Tuesday, March 31, 2009

11 Latest Research : Bicycles Second To Automobiles In Child Injuries

Comment#30 or so from my last post really bothered me. I thought I'd address this and make some things really clear here, just to show everyone the severity of what we're looking at.

Here's that comment, delivered by an anonymous poster :

"As someone who has been closely affected by a loved one who died from a head injury I have to ask, what is it about riding a bicycle that brings up this issue? Does this happen to people on bicycles more than others, because I don't think it does.

The loved one I knew that died did so from falling down the stairs, not riding a bicycle. In my long life, i have also known others that have been hospitalized with head injuries from falls off ladders and automobile accidents as well. I paid attention when Dr. Atkins died from a head injury while walking on an icy sidewalk because I was on his diet at the time.

I don't understand why these head injuries seem to be getting ignored yet bicycle injuries get attention. I'm no scientist but I don't think it takes one to see there are far fewer of these injuries happening to people riding bikes than all those others.

In the memory of the one I loved, I would ask everybody to put this into perspective and not ignore the many and focus on a few. From the way I see this being played out around the neighborhood, no one seems to have any sense of perspective anymore. When I grew up, riding a bicycle was a good healthy thing to do and the only ones that ran into problems doing it were the ones who lacked a lick of common sense and probably would have had a similar problem doing something else because they lacked the common sense to behave safely in the first place."

Dear Anonymous,

I'm deeply sorry to hear about your loved one. While your comment is relevant and hearing about any kind of head injury is sad, realize two important things.

1) I'm addressing bicycling chiefly because I'm interested in exploring the bicycle as a consumer product on this blog and any interesting issues related to it.

2) One of the latest papers in the March 2009 publication of Clinical Pediatrics (Vol 48, No. 2) spells out the bad news for all of us in more clearer terms than I have seen anywhere else.

The paper is titled "Bicycle Related Injuries Among Children And Adolescents In The United States" authored by professionals from the Nationwide Children's Hospital Research Institute : Tracy J. Mehan, MA, Ricky Gardner, BS, Gary A. Smith, MD, Dr P.H and Lara B. McKenzie, PhD, MA.

Clipping 1 : The only consumer product associated with more childhood injuries than bicycles in the U.S are automobiles. Ouch.

Clipping 2 : The research involved a 16 year study of bicycling–related injuries treated in US emergency departments (EDs) using the CPSC NEISS (National Electronic Injury Surveillence System). The NEISS receives data from a network of approximately 100 hospitals that represent a stratified probability sample of 6100 hospitals with at least 6 beds and a 24-hour ED. The database provides information regarding injury events presenting to participating hospitals, including the patient’s age, sex, race/ ethnicity, injury diagnosis, body part injured, products involved, disposition from the ED, and a brief narrative of the incident. Each year, the NEISS provides data on approximately 500 000 injury-related ED visits. The probability sample method of the NEISS allows the use of statistical weights to make nationally representative estimates of the number of injurious events. What is to be remembered is that these are strictly ED cases, and exclusive of all other types of lesser injuries associated with bicycles.

Clipping 3 : For the 16 year research period, 6,228,700 children and adolescents (confidence interval 95% (95% CI, 5 439,376-7,018,002) under 18 years were treated in ED for bicycle related injuries. This represents a mean of 389,300 patients annually. The number of injuries decreased slightly during the 16 years studied; however, even in the year with the fewest injuries, there was a mean of more than 850 bicycle-related injury events per day.

Clipping 4 : Whats most interesting and revealing is this detailed epidemiology and breakdown of injuries, something no other research paper will provide you with. The head ranks among the top 4 body parts injured accounting for 12.4%. Anything within that bound may be fatal. In this study, children with head injuries were significantly more likely to require hospitalization and to have their injuries result in death.

Clipping 5 : And here's something for the product design people...just so you're aware that handlebars are causing abdominal injuries in children, so are wheel spokes. The authors offer two suggestions for design improvements. Remember, these are kids. Not experienced riders.

Clipping 6 : This research provides an important nationally representative analysis of bicycle-related injuries occurring to children and adolescents in the United States. These injuries continue to be a major problem for US children. According to Healthy People 2010, increasing bicycle safety is a national priority.

