Head-ground impact conditions and helmet performance in E-scooter falls

The characteristics of e-scooter accidents reported by police in Türkiye

OBJECTIVES

Shared e-scooter service has been offered by various operators in Türkiye since 2019. The use of private and shared e-scooters is increasing, especially in large cities. This raises social concerns about the dangers e-scooters pose regarding traffic safety and injuries requiring medical attention. This study aims to investigate the accidents related to e-scooters in Türkiye to determine the contributing factors and accident characteristics.

METHODS

In this study, accident reports (collision reports) for 780 e-scooter collisions that occurred in 2021 in Türkiye were examined, and 771 accidents were included. Accident data were obtained from the Traffic Department of the Ministry of Interior, General Directorate of Security. Descriptive statistics of the factors affecting e-scooter accidents are presented to determine the relationship and differences; chi-square tests, independent samples t-tests, one-way analysis of variance, and binary logistic regression methods were used.

RESULTS

Male e-scooter riders are involved in crashes and injured approximately 4 times more often than female riders. The average age for men injured in e-scooter accidents is 30.4, and the mean age for women is 27.2. For both males and females, most injuries occurred in the 15 to 20 age group. Riders under the age of 18 constitute a significant proportion of the accidents (32.5%). Most e-scooter accidents occur on Mondays and during the month of August. Most accidents occurred between 12:00 p.m. and 1:59 p.m. (15.7%) and between 4:00 p.m. and 5:59 p.m. (15.7%), mainly during the daytime. About half of the accidents occurred at intersections. In 10.5% of accidents, the accident occurred at a pedestrian crossing. Approximately one-fifth of the accidents involved falls, and the most common type of collision was a side collision (44.2%). The binary logistic regression model showed that multivehicle accidents occur more often at intersections and during busy traffic hours. Single-vehicle accidents are more common on concrete roads and stone block roads.

CONCLUSIONS

Deaths and injuries caused by road traffic accidents are a public health problem in Türkiye and constitute a significant health burden. If necessary precautions are not taken, this burden is likely to increase. We hope that the findings from this study will help reduce e-scooter accidents in Türkiye.

Pilot Study Investigating Effects of Changing Process Variables on Elastic and Energy-Absorbing Characteristics in Polyurethane/Agglomerated Cork Mix for Use in Micro-Transport Helmet

This pilot investigation identifies the influence that changing the process variables of curing pressure, curing temperature, and mix ratio of a polyurethane/agglomerated cork matrix has on the mechanical properties of energy absorption, Young's modulus of elasticity, and spring stiffness in safety helmets intended for micro-transport riders. The results are compared to expanded polystyrene, a material commonly used in micro-transport helmets. Mechanical testing of the various samples found that, over the range tested, curing pressure had no effect on any of the mechanical properties, while increasing amounts of resin caused a stiffer structure, and increasing curing temperature led to increased energy absorption. Consistent with the elastic modulus findings, all polyurethane/agglomerated cork test samples demonstrated higher median levels of spring stiffness, ranging from 7.1% to 61.9% greater than those found for expanded polystyrene. The sample mixed at a 1.5:1 binder/cork ratio and cured at 40 °C displayed the closest spring stiffness to EPS. While the mechanical properties of the eco-friendly polyurethane/agglomerated cork matrix did not match those of expanded polystyrene, the difference in performance found in this study is promising. Further investigation into process variables could characterise this more ecologically based matrix with equivalent energy-absorbing and structural characteristics, making it equivalent to currently used expanded polystyrene and suitable for use in micro-transport helmets.

Characteristics and Injury Patterns in Traumatic Brain Injury Related to E-Scooter Use in Riga, Latvia: Multicenter Case Series

Background and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years-2022 and 2023-after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1-Q3, 20.25-37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted.

National Trends and Clinical Outcomes after Scooter Injury in the US: 2016 to 2020

BACKGROUND

In recent years, the adoption of electric scooters has been accompanied by a surge of scooter-related injuries in the US, raising concerns for their severity and associated healthcare costs. This study aimed to assess temporal trends and outcomes of scooter-related hospital admissions compared with bicycle-related hospitalizations.

