Bicycle injuries among the paediatric population at an emergency department in Singapore

Abstract

Among injuries from all recreational activities, bicycle injuries are the leading cause of emergency department (ED) visits. (1) Injuries to cyclists have been established as a significant worldwide public health burden. (2) This is of concern in Singapore, as cycling is a popular form of recreation, exercise and transport. These injuries are mainly due to falls from bicycles and collisions with moving or fixed objects. Fatal and serious injuries are mainly the result of collisions with motor vehicles. (3,4) Among the paediatric population, children aged 10-15 years have the highest fatality rates. (3) While fracture is the major cause of morbidity in children, traumatic brain injury is the leading cause of mortality and long-term disability. (2,4) In addition to this, handlebar accidents resulting in abdominal and pelvic organ injuries also result in a considerable amount of morbidity. (5) Children who ride in bicycle-mounted seats are also at risk for injury, (6) such as when their feet, legs or clothes get caught in the spokes of the wheel. (7) Wearing bicycle helmets is the single most effective measure for prevention of significant bicycle injuries, particularly child bicycle helmets, which have the highest cost-benefit ratio among all injury prevention interventions. (8) As the number of bicycle injuries remains high despite many education programmes aimed at preventing bicycle-related injuries, this retrospective study aimed to describe the patterns of paediatric bicycle-related injuries. METHODS This was a single-centre retrospective study based on data collected at the children's ED at KK Women's and Children's Hospital, Singapore, between 2011 and 2016. This facility was chosen primarily because it is the biggest children's ED in Singapore and manages the majority of children (aged ≤ 16 years) involved in accidents in Singapore. Our data was taken from the trauma registry and included all trauma-related injury, treatment, hospitalisations and deaths at the ED. This study was approved by the SingHealth Centralised Institutional Review Board hospital ethics committee. All data was recorded by trained medical personnel at the ED, including patient demographics, date and time of injury, place of occurrence, injury circumstances, mechanism of injury, interventions done at the ED and, subsequently, the patient's disposition. The mechanism of injury was categorised as follows: (a) fall; (b) direct collision with a bicycle; (c) road traffic accident; or (d) injury caused by a bicycle component. 'Yes' and 'No' variables were used to code interventions performed at the ED, which included radiological imaging, the need for toilet and suturing, manipulation and reduction, cast immobilisations, and the activation of Code Blue and trauma code. Data was entered in Microsoft Excel 2016 (Microsoft Corp, Redmond, WA, USA). SPSS Statistics version 22.0 (IBM Corp, Armonk, NY, USA) was used to generate descriptive data for reporting. Data was shown as number of cases and percentage.

Bicycle injuries presenting to the emergency department during COVID‐19 lockdown

“…Our findings of abrasions and soft tissue injuries as the most common injury followed by extremity injuries is consistent with previously reported work. 11,12 Injury patterns differed slightly in each of the cohorts. There were significantly more soft tissue injuries, and significantly fewer lacerations in the pandemic cohort.…”

“…11 In children, the types of injuries seen with bicycles are most commonly abrasions and soft tissue injuries, followed by extremity injuries, lacerations and head injuries. 11,12 In addition, the vast majority of injuries occur close to home. 11 Serious injuries have also been well documented.…”

“…These include severe head trauma, internal organ injury and bleeding (largely related to handle-bar injuries), and death. [11][12][13][14] To date, there has been no specific exploration of paediatric bicycle-related injuries during the COVID-19 pandemic. We sought to characterise the impact of the COVID-19 pandemic on bicycle-related injuries in children 0-17.99 years presenting to a tertiary care paediatric ED.…”

“…This risk is not evenly distributed; rather, the risk of injuries is highest amongst children 11 . In children, the types of injuries seen with bicycles are most commonly abrasions and soft tissue injuries, followed by extremity injuries, lacerations and head injuries 11,12 . In addition, the vast majority of injuries occur close to home 11 .…”

“…Serious injuries have also been well documented. These include severe head trauma, internal organ injury and bleeding (largely related to handle‐bar injuries), and death 11–14 . To date, there has been no specific exploration of paediatric bicycle‐related injuries during the COVID‐19 pandemic.…”