title: Emergency department management and follow-up of children with bicycle spoke injuries.
abstract: BACKGROUND
  Evidence for a standard x-ray study and cast immobilization in emergency department (ED) management and follow-up of children with bicycle spoke injury (BSI) is absent.
  
  
  OBJECTIVE
  To describe the injury pattern and outpatient follow-up and care of ED patients with BSI. In addition, patient characteristics predicting the presence of a fracture and long-term follow-up were assessed.
  
  
  METHODS
  This was a retrospective study including BSI patients < 9 years of age. Kruskal-Wallis test was used to compare groups with a fracture, soft tissue injury, and mild skin abrasion. Multivariable logistic regression analysis was used to identify independent predictors of a fracture and long-term outpatient follow-up.
  
  
  RESULTS
  Twenty-three percent of 141 included patients had a fracture, with a median (interquartile range) follow-up of 27 (23-40) days. For soft tissue injury and mild abrasions this was 9 (6-14) and 7 (5-9) days, respectively (p < 0.001). No clinical variables could predict a fracture. Fifty-six (40%) patients required no further care after the first outpatient visit at ∼1 week. Triage category yellow and swelling were independent predictors for more than one outpatient visit, besides presence of fracture. Corrected odds ratios (95% confidence interval) were 2.42 (0.99-5.88) and 4.76 (1.38-16.39), respectively. Only 12% of 141 patients had none of these predictors at ED presentation.
  
  
  CONCLUSIONS
  A quarter of ED patients with BSI have a fracture with no clinical signs that could predict the presence of a fracture, justifying a standard x-ray study in ED management. Only 12% of ED patients with BSI have no fracture and no signs that predict long-term follow-up. In this group, further studies are warranted to investigate the benefit of cast immobilization for fractures and soft tissue injury.
authors.affiliation: Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Gordon
authors.initials: G
authors.lastname: Chu
authors.affiliation: Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Vlok
authors.affiliation: Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Carlijn
authors.initials: C
authors.lastname: Zwaag-Pijls
authors.affiliation: Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Houser
authors.affiliation: Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: de Groot
mesh_terms: D001642:Bicycling; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D018409:Foot Injuries / Q000453:epidemiology / Q000209:etiology*; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D022125:Lacerations / Q000453:epidemiology / Q000209:etiology; D007869:Leg Injuries / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000209:etiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*
keywords: cast immobilization; outpatient follow-up; outpatient visits; spoke injury