The high morbidity associated with handlebar injuries in children.
BACKGROUND
Although injury prevention strategies for bicyclists have focused on legislation requiring helmet use to prevent head trauma, direct impact handlebar injuries account for a significant proportion of bicycle-related injuries. Little attention, however, has been paid to strategies that prevent direct impact handlebar injuries. We reviewed our experience with bicycle-related injuries and compared outcome for children who flipped over the handlebars to those for children who sustained direct impact from the handlebars.


METHODS
We queried our prospective trauma database for all bicycle injuries from 1998 to 2003. All patients with the descriptor "handlebar" in the subtext were selected. Patients were divided into two groups: those who flipped over the handlebars (n = 160) and those who sustained direct impact from the handlebars (n = 61). We examined age, gender, helmet use, injury severity score (ISS), Glasgow Coma Score (GCS), length of stay (LOS) and the need for operation. The Student's t test was used to compare continuous variables when the data were normally distributed and the Mann-Whitney was used when the data were skewed. Chi-square analysis or Fisher's exact test was used to compare categorical data.


RESULTS
There was no difference between the two groups with respect to age, gender, helmet use, ISS, and GCS. However, children who suffered from handlebar injuries were more likely to require operative intervention (19/61 versus 28/160, p = 0.04) and had a significantly longer LOS (3 days versus 1 day, p < 0.001). Children who sustained direct impact from the handlebars and required operative intervention were statistically more likely to suffer from abdominal or soft tissue injuries, while those who flipped over the handlebars were statistically more likely to suffer from facial or skeletal injuries.


CONCLUSIONS
Children who suffer from direct impact of the handlebars are more likely to require operative intervention and have a longer LOS than those who flip over the handlebars. While helmet utilization by bicyclists may have reduced the number of serious head injuries, direct impact from the handlebars remains a major source of bicycle-related morbidity since nearly one third of these patients required surgery. Future injury prevention strategies for bicyclists should be aimed at reducing the incidence of direct impact handlebar-related injuries.
Division of Pediatric Surgery, New York University School of Medicine, New York, NY 10016, USA. evan.nadler@med.nyu.edu
Evan P
EP
Nadler
Douglas A
DA
Potoka
Barbara L
BL
Shultz
Katie E
KE
Morrison
Henri R
HR
Ford
Barbara A
BA
Gaines
D000007:Abdominal Injuries / Q000209:etiology / Q000601:surgery; D034861:Abdominal Wall; D000293:Adolescent; D001642:Bicycling / Q000293:injuries*; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006260:Head Protective Devices; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000601:surgery