Risk Factors for Bicycling Injuries in Children and Adolescents: A Systematic Review

Epidemiological characteristics and factors affecting healing in unintentional pediatric wounds

Objective

To analyze the epidemiological characteristics and wound healing conditions of common unintentional skin lacerations in children.

Methods

A retrospective analysis was conducted on data from 1,107 children, aged 0-12 years, with skin lacerations who received emergency treatment at Qilu Hospital of Shandong University from January 1, 2019, to December 30, 2022. Data on age, injury site, time from injury to suturing, and wound healing conditions were statistically analyzed.

Results

Among the 1,107 cases, 714 (64.5%) were male and 393 (35.5%) were female, with a male-to-female ratio of 1.8:1; median age was 5 years (IQR, 3-7). Infants and toddlers (0-3 years old) constituted the highest proportion, accounting for 36.3% (402 cases). The number of children aged over 3 years gradually decreased with increasing age. In younger children, the most common injuries were to the forehead, scalp, and lower jaw; in school-aged children, the proportion of limb and trunk injuries significantly increased. Age (OR, 1.34; 95% CI, 1.23-1.46), outdoor injuries (OR, 2.21; 95% CI, 1.18-4.16), lower limb injuries (OR, 5.35; 95% CI, 2.86-10.00), and wound length greater than 3 cm (OR, 10.65; 95% CI, 5.02-22.60) were significant risk factors for poor wound healing. The risk of poor wound healing increased by 34% for each additional year of age.

Conclusion

In children, the common sites of unintentional skin lacerations show distinct age and gender distribution characteristics. Older age, outdoor injuries, longer wound lengths, and lower limb injuries are independent risk factors for poor wound healing.

Health Service Impacts and Risk Factors for Severe Trauma in Mountain Biking: A Narrative Review

Mountain biking is growing in participation but carries risk for severe injury and burden on health systems. Little is known about the impact of these injuries on emergency medical services, definitive healthcare, and factors contributing to accidents. This review aimed to determine the health service impacts of severe mountain bike trauma and risk factors, with a view to understanding critical gaps and needs. A systematic online search was conducted using the databases PubMed and MEDLINE complete and grey literature relating to mountain bike injury since the databases' inception to July 2023. The results show that although mountain biking has relatively high injury rates that are increasing, the impacts on health services were rarely documented, with some evidence indicating that even small increases in injuries from race events can overwhelm local health services. Severe injuries were more common in downhill disciplines. However, the definitions of what constitutes severe injury were variable. Severe injuries were more common in downhill disciplines, influenced by the rider skill level, demographics, participation in competitive events, trail design, environmental factors, and healthcare availability. Further research in these areas is needed, along with the more consistent reporting of injury severity.

Blame attribution analysis of police motor vehicle collision reports involving child bicyclists

BACKGROUND

Injuries resulting from collisions between a bicyclist and driver are preventable and have high economic, personal and societal costs. Studying the language choices used by police officers to describe factors responsible for child bicyclist-motor vehicle collisions may help shift prevention efforts away from vulnerable road users to motorists and the environment. The overall aim was to investigate how police officers attribute blame in child (≤18 years) bicycle-motor vehicle collision scenarios.

METHODS

A document analysis approach was used to analyse Alberta Transportation police collision reports from Calgary and Edmonton (2016-2017). Collision reports were categorised by the research team according to perceived blame (child, driver, both, neither, unsure). Content analysis was then used to examine police officer language choices. A narrative thematic analysis of the individual, behavioural, structural and environmental factors leading to collision blame was then conducted.

RESULTS

Of 171 police collision reports included, child bicyclists were perceived to be at fault in 78 reports (45.6%) and adult drivers were perceived at fault in 85 reports (49.7%). Child bicyclists were portrayed through language choices as being irresponsible and irrational, leading to interactions with drivers and collisions. Risk perception issues were also mentioned frequently in relation to poor decisions made by child bicyclists. Most police officer reports discussed road user behaviours, and children were frequently blamed for collisions.

CONCLUSIONS

This work provides an opportunity to re-examine perceptions of factors related to motor vehicle and child bicyclist collisions with a view to prevention.

