The casualties from electric bike and motorized scooter road accidents

Secular trends in the incidence and severity of injuries sustained by riders of electric bikes and powered scooters: The experience of a level 1 adult trauma center

BACKGROUND

The incidence of injuries caused by electric bicycles (E-bikes) and powered scooters (P-scooters) continues to increase. Data on the severity of those injuries is conflicting. The purpose of this study was to explore secular trends in the incidence and severity characteristics of patients following E-bike and P-scooter injuries and predictors for major trauma.

METHODS

A retrospective cohort study of patients aged ≥16 years following E-bike and P-scooter injuries was performed at a level 1-trauma center between 2017 and 2022. We explored secular trends in major trauma cases (primary outcome), emergency department (ED) visits, hospitalizations, and surgical interventions (secondary outcomes). Major trauma was defined by either an injury severity score (ISS) >15 or the patient's need for acute care, defined by any of the following: Intensive care unit admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death. Primary and secondary outcomes were compared between two time frames (2017-2018 vs.2019-2022).

RESULTS

In total, 9748 patients were presented following P-scooter and E-bike injuries. Of them, 1183 patients (12.1%) were hospitalized (854 males [72.2%],median age 33 years, median ISS 9).During the study period, the number of ED visits increased by 21-fold, with a parallel increase hospitalizations and surgical interventions numbers, which increased by 3.4-and 3.8-fold, respectively. Numbers of patients with ISSs >15 and patients who required acute care sharply increased during the study period, but no significant differences were found in the percentages of patients with ISSs >15 (p = 0.78) or patients' need for acute care (p = 0.32) between early and late periods. A severity analysis revealed that male sex (adjusted odds ratio [aOR] 1.7 [95% confidence interval (CI): 1.2-2.4], p = 0.001) and E-bike riders compared to P-scooter riders (aOR 1.5 [95% CI:1.1-2.0], p = 0.005) were independent predictors for severe trauma.

CONCLUSIONS

The incidence of E-bike and P-scooter injuries sharply increased over time, with a parallel elevation in numbers of hospitalizations, surgical interventions, and major trauma cases. Major trauma percentages did not increase during the study period. Male sex and E-bikes emerged as independent predictors for major trauma.

E-scooter accidents-epidemiology and injury patterns: 3-year results from a level 1 trauma center in Germany

INTRODUCTION

Since the introduction of e-scooters in Germany in 2019, they are becoming more and more popular and associated injuries have increased significantly. The aim of this study was to assess the injury patterns after e-scooter accidents.

MATERIALS AND METHODS

From May 2019 to October 2022, all consecutive patients who presented at our emergency department (ED) following e-scooter accidents were included in our study and retrospectively analyzed.

RESULTS

A total of 271 patients were included in our study. The mean age was 33 years. 38% of the patients were female and 62% were male. Most common injuries were traumatic brain injuries in 38% of the patients together with fractures affecting the upper limb (17%). An operative treatment was necessary in 40 patients. Most of the patients presented at night and about 30% were under the influence of alcohol.

CONCLUSIONS

Our study shows one of the largest cohort of patients suffering e-scooter accidents in Europe. Compulsory helmet use, stricter alcohol controls and locking periods could contribute significantly to safety.

Electric scooter-related accidents: a possible protective effect of helmet use on the head injury severity

Despite electric scooter use has proliferated in Italy since 2019, actionable data regarding injury incidence and patterns associated with electric scooter accidents are limited. This study aims at analyzing the rate, clinical, and demographic features of electric scooter accidents accessed to the Emergency Department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). This retrospective study included all patients older than 18 years riding an electric scooter in the ED from June 2019 to April 2022. Personal data, injury circumstances, helmet use, and health data were collected. Abbreviated Injury Scale (AIS) codes of all diagnoses were recorded, and the Injury Severity Score (ISS) was calculated for each patient. The analysis includes 92 patients admitted to the ED due to an e-scooter accident during the study period, with an increase in years. Thirty-two patients presented bone fractures especially concerning the extremities and the face districts. The median Injury Severity Score in the study cohort was 3, with the highest AIS represented by AIS Pelvic-Extremity and AIS External. Moreover, statistical significance was found between AIS Head-Neck and severity of trauma. E-scooters have become a familiar sight in cities worldwide recently, with many new companies renting them for use. But their arrival has also brought new safety concerns. Although most injuries reported are minor, the meager rate of helmet use is critical. Implementing compulsory helmet use for electric scooters for all ages could be a protective factor for being patient with head trauma on urban streets.

Neurosurgical Consequences of e-Scooter Use: Strategies to Prevent Neurological Injury

Rideshare electric scooter accidents have led to increasing emergency department (ED) visits and neurosurgical consultations. This study categorizes e-scooter-related injuries requiring neurosurgical consultation at a single level 1 trauma center. Patients who required neurosurgical consultation from June 2019 to June 2021 with a positive finding on computed tomography imaging were selected for review of patient and injury characteristics, resulting in a sample size of 50 cases. Average patient age was 36.9 (15-69) years, and 70% were male. Seventy-four percent of patients were under the influence of alcohol and 12% illicit drugs. None (0%) were helmeted. Seventy-eight percent of accidents occurred between 6:00 pm and 6:00 am. Twenty-two percent of patients required surgical intervention by craniotomy/craniectomy, and 4% required intracranial pressure monitor placement. Average intracranial hemorrhage volume was 17.8 cc (trace to 125). Volume of hemorrhage was associated with the need for an intensive care unit (ICU) stay (odds ratio [OR] = 1.01; p = 0.04), need for surgical intervention (OR = 1.007; p = 0.0001), and mortality (1.816; p < 0.001) and trended toward, but did not reach significance for, overall poor outcome (OR = 1.63; p = 0.06). Sixty-two percent of this patient pool required ICU admission. Average length of ICU stay was 3.5 days (0-35), and average length of hospital stay was 8.3 days (0-82). Mortality in this series was 8%. Lower admission Glasgow Coma Scale (OR = 0.974; p < 0.001) and increased volume of hemorrhage (OR = 1.816; p < 0.001) were associated with increased risk of mortality in the linear regression analysis. Electric scooters have become prevalent in most urban centers, and accidents are a potential source of severe intracranial injury requiring extended ICU and hospital stays, surgical intervention, and sometimes resulting in long-term morbidity and/or mortality. Injuries often occur in the evening hours and are often associated with alcohol/drug use and lack of helmet use. Policy changes to help mitigate the risk of these injuries are recommended.

Ocular injuries associated with two-wheeled electric transportation devices and motorcycle accidents

Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined the types and risk factors for ocular and periocular injuries associated with electric devices compared to motorcycle accidents. The study was conducted on the National Trauma Registry database from 20 trauma centers, including patients involved in accidents with electric bicycles, scooters, and motorcycles between 2014 to 2019. Injured riders were assigned into two groups: motorcycle group (M) and electric bicycle & scooter group (E). Data such as gender, age, protective gear use, ocular injury type, injury severity score (ISS), and ocular surgery were captured. Logistic regression models were conducted for injury types and the need for surgery. 8181 M-riders and 3817 E-riders were involved in an accident and hospitalized. E-riders suffered from ocular injury more than M-riders. Males were most vulnerable and the ages of 15-29. Orbital floor fracture was the most common injury, followed by ocular contusion, eyelid laceration, and other ocular wounds. Electric bicycle and scooter riders are more likely to suffer from ocular injury than motorcycle riders. Riders without helmets are at greater risk for injuries, specifically orbital floor fractures. ISS of 16 + was associated with injury demanding ocular surgery.

Maxillofacial Injuries Sustained by Riders of Electric-Powered Bikes and Electric-Powered Scooters

OBJECTIVES

The purpose of our study is to retrospectively analyze and compare the patterns of maxillofacial-related injuries among rides of electric-powered bikes (E-bikes) and electric-powered scooters (E-scooters), the associated risk factors, and the required treatment.

MATERIALS AND METHODS

The medical files of all riders presenting to the emergency department at the Tel Aviv Sourasky Medical Center between 2019 and 2020 with oral- and maxillofacial-related injuries due to E-bike and E-scooter accidents were reviewed.

RESULTS

A total of 320 riders sustained oral- and maxillofacial-related injuries due to trauma involving E-bikes and E-scooters during the study period. E-scooter riders were involved in 238 accidents (74.5%) while E-bike riders accounted for the remaining 82 accidents (27.5%). Eighty-four out of 320 riders (26.25%) were hospitalized and required surgical interventions. Most of the 232 riders (72.5%) who reported not wearing a protective helmet during the index accident were E-scooter riders. In addition, 39 riders (18.66%) were riding either of these electric-powered vehicles under the influence of alcohol.

