HIDDEN SPEARS - HANDLEBARS AS INJURY HAZARDS TO CHILDREN

Objectives. To delineate the mechanism of serious bicycle handlebar-re lated injuries in children and make recommendations for preventive str ategies. Methods. Prospective cross-sectional surveillance system of s eriously injured child bicyclists supplemented by in-depth, on-site cr ash investigation to delineate specific injury mechanisms. Interdiscip linary analyses involved engineers, clinicians, epidemiologists, and b iostatisticians. Setting. The emergency department and in-patient trau ma service of an urban level one pediatric trauma center between Octob er 1995 and September 1997. Participants. Patients under 18 years of a ge who were treated for serious bicycle-related injuries (Abbreviated Injury Scale scores of 2 or greater). Results. The surveillance system identified two distinct circumstances for serious child bicyclist inj ury: 1) handlebar-related injuries associated with minor incidents (fa lls from bicycles) and 2) nonhandlebar-related injuries associated wit h severe incidents (bicycle-motor vehicle crashes). Crash investigatio ns explored the minor incidents that resulted in serious handlebar-ass ociated injuries. In the typical mechanism, as the child lost control of the bicycle and began to fall, the front wheel rotated into a plane perpendicular to the child's body. The child then landed on the end o f the handlebar resulting in serious truncal injuries. Conclusions. A discordancy exists between the apparently minor circumstances and seri ous injuries sustained by child bicyclists who impact bicycle handleba rs. Recognition of the mechanism of handlebar-related injuries might a id the practitioner in early diagnosis of serious abdominal injuries i n child bicyclists. This injury mechanism may be avoided through bicyc le redesign that would involve both limiting rotation of the front whe el and modifying the ends of handlebars. An integrated approach involv ing a surveillance system to identify an injury hazard supplemented by in-depth, on-site crash investigations effectively provided the detai led mechanism of injury needed to develop interventions.