Visual Acuity and the Risk of Cycling Injuries: Register-Based Cohort Study From Adolescence to Middle-age

BACKGROUND

Cycling is increasingly encouraged in many countries as an inexpensive and healthy choice of transportation. Operating any vehicle on the road requires high visual acuity, but few studies to our knowledge have examined the association between vision and cycling injuries.

METHODS

We examined whether poorer visual acuity is associated with increased risk of fatal and nonfatal cycling injuries. We used prospectively recorded register data for 691,402 men born between 1970 and 1992 in Sweden. We followed these men from an average age of 18 years, when visual acuity was assessed during the conscription assessment, to age 45 at the latest. We identified fatal and nonfatal cycling and car injuries using Patient and Cause of Death registers. Cox regression models were used to estimate hazard ratios and 95% confidence intervals.

RESULTS

Based on visual acuity for the eye with the best vision, moderately impaired acuity 0.9 to 0.6 when wearing refractive correction was associated with increased risk for cycling injuries (hazard ratio = 1.44 [95% confidence interval = 1.16, 1.79]) compared with unimpaired vision (uncorrected visual acuity 1.0) and after adjustment for a wide range of potential confounders. This association remained consistent across various sensitivity analyses. Visual acuity was not associated with car injury risk.

CONCLUSIONS

In this cohort study, poorer vision was specifically associated with a higher rate of cycling injuries.

Cycling-Related Injuries During COVID-19 Lockdown: A North London Experience

Objectives

There has been a notable surge in cycling injuries during the COVID-19(SARS-CoV-2 virus) pandemic. Cycling in general increased during lockdown as a leisure & fitness activity along with reduction in the use of public transport for commuting. We investigated the bicycle-related maxillofacial injuries & associations presenting through our emergency department(ED) which covers more than 1.6 million of London population.

Study Design/Methods

A retrospective observational study was undertaken in the Barnet General Hospital ("hub") which receives all maxillofacial referrals from 6 "spoke" hospitals & other urgent primary/community care practices in North London area between 16 March 2020 & 16 July 2020. All data corresponding to cycling injuries during the lockdown period was analyzed with the aid of trauma database/trust-wide electronic patient records.

Results

Twenty-two patients (6.7%) with cycling-related injuries out of a total of 322 patients who attended during the 4 months study period with maxillofacial emergencies were identified. Average age of patient cohort was 35.4 years, mainly consisting of adult males (77%). Seven patients had minor head injury and 1 patient suffered traumatic brain injury. About 59% patients did not wear a protective helmet & 3 patients had heavy alcohol/recreational drug intoxication during the accidents. Four patients needed inpatient admission and treatment under general anesthesia.

Conclusions

Based on our humble study, we advocate the need for robust road & personal safety measures with mandatory government legislations, policing of drug intoxication & encouragement of physical & mental health improvement measures during these unprecedented times & beyond.

Pediatric Electrical Bicycle Road Accidents

INTRODUCTION

 The use of electric bicycles (EBs) among children younger than 18 years of age is rapidly increasing worldwide and becoming a substantial contributor to road accidents. We analyzed patterns and severity of pediatric bicycle-related injuries, comparing children riding EBs and classic bicycles (CBs).

MATERIALS AND METHODS

 This was a retrospective study (January 2016-December 2018) of patients arriving at our medical center due to a bicycle accident. Data were collected from medical records and included demographics, injury characteristics, treatment, and outcomes.

RESULTS

 Of 561 children, 197 (35%) were EB riders and 364 (65%) were CB riders. Injury severity score (ISS) of EB cyclists was significantly higher than CB cyclists (mean 4.08 ± 4.67 and 3.16 ± 2.84, respectively, p = 0.012). The rate of accidents involving motorized vehicles was higher in the EB versus CB group (25.9 vs. 11.3%, p < 0.001). Head injuries were the most common type of injury in both groups; incidence was higher in CB than in EB cyclists. However, loss of consciousness was more common in the EB group (18.3 and 12.1%, respectively, p = 0.057). Lower extremity injuries were more common in EBs versus CBs (55.8 and 37.6%, respectively, p < 0.001). Orthopaedic surgical interventions were significantly higher in the EB group (49.2 vs. 33.2%, p < 0.001), and length of stay in hospital and admission to pediatric intensive care unit were more common in EB compared with CB, although not significantly.

