P3D250: Balance Bikes Are Safer Than Bicycles for Children Ages Five Years and Younger, a Review of Emergency Department Visits from 2013-2022 in the United States

Background: Each year, millions of children around the United States mount their bicycles in an attempt to achieve independent balance. Injuries from such endeavors are a common presentation to the emergency department (ED). There is little evidence describing how the type of training bicycle (i.e., training wheels versus a balance bike) used by a child affects the injury risk. Our study aims to address this literature gap by investigating and characterizing the epidemiology of bicycle-related injuries (BRI) that present to the ED.

Methods: The National Electronic Injury Surveillance System (NEISS) database was queried using the bike-related product codes (1398- balance bikes, 5040- bicycles, and 5033- mountain bikes) for ED visits in the United States. We evaluated the frequency of injuries in children ages 0-5 years from 2013-2022. All reported values are population national estimates generated from actual ring-related injury encounters. These were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons.

Results: From 2013 – 2022, there were 19,001 estimated BRIs in the ED from 664 actual cases (95% confidence interval 10,435 – 27,568). Ninety-six percent of BRI occurred in children riding bicycles, and 4% occurred in children riding balance bikes. Twenty-one percent of injuries occurred at home. The median age of children presenting to the ED for BRI on bicycles was 3.9 years (interquartile range 2.5 – 4.3) versus 2.8 years (interquartile range 2.0 – 2.8) for injuries from balance bikes. Sixty-five percent of children presenting for BRI were diagnosed with soft tissue injury, while 18% of children presenting for BRI were diagnosed with a fracture. An estimated 2,276 children with BRI were diagnosed with a head injury. Of the head injuries captured, 94% were associated with children riding a bicycle as opposed to a balance bike. Ninety-six percent of cases of BRI were evaluated and then released directly from the ED.

Conclusion: This is the first nationwide estimate of specific bike-type related injuries in children presenting to an ED. Soft tissue injury was the most commonly diagnosed BRI, followed by fractures. Head injuries were also relatively frequent, with an overwhelming majority of those cases associated with riding a bicycle, not a balance bike. BRI occurred significantly more frequently in children riding bicycles as opposed to balance bikes. Although BRIs did not often require care escalation, our study suggests an injury risk reeducation when children use a balance bike as opposed to a regular bicycle. Our data can help inform targeted public health intervention and anticipatory guidance given by providers who care for young children as to the appropriate bicycle type selection during toddlerhood.