I hope I was able to clear any misconceptions in your mind and put a better perspective into what we're dealing with here. Child safety on bicycles is not to be taken lightly. The people who can really help are the ones designing bicycles for children, parents, and any volunteers who can cheer-lead and encourage safer biking practices among children. Shunning helmets and teaching kids to do the same is not the way to go.

* * *


  1. A bicycle or motorcycle helmet has never prevented an accident. Basic skills particularity how to ride a bike and follow traffic laws dramatically improve the safety of all cyclists and reduce falls, ~45% of all accidents.

    A helmet's primary function is to reduce potential impact of a crash. Far, far to often people who espouse helmets confuse protection with prevention. A helmet has never prevented an accident, basic skills will. Basic skills are more important and compliment the benefits of a helmet. Do not confuse a helmet as a substitute for basic skills.

  2. Danc : Wearing helmets is not the solution. Again, I'm reiterating it. It is one in a group of preventive measures. Child cycling in terms of injuries recorded doesn't seem to look good, looking at the data. There is a multi-pronged approach to dealing with it. Helmets, teaching basic skills, and do's and don'ts when riding on streets where children look to be killed more in are whats needed at this point. Again, shunning helmets takes away one of those insurances against head injuries and you just increase your chance of a fatality. Look at this in terms of probability.

  3. Ron, thanks for your work and big picture perspective on this hot issue. The bike has been a symbol to me and I am sure to most of us of total freedom. I think a lot of the energy behind opposing helmets is fueled by a concern of loosing some of this freedom.

  4. Without life, there is no freedom. :)

  5. Anonymous10:29 AM

    I like the statement in second to last graphic - "Because bicycle related injuries continue to be a major health concern in the United States, its important to consider all opportunities for injury prevention."

  6. Anonymous3:23 PM

    WOW...i wonder how the army of cyclists all over the WORLD did BEFORE helmets...?

  7. They died more.

  8. "Look at this in terms of probability."

    Which you didnt do.

    IF the actual probability were to throw up that a child is MORE likely (per hour spent on the activity) to sustain a serious head injury falling on stairs, or on a trampoline, or climbing-frame, or riding in a car or swimming then it would obviously follow that it would make more sense to address THESE issues before mandating cycle helmet use. I am not saying that these activities DO have a higher probability, but we need comparable figures if we are to have any idea of what 50k head injuries per year from cycling MEANS.

    I STILL feel that it is just as important that cyclists know HOW to fall and CAN fall well, and that helmets MAY inhibit this by their bulk. And that helmet DESIGN needs to come a long way in terms of comfort and practicality. A comment that you seem to have missed (or chosen to ignore on the previous post).


  9. João Paulo Magalhães7:26 PM

    I agree that helmet use is an important end-of-pipe solution to minimize injury risk. However, nothing is more important than properly learning how to ride a bike and deal with traffic. If you're going to hit your head on a crash, it's better to have your helmet than not having it - but in some cases the helmet won't save you (ask Saul Raisin).

    Helmet use should be strongly advised - as one of several ways of enhancing security. However, it must never be compulsory: that would interfere with our freedom of choice - I do with my destiny as I see fit and I recognize no one's right to dictate what I should wear.

    I use helmet for some 12000km a year. But there are times - some short recovery ride or a 1km ride to the café - when I consciously and deliberately choose not to use it (for example, when the temperature is sweet and I want to feel the wind in my head, to remember what it was like when I was a kid). It is a risk that I have the right to incur.

    If you defend compulsory helmet use, watch for the day when someone will defend that you should not ride your bike because the injury risk is greater than walking. Forcibly defending people against themselves is simply the wrong way to see things.

  10. Anonymous8:21 AM

    Is there any distinction between severity of injury?

    Surly, kids fall from bicycles, but doesn't that most often lead to simple bumps, bruises, cuts and scrapes? Isn't that all part of growing up and a learning tool to develop skills to learn to avoid such falls in the future?

    Bicycles have been around for a long, long, time and would they be so popular if they were actually dangerous?

    The tone of this is menacing and looks to be designed to scare folks away from bikes and that's not a good thing. That's a bad thng

  11. if kids hurt themselves o lot when riding bicycles, I wonder if anyone may consider how they are riding and how that may lead to more injuries while riding bikes.

    Seems to me, kids do all kinds of crazy things because they haven't yet learned that those crazy things lead to injuries, but when they do learn they do, they adjust their riding habits and become safer riders


Thank you. I read every single comment.