crush injury (n=3). Several children had more than one type of injury. Many children required prolonged hospitalization for attempted replan¬ tation of amputated fingers or other
surgical procedures.
Two mechanisms of injury were identified. The most frequent mecha¬ nism involved the chain and sprocket
assembly. Typically, the child caught the fingers of one hand between the chain and sprocket while turning the pedals with the other hand; however, in seven cases, the bicycle was being pedaled by older siblings. All of the siblings were younger than age 6 years. Injury associated with the chain and sprocket assembly resulted in finger amputation in 76% of the cases. The remaining cases involved children catching their fingers in the rotating spokes of the wheel. All of these cases resulted in finger ampu¬ tation. The fact that all of the finger injury cases resulted from only two mechanisms is important in directing preventive efforts. In 1989, the American Society for Testing and Materials developed a standard consumer safety specifica¬ tion describing ideal safety design features for stationary exercise bicy¬ cles.6 This standard was written to provide safety guidelines for the us¬ ers of exercise bicycles. The average consumer, however, is unlikely to be familiar with the American Society for Testing and Materials or its pub¬ lications. These guidelines, while also available to manufacturers, are not mandatory. Currently, no established federal safety standards or guidelines exist for the manufacture of exercise bicycles. Many manufacturers have made voluntary efforts to improve the safety of newer-generation bicy¬ cles, including spokeless wheels,
an
enclosed chain and sprocket appara¬ tus, and wheel and pedal locks to prevent use of the equipment without supervision. In a recent mailing from the American Academy of Pediatrics, the Schwinn Bicycle Company, Chi¬ cago, 111, prompted by consumer in¬ jury reports, distributed a safety no¬ tice regarding one of its exercise bicycle models. Along with provid¬ ing appropriate warnings, a free chain guard modification kit was of¬ fered. This kit is designed to pre¬ vent finger and toe amputation in children. Despite efforts to improve safety,
stationary bicycles
continue to pose
significant hazards to children. Re¬ cently, Consumer Reports compared and tested 20 popular exercise bikes. Of these, 16 had either no guard over
the resistance mechanism or holes in the flywheel or fan guard where the fingers of young children could be caught and injured.
Summary.—Injuries to children re¬ lated to exercise bicycles can result in significant morbidity, but are almost entirely preventable. To forestall these injuries, manufacturers should continue to focus their attention on improved design and developing safer equipment. In addition, pedia¬ tricians and other primary care pro¬ viders need to play a role in educat¬ ing parents and the community about the possible hazards that exercise bi¬ cycles present to young children. JOHN H. GOULD, MD WENDY J. WALLACE, DO ALLAN R. DE JONG, MD Department of Pediatrics Children's Health Center Thomas Jefferson University 909 Walnut St Philadelphia, PA 19107-5211 1. Rutherford
GW, Edmunds M. Hazard Anal-
Exercise Equipment. Washington, DC: Directorate for Epidemiology, Division of Hazard Analysis; 1982. US Consumer Product Safety Commission. 2. US Consumer Product Safety Commission. National Injury Information Clearinghouse Accident Investigations: Finger Injuries With Exercise Bikes: 1980-1991. Washington, DC: US Consumer Product Safety Commission; 1991. 3. US Consumer Product Safety Commission. National Injury Information Clearinghouse Reported Incidents: Finger Injuries With Exercise Bikes: 1980-1991. Washington, DC: US Consumer Product Safety Commission; 1991. 4. US Consumer Product Safety Commission. National Electronic Injury Surveillance System: Product Summary Report CY 1990. Washington, DC: US Consumer Product Safety Commission; 1991. 5. US Consumer Product Safety Commission. National Electronic Injury Surveillance System: Exercise Equipment\p=m-\Estimate Report 1990. Washington, DC: US Consumer Product Safety Commission; 1991. 6. American Society for Testing and Materials. Standard Consumer Safety Specifications for Stationary Exercise Bicycles, F 1250\p=m-\89. Philadelphia, Pa: American Society for Testing and Materials; 1989.
ysis:
Influenza Vaccination and Acute Otitis Media in Children Sir.\p=m-\Inspite of the study design limitations (possible biases due to a higher
Downloaded From: http://archpedi.jamanetwork.com/ by a Monash University Library User on 06/16/2015
exposure rate for the control children and biases due to the lack of double blinding), the findings in the recent article by Heikkinen et al1 suggest that influenza vaccination may be effective in the prevention of acute otitis media in children. The results, however, contain a statistical error that affects the conclusions. The study correctly reports a significantly higher proportion of cases of influenza A and acute otitis media (AOM) among control children compared with vaccinated children. The authors report diagnoses of influenza A in five (2.67%) of 187 vaccinated and 29 (15.51%) of 187 control children. As the authors report, this difference is statistically significant (\g=x\2=18.63; P=.00001),2 and represents an
83% protective efficacy against in-
fluenza A: protective efficacy=1 \m=-\(failure rate of the vaccine/failure rate of no
In
treatment)=1\m=-\(2.67/15.51)=0.83.3
addition, the authors made the di-
agnosis of AOM in 35 (19%) of 187 vaccinated children and 55 (29%) of 187 control children. This difference is also statistically significant ( 2=5.85; P=.015) and represents a 36% (1-19/ 29=0.36) protective efficacy against AOM.2
However, the authors
errone¬
that the incidence of AOM associated with influenza A was reduced by 83% and that the reduction was statistically signifi¬ cant. Three (60%) of five vaccinated children who developed influenza also developed AOM and 18 (67%) of 27 control children who devel¬ oped influenza also developed AOM. The authors incorrectly re¬ ported that this is a statistically sig¬ nificant (P
surgical procedures.
