Bicycle-riding circumstances and injuries in school-aged children. A case-control study
Y. D. Senturia, T. Morehead, S. LeBailly, E. Horwitz, M. Kharasch, J. Fisher and K. K. Christoffel
Department of Pediatrics, Children's Memorial Medical Center, Northwestern University, Chicago, Ill., USA. y-senturia@juno.com
OBJECTIVE: To identify bicycle-riding circumstances associated with
bicycle-related injury among school-aged children. DESIGN: Case-control.
SETTING: One metropolitan emergency department and 3 suburban emergency
departments. SUBJECTS: Consecutive sample of children aged 7 through 18
years who experienced bicycle-related trauma and control children seen for
non-bicycle-related trauma (matched for age within 1 year, sex, and area of
residence [urban vs suburban]). METHODS: Parents and case children were
interviewed by telephone about the bicycle ride resulting in their visit to
the emergency department. Parents and control children were interviewed
about their most recent bicycle ride. The survey instrument addressed the
following potential risk factors: helmet use, bicycle speed, road
conditions, riding location, bicycle condition, an adult presence, riding
destination, bicycle style, and stunt riding. RESULTS: Interviews were
completed with 47 (73%) of 64 eligible case children and 42 (69%) of 61
control children with the following age distribution: 27 (30%) of the
interviews were completed with children aged 7 to 9 years, 40 (45%) of the
interviews were completed with children aged 10 to 14 years, and 22 (25%)
of the interviews were completed with children aged 15 to 18 years.
Fourteen children (16%) were wearing helmets. There was a high degree of
agreement between parent and child responses, higher for case children than
for control children. In univariate analyses, injury was associated with
riding with other children (vs riding alone or with adults), riding fast or
slow (vs normal speed), riding a BMX-style (motocross) bicycle (vs another
standard or multispeed style bicycle), playing on the bicycle (vs going to
school or other purposeful or nonpurposeful trip), and riding only on the
sidewalk (vs in the street). More case children than control children were
farther than 3/4 mile (> 1.2 km) from home (38% vs 19%, P = .05).
Multiple logistic regression identified' slow riding speed (odds ratio,
10.3;95% confidence interval, 1.6-66.8), distance from home farther than
3/4 mile (> 1.2 km) (odds ratio, 3.7;95% confidence interval, 1.1-12.5),
and riding on the sidewalk (odds ratio, 6.1;95% confidence interval,
1.8-20.5) as independent risk factors for injury. CONCLUSIONS: This study
identifies 3 counterintuitive but apparently strong behavioral risk factors
for bicycle injuries treated in an emergency department in children aged 7
through 18 years in the Chicago (III) area. These findings will need to be
confirmed in larger samples from a wider range of locales. In addition to
stressing the importance of wearing a helmet when riding a bicycle, it may
be desirable to include the findings of this study in anticipatory guidance
discussions with school-aged children.
