P3.K219: Pediatric Bicycle Injuries: A Comparative Analysis of Standard, Mountain, and Electric Bikes

Background: Bicycling has maintained its popularity over time, both for travel and recreation, with a notable surge in demand during the pandemic. Various bike types differ in their intended use, riding mechanics, and associated risks. However, the comparative epidemiology of bike-related injuries, including variations in patient demographics, injury distribution patterns, and outcomes, remains understudied, especially within pediatric populations. This study seeks to address this gap by comparing national injury trends across three categories of bicycles: standard, mountain, and electric bikes.

Methods: Data were analyzed from the National Electronic Injury Surveillance System (NEISS) regarding standard, mountain, and electric bicycle injuries treated in U.S. emergency departments from 2013 - 2022. Only data from patients aged 21 or younger were included. NEISS sample weights were applied to determine trends in yearly incidence, patient demographics, and injury patterns. Statistical analysis involved one-way ANOVA followed by Tukey’s HSD test for the comparison of means and chi-square tests followed by pairwise z-tests for the comparison of proportions.

Results: There were an estimated 1,968,072 pediatric bicycle injuries from 2013 – 2022. While standard bicycle injuries comprised most of the total bicycle injuries, the proportions of mountain and electric bike injuries have increased over time (Fig 1). The majority of patients were white and male, particularly for mountain bike injuries (P < 0.001). Patients with mountain and electric bike injuries tended to be older (p < 0.0001, Fig 2). Mountain bike injuries more commonly involved upper extremities (p < 0.001) and fractures (p < 0.001), while electric bike injuries more commonly involved lower extremities (p < 0.001). The frequencies of head and neck injuries (p < 0.001), traumatic brain injuries (p < 0.001), and hospitalizations (p < 0.001) were greater for mountain and electric bikes.

Conclusion: Injury patterns were significantly different between standard, mountain, and electric bikes. The recent increase in the incidence of mountain and electric bike injuries may be a cause for concern, given the greater risk of traumatic brain injuries and hospitalizations. These results indicate the importance of helmet use among bicyclists, particularly for mountain and electric bikes, where the incidence of head and neck injuries is highest. Additionally, the significant increase in upper extremity injuries among mountain bicyclists may indicate a greater need for specialized protective equipment such as elbow guards and body armor. More complete narrative data is needed to determine additional risk factors.