Retrospective analysis of bicycle accidents at a referral pediatric emergency department: Mechanisms, outcomes and perspectives

Aim: We aimed to investigate the characteristics of patients involved in bicycle accidents, along with mechanisms of accidents and clinical outcomes in children. Our secondary aim was to assess the characteristics of patients with serious clinical consequences such as traumatic brain injury and permanent neurological sequelae.
Materials and Methods: Children admitted to the pediatric emergency department of a tertiary referral hospital during a four-year period due to bicycle accidents were included. The mechanism of accident was classified into two groups; high-energy trauma and low-energy trauma. Statistical analyses were performed to recognize injury patterns and clinical outcomes associated with mechanism of accident.
Results: 360 children were included. Two of the injured patients were using a bicycle helmet. 29 patients (8.1%) required surgery. Fourteen patients had clinically important traumatic brain injury. 18 patients had handlebar trauma to the abdomen. Eight patients had permanent neurologic sequelae (vision loss in three, hearing loss in three, spasticity and hemiparesis in two patients) and two patients had finger amputations. Abrasions/soft tissue injuries, scalp fractures, maxillofacial fractures and traumatic brain injury were also significantly more common types of injury in high-energy trauma.
Conclusions: Although the recommendation of using helmets while riding was made two decades ago, the rate of helmet use is still very low in our country. In this retrospective cohort with low rate and no obligatory regulation of helmet use, high-energy bicycle accidents have caused significant clinical outcomes, including maxillofacial-scalp fractures, traumatic brain injury, permanent sensory (visual and hearing) or motor (spasticity and hemiparesis) disability.