C. J. Allen2, J. Tashiro1, J. P. Meizoso2, J. J. Ray2, C. I. Schulman2, E. A. Perez1, D. Lasko1, H. L. Neville1, K. G. Proctor2, J. E. Sola1 1University Of Miami,Pediatric Surgery,Miami, FL, USA 2University Of Miami,Trauma And Critical Care,Miami, FL, USA
Introduction: Traffic accidents represent a leading cause of severe injury in children in the USA. Bicycles are connected to more pediatric injuries than any other consumer product, other than automobiles. Whereas patterns of injury in motor vehicle accidents have been well characterized and have led to major safety initiatives and treatment guidelines, information related to pediatric bicyclist injuries is lacking. With this recognition, our purpose is to identify major injury patterns associated with bicycle accidents in children admitted over a decade at a large pediatric level 1 trauma center.
Methods: From January 2000 to December 2012, consecutive pediatric admissions (≤17y) at a Level I trauma center were retrospectively reviewed for mechanism of injury, demographics, initial laboratory values and vital signs, injury patterns, Injury Severity Score (ISS), operative intervention, length of stay (LOS), and survival. Analysis was performed to recognize injury patterns and outcomes significantly associated with bicycle related accidents. Parametric data presented as mean±standard deviation and nonparametric data presented as median(interquartile range).
Results: A total of 80 pediatric patients were admitted following bicycle related trauma (4% of all pediatric trauma admissions). The cohort had an age of 11±4y, ISS of 11±10, was 48% black, and 81% male. Injury patterns included 21% isolated head, 21% isolated abdominal, 13% isolated extremity, and 35% multiple injuries. 15% required immediate operative intervention (6.3% abdominal, 8.8% orthopedic, no neurological). LOS was 5±7d with an overall mortality of 2.5%. The most common incident day of the week for bicyclist trauma was Friday at 24%, compared to 15% of all other traumas (p=0.03). Of these patients, 13% were age 0-6y, 49% were age 7-11y, and 39% were 12-17y (p<0.001). Younger children were significantly more likely to require an abdominal operation (20% in 0-6y vs 6.8% in 7-11y vs 3.2% in 12-17y, p=0.05). Mortality rates were similar at 0%, 2.3%, and 3.2% for the three age groups, respectively (p=NS).
Conclusion: The mortality rate associated with bicyclist injury in children is comparable to that of the overall pediatric trauma population. Orthopedic injury is the most frequent overall indication for surgery, yet the youngest children more often required an abdominal operation. This description of pediatric bicyclist injury patterns may help with the development of more specific preventive measures and anticipate injuries and outcomes according to age group.