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Bicycle Safety
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  1. Bicycle Safety Hilary Suzawa Med/Peds September 2006 Photo from SAFE KIDS

  2. Incidence • Bicycle-related injuries cause per year in the United States • 900 deaths • >20,000 hospital admissions • >500,000 ER visits • >1 million physician visits • Estimated cost of $8 billion annually

  3. Pediatric Injuries • Most common cause of serious head injury in children • Bicycle injuries account for 10% of all pediatric traumatic deaths

  4. Risk Factors • Peak incidence of bicycle-related injuries and fatalities • Age? • 9-15 years • Gender? • Male > Female

  5. Risk Factors • Male • 9-15 years old • Summer • Late afternoon or early evening • NO helmet • Motor vehicle involved • Unsafe riding environment • From an unstable family environment • Has a pre-existing psychiatric condition • Intoxicated • Competitive mountain-bike racing

  6. Acute Trauma • Most injuries occur to the upper or lower extremities • In order from most common to least common site of injury • Extremity • Head or face • Abdomen or thorax • Neck

  7. Acute Trauma • Superficial trauma: abrasions (“road rash”), contusions, lacerations • Extremities: Strains, fractures, dislocations • Abdomen or thorax: Blunt injury, handlebars • Face: Airborne objects leading to eye trauma • Neck: associated with MVA

  8. Acute Trauma • Head injuries • Occur in ~20-45% of injured bicyclists • Usually with MVA • Responsible for 60% of bicycle-related deaths • Younger children are more at risk for head injuries • ~50% of all bicycle-related injuries among children <10 years occur to the head or face vs. ~20% in older children

  9. Acute Trauma • Overall, off-road cyclists have a 40% lower incidence of head, facial and dental injuries than on-road bicyclists • Separation from motor vehicles • More frequent helmet use

  10. Overuse Injuries • Neck ache and backache • Hyperextension of the neck and flexion of the lower back • Tx rest, stretching, NSAIDs, shortening the handlebar reach • Compression Neuropathy • Ulnar neuropathy (from handlebars)

  11. Overuse Injuries • Buttock tenderness • Pressure over the ischial tuberosities • “Saddle sores” • From skin chafing • Tx powder, lubrication, seat positioning • GU conditions • Perineal folliculitis or maceration of the perineal skin • Traumatic urethritis with hematuria and mild dysuria • Nerve compression of pudendal nerve causing paresthesia of penis and scrotum in males • Females—vulval abrasions, lacerations, contusions

  12. Overuse Injuries • Hip pain • Trochanteric bursitits • Iliopsoas tendonitis • Knee pain • Patellofemoral syndrome • Foot pain • Metatarsalgia • Plantar fasciitis • Achilles tendonitis • Sun and heat

  13. Injury Prevention • Bike helmets reduce risk for bicycle-related injuries to the head by 75-85% and to the nose and upper face by ~65%. • Cyclists who strike heads in a crash are ~20 x more likely to sustain head trauma if NO helmet • Goal of Healthy People 2000 that 50% of bicyclists wear safety helmets (nationally 18%) • ~50% of children have bike helmets but only 15-25% wear them consistently and correctly

  14. Bike Helmet Fitting • Horizontal position—level front and back • Cover the top of the forehead—2 fingers above eyebrows • Straps forming a V around the ears • Buckle fastened • Fit snugly—when open mouth helmet moves down • Removable and extra-foam fitting pads to customize fit • Check fit by having child shake head—no side to side or back to front movement

  15. Bike Helmet Fitting

  16. Bike Helmet Fitting

  17. Bike Helmet Standards • Look for sticker on the helmet • States it meets standards of either • Snell Memorial Foundation • American National Standards Institute (ANSI) • Educate patients to replace bike helmet after an accident

  18. Barriers to Helmet Use • Financial—does not own a helmet • Peer pressure • Feels uncomfortable • Maternal employment (noted in one study)

  19. Factors Promoting Helmet Use • Legislation • 15 states have bicycle helmet laws • Texas as a state does not have legislation but cities do (eg. Austin) • Education • Parental attitudes • Peer attitudes

  20. Parents consistently overestimate their children’s likelihood of wearing a helmet. • Bicycle helmet use decreases as age increases

  21. Resources for Parents • AAP • National SAFE KIDS campaign • TMA Hard Hats for Little Heads • Bicycle Helmet Safety Institute • National Center for Bicycling and Walking • League of American Bicyclists

  22. Resources for Parents • Strap and Snap Program • Think First Foundation • EN CARE Bike with Care Program • National Center for Injury Prevention and Control • American Trauma Society • American Automobile Association • Harborview Injury Prevention and Research Center • United States Consumer Product Safety Commission

  23. Main Points • Bicycle-related accidents are a major cause of pediatric head injury and traumatic deaths • Peak risk group is age 9-15 years • Most common site of acute trauma: extremity • Head injuries are more common in younger children (<10 years) • Bike helmets reduce risk of head injury by ~75% • Know how to fit a bicycle helmet

  24. Bike Helmets at MLK Clinic • Any residents interested in coordinating an event and a bike-helmet program? • Funding? • Resources for helmets? • Survey of patients • How many own helmets? • How many wear helmets?

  25. Bibliography • Coffman, S. Bicycle Injuries and Safety Helmets in Children. Ortho Nurs 2003; 22(1): 9-15. • Clements J. Promoting the Use of Bicycle Helmets During Primary Care Visits. Jour of the Amer Acad of Nurs Pract 2005; 17 (9): 350-354. • Marsh E et al. Preventing Bicycle-Related Head Trauma in Children. Internat Jour of Trauma Nurs 2000; 6: 117-22. • Rezendes, J. Bicycle Helmets: Overcoming Barriers to Use and Increasing Effectiveness. Jour of Ped Nurs 2006; 21 (1): 35-44.

  26. Bibliography • Thompson, M and Rivara, F. Bicycle-Related Injuries. Amer Fam Phys 2001; 63 (10): 2007-2014. • Bicycle safety: Statistics pinpoint danger zones. www.bcm.edu/findings/vol2/is5/04may_n4.html • Section VII. Profiles. Austin, Texas. www.nhtsa.dot.gov/people/injury/pedbimot/bike/BikeHelmetUseLawsWeb/pages/7ProfileAAustin

  27. The End