title: Severe bicycling injury risk factors in children and adolescents: a case-control study.
abstract: BACKGROUND
  Bicycling is the most common cause of sports and recreation injury in children and adolescents; yet, there is limited evidence on the factors associated with severe bicycling injuries in youth.
  
  
  METHODS
  Case-control study of injured bicyclists less than 18 years old seen in seven emergency departments (EDs) from May 2008 to October 2010. Cases were bicyclists hospitalized after their ED visit (severe injury). Controls were bicyclists seen and discharged from the ED (non-severe injury). Personal, environmental, and crash characteristics were collected by interview. Injury data were collected from medical charts. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to estimate the odds of hospitalization associated with risk factors. Multiple imputation techniques were employed to address missing data.
  
  
  RESULTS
  There were 1470 participants including 119 cases. Those ages 13-17 had the highest proportion (23%) of severe injuries resulting from motor vehicle [MV] collision. In models including age, sex and MV collision, being male (OR: 2.02; 95% CI: 1.21-3.38), not wearing a helmet (OR: 2.18; 95% CI: 1.43-3.31) and MV collision (OR: 3.91; 95% CI: 2.26-6.78) were significant risk factors for severe injury. Riding on a paved surface (OR: 0.63; 95% CI: 0.41-0.97) and utilitarian (school, work) bicycling (OR: 0.44; 95% CI: 0.2-0.94) decreased injury risk. Results were similar, apart from utilitarian bicycling (OR: 0.49; 95% CI: 0.22-1.06), after imputation for missing data.
  
  
  CONCLUSIONS
  Bicycle-MV collisions increase severe injury risk in youth, and adolescents are often injured in these events. This suggests separating bicyclists from MVs or traffic calming strategies could improve safety.
authors: Departments of Paediatrics & Community Health Sciences, Alberta Children's Hospital Research Institute for Child & Maternal Health, Cumming School of Medicine, University of Calgary, C4-434, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Electronic address: brent.hagel@albertahealthservices.ca.
authors: Brent E
authors: BE
authors: Hagel
authors: Faculty of Kinesiology and Department of Paediatrics, Cumming School of Medicine, University of Calgary, KNB3300, 2500 University Dr. NW Calgary, Alberta T2N 1N4, Canada. Electronic address: ntruest@ucalgary.ca.
authors: Nicole T R
authors: NTR
authors: Romanow
authors: Undergraduate Nursing Program, Faculty of Nursing, University of Calgary, 2800 University Way N.W., Calgary, Alberta T2N 1N4, Canada. Electronic address: enns.nancy@gmail.com.
authors: Nancy
authors: N
authors: Enns
authors: Undergraduate Medical Education Program, Cumming School of Medicine, Health Sciences Centre Foothills Campus, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada. Electronic address: jjwillia@ucalgary.ca.
authors: Jacqueline
authors: J
authors: Williamson
authors: Department of Emergency Medicine & School of Public Health, University of Alberta, 1G1.50 Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada. Electronic address: browe@ualberta.ca.
authors: Brian H
authors: BH
authors: Rowe
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000367:Age Factors; D000416:Alberta / Q000453:epidemiology; D001642:Bicycling / Q000293:injuries* / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002980:Climate; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012449:Safety / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Bicycling; Child and youth; Hospitalization; Severe; Wounds and injuries