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J Emerg Med. 2014 Sep;47(3):259-67. doi: 10.1016/j.jemermed.2014.04.028. Epub 2014 Jun 11.

Emergency department management and follow-up of children with bicycle spoke injuries.

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Leiden University Medical Centre, Leiden, the Netherlands.
Erasmus Medical Center, Rotterdam, the Netherlands.



Evidence for a standard x-ray study and cast immobilization in emergency department (ED) management and follow-up of children with bicycle spoke injury (BSI) is absent.


To describe the injury pattern and outpatient follow-up and care of ED patients with BSI. In addition, patient characteristics predicting the presence of a fracture and long-term follow-up were assessed.


This was a retrospective study including BSI patients < 9 years of age. Kruskal-Wallis test was used to compare groups with a fracture, soft tissue injury, and mild skin abrasion. Multivariable logistic regression analysis was used to identify independent predictors of a fracture and long-term outpatient follow-up.


Twenty-three percent of 141 included patients had a fracture, with a median (interquartile range) follow-up of 27 (23-40) days. For soft tissue injury and mild abrasions this was 9 (6-14) and 7 (5-9) days, respectively (p < 0.001). No clinical variables could predict a fracture. Fifty-six (40%) patients required no further care after the first outpatient visit at ∼1 week. Triage category yellow and swelling were independent predictors for more than one outpatient visit, besides presence of fracture. Corrected odds ratios (95% confidence interval) were 2.42 (0.99-5.88) and 4.76 (1.38-16.39), respectively. Only 12% of 141 patients had none of these predictors at ED presentation.


A quarter of ED patients with BSI have a fracture with no clinical signs that could predict the presence of a fracture, justifying a standard x-ray study in ED management. Only 12% of ED patients with BSI have no fracture and no signs that predict long-term follow-up. In this group, further studies are warranted to investigate the benefit of cast immobilization for fractures and soft tissue injury.


cast immobilization; outpatient follow-up; outpatient visits; spoke injury

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