CONCLUSIONS

E-bike riders are more likely to sustain a maxillofacial fracture than E-scooter riders. Not wearing a protective helmet and riding under the influence of alcohol are major risk factors for maxillofacial injuries.

Is the osteosynthesis of lateral malleolar fractures by pin/cerclage effective? A retrospective study

INTRODUCTION

Lateral malleolar fractures are present in about 90% of ankle fractures. The standard treatment is plate osteosynthesis. Although the plates are thin, the risk of cicatricial complications is not insignificant and can lead to cutaneous or even infectious complications and the latter can cause functional repercussions. We therefore aimed to evaluate a technique consisting of osteosynthesis of the lateral malleolus using two cerclages and two intramedullary pins.

HYPOTHESIS

Our hypothesis is that the use of osteosynthesis by pin/cerclage of the lateral malleolus makes it possible to have objective reduction criteria, similar to the reference treatment.

METHODS

This is a retrospective study of patients who had an interligamentous spiral fracture of the lateral malleolus. One group of patients had internal fixation of the lateral malleolus fracture by pins, and the other by plate. Our primary outcome was to compare the reduction of the fracture of the lateral malleolus between the two techniques using the "Dime sign", the measurement of the talocrural angle and respect for Shenton's line.

RESULTS

A total of 118 lateral malleolar fractures were included: 56 patients (47.5%) in the "pin" group and 62 patients (52.5%) in the "plate" group. The mean age of the patients was 46.6 years (17.4) with an average body mass index of 25.2kg/m² (4.8) and 55.1% of the patients were women. We found a difference in the reduction criteria between the two groups by looking at Shenton's line: 73.2% (41/56) of postoperative X-rays in the "pin" group respected Shenton's line, compared to 90.3% (56/62) in the "plate" group (p=0.02). We did not find any difference regarding the "Dime sign" and the talocrural angle.

CONCLUSION

Our study shows the superiority of plate osteosynthesis for lateral malleolar fractures compared to pin/cerclage osteosynthesis, regarding one of the three radiological criteria for reduction. No significant difference was found in the one-year rates of complications and of hardware removal, between the two groups.

LEVEL OF EVIDENCE

IV, retrospective study.

Patterns of Active Travel and Physical Activity among Adolescents in Israel

Active travel (AT) is a core physical activity (PA) indicator for children and youth; contributing to health and wellbeing, at both the individual and societal levels. This analysis explores patterns of adolescent active school travel (AST) and cycling and associations with different PA measures. Secondary analysis of the cross-sectional 2018-2019 Health Behaviour in School Age Children study in Israel included an extended PA module with walking, cycling and e-cycling modes. The nationally representative sample includes students in grades 6-12 (n = 4407). Analysis of weighted data included descriptive analyses, inferential statistics, and regression analyses. AST was reported by 61.9% of adolescents; 39.3% reported 20 min or more daily AST; 27.1% reported habitual cycling (HC) and 17.4% reported habitual e-cycling (HEC). There are mixed results for socio-economic status and environment. AST and HC were associated with less sedentary hours daily (odds ratio [OR] = 1.190 and 1.397, respectively); HC was associated with positive sports self-rating (OR = 2.394). Stepwise regression analysis found that lower AST duration, time in minutes, was associated with watching television with the family. Promotion of adolescent AT may be associated with increased PA and joint parent-adolescent AT, and was utilized across different socio-demographic groups in Israel.

The e-scooter pandemic at a UK Major Trauma Centre: A cost-based cohort analysis of injury presentation and treatment

OBJECTIVES

The aim of the study was to describe injuries related to electric scooter at a Major-Trauma-Centre in the UK, We reviewed data from January 2020-December 2020.

METHODS

All patient-records mentioning electric-scooter at a major-MTC. Records were reviewed, and data were stratified according to two groups: electric scooter riders and other road users. A predefined survey was completed in all cases where 'e-scooter or electric scooter' was present. This contained variables such as patient demographics, mechanism of injury (including head and body protection), acuity, intoxication, treatment facility and clinical utilisation. Among incidents involving electric scooters, summary statistics on continuous and categorical variables of interest were reported. Healthcare modelling utilising time driven activity-based costing and Patient-Level-Activity-Costing used to conduct a post hoc analysis of health provider costs.

RESULTS

202 e-scooter injuries were identified. Riders were more likely to be young males aged 18-35, a minority of reported cases being associated with the influence of alcohol or drugs (7.4%). They fall independently involving no other party (87%); sustaining both minor and major injuries; with a significant proportion requiring urgent and emergent surgery 23.7% (n = 40) with 60.1% (n = 121) requiring further secondary care follow-up; whilst 16% require immediate admission with a mean LOS of 5.9 days, including 8-ITU admissions. The overall mortality rate was 0.5% (n = 1), and cost per patient was £1482.46/patient, reducing to £927.25/patient if immediate surgery (<12 h s) was not required.

CONCLUSION

Due to an emphasis on social distancing, changes in UK law, e-scooters injuries have increased. Most injuries are reported in riders, and are minor, however the mean health episode cost was over £1000.00/patient due to the minority of serious injuries. Research on interventions to prevent e-scooter injuries including protective clothing like helmet wearing is needed to address this growing area of concern, and unnecessary costly healthcare utilisation.

Risk assessment, consequences, and epidemiology of electric scooter accidents admitted to an emergency department: a prospective observational study

PURPOSE

This study aimed to describe the demographic and clinical characteristics of individuals involved in electric scooter (E-scooter) accidents and the factors associated with these incidents.

METHODS

We conducted a prospective observational study of individuals involved in E-scooter accidents admitted to the emergency department of Saint-Pierre Hospital. The highest abbreviated injury score above or equal to two classified the injury as significant. Injuries during working hours were compared to those during off-working hours.

RESULTS

During the study period from June 1, 2019, to June 30, 2020, 170 individuals were admitted to the emergency department following an E-scooter accident. In 73.5% of the accidents, rented E-scooters were involved. Of the patients, 68.2% were male, 6.4% wore helmets, and 30% were under the influence of alcohol. Upper limb and cranial injuries were more frequently severe (abbreviated injury score ≥ 2) than other injuries (p < 0.05). Accidents during off-working hours were significantly related to alcohol consumption (p < 0.001), non-usage of helmets (p < 0.01), head and neck injuries (p < 0.01), and rented E-scooters (p < 0.01). Alcohol consumption was itself associated with the non-usage of helmets (p < 0.05) and major head and neck injuries (p < 0.001).

CONCLUSION

Given the increasing popularity of E-scooters as an alternative mode of transportation, our study can inform public policy on patterns of injuries associated with E-scooter utilization for future injury prevention policies. Using helmets, avoiding alcohol consumption, and regulating use at night can improve outcomes in E-scooter accidents.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04778332.

Foot and ankle injuries related to the use of E-scooters - A case series and a review of literature

INTRODUCTION

As E-scooter use is increasing with the introduction of urban rental schemes in the United Kingdom, associated foot and ankle injuries will become more prevalent. The aim of this study is to assess the injury pattern and injury severity of foot and ankle trauma associated with E-scooter use.

METHODS

A retrospective case analysis of all E-scooter foot and ankle injuries presenting to three London hospitals between 1st January and 31st December 2020 was conducted. Data including demographics, mechanism and location of injury sustained, management, duration of hospital stay and mortality were collected.

RESULTS

20 patients were identified with a total of 27 foot and ankle fractures. Eight patients had fracture dislocations, four sustained open injuries and 45% (9/20) of patients required surgical treatment. Those travelling over 15.5 mph were significantly more likely to require operative intervention (70%) than those travelling below 15.5 mph (20%) (P < 0.033) and were more likely to have an open fracture (40% compared to 0%) (P < 0.0886), however the latter was not of statistical significance. 85% (17/20) of rider's injuries involved the foot and/or ankle only. There were no mortalities at 30 days.

CONCLUSIONS

E-scooter use can cause serious foot and ankle injuries. Robust guidelines and legislation restricting top speeds and enforcing the wearing of protective clothing could be implemented. This may protect the E-scooter user from significant foot and ankle injury.

Increased injury severity and hospitalization rates following crashes with e-bikes versus conventional bicycles: an observational cohort study from a regional level II trauma center in Switzerland

Background

As electric bicycles (e-bikes) become increasingly popular, reports of injuries associated with e-bike usage are also rising. Patterns, characteristics, and severity of injuries following e-bike crashes need further investigation, particularly in contrast to injuries from conventional bicycle crashes.

