title: The full spectrum of handlebar injuries in children: a decade of experience.
abstract: BACKGROUND
  Traumatic paediatric handlebar injury (HBI) is known to occur with different vehicles, affect different body regions, and have substantial associated morbidity. However, previous handlebar injury research has focused on the specific combination of abdominal injury and bicycle riding. Our aim was to fully describe the epidemiology and resultant spectrum of injuries caused by a HBI.
  
  
  METHODS
  Retrospective data analysis of all paediatric patients (<18 years) in a prospectively identified trauma registry over a 10-year period. Primary outcome was the HBI, its location and management. The effects of patient age, vehicle type, the impact region, and Injury Severity Score (ISS) were also evaluated. HBI patients were compared against a cohort injured while riding similar vehicles, but not having sustained a HBI.
  
  
  RESULTS
  1990 patients were admitted with a handlebar-equipped vehicle trauma; 236 (11.9%) having sustained a HBI. HBI patients were twice as likely to be aged between 6 and 14 years old compared with non-HBI patients (OR 2.2; 95% CI 1.5-3.2). 88.6% of the HBI patients sustained an isolated injury, and 45.3% had non-abdominal handlebar impact. There were no significant differences in median ISS (p=0.4) or need for operative intervention (OR 1.1; 95% CI 0.9-1.5) between HBI and non-HBI patients. HBI patients had a significantly longer LOS (1.8 days vs. 1.2 days; p=0.001), and more frequently required a major operation (OR 3.4; 95% CI 2.2-5.4). The majority of splenic, renal and hepatic injuries were managed conservatively.
  
  
  CONCLUSIONS
  Although the majority of paediatric HBI is associated with both intra-abdominal injury and bicycle riding, it produces a spectrum of potentially serious injuries and patients are more likely to undergo major surgery. Therefore these patients should always be treated with a high degree of suspicion.
authors: Trauma Service, The Royal Children's Hospital, Melbourne, Australia.
authors: R M
authors: RM
authors: Nataraja
authors: Trauma Service, The Royal Children's Hospital, Melbourne, Australia.
authors: C S
authors: CS
authors: Palmer
authors: Department of Paediatric Surgery, Birmingham Children Hospital, Birmingham, UK.
authors: G S
authors: GS
authors: Arul
authors: Trauma Service, The Royal Children's Hospital, Melbourne, Australia.
authors: C
authors: C
authors: Bevan
authors: Trauma Service, The Royal Children's Hospital, Melbourne, Australia. Electronic address: joe.crameri@rch.org.au.
authors: J
authors: J
authors: Crameri
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000209:etiology*; D000058:Accidental Falls / Q000706:statistics & numerical data*; D000293:Adolescent; D001642:Bicycling; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000209:etiology*; D005151:Facial Injuries / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney; D007902:Length of Stay; D008099:Liver; D008297:Male; D009049:Motorcycles; D012189:Retrospective Studies; D013154:Spleen; D013898:Thoracic Injuries / Q000453:epidemiology / Q000209:etiology*; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000209:etiology*
keywords: Bicycle; Handlebar injury; ISS; Injury Severity Score; Motorcycle; Paediatric trauma; Trauma operations