CONCLUSION

 Injury severity of EB patients was significantly higher than that of CB patients. Accidents involving motorized vehicles were more common in the EB group. Head injury associated with loss of consciousness was significantly higher in EB patients.

Factors related to youth self-efficacy for injury prevention bicycle skills

INTRODUCTION

Bicycle riding is a common activity for children, but they are prone to bicycle-related injuries. It is well-established that injury prevention measures such as wearing a helmet and correctly riding a bicycle can reduce the severity of an injury and the likelihood of having an accident. However, how to increase bicycle injury prevention behaviors among children, who collectively fail to engage in injury prevention behaviors, is less well understood. Self-efficacy is consistently predictive of injury prevention behavior, making it an important approach to understanding injury prevention skills among this key population. The objective of this study was to explore and identify factors internal to the child as well as factors about his or her environment that predict a child's self-efficacy for injury prevention skills.

METHOD

Two generalized linear mixed effects models were created from survey data collected from elementary school students (n = 2,255) as part of a school-based bicycle education program. Models focused on self-efficacy for riding a bicycle and self-efficacy for wearing a helmet correctly.

RESULTS

In both models, road safety knowledge, opportunity for skill building through owning appropriate equipment (a bicycle or helmet), and situation through perception of neighborhood safety were predictive. The analyses reveal these variables as key factors for greater confidence, with feeling safe riding in the neighborhood, in particular, emerging as highly predictive of self-efficacy for injury prevention skills.

CONCLUSIONS

These findings highlight the interplay of individual and environmental factors within confidence for injury prevention behavior. Given self-efficacy's strong relationship to prevention behavior, these findings indicate actionable strategies. Practical Applications: The key factors highlighted in this study can be used by policymakers to target specific areas (e.g., neighborhood safety) to promote self-efficacy and thus improve injury prevention. These factors can also inform strategies for establishing safety skills in bicycle-safety education programs.

Alcohol and Drug Use While Cycling Significantly Increases the Likelihood of Facial Fractures

PURPOSE

Substance use, including alcohol and drugs, has been found to amplify the risks associated with cycling. Our purpose was to determine the relationship between alcohol or drug use and facial injuries in a nationwide population of patients experiencing cycling trauma.

METHODS

The authors report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System from January 1, 2019 to December 31, 2019, in the United States. Patients were included in our study if they were evaluated in the emergency department for a cycling-related injury. Primary outcome was facial injury.

RESULTS

There were a total of 6499 adult patients who experience an injury after cycling trauma reported by the National Electronic Injury Surveillance System-participating emergency departments during the study period. A total of 553 (553/6499; 8.5%) patients had a facial injury and 82 patients with facial injuries had alcohol/drug use recorded (82/553; 14.8%). The proportion of males with facial injuries was higher in the alcohol/drug group than the no alcohol/drug group (86.6% versus 76.4%, respectively; P = 0.04). Injured cyclists in the alcohol/drug group experienced greater odds of sustaining a facial injury (odds ratio: 2.21, 95% confidence interval: 1.71-2.84, P < 0.0001) and a facial fracture (odds ratio: 2.75, 95% confidence interval: 1.83-4.13, P < 0.0001) than injured cyclists in the no alcohol/drug group.

CONCLUSIONS

Substance use while cycling is not safe and significantly increases the likelihood of a facial injury and of facial fractures. This prevalence of injuries would suggest that cycling under the influence should always be illegal, and the law strictly enforced.

Factors associated with risk behaviors in adolescence: a systematic review

OBJECTIVE

Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing and reducing morbidity and mortality in this population. This study sought to investigate the factors associated with the following adolescent risk behaviors: i) aggressiveness and violence, ii) tobacco, alcohol, and illicit substance use, iii) depressive behavior and self-harm (including suicidal ideation and attempts), iv) sexual risk behavior, and v) multiple risk behavior.

METHODS

A systematic review was conducted to identify longitudinal studies that examined factors associated with adolescent risk behaviors. The PubMed, PsycINFO, and LILACS databases were searched.

RESULTS

Of the 249 included studies, 23% reported distal risk factors, while the remaining reported proximal risk factors. Risk factors were related to sociodemographic characteristics (neighborhood, school, and peers), family patterns, and the presence of other adolescent risk behaviors.