Methods

This prospective observational study included 82 patients treated at a Level II trauma center for injuries resulting from an electric or conventional bicycle crash. Data were collected over one year (05.09.2017–19.09.2018) during in- and outpatient visits. A study-specific case report form was used to identify the bicycle type, cycling behavior (e.g., use of a helmet, safety gear, alcohol), and circumstances of the crash (e.g., road conditions, speed, cause of the incident, time of day, season). Additional information about patient demographics, treatment, and injury characteristics, such as the Injury Severity Score (ISS) and body region injured, were documented. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Simple logistic or linear regression models were used to estimate associations.

Results

Of the 82 patients, 56 (67%) were riding a conventional bike and 27 (33%) were using an e-bike. Most incidents were either single-bicycle crashes (66%) or automobile collisions (26%), with no notable difference in prevalence rates between groups. Although a higher proportion of conventional bikers were male (67% vs. 48%), the difference was not significant. E-bikers were older (median 60 years (IQR 44–70) vs. 45 years (IQR 32–62); p = 0.008), were hospitalized more often (48% vs. 24%, p = 0.025), and had worse ISS (median 3 (IQR 2–4) vs. 1 (IQR 1–3), p < 0.001), respectively. Body regions most affected were the extremities (78%) and external/skin (46%), and these were distributed similarly in both groups. Concomitant injury patterns of the thorax/chest with external/skin were higher among e-bikers (p < 0.001). When we controlled for the difference in the median age of the two groups, only the injury severity score of e-bikers remained significantly worse.

Conclusions

Hospitalization and chest trauma rates were higher among e-bikers. After controlling for the older age of this group, the severity of their injuries remained worse than in conventional cyclists. Initial clinical assessments at trauma units should include an evaluation of the thorax/chest, particularly among elderly e-bikers.

Level of evidence

Level III.

Impact of Helmet-Wearing Policy on E-Bike Safety Riding Behavior: A Bivariate Ordered Probit Analysis in Ningbo, China

At present, Chinese authorities are launching a campaign to convince riders of electric bicycles (e-bikes) and scooters to wear helmets. To explore the effectiveness of this new helmet policy on e-bike cycling behavior and improve existing e-bike management, this study investigates the related statistical distribution characteristics, such as demographic information, travel information, cycling behavior information and riders’ subjective attitude information. The behavioral data of 1048 e-bike riders related to helmet policy were collected by a questionnaire survey in Ningbo, China. A bivariate ordered probit (BOP) model was employed to account for the unobserved heterogeneity. The marginal effects of contributory factors were calculated to quantify their impacts, and the results show that the BOP model can explain the common unobserved features in the helmet policy and cycling behavior of e-bike riders, and that good safety habits stem from long-term safety education and training. The BOP model results show that whether wearing a helmet, using an e-bike after 19:00, and sunny days are factors that affect the helmet wearing rate. Helmet wearing, evenings during rush hour, and picking up children are some of the factors that affect e-bike accident rates. Furthermore, there is a remarkable negative correlation between the helmet wearing rate and e-bike accident rate. Based on these results, some interventions are discussed to increase the helmet usage of e-bike riders in Ningbo, China.

The hidden danger of lithium battery powered electric bicycles and scooters: A case series of the Israeli National Burn Center experience

Electric powered bicycles and scooters that use rechargeable lithium batteries are an urban transportation alternative and have become increasingly popular. However, in recent years, there has been an increase in patient admissions to the Israeli National Burn Center with burns associated with their use. In this case series of all patients (n=9) referred to the Emergency Department (February 2016 - October 2020) with lithium related battery burns from electric powered bicycles and scooters, we present burn depth, size, treatment, inhalation injuries and hospitalization. All patients were admitted to in the Israeli National Burn Center for treatment. The average total burn surface area was 27.5% (range 3-57%). All but one patient had a combination of partial to full-thickness burns affecting the upper and lower limbs. Three patients sustained inhalation injuries and a total of four patients required intubation. Seven patients required surgery that included debridement and, in most cases, skin grafting. The availability and increase in the use of battery powered bicycles and scooters may lead to an increase in injuries and death if consumers are not aware of the potential dangers related to the safe use of lithium batteries.

Seasonal differences in emergency department visits for scooter associated injuries

Hoverboards and electric scooters have surged in popularity in the past decade. These devices carry their own injury profiles and have caused increasing emergency department visits for injury. The purpose of this study was to compare both hoverboards and electric scooters to more traditional scooters and evaluate seasonal variations in their injury patterns. The National Electronic Injury Surveillance System (NEISS) database was used, downloading cases with the appropriate consumer product codes. Four distinct scooter groups were created, and were: non-powered scooters, powered scooters, electric scooters, and hoverboards. Statistical analyses were first performed with SUDAAN software to account for the stratified and weighted nature of the data to obtain national estimates of injuries and associated demographic variables. Cosinor analyses were performed to analyze the estimated number of emergency department (ED) visits for rhythmic variation by month and weekday of injury. Weekday by month analyses were studied using a three-dimensional topographic concept. Overall, there were over 1 million ED visits over the 20 years for injuries due to the four different types of scooters (75.8% nonmotorized scooters, 12.4% motorized scooters, 6.8% hoverboards, and 2.4% electric scooters). Cosinor analyses demonstrated that there was a peak in injuries in the summer and on weekends for all scooters, except for hoverboards. For hoverboards 21% of all ED visits occurred in December, with mostly occurring exactly around Christmas Day. This study confirms previous findings that scooter injuries occur mostly in warmer months and is the first to demonstrate a topographical "Christmas Effect" of hoverboard injuries. This information can be used in health care resource allocation as well as design of potential prevention strategies.

Orthopedic fracture hospitalizations are revving up from E-Scooter related injuries

INTRODUCTION

Due to market expansion of electric-scooter companies, a significant rise of personal e-scooter use in dense, urban communities has been observed. No literature has specifically focused on e-scooter fracture epidemiology and risk factors associated with direct hospital admission. The aims of this study were to evaluate the 1) patterns of e-scooter related orthopaedic fractures 2) risk factors associated with direct hospital admission.

MATERIALS AND METHODS

A retrospective review of National Electronic Injury Surveillance System (NEISS) from the United States between 2015 and 2019 was utilized to identify e-scooter fracture epidemiology. Uni/multivariable analyses were conducted to identify independent variables associated with direct hospital admission.

RESULTS

5,016 patients were identified. The most common fracture location was the upper extremity (25.4%). Multiple distinct fractures diagnoses (p < 0.001), fracture of the upper arm (p = 0.01), metacarpal (p = 0.03), skull(p < 0.001), and associated internal organ injury (p = 0.02) all had a statistical increase over time. Fracture of the upper leg (OR 58.31), lower trunk (OR: 47.04), and associated internal organ damage (OR: 37.82) had the greatest association with direct hospital admission.

DISCUSSION

This study highlights that e-scooter fracture related injuries continue to progress, and without appropriate educational and public health efforts, these injuries will continue to rise.

Shared E-Scooters: A Review of Uses, Health and Environmental Impacts, and Policy Implications of a New Micro-Mobility Service

Shared e-scooters refer to a micro-mobility service that enables the short rentals of e-scooters. The rapid growth of e-scooter sharing has sparked a heated discussion about its role in the urban mobility sector. This article presents a systematic review of the current knowledge on its uses and users, health and environmental impacts, and policy issues. The analysis is based on academic literature, identified with Google Scholar by using keywords and publication years from 2017, and relevant gray literature. Firstly, we highlight that the profiles of e-scooter renters seem to highly match the characteristics of other micro-mobility services users. Secondly, e-scooters are often associated with a high perception of risk from the public and an increasing occurrence of related road accidents. Thirdly, even if promoted as a green mobility option, the true environmental impact of shared e-scooters has only started to be investigated. Early studies point out negative impacts around their production, usage, and maintenance. Fourthly, the integration of shared e-scooters into the existing transport systems requires policy changes, both at the local and national level, including traffic regulations, safety rules, and physical infrastructure. Finally, this paper reveals the ambiguity of the term “e-scooter” and stresses the need for more research, as the future of cities is tied to the development of low-car lifestyles.

Comparing the Severity of Injury and Trauma Pattern between Scooter and Street Motorcycle Riders; a Prospective Cohort Study

Introduction:

The popularity of motorcycle riding in Iran is increasing. However, there is a lack of information about the safety of different motorcycle types. This study aimed to compare the severity of injury and trauma pattern between scooter (vespa) and street (standard) motorcycle riders.

Method:

In a prospective cohort study, a comparison of demographics, injury severity, trauma pattern, and clinical characteristics between 324 riders (162 Vespa and 162 standard motorcycles) admitted to emergency departments was undertaken. The risk factors associated with severe injuries in the two groups were also determined. An emergency medicine specialist determined the severity of trauma based on the abbreviated injury scale (AIS).

