Severe bicycling injury risk factors in children and adolescents: A case–control study

• Children and adolescents have high hospitalization rates for bicycle injuries.
• There is little evidence on severe bicycling injuries in children and youth.
• Bicycle–motor vehicle collisions increase the odds of severe injuries.
• Helmet use reduces the odds of severe bicycling injuries.
• Separating bicyclists from motor vehicles and traffic calming could increase safety.

BackgroundBicycling is the most common cause of sports and recreation injury in children and adolescents; yet, there is limited evidence on the factors associated with severe bicycling injuries in youth.MethodsCase–control study of injured bicyclists less than 18 years old seen in seven emergency departments (EDs) from May 2008 to October 2010. Cases were bicyclists hospitalized after their ED visit (severe injury). Controls were bicyclists seen and discharged from the ED (non-severe injury). Personal, environmental, and crash characteristics were collected by interview. Injury data were collected from medical charts. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to estimate the odds of hospitalization associated with risk factors. Multiple imputation techniques were employed to address missing data.ResultsThere were 1470 participants including 119 cases. Those ages 13–17 had the highest proportion (23%) of severe injuries resulting from motor vehicle [MV] collision. In models including age, sex and MV collision, being male (OR: 2.02; 95% CI: 1.21–3.38), not wearing a helmet (OR: 2.18; 95% CI: 1.43–3.31) and MV collision (OR: 3.91; 95% CI: 2.26–6.78) were significant risk factors for severe injury. Riding on a paved surface (OR: 0.63; 95% CI: 0.41–0.97) and utilitarian (school, work) bicycling (OR: 0.44; 95% CI: 0.2–0.94) decreased injury risk. Results were similar, apart from utilitarian bicycling (OR: 0.49; 95% CI: 0.22–1.06), after imputation for missing data.ConclusionBicycle–MV collisions increase severe injury risk in youth, and adolescents are often injured in these events. This suggests separating bicyclists from MVs or traffic calming strategies could improve safety.