CONCLUSION

Distal and proximal factors in adolescent risk behavior that are not exclusively socioeconomic, familial, environmental, or social should be explored more thoroughly.

Meta-synthesis of qualitative evidence in road traffic injury prevention: a scoping review of qualitative studies (2000 to 2019)

BACKGROUND

A considerable number of qualitative studies have been published in recent years on the issues that the quantitative studies have limitations on. This study aimed at performing a meta-synthesis on qualitative studies on Road Traffic Injuries (RTIs) with a scoping review approach.

METHODS

This meta-synthesis study was conducted as a scoping review in 2019. The Arkesy and O'Malley framework was applied which has six steps of identifying the research question, identifying the relevant studies, selecting the studies, charting the data, data analysis and reporting the results, and consultation exercise. The required data were gathered by searching the relevant keywords in databases of PubMed, web of knowledge, Scopus, Cochrane Library, Science Direct, Google scholar, Sid, IranMedex. Extracted data were analyzed by the Content-Analysis method.

RESULTS

Finally, 30 studies were included. Extracted data summarized in five main themes and 17 sub-themes. The main themes were: consequences (individual, family, social, financial), the needs of survivors (social support and healthcare), risk factors (general risk factors, risk factors for motorcyclists, risk factors for children and adolescents), barriers of prevention (general barriers, pre-hospital barriers, emergency, and hospital barriers), and prevention solutions (increasing safety, rules and regulations, education, increasing equipment, scientific solutions) of RTIs.

CONCLUSION

This study combined the methods of the scoping review and the meta-synthesis to mapping all qualitative studies on the RTIs, with this approach, this study provides extensive and practical information for policy-makers, managers, practitioners, and researchers in the field of RTIs. Also, by applying this approach, the gaps in the existing knowledge and areas in need of further research are identified.

Safer Roads to School

Any and all advances made by medical science cannot solve the problem of road traffic injuries (RTIs) in school-going children, especially if the only concerned people are those of the medical fraternity. Children are a vulnerable part of the traveling population and thus have been persistent due to the callous nature of the citizens and policy makers toward road safety and injury prevention. In our multicultural and multilingual country, there is a need for multistakeholder initiative with a countrywide presence if we are to stem the rise of mortality and morbidity due to these accidents. The first question we need to ask is how to prevent road traffic accidents and improve the condition of our roads. Pediatric RTIs are eternal problem of industrial revolution with complications and effects that may affect individual and society with increase in the number of motorized communications. Dedicated capacity building is urgently need who should be able to provide the necessary care to the injured children at the road crash spot as well as should be informed where to take the injured child and whom to contact in the dedicated injury care center while transporting the victims of situations.

Preventing injuries must be a priority to prevent disease in the twenty-first century

Injuries continue to be the leading cause of morbidity and mortality for children, adolescents, and young adults aged 1-24 years in industrialized countries in the twenty-first century. In this age group, injuries cause more fatalities than all other causes combined in the United States (U.S.). Importantly, many of these injuries are preventable. Annually in the U.S. there are >9 million emergency department visits for injuries and >16,000 deaths in children and adolescents aged 0-19 years. Among injury mechanisms, motor vehicle crashes, firearm suicide, and firearm homicide remain the leading mechanisms of injury-related death. More recently, poisoning has become a rapidly rising cause of both intentional and unintentional death in teenagers and young adults aged 15-24 years. For young children aged 1-5 years, water submersion injuries are the leading cause of death. Sports and home-related injuries are important mechanisms of nonfatal injuries. Preventing injuries, which potentially cause lifelong morbidity, as well as preventing injury deaths, must be a priority. A multi-pronged approach using legislation, advancing safety technology, improving the built environment, anticipatory guidance by clinical providers, and education of caregivers will be necessary to decrease and prevent injuries in the twenty-first century.

Characteristics of bicycle crashes among children and the effect of bicycle helmets

Objective: Focusing on children (0-17 years), this study aimed to investigate injury and accident characteristics for bicyclists and to evaluate the use and protective effect of bicycle helmets.Method: This nationwide Swedish study included children who had visited an emergency care center due to injuries from a bicycle crash. In order to investigate the causes of bicycle crashes, data from 2014 to 2016 were analyzed thoroughly (n = 7967). The causes of the crashes were analyzed and categorized, focusing on 3 subgroups: children 0-6, 7-12, and 13-17 years of age. To assess helmet effectiveness, the induced exposure approach was applied using data from 2006 to 2016 (n = 24,623). In order to control for crash severity, only bicyclists who had sustained at least one Abbreviated Injury Scale (AIS) 2+ injury (moderate injury or more severe) in body regions other than the head were included.Results: In 82% of the cases the children were injured in a single-bicycle crash, and the proportion decreased with age (0-6: 91%, 7-12: 84%, 13-17: 77%). Of AIS 2+ injuries, 8% were head injuries and 85% were injuries to the extremities (73% upper extremities and 13% lower extremities). Helmet use was relatively high up to the age of 10 (90%), after which it dropped. Helmets were much less frequently used by teenagers (14%), especially girls. Consistently, the share of head injuries increased as the children got older. Bicycle helmets were found to reduce all head injuries by 61% (95% confidence interval [CI], 10: +/- 10%) and AIS 2+ head injuries by 68% (95% CI, 12: +/- 12%). The effectiveness in reducing face injuries was lower (45% CI +/- 10% for all injuries and 54% CI +/- 32% for AIS2+ injuries).Conclusions: This study indicated that bicycle helmets effectively reduce injuries to the head and face. The results thus point to the need for actions aimed at increasing helmet use, especially among teenagers. Protective measures are necessary to further reduce injuries, especially to the upper extremities.

Parent-adolescent bicycling safety communication and bicycling behavior

INTRODUCTION

Efforts to encourage bicycling to school have increased in the United States. However, little is known about how parent-child communication affects bicycle safety. The purpose of this study was to examine parent-child agreement on biking instructions and their correlation with the early adolescents' real-world riding behavior.

METHODS

Parent-child dyads were asked open-ended questions about instructions they had given/received about bicycling. Answers were then coded into nine categories (e.g., crossing the road, bicycle control/handling). Distributions of parent-child agreement on parent-given bicycle safety instructions were examined in relation to the adolescent's real-world riding behaviors.

RESULTS

36 parent-child dyads were included. Average age was 11.9 (Range: 10-15) for adolescents and 43.3 (Range: 30-59) for parents. Common parental instructions included: wear helmet, ride on sidewalk, and trip routing specifications. High 'ride on sidewalk' instruction (38.9% both parent and adolescent, 22.2% parent only, 16.7% adolescent only) was concerning due to potential driveway conflicts. Agreement between parents and adolescents on reported instructions was low, overall. Mean safety-relevant event rates in real-world cycling did not differ significantly between bicycle safety instruction agreement groups (both parent & adolescent reported, parent only, adolescent only, neither). The proportion of time an adolescent rode on different infrastructure types (sidewalk, street, etc.) did not vary between dyads reporting parents had given instructions to ride on the sidewalk and those who had not.

CONCLUSIONS

Results highlight lack of agreement between parents and adolescents on cycling instructions the adolescent receives from the parent. Parent instructions to adolescents regarding bicycling safety were not associated with actual riding behaviors. Results suggest parent messaging to adolescents may be ineffective. Given parents are in a position of influence, results indicate a need for parental training on effective safety-related communication strategies to assist them in capitalizing on their parental role to increase their child's safety.

Child and adolescent bicycling injuries involving motor vehicle collisions

Background

Bicycle-related injuries are among the most common recreational injuries for children in Canada; moreover, bicycle-motor vehicle collisions often result in serious injuries. This study seeks to examine environmental, motorist, and bicyclist characteristics of bicycle-motor vehicle collisions that resulted in police reported severe injuries in youth (< 18 years old) bicyclists, in Alberta, Canada.

Findings

Using Calgary and Edmonton police collision reports, 423 youth bicycle-motor vehicle collisions were identified from 2010 to 2014. Forty-three (10.2%) of these collisions resulted in major/fatal (severe) injuries. These severe injury cases were compared with the 380 youth bicycle-motor vehicle collisions resulting in minor or no injury (controls) using classification tree and logistic regression analyses. There were no driver or bicyclist characteristics with a significant effect on the odds of severe injury to youth bicyclists; however, lower odds were found on each of: divided roads with no barrier (aOR = 0.36; 95% CI: 0.13-0.97) or during peak traffic time (aOR = 0.44; 95% CI: 0.16-0.99).

