Search

Background Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury. Methods First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist’s route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries. Discussion This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team’s national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

CONTEXT: Child and adolescent bicycling is beneficial, but injuries occur and can be severe and costly. OBJECTIVE: To systematically review the individual and environmental factors associated with bicycling injury risk in children and adolescents. DATA SOURCES: Fourteen electronic databases were searched. STUDY SELECTION: Two authors independently assessed potentially relevant articles for eligibility. The inclusion criteria were as follows: bicyclists younger than 20 years old; examined individual and environmental characteristics of bicycling crashes; compared injured and uninjured bicyclists or bicyclists with different types or severity of injury; study designs with a predetermined comparison group; and published in English from January 1990 to May 2015. The exclusion criteria were outcomes related to helmet use, helmet legislation, or mountain biking, and comparisons of census-based injury rates. DATA EXTRACTION: Data on study design, setting, population, injury definitions, injury risk factors, and results were extracted. Risk of bias was assessed by using the Newcastle-Ottawa Scales. RESULTS: Fourteen articles were included. Lower socioeconomic status, riding on the road, riding in rural compared with urban areas, and riding on the sidewalk were associated with bicycling injury. Bicycling safety education did not protect children against future injury. Injuries related to a motor vehicle collision were more severe than other bicycling injuries. LIMITATIONS: Study heterogeneity prevented meta-analyses. Study quality was affected by inadequate definitions of study groups and self-reported data. CONCLUSIONS: Lower socioeconomic status and riding location were associated with bicycling injury and severity increased with motor vehicle collisions. The bicycling environment is a promising avenue for prevention.

Background The standard response time benchmark for Emergency Medical Services (EMS) has been set at eight minutes or less for ground ambulances in many parts of the world. It has not been extensively studied, especially in paediatric patients who suffered a traumatic injury. As injury is the leading cause of death for those under the age of 18 it is important to determine if this benchmark for EMS response time may be a factor in paediatric mortality and morbidity outcomes. Methods All paediatric calls made to EMS between April 2010 to September 2013 in the cities of Calgary and Edmonton, Alberta, Canada were examined to select patients who had suffered a traumatic injury. These records were then linked to emergency department records and hospitalisation records using a deterministic linkage strategy using personal healthcare number, sex, and receiving facility. Patients were excluded if they were ≥18 years old, attended to outside of Calgary or Edmonton areas or suffered a medical complaint not related to an injury. Response time, the exposure, was defined as time of call to 9–1–1 to arrival of ambulance on scene. Response time was dichotomized into Results 42 620 patients were attended to between April 2010 and September 2013. Overall, 6778 patients were included in the study. 52 patients died and 628 patients were admitted to hospital. The adjusted mortality risk ratio given a response time of ≥8 minutes was 0.635 (95% CI: 0.346–1.166; p = 0.143). The adjusted hospital admission risk ratio given a response time of ≥8 minutes was 1.165 (95% CI: 0.985–1.379; p = 0.075). Conclusions A response time of ≥8 minutes was not associated with a difference in all cause mortality or hospital admission for paediatric patients suffering from a traumatic injury.

Background Bicycling injuries in young people represent a substantial cost to health care systems. The objective of this review was to examine the individual and environmental factors associated with bicycling-related injury risk in children and youth. Methods Fourteen electronic databases were searched using exploded subject headings and keywords. Two authors independently screened article titles and abstracts for inclusion. The full-text of the potential articles was assessed to determine eligibility. The inclusion criteria were bicyclists less than 18 years old; individual and environmental characteristics of bicycling outcomes; comparisons between injured and uninjured bicyclists, injury type or severity level; study designs with a pre-determined comparison group; and publications in English from 1990 to May 2015. The exclusion criteria were injury outcomes related to helmet use, helmet legislation or mountain biking; comparisons of census-based injury rates; cross-sectional studies; and letters to the editor. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. Results Fifteen articles met the inclusion and exclusion criteria. Overall, 46 different risk factors were examined. The most commonly reported risk factors were age (N = 10 studies), sex (N = 7), equipment related factors (N = 6), bicycling exposure (N = 5), bicycling purpose (N = 5), and motor vehicle (MV) collision (N = 4). The reviewed studies varied in quality; the main weaknesses were inadequate definitions of study groups, lack of control for potential confounders, and the use of self-reported data. Conclusions While many of the studies had significant limitations, one recurring theme was that young bicyclists received more severe injuries when exposed to MV collisions. To reduce injuries in children and adolescents, we recommend separating bicyclists from MVs on the road and implementing strategies to reduce traffic speed and volume.