STUDY DESIGN

This was a retrospective cohort study using the 2016 to 2020 National Inpatient Sample for patients younger than 65 years who were hospitalized after bicycle- and scooter-related injuries. The Trauma Mortality Prediction Model was used to quantify injury severity. The primary outcomes of interest were temporal trends of micromobility injuries. In-hospital mortality, rates of long bone fracture, traumatic brain injury, paralysis, length of stay, hospitalization costs, and nonhome discharge were secondarily assessed.

RESULTS

Among 92,815 patients included in the study, 6,125 (6.6%) had scooter-related injuries. Compared with patients with bicycle-related injuries, patients with scooter-related injuries were more commonly younger than 18 years (26.7% vs 16.4%, p < 0.001) and frequently underwent major operations (55.8% vs 48.1%, p < 0.001). After risk adjustment, scooter-related injuries were associated with greater risks of long bone fracture (adjusted odds ratio 1.40, 95% CI 1.15 to 1.70) and paralysis (adjusted odds ratio 2.06, 95% CI 1.16 to 3.69) compared with bicycle-related injuries. Additionally, patients with bicycle- or scooter-related injuries had comparable index hospitalization durations of stay and costs.

CONCLUSIONS

The prevalence and severity of scooter-related injuries have significantly increased in the US, thereby attributing to a substantial cost burden on the healthcare system. Multidisciplinary efforts to inform safety policies and enact targeted interventions are warranted to reduce scooter-related injuries.

Unveiling the Surge: A Comprehensive Analysis of E-Scooter-Related Injuries at an Urban Level 1 Trauma Center in Vilnius, Lithuania (2018-2021)

Background The surge in electric scooter (e-scooter) adoption in 2019 fueled by sharing platforms has raised safety concerns, leading to an increased incidence of e-scooter-related injuries. Despite regulatory efforts, there has been a notable rise in accidents, prompting a comprehensive investigation. This study conducted at the Republican Vilnius University Hospital (RVUH), a level 1 trauma center, is one of the first in the Baltic States aiming to analyze the causes, severity, and frequency of e-scooter injuries from 2018 to 2021. This research addresses a critical gap in understanding e-scooter safety in the Baltic States, providing valuable insights for informed policy and preventive measures. Methodology This retrospective study analyzed e-scooter-related injuries in Vilnius, Lithuania, from April to September during 2018-2021. Data from the RVUH emergency department were examined. Using keywords such as "scooter" and "electric," relevant cases were extracted from the RVUH electronic health system. Included were individuals, both riders and pedestrians, with clear e-scooter involvement, excluding duplicates, those under 18, and users of other types of scooters. Extracted medical records provided data on demographics, injury specifics, helmet use, alcohol consumption, and more. Trauma severity was assessed through the New Injury Severity Score (NISS) and Abbreviated Injury Scale (AIS). Statistical analysis utilized GraphPad Prism software and Excel, adhering to ethical guidelines with RVUH Bioethics Committee approval. Results Over four years, 1,036 e-scooter-related injuries at RVUH revealed a gender-based shift, with males sustaining more injuries. The introduction of rentals in 2019 triggered a 334% surge in injuries compared to 2018. Despite an annual 208% increase from 2018 to 2021, 2021 saw a 710.93% rise. Trauma severity remained consistent, with AIS scores 1 and 2 being prevalent. Non-helmet wearers constituted 97.97%, and soft tissue damage was predominant. Ownership patterns shifted toward rentals (81.15%), reflecting the popularity of sharing platforms. Alcohol influence showed no significant change, but intoxicated patients had a higher surgery rate during four years. Mechanism analysis highlighted tripping as the primary cause. Injury characteristics revealed fractures in 34.56% of cases, primarily affecting upper limbs (53.35%). Soft tissue trauma was prominent (65.44%), with lower limbs being significantly impacted. Conclusions The surge in e-scooter injuries demands urgent preventive action. While most injuries are mild, a significant proportion is moderate to severe, even fatal. Inadequate education, lax enforcement, and uneven infrastructure contribute to the risk. Urgent measures, including road maintenance, speed reduction, and mandatory helmet use, are crucial. Clarity in government directives for designated e-scooter areas is vital. Further research is needed to understand the broader impact of informed policymaking and safer urban mobility. Expanding research to other Lithuanian regions would enhance the current study.

Lessons learned? Increasing injury severity of electric-scooter accidents over a period of one year: a monocentric follow-up study at a level 1 trauma center

PURPOSE

After major COVID-19 lockdown measures were suspended in 2021, E-scooter mobility regrew rapidly. In the meantime, multiple studies were published on the potential risks for e-scooter drivers and the necessity for wearing protective equipment. But did the drivers learn their lessons?

