title: Risk Factors for Bicycling Injuries in Children and Adolescents: A Systematic Review.
abstract: Child and adolescent bicycling is beneficial, but injuries occur and can be severe and costly.
  
  
  
  To systematically review the individual and environmental factors associated with bicycling injury risk in children and adolescents.
  
  
  
  Fourteen electronic databases were searched.
  
  
  
  Two authors independently assessed potentially relevant articles for eligibility. The inclusion criteria were as follows: bicyclists younger than 20 years old; examined individual and environmental characteristics of bicycling crashes; compared injured and uninjured bicyclists or bicyclists with different types or severity of injury; study designs with a predetermined comparison group; and published in English from January 1990 to May 2015. The exclusion criteria were outcomes related to helmet use, helmet legislation, or mountain biking, and comparisons of census-based injury rates.
  
  
  
  Data on study design, setting, population, injury definitions, injury risk factors, and results were extracted. Risk of bias was assessed by using the Newcastle-Ottawa Scales.
  
  
  
  Fourteen articles were included. Lower socioeconomic status, riding on the road, riding in rural compared with urban areas, and riding on the sidewalk were associated with bicycling injury. Bicycling safety education did not protect children against future injury. Injuries related to a motor vehicle collision were more severe than other bicycling injuries.
  
  
  
  Study heterogeneity prevented meta-analyses. Study quality was affected by inadequate definitions of study groups and self-reported data.
  
  
  
  Lower socioeconomic status and riding location were associated with bicycling injury and severity increased with motor vehicle collisions. The bicycling environment is a promising avenue for prevention.
authors.affiliation: Departments of Paediatrics and.
authors.forename: Tania E
authors.initials: TE
authors.lastname: Embree
authors.affiliation: Departments of Paediatrics and.
authors.forename: Nicole T R
authors.initials: NT
authors.lastname: Romanow
authors.affiliation: Departments of Paediatrics and.
authors.forename: Maya S
authors.initials: MS
authors.lastname: Djerboua
authors.affiliation: Cumming School of Medicine.
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Morgunov
authors.affiliation: Postgraduate Medical Education, Faculty of Medicine, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Bourdeaux
authors.affiliation: Departments of Paediatrics and brent.hagel@albertahealthservices.ca.|Cumming School of Medicine.|Community Health Sciences.|Sport Injury Prevention Research Centre, Faculty of Kinesiology, and.|O'Brien Institute for Public Health.|Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; and.
authors.forename: Brent E
authors.initials: BE
authors.lastname: Hagel
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D001642:Bicycling / Q000293:injuries*; D002648:Child; D006801:Humans; D015601:Injury Severity Score; D012307:Risk Factors; D012424:Rural Population; D012923:Social Class