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Lisa Black

Children were not wearing helmets in 85% of the cases involving skull fractures

ANAHEIM, CA.--More than one million U.S. children fractured a bone while riding a bicycle over the past 20 years, and most of them were boys between ages 10 to 15 years old, according to research presented during the 2022 American Academy of Pediatrics National Conference & Exhibition.

Authors of the abstract, “Pediatric Fractures Associated with Riding Bicycles: A National Twenty-Year Analysis,” found that, despite efforts to make roads more bike-friendly, over 65,000 injuries occurred in an accident involving a motor vehicle. About 85% of children who sustained a skull fracture while riding bicycles were not wearing helmets.

“The results of our study suggest that continued efforts teaching road safety and promoting helmet use should be targeted towards all children, but with additional efforts being directed towards the most affected population, namely 10- to 15-year-old boys,” said J. Todd R. Lawrence, MD, PhD, at Children’s Hospital of Philadelphia. “Municipalities should continue to evaluate traffic patterns on their local roads to improve bike safety for children.”

The researchers examined information provided in the National Electronic Injury Surveillance System database for the years 2001 through 2020 to identify patients ages 18 or younger who showed up at U.S. emergency departments with fractures associated with bicycles. They found an average 50,975 fractures reported annually, with about 71% of patients being male. Only a small minority of patients with skull fractures were wearing helmets; nearly 87% of patients were not wearing helmets at the time of the skull fracture.

While the number of fractures from children riding bicycles has decreased over the past two decades, researchers noted an increase in fractures in 2020 that is consistent with literature showing a significant increase in other injuries during the COVID-19 pandemic. This is potentially due to an increased use of bicycles from stay-at-home orders and cancellation of school and summer camps.

“Given the results of our study, we recommend targeting bicycle safety efforts toward the most affected populations, largely 10- to 15-year-old boys,” said William Huffman, a medical student. “Teaching road and helmet safety for bicycle riders is paramount to keeping children safe.”

William Huffman is scheduled to present an abstract of the study, available below between 7:30-9 AM PT Sunday, Oct. 9, during the Section on Orthopaedics at the Anaheim Marriott, Grand Ballroom GH. To request an interview with the author, journalists may contact Kaila Revello at

In addition, Dr. Lawrence and Mr. Huffman will be among highlighted abstract authors will give brief presentations and be available for interviews during a press conference from 8:30 a.m.-10 a.m. PT Saturday, Oct. 8, in the National Conference Press Room, 213 AB. During the meeting, you may reach AAP media relations staff in the Press Room.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at

Program Name: 2022 AAP National Conference & Exhibition

Abstract Title: Pediatric Fractures Associated with Riding Bicycles: A National Twenty-Year Analysis

William Huffman

Philadelphia, PA, United States

Biking is a popular childhood activity that has an intrinsic risk of injury. While multiple advocacy groups have pushed for protective equipment to help mitigate these risks, to date, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth.

The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged ≤ 18 years with fractures presenting to U.S. Emergency Departments associated with bicycles. The narrative section of each entry was then individually analyzed to exclude patients not actively riding a bicycle to cause the fracture, as well as to note helmet use and motor vehicle involvement. Analysis of the annual incidence over time was performed with linear regression to determine the significance of trends observed in the number of bicycle-related fractures. National estimates and analysis of demographic and injury characteristics were performed with 95% confidence intervals.

A total of 34,722 fractures were identified in the database, representing an estimated 1,019,509 fractures from 2001-2020, or 50,975 fractures annually. Linear regression noted that the overall trend was significant for decreasing fractures over the time period (R2=0.8997; P< 0.001). Most fractures occurred in patients who were male (71.8%, 95% Confidence Interval [C.I.] 70.3–73.2%), White (53.0%, C.I. 45.9–60.0%), and aged 10-12 (30.6%, C.I. 29.6–31.7%) or 13-15 years (24.8%, C.I. 23.4–26.2%). Fractures occurred most commonly in the Spring (34.2%, C.I. 32.4–36.2%) or Summer (37.8%, 34.4–41.4%) and at the lower arm (25.2%, C.I. 22.8–27.8%), wrist (21.2%, C.I. 19.5–22.9%), or shoulder (10.5%, C.I. 9.7–11.3%). Patients who sustained fractures with the involvement of a motor vehicle were more likely to be admitted to the hospital (27.1%, C.I. 21.3–33.9%) compared to patients without the involvement of a motor vehicle (6.7%, C.I. 5.2–8.5%). Where helmet use was recorded in patients with skull fractures, only a small minority were wearing helmets (14.2%, C.I. 7.5–25.4%) with the majority of patients not wearing helmets at the time of fracture (85.7%, C.I. 28.7–40.8%).

The national burden of fractures associated with riding bicycles in pediatric populations has shown a steady decrease for many years. However, the recent increase in fractures noted in 2020 is consistent with literature noting a significant increase in other injuries during the COVID-19 pandemic, potentially due to an increased use of bicycles from stay-at-home orders and cancellation of school and summer camps. The significant number of fractures requiring hospitalization with the involvement of a motor vehicle warrants further research in prevention of these injuries in children. The alarming number of skull fractures in which children were not wearing helmets supports continued efforts to promote consistent helmet use in children.

Figure 1

Figure 1 Fractures.png

Fractures Presenting to U.S. Emergency Departments Associated with Riding Bicycles in Patients Aged ≤ 18 Years from 2001-2020

Table 1

Table 1 Demographic.png

Demographic and Injury Characteristics of Patients ≤ 18 Years of Age Presenting to U.S. Emergency Departments Between 2001 and 2020 with Fractures Associated with Riding Bicycles


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