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

The Incidence and Severity of Pediatric Injuries Sustained by Electric Bikes and Powered Scooters: The Experience of an Urban, Tertiary Pediatric Emergency Department

OBJECTIVES

This study aimed to describe the incidence and severity of electrical bicycle (E-bike)- and power scooter (P-scooter)-related injuries and their secular trends among pediatric patients presenting to a pediatric emergency department (ED).

METHODS

This retrospective cohort study of patients aged <18 years who sustained E-bike and P-scooter injuries was performed between 2018 and 2023. We explored trends of severe trauma cases, ED visits, hospitalizations, and surgical interventions. Severity of trauma was rated by either an injury severity score (ISS) of >15 or the patient's need for acute care as defined by intensive care unit (ICU) admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death.

RESULTS

Of the 1466 pediatric patients who presented to our pediatric ED following P-scooter and E-bike injuries, 216 (14.7%) were hospitalized, with a median age of 14.0 years (interquartile range, 10.5-16.0 years) and male predominance (69.0%). The number of ED visits increased 3.5-fold by study closure, with a parallel increase in hospitalizations, surgical interventions, and severe trauma cases. The relative percentages of severe trauma cases were not significantly different over time. Among hospitalized patients, 3 patients (1.4%) died and 9 (4.1%) required rehabilitation care.

CONCLUSIONS

The incidence and severity of E-bike and P-scooter injuries and fatalities continue to increase within the pediatric population. Current personal and road safety regulations are providing inadequate in preventing these injuries, highlighting an urgent need for revision and stricter enforcement.

Trends and projections in fall death in the Netherlands from 1990 to 2045

BACKGROUND

Increasing life expectancy in high-income countries has been linked to a rise in fall mortality. In the Netherlands, mortality rates from falls have increased gradually from the 1950s, with some indication of stabilisation in the 1990s. For population health and clinical practice, it is important to foresee the future fall mortality trajectories.

METHODS

A graphical approach was used to explore trends in mortality by age, calendar period and cohorts born in the periods of 1915-1945. Population data and the numbers of people with accidental fall fatality as underlying cause of death from 1990 to 2021 were derived from Statistics Netherlands. Age-standardised mortality rates of unintentional falls per 100 000 population were calculated by year and sex. A log-linear model was used to examine the separate effects of age, period and cohort on the trend in mortality and to produce estimates of future numbers of fall deaths until 2045.

RESULTS

While the total population increased by 17% between 1990 and 2021, absolute numbers of fall-related deaths rose by 230% (from 1584 to 5234), which was 251% (an increase of 576 deaths in 1990 to 2021 deaths in 2020) for men and 219% (from 1008 to 3213) for women. Age-standardised figures were higher for women than men and increased more over time. In 2020, 79% of those with death due to falls were over the age of 80, and 35% were 90 years or older. From 2020 to 2045, the observed and projected numbers of fall deaths were 2021 and 7073 for men (250% increase) and 3213 and 12 575 for women (291% increase).

CONCLUSION

Mortality due to falls has increased in the past decades and will continue to rise sharply, mainly caused by growing numbers of older adults, especially those in their 80s and 90s. Contributing risk factors are well known, implementation of preventive measures is a much needed next step. An effective approach to managing elderly people after falls is warranted to reduce crowding in the emergency care and reduce unnecessary long hospital stays.

Trends in Head and Neck Injuries Related to Electric Versus Pedal Bicycle Use in the United States

OBJECTIVES

To describe the incidence of head and neck trauma related to electric bicycles and to characterize head and neck injury patterns seen in electric bicycle (eBike) users versus pedal bicyclists in the United States.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried from 2009 to 2020 for patients with head and neck injuries related to electric and pedal bicycles. Extracted data included patient demographics, injury patterns, hospital admission, and helmet use. Univariate chi-squared analyses were performed to compare demographics and injury patterns between bicycle groups. Effect sizes were reported with Cramer V values (V).

RESULTS

The incidence of eBike-related head and neck injuries increased from 2993 in 2009 to 9916 in 2020. Compared to pedal bicycle users, eBike users were more likely to have head injuries (60.4% vs. 52.0%) and fractures (10.9% vs. 6.0%), and were more likely to require hospitalization (20.6% vs. 10.4%). The effect size of helmet use was significantly greater in eBike users compared to pedal bicyclists when examining distributions of age group (V = 0.203 vs. V = 0.079), injury location (V = 0.220 vs. V = 0.082), and injury type (V = 0.162 vs. V = 0.059). Helmeted injuries in eBike users more commonly involved neck injuries and sprains, rather than head injuries and fractures.