Conclusion

Personal and environment characteristics should be considered in future research and interventions focused on reducing severe youth bicycle-motor vehicle collision injuries.

Psychosocial Adversity in Infancy and Mortality Rates in Childhood and Adolescence: A Birth Cohort Study of 1.5 Million Individuals

BACKGROUND

Childhood and adolescent mortality accounts for a substantial proportion of years lost prematurely. Reducing childhood and adolescent mortality relies on knowing characteristics of those at elevated risk of dying young. We therefore aimed to identify such characteristics; our main hypothesis is that psychosocial adversity in infancy is linked to increased mortality rates in childhood and adolescence.

METHODS

We conducted a register-based cohort study involving all 1,549,581 children born to Danish-born parents in Denmark between 1 January 1981 and 31 December 2010. For each infant, we extracted data relevant to Rutter's indicators of adversity (low social class, parents not cohabiting, large family size, paternal criminality, maternal mental disorder, and placement in out-of-home care). Follow-up began on the cohort member's first birthday. We estimated the association between adversity score (the number of Rutter's indicators of adversity present in infancy) and death via. Cox regression.

RESULTS

During follow-up (18,874,589 person-years), 2,081 boys and 1,420 girls died before or on their 18th birthday. The hazard ratios for death were 2.3 (95% CI = 1.9, 2.9) and 2.1 (95% CI = 1.6, 2.7) for boys and girls with adversity scores of 3-6 compared with those with a score of 0. These associations were driven by causes of death with known links to psychosocial adversity.

CONCLUSION

While absolute mortality rates were low, infants with adversity scores of 3-6 were approximately twice as likely to die prematurely compared with infants with adversity scores of 0. Whether these associations generalize to other countries should be subjected to further study.

Bicycle-related injuries among children treated in US emergency departments, 2006-2015

OBJECTIVE

One of the leading causes of non-fatal injury among children is bicycling. Past studies indicate that helmets are protective against bicycle-related injuries and involvement of motor vehicles is associated with severe injuries, but research utilizing a nationally representative data set for this population and focusing on these risk factors does not exist. The objective of this study was to describe the epidemiology of bicycle-related injuries among children treated in hospital emergency departments (EDs) in the United States (US).

METHODS

A retrospective analysis was conducted with data from the National Electronic Injury Surveillance System for children 5-17 years of age who were treated in US EDs from 2006 through 2015 for a bicycle-related injury. Helmet use and motor vehicle involvement were two variables that were created and coded using keyword searches of the case narratives. Rates of injuries over time were described. Multivariate logistic regression along with 95% confidence intervals (CIs) were used to contrast types of injuries sustained among injured helmet users with non-users.

RESULTS

An estimated 2 219 742 (95% CI: 1 871 120-2 568 363) children 5-17 years of age were treated in US EDs for bicycle-related injuries over the 10-year study period, an average of 608 injuries per day. Most injuries (45.7%) involved children 10-14 years of age. The rate of bicycle-related injuries significantly decreased from 447.4 per 100 000 children in 2006 to 321.1 per 100 000 children in 2015 (P < 0.001). Helmet use at the time of injury was significantly associated with lower likelihood of head and neck injuries (OR: 0.52 [95% CI: 0.40-0.59]) and hospitalizations (OR: 0.71 [95% CI: 0.54-0.94]), but there was no significant change in the rate of injury among helmet users over the study period (P = 0.224). Motor vehicle involvement increased the odds of bicycle-related traumatic brain injuries (TBIs) (OR: 1.98 [95% CI: 1.49-2.64]) as well as injury-related hospitalizations (OR: 4.04 [95% CI: 3.33-4.89]).

CONCLUSIONS

Despite decreasing injury rates, bicycling remains an important source of injury for children. Helmet use has demonstrated significant protective effects for TBIs, head and neck injuries, and hospitalizations. Motor vehicle involvement increased the risk of hospitalization. More efforts are needed to promote use of helmets and to reduce the possibility of bicycle-motor vehicle collisions to prevent bicycle-related injuries among children.