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The full spectrum of handlebar injuries in children: a decade of experience
R M Nataraja1, C S Palmer1, G S Arul2
1Trauma Service, The Royal Children's Hospital, Melbourne, Australia.
Insights
Pediatric handlebar injuries (HBI) affect children aged 6-14 and often result in serious injuries requiring major surgery. These injuries, though not always abdominal, demand high clinical suspicion for proper management.
Area of Science:
- Pediatric Trauma Surgery
- Injury Epidemiology
- Biomechanics of Injury
Background:
- Traumatic pediatric handlebar injuries (HBI) are associated with significant morbidity across various body regions.
- Previous research on handlebar injuries primarily focused on abdominal injuries from bicycle accidents.
- A comprehensive understanding of HBI epidemiology and injury patterns is lacking.
Purpose of the Study:
- To fully describe the epidemiology of handlebar-equipped vehicle trauma in pediatric patients.
- To characterize the spectrum of injuries resulting from handlebar-equipped vehicle trauma.
- To compare injury patterns and outcomes between handlebar injuries and other similar vehicle traumas.
Main Methods:
- Retrospective analysis of a prospectively identified trauma registry over 10 years.
- Inclusion criteria: pediatric patients (<18 years) with handlebar-equipped vehicle trauma.
- Comparison group: pediatric patients injured on similar vehicles without handlebar involvement.
Main Results:
- 236 (11.9%) of 1990 patients sustained handlebar injuries (HBI).
- HBI patients were more likely to be 6-14 years old (OR 2.2).
- HBI patients had longer hospital stays (1.8 vs. 1.2 days) and higher rates of major surgery (OR 3.4).
Conclusions:
- Pediatric handlebar injuries can cause a spectrum of serious injuries, not limited to the abdomen.
- Patients with HBI are more likely to require major operative intervention.
- High clinical suspicion is crucial for managing pediatric handlebar injuries.
Background:
Traumatic paediatric handlebar injury (HBI) is known to occur with different vehicles, affect different body regions, and have substantial associated morbidity. However, previous handlebar injury research has focused on the specific combination of abdominal injury and bicycle riding. Our aim was to fully describe the epidemiology and resultant spectrum of injuries caused by a HBI.
Methods:
Retrospective data analysis of all paediatric patients (<18 years) in a prospectively identified trauma registry over a 10-year period. Primary outcome was the HBI, its location and management. The effects of patient age, vehicle type, the impact region, and Injury Severity Score (ISS) were also evaluated. HBI patients were compared against a cohort injured while riding similar vehicles, but not having sustained a HBI.
Results:
1990 patients were admitted with a handlebar-equipped vehicle trauma; 236 (11.9%) having sustained a HBI. HBI patients were twice as likely to be aged between 6 and 14 years old compared with non-HBI patients (OR 2.2; 95% CI 1.5-3.2). 88.6% of the HBI patients sustained an isolated injury, and 45.3% had non-abdominal handlebar impact. There were no significant differences in median ISS (p=0.4) or need for operative intervention (OR 1.1; 95% CI 0.9-1.5) between HBI and non-HBI patients. HBI patients had a significantly longer LOS (1.8 days vs. 1.2 days; p=0.001), and more frequently required a major operation (OR 3.4; 95% CI 2.2-5.4). The majority of splenic, renal and hepatic injuries were managed conservatively.
Conclusions:
Although the majority of paediatric HBI is associated with both intra-abdominal injury and bicycle riding, it produces a spectrum of potentially serious injuries and patients are more likely to undergo major surgery. Therefore these patients should always be treated with a high degree of suspicion.
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