Results:

The Odds Ratio (OR) of severe injuries was significantly higher in the standard motorcycle riders’ group (OR: 3.09; 95% CI: 1.9-4.21; p: 0.013). The frequency of lower extremity fractures was significantly lower in the Vespa group (OR: 4.11; 95% CI: 2.01-6.25; p = 0.012). The frequency of admission to the intensive care unit was significantly higher in the standard motorbike riders’ group (OR: 1.64; 95% CI: 1.11-2.51; p = 0.033). The multivariate analysis indicated that motorcycle type, the speed at the time of the accident, use of helmet, and age of riders are the most important predictors of trauma severity in riders (p<0.05).

Conclusion:

The pattern of injury varies between standard and Vespa motorcycles. The standard motorcycle riders were prone to a higher risk of adverse outcomes such as severe injuries. Due to the particular structure of scooters, the rate of lower limb injuries was significantly lower than standard motorcycles.

Analysis of electric scooter injuries admitted to the emergency service

BACKGROUND

Electric scooters (e-scooters) have become popular within a short time. With its growing popularity, the number of admissions to emergency services due to e-scooter injuries has also increased. In this study, we aimed to analyze the clinical and demographic characteristics of e-scooter injuries applied to our emergency department.

METHODS

In this study, demographic data of e-scooter injuries, injury type and pattern, usage of the helmet and protective clothing, and pathological findings, which were detected as a result of injury, were analyzed retrospectively.

RESULTS

We analyzed 70 e-scooter injuries (mean [SD] age 25.82 ± 8.04 years; 52.9% male). The most common reasons for admission to the emergency department were soft tissue trauma with a rate of 45.7% (n = 32) and head trauma with a rate of 40% (n = 28). Based on the performed examinations, orthopedic fractures and sprains were detected in 18.5% (n = 13) of the patients, while maxillofacial fractures were detected in 11.4% (n = 8). Helmet use was detected in 4.3% (n = 3) of e-scooter users, while 2.9% (n = 2) of the patients had a blood alcohol level of > 10 mg/dl. In our patient group, 4.3% (n = 3) were transferred to the ward and 1.4% (n = 1) to the intensive care unit.

CONCLUSIONS

We consider that serious injuries can be prevented by establishing legal regulations regarding the use of e-scooters and determining the appropriate routes for e-scooters, hence making e-scooters a safer means of transportation.

Craniofacial Injuries Seen Among Electric-Motorized Bicycle Riders

The popularity of electric-motorized bicycles (E-bikes) has increased dramatically over the past few years. As a result, E-bike--associated injuries are quickly becoming a substantial issue. The aim of the present study was to evaluate the epidemiology and general nature of these injuries, with special attention to craniofacial trauma. This was a retrospective study of 84 E-bike riders who suffered from trauma and treated at our level 1 trauma center between the years 2014 and 2018. The information consisted of demographics, characteristics of injury, Injury Severity Score, and number of hospitalization days.Regarding craniofacial trauma, the mean age was 22.7 years. Data about helmet usage was missing. The most common cause of injuries in maxillofacial region, was falling (80%). The most prevalent injury in the maxillofacial region was fractures of the zygomatic complex with the orbit (33%) and soft tissue lacerations.There is little data regarding craniofacial trauma attributed to electric-motorized bicycle accidents. In Israel there are a lot of young adults and teenagers that use E-bikes as an economical solution for mobility. Education regarding road behavior and the proper use of protective measures such as wearing a helmet can reduce significantly overall injuries and cranio-facial trauma in particular.

Characterization of electric scooter injuries over 27 months at an urban level 1 trauma center

BACKGROUND

Electric scooters (e-scooters) have become a widespread method of transportation. The purpose of this study is to provide risk stratification tools for modifiable risk factors associated with e-scooter injury morbidity.

METHODS

Patients at an urban Level 1 Trauma center sustaining e-scooter injuries between November 2017 through March 2020 were identified. Primary outcomes of interest were major trauma, as defined by an Injury Severity Score (ISS) >15, or hospital admission.

RESULTS

A total of 442 patients sustained orthopaedic (51%), facial (31%), cranial (13%), and chest/abdominal injuries (4.5%). Rate of helmet use was 2.5%, hospital admission was 40.7%, and intensive care was 3%. Patients with facial injuries were half as likely to sustain major trauma as compared to orthopaedic injuries (p < 0.05). Factors with higher likelihood of hospital admission included age > 40 years (OR 4.20, p < 0.01), alcohol or other substance intoxication (OR 4.14 and 9.87, p < 0.001), loss of consciousness (OR 2.72, p < 0.003), or transport to the hospital by ambulance (OR 4.47, p < 0.001).

CONCLUSIONS

There is a substantial proportion of major trauma within e-scooter injuries. Modifiable risk factors for hospital admission include use of head protection and substance use while riding e-scooters.

E-bike and classic bicycle-related traumatic brain injuries presenting to the emergency department

BACKGROUND

E-bike usage is increasingly popular and concerns about e-bike-related injuries and safety have risen as more injured e-bikers attend the emergency department (ED). Traumatic brain injury (TBI) is the main cause of severe morbidity and mortality in bicycle-related accidents. This study compares the frequency and severity of TBI after an accident with an e-bike or classic bicycle among patients treated in the ED.

METHODS

This was a prospective cohort study of patients with bicycle-related injuries attending the ED of a level 1 trauma centre in the Netherlands between June 2016 and May 2017. The primary outcomes were frequency and severity of TBI (defined by the Abbreviated Injury Scale head score ≥1). Injury Severity Score, surgical intervention, hospitalisation and 30-day mortality were secondary outcomes. Independent risk factors for TBI were identified with multiple logistic regression.

RESULTS

We included 834 patients, of whom there were 379 e-bike and 455 classic bicycle users. The frequency of TBI was not significantly different between the e-bike and classic bicycle group (respectively, n=56, 15% vs n=73, 16%; p=0.61). After adjusting for age, gender, velocity, anticoagulation use and alcohol intoxication the OR for TBI with an e-bike compared with classic bicycle was 0.90 (95% CI 0.56 to 1.45). Independent of type of bicycle, TBI was more likely if velocity was 26-45 km/hour, OR 8.14 (95% CI 2.36 to 28.08), the patient was highly alcohol intoxicated, OR 7.02 (95% CI 2.88 to 17.08) or used anticoagulants, OR 2.18 (95% CI 1.20 to 3.97). TBI severity was similar in both groups (p=0.65): eight e-bike and seven classic bicycle accident victims had serious TBI.

CONCLUSION

The frequency and severity of TBI among patients treated for bicycle-related injuries at our ED was similar for e-bike and classic bicycle users. Velocity, alcohol intoxication and anticoagulant use were the main determinants of the risk of head injury regardless of type of bicycle used.

Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)

BACKGROUND

Electric scooters (e-scooters) have become a widespread method of transportation due to convenience and affordability. However, the financial impact of medical care for sustained injuries is currently unknown. The purpose of this study is to characterize total billing charges associated with medical care of e-scooter injuries.

METHODS

A retrospective review of patients with e-scooter injuries presenting to the trauma bay, emergency department or outpatient clinics at an urban level 1 trauma center was conducted from November 2017 to March 2020. Demographic and clinical data were collected. Primary outcomes of interest were total billing charges and billing to insurance (hospital and professional). Multivariable models were used to identify preventable risk factors associated with higher total billing charges.

RESULTS

A total of 63 patients were identified consisting of 42 (66.7%) males, average age 40.19 (SD 13.29) years and 3.2% rate of helmet use. Patients sustained orthopedic (29%, n=18), facial (48%, n=30) and cranial (23%, n=15) injuries. The average total billing charges for e-scooter clinical encounters was $95 710 (SD $138 215). Average billing to insurance was $86 376 (SD $125 438) for hospital charges and $9 334 (SD $14 711) for professional charges. There were no significant differences in charges between injury categories. On multivariable regression, modifiable risk factors independently associated with higher total billing charges included any intoxication prior to injury ($231 377 increase, p=0.02), intracranial bleeds ($75 528, p=0.04) and TBI ($360 898, p=0.006).

DISCUSSION

Many patients sustain high-energy injuries during e-scooter accidents with significant medical and financial consequences. Further studies may continue expanding the financial impact of e-scooter injuries on both patients and the healthcare system.

LEVEL OF EVIDENCE

III.

Electric Scooter Orthopaedic Injury Demographics at an Urban Level I Trauma Center

OBJECTIVES

This study highlights demographics and orthopaedic injuries of electric scooter-related trauma that presented to our institution over a 27-month period.

