O2068: Pediatric Fractures Associated with Riding Bicycles: A National Twenty-year Analysis

Background: Biking is a popular childhood activity that has an intrinsic risk of injury. While multiple advocacy groups have pushed for protective equipment to help mitigate these risks, to date, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth.

Methods: The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged ≤ 18 years with fractures presenting to U.S. Emergency Departments associated with bicycles. The narrative section of each entry was then individually analyzed to exclude patients not actively riding a bicycle to cause the fracture, as well as to note helmet use and motor vehicle involvement. Analysis of the annual incidence over time was performed with linear regression to determine the significance of trends observed in the number of bicycle-related fractures. National estimates and analysis of demographic and injury characteristics were performed with 95% confidence intervals.

Results: A total of 34,722 fractures were identified in the database, representing an estimated 1,019,509 fractures from 2001-2020, or 50,975 fractures annually. Linear regression noted that the overall trend was significant for decreasing fractures over the time period (R2=0.8997; P< 0.001). Most fractures occurred in patients who were male (71.8%, 95% Confidence Interval [C.I.] 70.3–73.2%), White (53.0%, C.I. 45.9–60.0%), and aged 10-12 (30.6%, C.I. 29.6–31.7%) or 13-15 years (24.8%, C.I. 23.4–26.2%). Fractures occurred most commonly in the Spring (34.2%, C.I. 32.4–36.2%) or Summer (37.8%, 34.4–41.4%) and at the lower arm (25.2%, C.I. 22.8–27.8%), wrist (21.2%, C.I. 19.5–22.9%), or shoulder (10.5%, C.I. 9.7–11.3%). Patients who sustained fractures with the involvement of a motor vehicle were more likely to be admitted to the hospital (27.1%, C.I. 21.3–33.9%) compared to patients without the involvement of a motor vehicle (6.7%, C.I. 5.2–8.5%). Where helmet use was recorded in patients with skull fractures, only a small minority were wearing helmets (14.2%, C.I. 7.5–25.4%) with the majority of patients not wearing helmets at the time of fracture (85.7%, C.I. 28.7–40.8%).

Conclusion: The national burden of fractures associated with riding bicycles in pediatric populations has shown a steady decrease for many years. However, the recent increase in fractures noted in 2020 is consistent with literature noting a significant increase in other injuries during the COVID-19 pandemic, potentially due to an increased use of bicycles from stay-at-home orders and cancellation of school and summer camps. The significant number of fractures requiring hospitalization with the involvement of a motor vehicle warrants further research in prevention of these injuries in children. The alarming number of skull fractures in which children were not wearing helmets supports continued efforts to promote consistent helmet use in children.