduced the odds of traumatic brain injury, minorities and children without private insurance were less likely to be helmeted. Public health interventions should increase helmet access to children without private insurance, especially uninsured children.
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Affiliation(s)
- Ayman Ali
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jessica Friedman
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Danielle Tatum
- Department of Surgery, Our Lady of the Lake RMC, Baton Rouge, Louisiana
| | - Glenn Jones
- Department of Surgery, LSU Health Baton Rouge, LSU Medical Education and Innovation Center, Baton Rouge, Louisiana
| | - Chrissy Guidry
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Patrick McGrew
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Rebecca Schroll
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles Harris
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Juan Duchesne
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sharven Taghavi
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
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Chen H, Scarborough J, Zens T, Brummeyer B, Agarwal S, Haines KL. Race and Insurance Status as Predictors of Bicycle Trauma Outcome in Adults. J Surg Res 2019; 245:198-204. [PMID: 31421362 DOI: 10.1016/j.jss.2019.07.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. METHODS This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included. RESULTS A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients. CONCLUSIONS Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.
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Affiliation(s)
- HuaFu Chen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - John Scarborough
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tiffany Zens
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brandon Brummeyer
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Suresh Agarwal
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Krista L Haines
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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