ArticlePediatric surgery international2026
Predictors of organ injury in pediatric bicycle handlebar trauma: a single-center retrospective study.
Article in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeBicycle handlebar injuries in children can cause severe internal trauma despite a seemingly low-energy mechanism. External signs are unreliable indicators of underlying organ damage, and independent clinical predictors of organ injury have not been systematically evaluated.
methodsA retrospective review was performed of patients under 18 years presenting with bicycle handlebar injuries to a tertiary pediatric surgery center (June 2023-December 2025). Firth penalized-likelihood logistic regression was used to identify independent predictors of abdominal organ injury, and diagnostic performance metrics were calculated for key clinical findings.
resultsFifty-one patients were included (mean age 10.5 ± 2.7 years; 90.2% male). Seventeen patients (31.4%) sustained organ injuries. Abdominal pain (43.1%) and chest pain (9.8%) were the most common symptoms. On multivariable analysis, abdominal pain was an independent predictor of abdominal organ injury (adjusted OR = 11.00; 95% CI 2.31-52.33; p < 0.001; AUC = 0.78). Chest pain was recorded in 5 patients and accompanied thoracic injury in all of them. The handlebar sign was present in 45.1% but was not a significant predictor overall; however, upper abdominal bruise location was associated with organ injury in 77.8% of cases, whereas no organ injury occurred with lower abdominal bruising. Ten patients (19.6%) required surgery. No mortality was observed.
conclusionAbdominal pain was an independent predictor of abdominal organ injury. Upper abdominal bruise location was associated with a high rate of organ injury and may serve as a localizing sign, and chest pain reflected thoracic injury. These results support a symptom and anatomy-guided triage approach for pediatric handlebar trauma. LEVEL OF EVIDENCE: IV (Retrospective study).
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