DESIGN

Retrospective review.

SETTING

Urban Level 1 trauma center.

PATIENTS

Patients presenting to the emergency department, trauma bay, or outpatient clinic after electric scooter injury were identified from November 2017 through January 2020 using ICD-10 diagnosis codes.

MAIN OUTCOMES

Patient charts were reviewed for demographics, injury characteristics, imaging, treatment, perioperative data, and Injury Severity Scores.

RESULTS

Four hundred eighty-five patients presented during the study period. Of these, 44% had orthopaedic injuries, including 30% with pelvis or extremity fractures. There were 21 (10%) polytraumatized patients in the orthopaedic cohort. The age ranged from 16 to 79 years (average 36 years), with 58% men, and 18% were visitors from out of town. Of 49 patients requiring orthopaedic surgery, 8 underwent surgery on an urgent basis. The average Injury Severity Score for orthopaedic patients was 8.4 with a median of 5.0 for nonoperative injuries versus a significantly higher median of 16.0 for operative injuries. Twenty-nine percent of patients were intoxicated and only 2% wore a helmet.

CONCLUSIONS

Electric scooter injuries are increasing, and many patients sustain high-energy injuries. As electric scooter use continues to increase, the prevalence of orthopaedic injuries is also likely to rise. Further studies are needed to fully understand the impact scooter-related injuries have on individual patients and the health care system.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

[E-scooter accidents and their consequences : First prospective analysis of the injury rate and injury patterns in the urban area of a German city with over 1 million residents]

Hintergrund

Seit ihrer Zulassung in Deutschland im Juli 2019 erfreuen sich E‑Scooter zunehmender Popularität. Diese steigende Beliebtheit und die einfache Zugänglichkeit der E‑Scooter für jedermann haben jedoch auch zu teils schweren Unfällen geführt.

Ziel der Arbeit

Das Ziel dieser Studie war es, die Art und Schwere der Verletzungen, die in direktem Zusammenhang mit der Nutzung von E‑Scootern in einer deutschen Millionenstadt stehen, zu analysieren und hieraus Schlüsse für zukünftige Sicherheitskonzepte und Verhaltensregeln zu ziehen.

Methodik

Alle Patienten, die sich aufgrund eines Unfalls mit einem E‑Scooter in der interdisziplinären Notaufnahme des Klinikums rechts der Isar, Universitätsklinikum der Technischen Universität München, zwischen dem 01.07.2019 und dem 01.04.2020 vorstellten, wurden erfasst und sowohl demografische Daten als auch Informationen zu Traumamechanismus und den entstandenen Verletzungen dokumentiert.

Ergebnisse

Im oben genannten Zeitraum wurden prospektiv 60 Patienten erfasst, wovon 34 (56,7 %) Männer waren. Durchschnittlich waren die Patienten 34,7 Jahre (18 bis 73 Jahre) alt. Unter Alkoholeinfluss fuhren 22 Patienten (36,7 %); ein Helm wurde lediglich von einer Person getragen. Verletzungen des Kopfes waren mit Abstand am häufigsten, gefolgt von Verletzungen der oberen und der unteren Extremität (Radiusköpfchenfraktur n = 5, Riss-Quetsch-Wunden an Fuß/Sprunggelenk n = 8). 2 Patienten (3,3 %) waren schwer verletzt (ISS ≥16)

Diskussion

Mit zunehmender Beliebtheit der E‑Scooter steigt auch die Anzahl an Verletzungen. Am häufigsten ist die Kopfregion betroffen, weshalb zukünftig eine Helmpflicht sinnvoll erscheint. Zudem sollten eine breitere Informationskampagne und strengere polizeiliche Kontrollen im Hinblick auf die Vielzahl an alkoholisierten Unfallopfern erfolgen.

Spatial associations of dockless shared e-scooter usage

In this study, we explore the usage of e-scooter sharing services in Austin, Texas over about a six-month period. The study is based on trip records of all the shared e-scooter operators in Austin and includes trip start and end locations. We use both analysis of trip patterns and spatial regression techniques to examine how the built environment, land use, and demographics affect e-scooter trip generation. Our findings show that people use e-scooters almost exclusively in central Austin. Commuting does not seem to be the main trip purpose, and usage of e-scooters is associated with areas with high employment rates, and in areas with bicycle infrastructure. People use e-scooter sharing regardless of the affluence of the neighborhood, although less affluent areas with high usage rates have large student populations, suggesting that students use this mode of travel. Implications for planners suggest that better bicycle infrastructure will facilitate e-scooter usage, college towns are a ready market for e-scooter sharing services, and e-scooters may be a substitute for some short non-work trips, reducing car usage, and benefiting the environment.

Considering the Potential Health Impacts of Electric Scooters: An Analysis of User Reported Behaviors in Provo, Utah

Electric scooters (e-scooters) are an increasingly popular form of transportation in urban areas. While research on this topic has focused primarily on injuries, there are multiple mechanisms by which e-scooter share programs may impact health. The aim of this study is to explore the health-related behaviors of e-scooter users and to discuss their implications for public health. Data were collected using an online survey emailed to registered e-scooter users. A total of 1070 users completed the survey. Descriptive variable statistics and chi-squared analysis were performed to determine variable dependent relationships and equality of proportions. The most common destinations reported were “just riding around for fun”, home, and dining/shopping. The two most common modes of transportation that would have been used if e-scooters were not available were walking (43.5%) and using a personal vehicle (28.5%). Riding behavior was equally mixed between on the street, on the sidewalk, and equal amounts of both. e-Scooters in Provo are likely having both positive (e.g., air pollution) and negative impacts on health (e.g., injuries, physical inactivity). Future research should further explore patterns of e-scooter use and explicitly examine the linkages between e-scooters and areas of health beyond just injuries.

The Orthopedic Injury Burden of Personal Mobility Devices in Singapore - Our Experience in the East Coast

PURPOSE

Personal mobility devices (PMDs) have become increasingly popular as a modality of transport worldwide. Starting out as novelty toys, PMDs are gradually being adopted as the mainstream mode of travel. There is an increasing number of accidents involving both PMD riders and other road users since its introduction, leading to a concomitant increase in demand for healthcare resources to manage the injuries. The main objective of this study was to evaluate the inpatient cost and the orthopedic injury pattern due to PMD accidents.

METHODS

All patients admitted to the Department of Orthopedic Surgery between December 2016 to February 2018 with injuries due to PMD accidents were recruited. Data collection was performed retrospectively on the demographic profiles, injury patterns, admission related outcomes and expenditures of these patients.

RESULTS

43 patients were included in this study. The mean duration of admission was 7.81 days and the median cost of admission was S$7835.01 (approximately US$5620). These were comparable to accidents arising from other modes of transport, such as motorcycles and bicycles. In addition, more than 80% of patients were not wearing protective gear at time of accident. These patients had a slightly higher median cost payable per patient as compared to those who donned protective gear, with a difference of S$1669.78 (approximately US$1221).

CONCLUSION

There is a significant health and financial cost to the individual and society from PMD injuries and admission. This can be reduced with strict regulations on PMD use, advocating protective gear use, and promoting awareness on safety measures and the consequences of PMD accidents. The most common injury mechanism and orthopedic injury type for PMD accidents are different from motorcycle accidents.

Speeds of Young E-Cyclists on Urban Streets and Related Risk Factors: An Observational Study in Israel

In Israel, a growing use of electric bicycles by youngsters has been noted, with an increase in related injuries. In this study, an observational survey was conducted on typical urban streets, aiming to characterize the riding speeds of young e-cyclists compared to regular cyclists and the associated risk factors in their behaviors. The survey covered 39 sites in eight cities, and included 1054 cyclists. The results showed that mean speeds of young e-cyclists were higher than those of regular cyclists at all types of sites, with a difference of 6–9 km/h. The mean speeds of e-bicycles were below 25 km/h, as prescribed by law, but the 85-percentile speeds were higher. E-cyclist speeds depend on the type of street, road layout and place of riding. More e-cyclists used the roadway compared to regular cyclists, however, on divided roads, more e-cyclists used sidewalks in spite of the law prohibition, thus endangering pedestrians. The majority of cyclists did not wear helmets. The unsafe behaviors of teenage e-cyclists increase the injury risk for themselves and for other road-users. Thus, separate bicycle infrastructure should be promoted in the cities. Road safety education and training of young e-cyclists with stronger enforcement of traffic regulations are also needed.

Dental and maxillofacial injuries associated with electric-powered bikes and scooters in Israel: A report for 2014-2019

BACKGROUND/AIMS

Electric-Powered Bikes and powered scooters present a new method of transportation and are becoming commonly used worldwide. However, the reports on traumatic dental injuries related to their use are scarce. The aim of this study was to report the frequency and severity of dental and maxillofacial injuries associated with electric-powered bikes and scooters in Israel between the years 2014 and 2019.