Two mechanisms of injury were identified. The most frequent mecha¬ nism involved the chain and sprocket
assembly. Typically, the child caught the fingers of one hand between the chain and sprocket while turning the pedals with the other hand; however, in seven cases, the bicycle was being pedaled by older siblings. All of the siblings were younger than age 6 years. Injury associated with the chain and sprocket assembly resulted in finger amputation in 76% of the cases. The remaining cases involved children catching their fingers in the rotating spokes of the wheel. All of these cases resulted in finger ampu¬ tation. The fact that all of the finger injury cases resulted from only two mechanisms is important in directing preventive efforts. In 1989, the American Society for Testing and Materials developed a standard consumer safety specifica¬ tion describing ideal safety design features for stationary exercise bicy¬ cles.6 This standard was written to provide safety guidelines for the us¬ ers of exercise bicycles. The average consumer, however, is unlikely to be familiar with the American Society for Testing and Materials or its pub¬ lications. These guidelines, while also available to manufacturers, are not mandatory. Currently, no established federal safety standards or guidelines exist for the manufacture of exercise bicycles. Many manufacturers have made voluntary efforts to improve the safety of newer-generation bicy¬ cles, including spokeless wheels,
an
enclosed chain and sprocket appara¬ tus, and wheel and pedal locks to prevent use of the equipment without supervision. In a recent mailing from the American Academy of Pediatrics, the Schwinn Bicycle Company, Chi¬ cago, 111, prompted by consumer in¬ jury reports, distributed a safety no¬ tice regarding one of its exercise bicycle models. Along with provid¬ ing appropriate warnings, a free chain guard modification kit was of¬ fered. This kit is designed to pre¬ vent finger and toe amputation in children. Despite efforts to improve safety,
stationary bicycles
continue to pose
significant hazards to children. Re¬ cently, Consumer Reports compared and tested 20 popular exercise bikes. Of these, 16 had either no guard over
the resistance mechanism or holes in the flywheel or fan guard where the fingers of young children could be caught and injured.
Summary.—Injuries to children re¬ lated to exercise bicycles can result in significant morbidity, but are almost entirely preventable. To forestall these injuries, manufacturers should continue to focus their attention on improved design and developing safer equipment. In addition, pedia¬ tricians and other primary care pro¬ viders need to play a role in educat¬ ing parents and the community about the possible hazards that exercise bi¬ cycles present to young children. JOHN H. GOULD, MD WENDY J. WALLACE, DO ALLAN R. DE JONG, MD Department of Pediatrics Children's Health Center Thomas Jefferson University 909 Walnut St Philadelphia, PA 19107-5211 1. Rutherford
GW, Edmunds M. Hazard Anal-
Exercise Equipment. Washington, DC: Directorate for Epidemiology, Division of Hazard Analysis; 1982. US Consumer Product Safety Commission. 2. US Consumer Product Safety Commission. National Injury Information Clearinghouse Accident Investigations: Finger Injuries With Exercise Bikes: 1980-1991. Washington, DC: US Consumer Product Safety Commission; 1991. 3. US Consumer Product Safety Commission. National Injury Information Clearinghouse Reported Incidents: Finger Injuries With Exercise Bikes: 1980-1991. Washington, DC: US Consumer Product Safety Commission; 1991. 4. US Consumer Product Safety Commission. National Electronic Injury Surveillance System: Product Summary Report CY 1990. Washington, DC: US Consumer Product Safety Commission; 1991. 5. US Consumer Product Safety Commission. National Electronic Injury Surveillance System: Exercise Equipment\p=m-\Estimate Report 1990. Washington, DC: US Consumer Product Safety Commission; 1991. 6. American Society for Testing and Materials. Standard Consumer Safety Specifications for Stationary Exercise Bicycles, F 1250\p=m-\89. Philadelphia, Pa: American Society for Testing and Materials; 1989.
ysis:
Influenza Vaccination and Acute Otitis Media in Children Sir.\p=m-\Inspite of the study design limitations (possible biases due to a higher
Downloaded From: http://archpedi.jamanetwork.com/ by a Monash University Library User on 06/16/2015
exposure rate for the control children and biases due to the lack of double blinding), the findings in the recent article by Heikkinen et al1 suggest that influenza vaccination may be effective in the prevention of acute otitis media in children. The results, however, contain a statistical error that affects the conclusions. The study correctly reports a significantly higher proportion of cases of influenza A and acute otitis media (AOM) among control children compared with vaccinated children. The authors report diagnoses of influenza A in five (2.67%) of 187 vaccinated and 29 (15.51%) of 187 control children. As the authors report, this difference is statistically significant (\g=x\2=18.63; P=.00001),2 and represents an
83% protective efficacy against in-
fluenza A: protective efficacy=1 \m=-\(failure rate of the vaccine/failure rate of no
In
treatment)=1\m=-\(2.67/15.51)=0.83.3
addition, the authors made the di-
agnosis of AOM in 35 (19%) of 187 vaccinated children and 55 (29%) of 187 control children. This difference is also statistically significant ( 2=5.85; P=.015) and represents a 36% (1-19/ 29=0.36) protective efficacy against AOM.2
However, the authors
errone¬
that the incidence of AOM associated with influenza A was reduced by 83% and that the reduction was statistically signifi¬ cant. Three (60%) of five vaccinated children who developed influenza also developed AOM and 18 (67%) of 27 control children who devel¬ oped influenza also developed AOM. The authors incorrectly re¬ ported that this is a statistically sig¬ nificant (P
