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The Risk of Under-Triaging Impalement Bicycle Handle Bar Injuries in Children

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The Risk of Under-Triaging Impalement Bicycle Handle Bar Injuries in Children
Carmen Ramos, MD, MSc (Staff Pediatric Surgeon), Shakeva Swain, MSN, RN, (Trauma Program Manager) and Samantha Troncoso-Munoz, RN, (Trauma Registry RN Coordinator), Nicklaus Children's Hospital, Miami FL

Objective: Impalement bicycle handlebar trauma injuries are rare; however, on initial assessment, they have the potential of being under-triaged. We reviewed our prospective trauma database of 3894 patients for all bicycle injuries from 2010 to 2015. Isolated pedal bike injuries were reported in 2.6% (N=101) of the patients who were admitted to the trauma service. Fifteen patients suffered direct handlebar trauma. Patients were grouped into blunt trauma (n= 12) and impalement trauma (n= 3). We examined gender, age, injury severity score (ISS), Glasgow Coma Score (GCS), use of protective devices, need for surgical intervention , need for intensive care (ICU) and hospital length of stay (LOS). Student's t-test was used to analyze continuous variables and Chi-square was used to compare categorical data. There were no differences between the two groups with respect to age, gender, ISS, GCS, and LOS. None of the children were wearing a protective device. Three patients with blunt injuries required ICU care. All the children who sustained impalement injuries required several surgical interventions. Their initial lengths of stay were shorter than blunt trauma patients because of misjudgment of their injuries at presentation (mean 18 hrs vs. 74 hrs, p=0.46). Impalement injuries included a traumatic direct inguinal hernia, a lateral thigh deep laceration and a medial groin and thigh laceration. Impalement bicycle handlebar injuries must be thoroughly evaluated with a similar importance given to blunt injuries. Emphasis should be given to a thorough history and physical examination despite other distracting injuries.
Objective: 1) Describe the frequency of impalement injuries due to bicycle handlebar trauma at a pediatric trauma center 2) Identify risk factors and early assessment queues associated with bicycle impalement injuries 3) Understand the potential morbidity associated with bicycle impalement injuries.Objective Content: I. Frequency of impalement injuries A. Total number of trauma cases in pediatric trauma registry 1. Inclusion criteria: cases classified as E.826.X 2. Age inclusion 0-21 years 3. Gender: Male and female II. Risk factors and early assessment queues A. Mechanism of injury 1. Impalement 2. Blunt B. Use of protective device 1. Helmet 2. Elbow and knee pads C. Injury severity score (ISS) D. Glasgow Coma Score (GCS) E. Need for Intensive Care F. Need for surgical intervention III. Morbidity of handlebar impalement A. Timing of diagnosis B. Associated injuries C. Need for surgical intervention D. Hospital length of stay.


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