METHODS

This was a retrospective cohort study based on data from the Israeli National Trauma Registry (INTR). The INTR provides comprehensive data on hospitalized patients from all six Level I trauma centers (TC) and 15 of the 20 Level II TCs in Israel. All injured patients who were hospitalized due to a traffic collision between 2014 and 2019 were identified. The data for those hospitalized due to an e-bike or motorized scooter accident were extracted as well as for pedestrians who were injured as a result of a crash with these vehicles.

RESULTS

A total of 3,686 hospital admissions were related to electric-powered bikes and scooters. Of those, 378 (10.3%) were oral and maxillofacial injuries. Most of the oral and maxillofacial injuries were attributed to powered bikes (321 out of 378; 84.92%) and the rest to powered scooters. There was a constant increase in general as well as the oral and maxillofacial injuries during the study years. Almost 20% of the cases involved injuries to the teeth. Overall, 291 pedestrians were reported to be injured due to electric-powered bikes and scooters; 29 (9.97%) of them, suffered from oral and maxillofacial injuries. Most of those were children aged 0-15 years (41.38%) and elders older than 60 years (37.39%).

CONCLUSIONS

Trauma related to electric-powered bikes and scooters is an increasing concern. Dental professionals should be actively involved in educational and legislative efforts focusing on the prevention of e-bike and scooter-related injuries, in general, and specifically maxillofacial injuries.

Bicycle-related injuries in the emergency department: a comparison between E-bikes and conventional bicycles: a prospective observational study

PURPOSE

To investigate the mechanisms and severity of injuries of e-bikers compared with conventional bicycle (CB) users at the emergency department (ED) of a level 2 trauma center in the Netherlands.

METHODS

We performed a prospective observational study. All patients ≥ 16 years who presented at the ED with an e-bike or conventional bicycle accident were eligible for inclusion. Primary outcomes were mechanisms and severity of injury. Injury severity was defined by the abbreviated injury score and the injury severity score (ISS). Data were analyzed using SPSS (IBM version 24).

RESULTS

A total of 78 e-bikers and 91 CB, were included. The mean age of the e-bikers was 66.9 ± 13.6 years (CB 45.2 ± 20.5 years, P < 0.001). The Charlson comorbidity index was higher in e-bikers (3.1 vs. 1.2, P < 0.001). Mechanism of injury and ISS did not differ between the groups (median ISS 4.0), even though two e-bikers were severely injured (ISS ≥ 16). Alcohol was consumed twice as frequently in CB-related injuries (40% vs. 19.2%, P < 0.01).

CONCLUSION

In this cohort of bicycle injuries in the ED of a level 2 trauma center, e-bikers were older and had more comorbidities than CB users. Except for a higher rate of thoracic and soft-tissue trauma in e-bikers, no differences were found in the mechanism and severity of injury. While it is important to note that helmet use and alcohol avoidance have demonstrable health benefits for bicyclists, further studies to quantify these benefits are recommended.

An Early Look at Operative Orthopaedic Injuries Associated with Electric Scooter Accidents: Bringing High-Energy Trauma to a Wider Audience

BACKGROUND

There is a new method of transportation that started in our community in late 2017- rideshare electric scooters (e-scooters). These scooters have proven immensely popular and can now be found in many cities around the world. Despite the pervasiveness of e-scooters, their associated injury patterns are poorly understood. The purpose of this study was to describe our department's experience at the epicenter of the e-scooter phenomenon that is sweeping the globe and to characterize operative orthopaedic injuries that are related to e-scooter accidents.

METHODS

We performed a retrospective chart review of all of the operative orthopaedic cases and trauma consults at 2 trauma centers (a level-I center and a level-II center) between September 2017 and August 2019. We identified all operative injuries in which the cause of injury was an e-scooter accident. Data that included demographics, mechanism of injury, diagnosis, and treatment were collected.

RESULTS

Seventy-five operative injuries were identified in 73 patients during the study period. The mean patient age was 35.4 years (range, 14 to 74 years), and the median age was 32 years. There were 4 pediatric patients (14, 15, 15, and 17 years old). Thirty-two patients (43.8%) sustained upper-extremity injuries, and 42 patients (57.5%) sustained lower-extremity injuries; 1 of these patients had both upper and lower-extremity injuries. Nine patients (12.3%) had open fractures. There were 7 hip fractures in patients with an average age of 42.4 years (range, 28 to 68 years). Seventy-one (97.3%) of 73 patients were e-scooter riders, and 2 (2.7%) were pedestrians who were struck by e-scooter riders.

CONCLUSIONS

E-scooters can cause serious injury. Seventy-three patients required operative treatment in just the first 2 years of e-scooter use in our community. Operative injuries occurred throughout the skeletal system, and several were injuries that are typically associated with high-energy trauma. Although, as a rule, e-scooter use is limited to adults and banned in high pedestrian-traffic areas in our city, the inclusion of 4 underage riders and 2 pedestrians in our cohort suggests that these rules are not always followed. As e-scooters continue to increase in popularity, additional steps should be taken to regulate their use and protect riders and the public.

Traumatic Injuries Associated With Standing Motorized Scooters

This cross-sectional study assesses the incidence and severity of traumatic injuries associated with motorized scooters, as well as the associated use of protective devices and intoxicants.

The electric scooter: A surging new mode of transportation that comes with risk to riders

Objective: The proliferation of electric scooter sharing companies has inundated many municipalities with electric scooters. The primary objective of this study is to characterize the epidemiology of injuries from this new mode of transportation in order to inform injury prevention efforts.Methods: A multicenter, retrospective study was conducted at two level 1 trauma centers in an urban setting. Patients seen in the emergency department from September 4, 2018 to November 4, 2018 were included if injury coding and chart review identified a scooter-related injury. Demographics, injury patterns, and other injury related factors were obtained via chart review.Results: Ninety-two patients were identified over the study period in 2018 with electric scooter-related injuries. Of the patients utilizing an electric scooter; none used protective gear and 33% used alcohol prior to presentation. More than 60% of patients required medical intervention including laceration repair (26%), fracture reduction (17%), operative fixation of a fracture (7%), or arterial embolization for an associated arterial injury (1%). Approximately 10% of patients required inpatient admission and one required an admission to the intensive care unit.Conclusion: We found a substantial increase in the number of scooter-related injuries during the first two months of electric scooter legalization. There was a lack of safety equipment utilization and concomitant alcohol utilization was common. These may offer areas of focus for injury prevention efforts. Additionally, standardization of injury coding for electric scooter related injury is critical to future studies and will help better understand the impact of this new mode of transportation.

Injury from electric scooters in Copenhagen: a retrospective cohort study

OBJECTIVE

To analyse injuries related to manual and electric scooter use from January 2016 up to and including July 2019.

SETTING

Electric scooter rental services were launched in Denmark in January 2019. The services were provided by private companies. Although rules for handling and riding scooters have been established, no reports either before or after introduction of electric scooters anticipated the full extent of use, and injuries to riders and pedestrians.

PARTICIPANTS

All patient records mentioning manual or electric scooters. Records were reviewed, and data were stratified according to two groups: manual and electric scooters.

INTERVENTIONS

A predefined survey was completed in all cases where 'scooter' was present. This contained variables such as type of scooter, type of participant, mechanism of injury, acuity, intoxication, referral to treatment facility.

OUTCOME MEASURES

Among incidents involving scooters, summary statistics on continuous and categorical variables of interest were reported.

RESULTS

468 scooter-related injuries were recorded. We found that manual scooter riders were more likely to be children under the age of 15; fall alone-involving no other party; sustain contusions, sprains and lacerations; and bruise either their fingers or toes. Riders of electric scooters were likely to be 18-25 years, sustain facial bruising and lacerations requiring sutures, and be under the influence of alcohol or drugs. Non-riders of electric scooters were mostly elderly people who tripped over scooters, consequently sustaining moderate to severe injuries.

CONCLUSION

There were two different types of population sustaining injuries from manual and electric scooters, respectively. The proportion of non-riders injured by electric scooters were surprisingly large (17%), and while electric scooters are here to stay, several apparently preventable injuries occur as a result of reckless driving and discarded electric scooters. Current rules for usage might not prevent unnecessary accidents and secure traffic safety and the lives of older individuals.

An evaluation of scooter injury and injury patterns following widespread adoption of E-scooters in a major metropolitan area

OBJECTIVE

Despite the increasing use of e-scooters globally, the pattern of injuries on diagnostic imaging had not been well-documented to date. We performed a retrospective study utilizing our health system's radiology database to characterize the injury distribution and imaging features of scooter injuries.

