title: The risk of pediatric bicycle handlebar injury compared with non-handlebar injury: a retrospective multicenter study in Osaka, Japan.
abstract: BACKGROUND
  Bicycle accidents are one of the major causes of unintentional traumatic injury in childhood. The purpose of this study was to examine characteristics and risks of handlebar injury in childhood.
  
  
  METHODS
  We conducted a more than 5-year retrospective survey of patients under 15 years of age with bicycle-related injuries admitted to eight urban tertiary emergency centers in Osaka, Japan. Patients were divided into the direct-impact handlebar injury (HI) group and the non-handlebar injury (NHI) group.
  
  
  RESULTS
  The HI group included 18 patients and the NHI group included 308 patients. Median Injury Severity Score (ISS) in the HI group was 9. Injury sites included the chest, 2 (chest bruise, 1; tracheal injury, 1) and abdomen, 16 (hepatic injury, 6; pancreatic injury, 2; duodenal injury, 1; splenic injury, 1; small intestinal injury, 1; retroperitoneal hemorrhage, 1; renal injury, 1; abdominal wall musculature injury, 2; bladder injury, 1; and perineal laceration, 1). There were no significant differences in age, sex, ISS, and prognosis between the two groups. However, significant differences were seen in the abdominal median Abbreviated Injury Scale (AIS) score, which was higher in the HI group (3 vs 0, p < 0.01), and in the head median AIS score, which was higher in the NHI group (0 vs 2, p < 0.01). As mechanisms of injury, falling while riding a bicycle occurred significantly more frequently in the HI group (17 [94.4 %] vs 65 [21.1 %], p < 0.01). Direct transportation from the scene of the accident occurred significantly more often in the NHI group (5 [27.8 %] vs 255 [82.8 %], p < 0.01), whereas transfer from another hospital occurred significantly more frequently in the HI group (11 [61.1 %] vs 45 [14.6 %], p < 0.01).
  
  
  CONCLUSIONS
  Handlebar injuries in children have significant potential to cause severe damage to visceral organs, especially those in the abdomen.
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. htomoya1979@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. ogura@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.affiliation: Department of Emergency Medicine, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan. take_yuki888@yahoo.co.jp.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Kiguchi
authors.affiliation: Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku-orai kita, Izumisano, 598-8577, Japan. y-mizushima@rgmc.izumisano.osaka.jp.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Mizushima
authors.affiliation: Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka, 565-0862, Japan. kingyo2104@gmail.com.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Kimbara
authors.affiliation: Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka, 543-0035, Japan. shimazaki@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Junya
authors.initials: J
authors.lastname: Shimazaki
authors.affiliation: Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, 3-4-13 Nishiiwata, Higashiosaka City, Osaka, 578-0947, Japan. shiono@nmcam.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Shiono
authors.affiliation: Department of Trauma and Critical Care Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan. yamamura@med.osaka-cu.ac.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamamura
authors.affiliation: Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka, 540-0006, Japan. gogowakasama@gmail.com.
authors.forename: Akinori
authors.initials: A
authors.lastname: Wakai
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. antique0503@yahoo.co.jp.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Takegawa
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. h.matsumoto0828@gmail.com.
authors.forename: Hisatake
authors.initials: H
authors.lastname: Matsumoto
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. mohnishi@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ohnishi
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. shimazu@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology / Q000628:therapy*; D001642:Bicycling / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk