Risk Factors for Bicycling Injuries in Children and Adolescents: A Systematic Review.

CONTEXT Child and adolescent bicycling is beneficial, but injuries occur and can be severe and costly. OBJECTIVE To systematically review the individual and environmental factors associated with bicycling injury risk in children and adolescents. DATA SOURCES Fourteen electronic databases were searched. STUDY SELECTION Two authors independently assessed potentially relevant articles for eligibility. The inclusion criteria were as follows: bicyclists younger than 20 years old; examined individual and environmental characteristics of bicycling crashes; compared injured and uninjured bicyclists or bicyclists with different types or severity of injury; study designs with a predetermined comparison group; and published in English from January 1990 to May 2015. The exclusion criteria were outcomes related to helmet use, helmet legislation, or mountain biking, and comparisons of census-based injury rates. DATA EXTRACTION Data on study design, setting, population, injury definitions, injury risk factors, and results were extracted. Risk of bias was assessed by using the Newcastle-Ottawa Scales. RESULTS Fourteen articles were included. Lower socioeconomic status, riding on the road, riding in rural compared with urban areas, and riding on the sidewalk were associated with bicycling injury. Bicycling safety education did not protect children against future injury. Injuries related to a motor vehicle collision were more severe than other bicycling injuries. LIMITATIONS Study heterogeneity prevented meta-analyses. Study quality was affected by inadequate definitions of study groups and self-reported data. CONCLUSIONS Lower socioeconomic status and riding location were associated with bicycling injury and severity increased with motor vehicle collisions. The bicycling environment is a promising avenue for prevention.