METHODS

We utilized our radiology report database searching for any imaging report containing the word "scooter", beginning September 1, 2017, when scooters were first introduced to our area through December 1, 2018.

RESULTS

Our search yielded a total of 54 patients with 105 imaging studies. The injuries predominantly affected the musculoskeletal system, with a predilection to the upper extremity. We had no cases of visceral or neurotrauma.

CONCLUSION

Musculoskeletal injuries were the predominant form of scooter injury. The lack of visceral injury suggests that emergency physicians should consider having a higher clinical threshold for ordering these studies in patients with scooter injuries.

Riding behavior and electric bike traffic crashes: A Chinese case-control study

Objective: The present case-control study sought to explore at-risk riding behaviors associated with e-bike related traffic crashes among e-bike riders in China.Methods: Cases were recruited from residents aged 16 years and over in communities which stated "selected e-bikes as travel tools and experienced traffic crashes in the last year". Two controls for each case were randomly selected from a population of e-bike riders who had not experienced a traffic crash in the past year. The cases and controls were matched by gender, age (within 5 years) and school education level. Data were collected using questionnaires and face-to-face interviews from July 2015 to September 2015 in China. After conducting univariate logistic analysis on study variables, a conditional logistic regression model based on the 1:2 matched case-control study design was developed.Results: Multiple-factor conditional logistic regression analysis of e-bike related traffic crashes showed that running red lights (always vs. never, AOR = 3.094, 95% CI, 1.077-8.891, P < .05), riding after drinking (yes vs. no, AOR = 1.578, 95% CI, 1.102-2.259, P < .05), carrying adults while riding (always vs. never, AOR = 2.140, 95% CI, 1.273-3.595, P < .05), turning without signaling (sometimes vs. never, AOR = 1.446, 95% CI, 1.805-1.928, P < .05), riding in the motor vehicle lane (always vs. never, AOR = 2.413, 95% CI, 1.576-3.695, P < .01), prior crash history (yes vs. no, AOR = 1.670, 95% CI, 1.257-2.220, P < .05), and type of e-bikes (scooter-style e-bikes vs. bicycle-style e-bikes, AOR = 1.471, 95% CI, 1.068-2.026, P < .05) were identified as possible risk factors for e-bike traffic crashes.Conclusion: The findings of this research provide evidence about specific risky behaviors related to road traffic crashes involving e-bikes and indicated that behavioral intervention and education need to be strengthened to reduce dangerous riding behaviors. These results will be helpful for design of e-bike road risk prevention programs.

Injuries associated with electric-powered bikes and scooters: analysis of US consumer product data

BACKGROUND

Powered, two-wheeled transportation devices like electric bicycles (E-bikes) and scooters are increasingly popular, but little is known about their relative injury risk compared to pedal operated bicycles.

METHODS

Descriptive and comparative analysis of injury patterns and trends associated with E-bikes, powered scooters and pedal bicycles from 2000 to 2017 using the US National Electronic Injury Surveillance System.

RESULTS

While persons injured using E-bikes were more likely to suffer internal injuries (17.1%; 95% CI 5.6 to 28.6) and require hospital admission (OR=2.8, 95% CI 1.3 to 6.1), powered scooter injuries were nearly three times more likely to result in a diagnosis of concussion (3% of scooter injuries vs 0.5% of E-bike injuries). E-bike-related injuries were also more than three times more likely to involve a collision with a pedestrian than either pedal bicycles (OR=3.3, 95% CI 0.5 to 23.6) or powered scooters (OR=3.3, 95% CI 0.3 to 32.9), but there was no evidence that powered scooters were more likely than bicycles to be involved in a collision with a pedestrian (OR=1.0, 95% CI 0.3 to 3.1). While population-based rates of pedal bicycle-related injuries have been decreasing, particularly among children, reported E-bike injuries have been increasing dramatically particularly among older persons.

CONCLUSIONS

E-bike and powered scooter use and injury patterns differ from more traditional pedal operated bicycles. Efforts to address injury prevention and control are warranted, and further studies examining demographics and hospital resource utilisation are necessary.

Gender differences in accident risk with e-bikes-Survey data from Norway

E-bikes are becoming increasingly popular, and are given an important role in the green mobility of the future. However, some have raised concerns that the increased speed and the increased weight of the e-bike can lead to more accidents among cyclists riding an e-bike, as compared to conventional bicycles. Furthermore, it has been suggested that e-bikes may appeal to new groups of cyclists with little cycling experience, which may further impede cyclist safety. Previous research has not provided a clear picture. We investigate these questions with data from three surveys carried out in Norway (N = 7752). A logistic regression analysis comparing conventional and electric bicycles, controlling for age gender and exposure, shows an overall risk increase (all accidents) for e-bike users. The results suggest that this increased risk derives from females having a higher accident risk on e-bikes. For men there is no risk difference between e-bikes and conventional bikes. Some, but not all, of this elevated risk can be attributed to being unfamiliar with the bicycle. E-bikes are not more likely to cause serious accidents than conventional bicycles. In-depth analysis of accident causation showed that there was no difference in the factors leading to accidents, except that there was a somewhat higher prevalence of accidents resulting from balance problems with e-bikes.

Craniofacial injuries related to motorized scooter use: A rising epidemic

OBJECTIVES

Over the last decade, there has been increased interest in utilizing motorized scooters for transportation. The limited regulation of this modernized vehicle raises numerous safety concerns. This analysis examines a national database to describe the yearly incidence of craniofacial injuries and patterns of injury related to motorized scooter use.

METHODS

The Consumer Product Safety Commission's National Electronic Injury Surveillance system was queried for craniofacial injuries associated with motorized scooter use. Patient demographics, injury type, anatomic location, injury pattern, and helmet status were extracted for analysis.

RESULTS

From 2008 to 2017, there were 990 recorded events for craniofacial injuries secondary to motorized scooters extrapolating to an estimated 32,001 emergency department (ED) visits. The annual incidence was noted to triple over that 10-year period. The majority of patients were male (62.1%) and the common age groups at presentation were young children 6-12 years old (33.3%), adolescents 13-18 years old (16.1%) and young adults 19-40 years old (18.0%). The most common injury pattern was a closed head injury (36.1%) followed by lacerations (20.5%). Facial fractures were only present in 5.2% of cases. In cases in which helmet use was recorded, 66% of the patients were not helmeted.

CONCLUSION

The incidence of motorized scooter related craniofacial trauma is rising, resulting in thousands of ED visits annually. Many patients are experiencing morbid traumatic injuries and may not be wearing appropriate protective equipment. This study highlights the importance of public awareness and policy to improve safety and primarily prevent craniofacial trauma.

The e-merging e-pidemic of e-scooters

Introduction

Since their release in 2017, standing electric motorized scooters (eScooters) have risen in popularity as an alternative mode of transportation. We sought to examine the incidence of injury, injury patterns, prevalence of helmet and drug and alcohol use in eScooter trauma.

Methods

This was a multi-institutional retrospective case series of patients admitted for injuries related to operation of an eScooter following the widespread release of these devices in September 2017 (September 1, 2017 to October 31, 2018). Demographics, drug and alcohol use, helmet use, admission vitals, injuries, procedures, hospital and intensive care unit length of stay (LOS), death, and disposition were analyzed.

Results

103 patients were admitted during the study period, and monthly admissions increased significantly over time. Patients were young men (mean age 37.1 years; 65% male), 98% were not wearing a helmet. Median LOS was 1 day (IQR 1-3). 79% of patients were tested for alcohol and 48% had a blood alcohol level >80 mg/dL. 60% of patients had a urine toxicology screen, of which 52% were positive. Extremity fractures were the most frequent injury (42%), followed by facial fractures (26%) and intracranial hemorrhage (18%). Median Injury Severity Score was 5.5 (IQR 5-9). One-third of patients (n=34) required an operative intervention, the majority of which were open fixations of extremity and facial fractures. No patients died during the study. The majority of patients were discharged home (86%).

Conclusion

eScooter-related trauma has significantly increased over time. Alcohol and illicit substance use among these patients was common, and helmet use was extremely rare. Significant injuries including intracranial hemorrhage and fractures requiring operative intervention were present in over half (51%) of patients. Interventions aimed at increasing helmet use and discouraging eScooter operation while intoxicated are necessary to reduce the burden of eScooter-related trauma.

Level of evidence

Level IV.

New peril on our roads: a retrospective study of electric scooter-related injuries

INTRODUCTION

The electric scooter has been gaining popularity locally as a commute mode. We aimed to understand the current landscape of electric scooter-related injuries in Singapore.