METHODS

We observed data of E-scooter-related accidents admitted to the emergency department of a level 1 German trauma center in the year 2021 and compared the data with our previous report (July 2019-July 2020).

RESULTS

N = 97 E-scooter-related accidents were included, marking a 50% increase when compared to the previous observation. Most patients were young adults (28.18 ± 1.13 years) with a notable shift towards a male population (25 vs. 63, p = 0.007). While the injury pattern remained unchanged, injury severity, reflected by a significant increase in shock room treatments (p = 0.005), hospital admissions (p = 0.45), and ICU admissions (p = 0.028), increased. Lastly, we report a higher injury severity of patients driving under the influence of alcohol, expressed by significant differences in hospital admissions, shock room treatments, ICU admissions, intracerebral bleeding (p < 0.0001), and injuries requiring surgery (p = 0.0017).

CONCLUSION

The increase in injury severity and especially the substantial number of accidents due to driving under the influence of alcohol, are alarming for both trauma- and neurosurgeons. As the controversy surrounding the general use of E-scooters will continue, we urge representatives to intensify their efforts regarding prevention campaigns focusing on the potential dangers of E-scooters, especially when driving under the influence of alcohol.

Analysis of the consequences of car to micromobility user side impact crashes

INTRODUCTION

The strong rise in modes of travel commonly referred to as micromobility has changed the mobility patterns and lifestyles in cities worldwide, especially after the COVID-19 pandemic. It has led to a significant increase in the number of crashes involving these types of vehicles, especially bicycles and stand-up e-scooters. The risk of crashes is higher at intersections where motor-vehicles perform a turning maneuver crossing a bike lane.

METHOD

The consequences of a passenger car-to-micromobility vehicle side-impact crashes, considering both bicycle and e-scooter, were studied based on the results of the simulation of several scenarios with PC-Crash software. Two injury criteria were applied: Head Injury Criterion (HIC15) and 3 ms chest acceleration criterion.

RESULTS

When motor-vehicle speed is lower than 50 km/h, the 3 ms chest acceleration never exceeds the 60 g threshold. However, at 50 km/h, it is close to 50 g in the case of e-scooter rides. At this speed, HIC15 is considerably greater than 1000, both for bicycles and for e-scooters, and the safety margin of 700 is exceeded at 45 km/h for e-scooters.

CONCLUSIONS

In case of motor vehicle-to-micromobility vehicle side-impact crash, riding a bicycle is safer than riding an e-scooter since the observed HIC15 experienced by the cyclists is lower than that experienced by the e-scooter rider when motor vehicle speed is greater than 30 km/h.

PRACTICAL APPLICATIONS

To reduce micromobility users injury risk at intersections, motor vehicle speed limit should be equal or lower than 40 km/h. At this impact speed, the activation of hood or bumper airbags could be justified.

A Numerical Investigation of Rider Injury Risks During Falls Caused by E-Scooter-Stopper Impacts

Within the past decade, injuries caused by electric scooter (e-scooter) crashes have significantly increased. A primary cause is front wheel collisions with a vertical surface such as a curb or object, generically referred to as a "stopper." In this study, various e-scooter-stopper crashes were simulated numerically across different impact speeds, approach angles, and stopper heights to characterize the influence of crash type on rider injury risk during falls. A finite element (FE) model of a standing Hybrid III anthropomorphic test device was used as the rider model after being calibrated against certification test data. Additionally, an FE model of an e-scooter was developed based on reconstructed scooter geometry. Forty-five FE simulations were run to investigate various e-scooter crash scenarios. Test parameters included impact speed (from 3.2 m/s to 11.16 m/s), approach angle (30 deg to 90 deg), and stopper height (52 mm, 101 mm, and 152 mm). Additionally, the perpendicular (90 deg) impact scenarios were run twice: once with Hybrid-III arm activation to mimic a rider attempting to break a fall with their hands and once without this condition. Overall, the risks of serious injury to the rider varied greatly; however, roughly half the impact scenarios indicated serious risk to the rider. This was expected, as the speeds tested were in the upper 25th percentile of reported scooter speeds. The angle of approach was found to have the greatest effect on injury risk to the rider, and was shown to be positively correlated with injury risk. Smaller approach angles were shown to cause the rider to land on their side, while larger approach angles caused the rider to land on their head and chest. Additionally, arm bracing was shown to reduce the risk of serious injury in two thirds of the impact scenarios.

