Wheels of Misfortune: A Tale of Two Rides

Laurel Barker
Jaycelyn Holland, MD
Jennifer McCain, MD
William King, DrPH
Kathy Monroe, MD, MSQI

Injuries are the number one cause of death in children and cause significant morbidity. Common scenarios for injury involve wheeled recreational devices (WRDs) as they allow children to be mobile and independent. This study compares injury patterns and mechanisms between dirtbikes (motorized, often used in organized events) and bicycles (primarily used for recreation and transportation) to evaluate common injuries and outcomes.

Following IRB approval, the Children’s Injury Database (CID) of our emergency department (ED) at a tertiary care children’s hospital was queried to identify all patients with an injury related to a dirtbike or bicycle during a two year period (2023 and 2024). Demographic information along with injury specific data (dirtbike versus bicycle, helmet use and admission rates) were collected and analyzed.

A total of 282 patients met criteria for inclusion with 123 dirtbike riders and 159 bicycle riders. Ages of patients ranged from 2 to 16 years for dirtbikes and 1 to 16 years for bicycles. The mean age was significantly higher for dirtbikes as compared to bicycles (11.1 versus 8.8 years; t=5.4, p< 0.0001). The majority of patients were Caucasian (81% for dirtbikes, 66% for bicycles), which is in contrast to our overall ED population, which is only 42% Caucasian. The majority of patients were male (88.62% for dirtbikes, 69.18% for bicycles).

Helmet documentation was done in 173 charts (61%) with usage rates being 65% for dirtbikes versus 16% for bicycles among documented cases. Non-documentation was higher for bicycles (53%) than dirtbikes (20%). Patients with injuries from dirtbike mechanisms were at a significantly higher likelihood of requiring admission as compared to bicycle-related injuries (34% versus 13%, p<0.00001) and also as compared to the general admission rate for all injuries (13.4%, p<0.00001).

This study reveals distinct injury differences between motorized dirtbike riders and bicycle riders in pediatric population. While demographic differences were minimal, dirtbike riders were found to be significantly older. Despite higher helmet documentation and usage rates among dirtbike riders, they required hospitalization at nearly three times the rate of bicycle riders, indicating likely more severe injuries in this group. These findings highlight the importance of age-appropriate safety measures and protective equipment for all WRD users.

1. Participants will identify key differences in dirtbike and bicycle injuries and severity
2. Participants will compare differences in hospital admission rates and helmet usage between the two mechanisms
3. Participants will describe epidemiological characteristics of pediatric WRB injuries presenting to emergency departments