METHODS

A retrospective review was performed of the medical records of patients seen from 2015 to 2016 at an emergency department (ED) in Singapore. Patient demographics, circumstances of the accident, injuries sustained and clinical progress were analysed.

RESULTS

There were 36 cases, all of whom were electric scooter users. The median age was 34 (range 17‒70) years and 66.7% were male. There was a 2.3-fold increase in the number of cases from 2015 to 2016. In 11 (30.6%) of cases, another road user was implicated. Two cases involved the use of protective equipment. 14 (38.9%) cases were conveyed by Emergency Medical Services. In the ED, 4 (11.1%), 17 (47.2%) and 15 (41.7%) cases were triaged as P1 (emergent), P2 (urgent) and P3 (ambulatory), respectively. Investigations were performed in the ED for 31 (86.1%) cases. External injuries were most common (72.2%), followed by extremity injuries (33.3%), with median Abbreviated Injury Scale scores of 1 and 2, respectively. Overall, the median Injury Severity Score was 1. Nine patients were admitted to the hospital with three requiring surgery. The median length of stay was 2 (range 1‒6) days.

CONCLUSION

The incidence of electric scooter-related injuries appears to be on the rise and may potentially incur significant morbidity and healthcare costs. Further efforts at safety education and enforcement should be made to prevent accidents and minimise the impact of these injuries.

The price of personal mobility: burden of injury and mortality from personal mobility devices in Singapore - a nationwide cohort study

BACKGROUND

Personal mobility devices (PMDs) like skate-scooters, electric bicycles (e-bikes) or motorised scooters (e-scooters) have become widely available globally. There are several studies describing the rising incidence of injury from such devices. The aim of our study was to examine PMD user factors between motorised (MotPMDs) vs non-motorised PMDs (NonPMDs) as risk factors for severe injury and the need for hospital admission.

METHODS

We analysed de-identified National Trauma Registry data (2015 to 2017) from all public sector hospitals in Singapore for patients aged 12 and above presenting to emergency departments with PMD-related injuries. Multivariable logistic regression was used to identify risk factors for the primary outcome of interest (higher injury severity, defined as Injury Severity Score / ISS > =9), and the secondary outcome of interest (need for hospital admission). Additional subgroup analysis was conducted comparing only scooters (manual vs electric), the most common sub-type of PMD in our study.

RESULTS

Of the 614 patients in our study, majority were male (74%), median age 33 years, with 136 (22%) sustaining injuries with ISS > =9; 185 (30%) admitted [median stay length 3 days (IQR: 1-6)] and 93 (15%) required surgery. MotPMDs were more common (480, 78%), with e-scooters being the most common motorised device (393, 64%). There were 6 deaths, all in MotPMD users. On both univariate and multivariable regression, MotPMD users [OR 3.82, 95% CI 1.51-12.9, p = 0.01] and older users (> = 60 years) [OR 9.47, 95% CI 2.45-62.9, p = 0.004] were more likely to sustain injuries with ISS > =9, and more likely to need admission (MotPMD users [OR 1.8, 95% CI 1.04-3.29, p = 0.045], age > =60 years [OR 4.72, 95% CI 1.86-13.0, p = 0.002]).

CONCLUSION

MotPMDs tripled the risk of severe injury and doubled the risk of requiring hospitalisation, compared to NonPMDs, likely due to higher travelling speeds. Increased age was also associated with severe injury and requiring hospitalisation.

Rider factors associated with severe injury after a light motorcycle crash: A multicentre study in an emerging economy setting

Objective

In Taiwan, light motorcycles (LMCs) with cylinder capacities between 50 and 250 cc are widely used for daily commute. These vehicles are operated in a mixed traffic environment and prohibited on highways. In light of increasing motorcycle casualties, we conducted a multicentre study to analyse rider factors affecting injury severity.

Methods

Riders hospitalised upon LMC crashes were contacted. Information on demographics, comorbidities, and riding behaviours was collected through questionnaires and linked to hospital data. The injury severity score (ISS) and length of hospitalisation (LOH) were used as injury severity measures.

Results

In total, 725 patients (mean age: 37.7 years; 64% men) completed their questionnaires. Multivariate analysis results showed that age ≥ 65 years, half-face helmets, protective clothing, collisions with a bus/truck or car, and fatigue riding were risk factors for having an ISS of ≥9. Age ≥ 65 years; motorcycle crashes ≥2 times in the previous year; anaemia; rural crashes; half-face helmets; protective boots; collisions with a bus/truck, car, or a stationary object; alcohol/stimulating refreshment consumption; and fatigue riding were risk factors for increased LOH. A protective factor was individuals working in commerce. Collisions with opening car doors caused low risks of having an ISS of ≥9 and a short LOH.

Conclusion

Certain factors were significantly associated with riders’ injury severity and related medical resource consumption. Because of differences in the power output, use, and riding environment, risk factors for severe injuries in LMC crashes are dissimilar from those for heavy motorcycles (cylinder capacities > 250 cc) in developed countries and deserve more attention for injury prevention. Further in-depth evaluation of significant factors based on this study’s results can yield valuable information to reduce severe injuries after LMC crashes in countries and areas with a high dependency on motorcycles, even considering the popularity of electric motorcycles.

Pediatric electric bicycle injuries and comparison to other pediatric traffic injuries

Objective: The objective of this study was to conduct a comprehensive analysis of demographics, injury characteristics and hospital resource utilization of significant pediatric electric bicycle (e-bike) injuries leading to hospitalization following an emergency department visit in comparison to pediatric injuries caused by other traffic related mechanisms. Methods: A retrospective review of all pediatric traffic injury hospitalizations following an emergency department visit to a level I trauma center between October 2014 and September 2016 was conducted. Data regarding age, sex, number of computed tomography (CT) scans obtained, number of major procedures, length of hospital stay (LOS), Injury Severity Score (ISS), and number of injuries per patient were collected and compared between e-bike injuries and other traffic injuries. Results: Three hundred thirty-seven admissions were analyzed: 46 (14%) were due to e-bike injuries (29% of patients >12 years). Age, proportion of brain injuries, and use of CT were significantly increased compared to mechanical bicycle injuries (13.1 ± 3.4 vs. 10.6 ± 3.6, 13% vs. 3%, 1 [0-3] vs. 1 [0-1], P < .01, P = .03, P = .05). Age, LOS, and use of CT were significantly increased compared to injuries caused to automobile passengers (13.1 ± 3.4 vs. 7.4 ± 5.3, 1 [1-3] vs. 1 [1-2], 1 [0-3] vs. 0 [0-1], P < .01, P = .03, P = .01), as well as ISS and number of injuries per patient (P = .04, P < .01). Injuries caused by e-bikes were similar to injuries caused to pedestrians, except for age (13.1 ± 3.4 vs. 8.5 ± 3.7, P < .01). Multivariable analysis revealed a significant association between mechanism of injury and ISS, with increased ISS among e-bike injuries compared to mecahnical bike injuries (OR 2.56, CI 1.1-5.88, P = 0.03) and automobile injuries (OR 4.16, CI 1.49-12.5, (P < .01). Conclusion: E-bikes are a significant cause of severe injury in children compared to most other traffic injuries, particularly in older children.

Road safety risk factors for non-motorised vehicle users in a Chinese city: an observational study

OBJECTIVE

The objective of this study is to describe and analyse the prevalence of speeding, helmet use and red-light running among riders of non-motorised vehicles (NMVs) in Shanghai, China, with a focus on electric bikes (ebikes).

METHODS

Observational studies were conducted in eight randomly selected locations in Shanghai. Descriptive statistics and a Cox proportional hazard (PH) model were used in the analyses.

FINDINGS

A total of 14 828 NMVs were observed in November 2017. At the free flow sites, the average speed was 22.5 km/hour for ebikes and 13.4 km/hour for bicycles. 95.5% of ebikes run above 15 km/hour, the legal speed limit for NMVs in China and 83.8% above 20 km/hour, the maximum design speed for ebikes. Helmet wearing rate was 13.5% for ebike drivers and 9.4% for passengers. Riders of commercial ebikes were nearly three times more likely to wear a helmet than personal ebikes. 22.4% of ebikes were observed to run a red light. The Cox PH model showed that ebikes (vs bicycles), males (vs females), clear weather (vs cloudy, rainy and snowy), helmet users (vs nonusers) are associated with a higher hazard for running a red light.

CONCLUSION

To our knowledge, this study is among the first comprehensive evaluation of road user behaviours for NMVs in China. An effective intervention package including regulating ebike production to national standards, strengthening speed enforcement and passing legislation on mandatory helmet use for ebike users may be able to help.