Severe Bicycling Injury Risk Factors – Children and Adolescents

severe bicycling injury risk factors in children and adolescents

The cycling research page has been updated with the addition of a paper looking at severe bicycling injury risk factors in children and adolescents. The details of the paper follows.

Severe Bicycling Injury Risk Factors – Children and Adolescents

Hagel, B. E., Romanow, N.T.R., Enns, N., Williamson,J. & Rowe, B. H. (2015). Severe bicycling injury risk factors in children and adolescents: A case–control study. Accident Analysis and Prevention, 78, 165-172.

The abstract of the paper follows:


Bicycling is the most common cause of sports and recreation injury in children and adolescents; yet, there is limited evidence on the factors associated with severe bicycling injuries in youth.


Case–control study of injured bicyclists less than 18 years old seen in seven emergency departments (EDs) from May 2008 to October 2010. Cases were bicyclists hospitalized after their ED visit (severe injury). Controls were bicyclists seen and discharged from the ED (non-severe injury). Personal, environmental, and crash characteristics were collected by interview. Injury data were collected from medical charts. Crude and adjusted odds ratios (Ors) and 95% confidence intervals (CIs) from logistic regression were used to estimate the odds of hospitalization associated with risk factors. Multiple imputation techniques were employed to address missing data.


There were 1470 participants including 119 cases. Those ages 13–17 had the highest proportion (23%) of severe injuries resulting from motor vehicle [MV] collision. In models including age, sex and MV collision, being male (OR: 2.02; 95% CI: 1.21–3.38), not wearing a helmet (OR: 2.18; 95% CI: 1.43–3.31) and MV collision (OR: 3.91; 95% CI: 2.26–6.78) were significant risk factors for severe injury. Riding on a paved surface (OR: 0.63; 95% CI: 0.41–0.97) and utilitarian (school, work) bicycling (OR: 0.44; 95% CI: 0.2–0.94) decreased injury risk. Results were similar, apart from utilitarian bicycling (OR: 0.49; 95% CI: 0.22–1.06), after imputation for missing data.


Bicycle–MV collisions increase severe injury risk in youth, and adolescents are often injured in these events. This suggests separating bicyclists from MVs or traffic calming strategies could improve safety.


CI, confidence interval;
ED, Emergency Department;
MV, motor vehicle;
OR, odds ratio;
RA, research assistant

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