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 Not surprisingly, injuries related to motor vehicle collisions are
more severe than other bicycling injuries, the authors found.
“Personal characteristics like age and sex were not consistently
associated with bicyclist injury among children and adolescents,”
which was in surprising, said senior author Brent E. Hagel of
Alberta Children’s Hospital in Canada.
The authors reviewed 14 studies on bicyclists younger than age 20
published between 1990 and 2015. Four studies took place in
Australia, four in the U.S., three in Canada, two in Taiwan and one
in Norway.
In terms of economic status and education level, children of parents
in the lowest of four income groups (according to parental reports)
were more likely to end up in an emergency room with a bicycling
injury than those in the higher income groups.
Bicycling speed was not associated with injury requiring hospital
admission; however, bicycling at a slow compared with normal speed
was linked with a 10-times higher risk of presenting to an ED with
an injury.
Children who began bicycling at ages 4 to 5 were injured earlier in
their first year of bicycling compared with those who started
bicycling at ages 6 to 7, the researchers found.
“Many of the higher quality studies identified environmental factors
that were associated with bicycling injury risk,” they reported.
For example, the risk of admission to a hospital or trauma center
for a head injury was greater in rural compared with urban areas and
for children bicycling on the road or in public spaces (playgrounds,
parks, or sports fields) compared with those bicycling in a
residential area (all private places of residence including yard,
garden, driveway, and garage).
Bicycling exclusively or extensively on the sidewalk compared with
riding sometimes or always in the street was also associated with
emergency department visits for bicycling injuries.
Results on cycling equipment, reflective materials, speed and
bicycling behavior were mixed.
Injuries requiring hospital admission were four times more common in
cyclists who collided with a moving vehicle than for others, as
reported in Pediatrics.
“As we indicate in the paper, these findings highlight the challenge
of finding safe locations for children and adolescents to bicycle,”
Hagel told Reuters Health by email.
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“Our focus was on children and youth,” but motor vehicle involvement
and high traffic speed and volume exposure increase injury risk for
cycling adults too, he said.
“Therefore, traffic calming measures and dedicated bicycling
infrastructure (e.g., separated bicycle tracks) would likely
decrease risk in both adults and children,” Hagel said.
It could be that lower socioeconomic areas may be associated with
greater motor vehicle traffic and other environmental exposures,
like less bicycling infrastructure, which leads to more injuries, he
said.
Bicycle skills training was not associated with reduced risk.
“We want children to bicycle for health and environmental benefits,”
Hagel said.
Since skills training does not appear to reduce risk, “the best
strategies would involve parents advocating for dedicated bicycling
infrastructure such as separated bicycle paths as well as reduced
speed limits and traffic calming measures to reduce the risk of
injury for children who bicycle,” he said.
“In turn, drivers should avoid distractions (e.g., cell phone use)
and obey the speed limits with a healthy respect for the damage a
motor vehicle can do in a collision with a bicyclist or a
pedestrian,” Hagel said. “If we create safer environments for
bicycling, then it is likely that more children and adolescents will
bike for transportation and recreation and this increased activity
may create a healthier population if children carry their active
transportation habits into adulthood.”
SOURCE: http://bit.ly/2f9nYZU Pediatrics, online October 24, 2016.
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