Head impact kinematics and injury risks during E-scooter collisions against a curb

E-scooters as a mode of transportation is rapidly growing in popularity. This study evaluates head impact conditions and injury risk associated with E-scooter crashes. A multibody model of E-scooter falls induced by wheel-curb collision was built and compared with an experimental E-scooter crash test. A total of 162 crash scenarios were simulated to assess the effect of fall conditions (E-scooter initial speed and inclination, obstacle orientation, and user size) on the head impact kinematics. The forehead hit the ground first in 44% of simulations. The average tangential and normal impact speeds were 3.5 m/s and 4.8 m/s respectively. Nearly 100% of simulations identified a risk of concussion (linear acceleration peak >82 g and rotational acceleration peak >6383 rad/s2) and 90% of simulations suggested a risk of severe head injuries (HIC>700). This work provides preliminary data useful for the assessment and design of protective gears.

Characteristics of E-Scooter-Related Maxillofacial Injuries over 2019-2022-Retrospective Study from Poznan, Poland

Recently, there has been a considerable rise in the popularity and use of electric scooters. Because of this, the number of accidents involving them has also risen. Head and neck injuries are the most common. The aim of the study was to determine the most frequent craniofacial injuries resulting from accidents involving electric scooters, and to identify the risk factors directly related to their placement and severity. The study carried out a retrospective analysis of the medical records of patients of the Clinic of Maxillofacial Surgery over 2019-2022, in terms of craniofacial injuries suffered as a result of e-scooter-related accidents. In the study population (31 cases), of which 61.3% were men, the median age was 27 years. At the time of the accident, 32.3% patients were under the influence of alcohol. Accidents were most common in the 21-30 age group; more often than not, they occurred during warm months and on weekends. The study identified a total of 40 fractures in the patients. The most common craniofacial injuries were mandibular fractures (37.5%), zygomatic-orbital fractures (20%) and frontal bone fractures (10%). A multidimensional correspondence analysis was also performed, which showed that at an age of under 30, alcohol consumption and female gender were associated with a higher likelihood of mandibular fracture. Proper education on the risks associated with the use of e-scooters is essential, with particular emphasis on the impact of alcohol on the driver. It is important to develop diagnostic and therapeutic algorithms for doctors, both in ED and in specialised departments.

Trauma Characteristics Associated with E-Scooter Accidents in Switzerland-A Case Series Study

E-scooters have gained popularity worldwide in the last few years. Due to the increase in users, more accidents related to e-scooters can be observed. The present study aimed to analyse epidemiological data, characteristics, and severity of injuries in patients admitted to a Level I trauma centre in Switzerland (Inselspital Bern, University Hospital Bern) after accidents associated with e-scooters. This retrospective case series evaluated 23 patients who presented to the University Hospital of Bern between 1 of May 2019 and 31 of October 2021 after an e-scooter accident. Data were collected on patient demographics, time and cause of the accident, speed, alcohol consumption, helmet use, type and localisation of injury, number of injuries per patient, and outcome. Men were most frequently affected (61.9%). The mean age was 35.8 (STD 14.8) years. Slightly more than half (52.2%) of all accidents were self-inflicted. Most accidents were reported during the night (7 p.m. to 7 a.m., 60.9%) and in summer (43.5%). Alcohol consumption was reported in 43.5% of cases, with a mean blood alcohol level of 1.4 g/l. Most injuries were observed in the face (25.3%) and head/neck area (20.25%). Skin abrasions (56.5%) and traumatic brain injury (43.5%) were the most common types of traumata in terms of total number of patients. Only in one case it was reported that a protective helmet had been worn. Five patients required hospitalisation and four patients underwent surgery. Three patients underwent emergency orthopaedic surgery, and one patient underwent emergency neurosurgery. E-scooter accidents result in a significant number of facial and head/neck injuries. E-scooter riders would potentially benefit from a helmet to protect them in the event of an accident. Additionally, the results of this study indicate that a significant number of e-scooter accidents in Switzerland occurred under the influence of alcohol. Prevention campaigns to raise awareness of the risks of driving e-scooters under the influence of alcohol could help prevent future accidents.