Kids and teens ride bikes for fun, for transportation, and for exercise. And when parents worry about their young cyclists, they tend to focus more on serious accidents, such as being hit by a car. But in relatively minor bike accidents that don’t involve cars, the bicycle’s handlebars alone can seriously injure organs and structures in the abdomen, such as the liver, spleen, abdominal wall, and abdominal arteries. The September 2002 Archives of Pediatric and Adolescent Medicine reports new research on bicycle accidents not involving motor vehicles. The findings suggest that some 80% of abdominal injuries in these relatively minor bike accidents result from the handlebars being driven into the abdomen. And, the medical care costs associated with these injuries are quite high.

About the Study

Researchers from the Children’s Hospital of Philadelphia and the Universities of Pennsylvania and Pittsburgh studied hospital discharge records of children (up to age 19) who had been treated for bicycle injuries. They only included bicycle crashes that didn’t involve motor vehicles, because in such accidents, it is difficult to distinguish between injuries caused by the car and those caused by the handlebars. Injuries considered to be superficial were excluded from this analysis.

First, the researchers reviewed the child bicycle injury records from a large hospital registry database covering 19 US states for the year 1997. The database included information on the nature, cause, and severity of the injury; medical procedures performed; and medical care costs. Using these data, the researchers estimated the number of abdominal organ injuries resulting from handlebar impact in the entire US in 1997.

Next, they reviewed the medical records of all children up to age 19 treated for non-motor vehicle bicycle accidents at the Children’s Hospital of Philadelphia between January 1, 1996 and December 31, 2000. These records also included nature, cause, and severity of the injury; medical procedures performed; and medical care costs. In addition, information was verified by talking to patients and their parents. Researchers calculated the costs of lifetime medical care, insurance processing, lost worker productivity, and reduced quality of life.

Finally, the researchers used the medical care costs of the children treated at Children’s Hospital and their national estimate of handlebar-related injuries to calculate the medical care costs of such injuries nationwide.

The Findings

On the national level, the researchers estimate that 1147 children in the US suffered abdominal organ injuries in bicycle accidents not involving motor vehicles in 1997. Handlebars were described as a causative factor for about 80% of the abdominal organ injuries. Nationally, these injuries cost $9.6 million in total hospital costs, $10 million in lifetime medical care, and $11.5 million in lifetime productivity losses.

These results suggest that handlebars are to blame for serious abdominal organ injury and high medical care costs in relatively minor bicycle accidents, but this study has its limitations. First, the accuracy of the information on cause of injury in the multistate registry is unknown, because that information is not verified in any way. Second, the national estimate of handlebar-related abdominal injuries is based on the assumption that the injury statistics in the 19 states included in the registry are similar to the statistics in the other 31 US states. Third, some handlebar-related injuries could be misclassified as not handlebar related if medical staff failed to note handlebars as a cause in the medical record, or if patients failed to mention contact with the handlebars. Finally, in generating the cost estimates, researchers had to take figures from previous years and inflate them to account for rising costs over time. This type of forecasting is fraught with uncertainty.

How Does This Affect You?

These results confirm the findings of previous research that handlebars can cause rather serious injuries in bicycle accidents that otherwise should be relatively minor. Right now, the handlebars on most children’s bikes are designed in a way that they can easily be driven into the abdomen in an accident. However, some bikes have somewhat safer handlebar designs than others, and the US Consumer Product Safety Commission is considering regulating the design of handlebars to reduce the risk of injury on impact.

What can you do to prevent a serious abdominal organ injury in your young bicyclist? Because definitively safe handlebar designs are not the norm yet (though one of the study authors has a patent pending on a safer design), you’ll have to settle for efforts that reduce the risk of getting into a bike accident. Have your child’s bicycle tuned up regularly. A bike in good working condition is less likely to malfunction and cause an accident. In addition, make sure the bike is a good fit for your child, so that he or she can safely ride it. Teach your child safe bicycling habits. Finally, you can buy handlebar guards that fit on some bikes and make the ends of the handlebars less pointed, although there is no convincing evidence that these guards significantly affect the rate or seriousness of injuries.