CONCLUSION

Head and neck trauma related to eBike use is increasing in the United States. Injury patterns and admission rates reflect greater injury severity in eBike users compared to pedal bicyclists. Helmet use may be particularly beneficial in mitigating head and neck injury in eBike users.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2734-2740, 2024.

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-Scooters and Craniofacial Trauma: A Systematic Review

Study Design

Systematic review.

Objective

Standing electric scooters (e-scooters) provide a cheap and environmentally friendly transport alternative, but also elicit substantial concern regarding their volume of associated injuries especially in the craniofacial region. This review aims to explore the demographics, risk factors, types of injury and surgical management of craniofacial trauma associated with e-scooters.

Methods

PubMed and Scopus databases were systematically searched. Inclusion criteria were clinical studies investigating craniofacial trauma associated with e-scooters. Exclusion criteria were duplicates; non-English publications; non-full-text publications; studies with insufficient data.

Results

Of the 73 articles identified, 10 eligible articles representing 539 patients were included. The mean age was 31.5 years. Most cases were male (63.7%). Common risk factors were alcohol/drug intoxication, absence of distal extremity injuries and lack of helmet use. The most common mechanism of injury was mechanical falls (72.4%). The most common facial fracture pattern was middle third fractures (58.3%). Surgical management was required for 43.3% of fractures. Other types of injuries reported were traumatic brain injuries (17.6%), soft tissue injuries (58.3%), dental injuries (32.9%) and ophthalmological injuries (20.6%).

Conclusions

The findings of this review suggest common presentations for craniofacial trauma associated with e-scooters. Robust longitudinal evaluations with standardised descriptions of types of injuries are required. Gaps in knowledge relate to surgical management, post-operative complications and associated risk factors.

Odds of self-reported minor cycle crashes with conventional and electric assisted cycles adjusted for cycling frequency in Dutch and Belgian adults a retrospective study

BACKGROUND

Cycling for transportation and recreation is gaining in popularity, especially in older age groups. The rise in electric assisted cycles (EAC) may also have a role to play in this. With an increase in the number of cyclists comes an increase in the prevalence of cycle crashes. However, there is a lack of knowledge on EAC crashes and crash studies including cycle use data. An important question is also whether the high number of serious road injuries among older cyclists, is due to increased risk or more serious consequences in the event of a crash.

STUDY AIM

To compare the odds of reporting a cycle crash on a conventional (CC) against electrically assisted cycle (EAC), while controlling for age, gender, BMI, impairments while cycling, cycling frequency and region of residence.

METHODS

A 12-month retrospective cross-sectional survey-based study, including male and female cyclists aged 40+ years, was conducted in Belgium and the Netherlands. Socio-demographics, physical and mental impairments while cycling (such as lower reaction time), crash details and cycling frequency data were collected. Cyclists were grouped into CC, EAC or both (CC + EAC) based on the type of cycle they used during the study period. Logistic regression models were used to calculate the odds of reporting a cycle crash. Main and interaction effects were studied.

RESULTS

1,919 cyclists were included in the data analysis (63.2 ± 11.1 years; 50% women). 319 (17% of the total sample) cyclists reported a crash in the previous 12 months, of which 36% were EAC crashes. Those reporting a crash were significantly younger compared to those not reporting a crash. The following significant main effects were observed: those cycling on an EAC had a higher odds of reporting a cycle crash compared to those cycling on a CC (OR = 1.41, 95% CI = 1.01-1.97); cyclists in the category average and high on mental impairments while cycling had a higher odds of reporting a cycle crash compared to those in the category low (OR = 1.72, 95% CI = 1.23-2.40 and OR = 3.49, 95% CI = 2.51-4.90, respectively); higher cycling frequency is related to higher odds of reporting a cycle crash (OR = 3.25, 95% CI = 2.25-4.90). A significant interaction effect was observed between age category and gender (OR = 1.93, 95% CI = 1.15-3.26). Post-hoc tests revealed that men in the younger age category (40-64 years) had the highest probability (18.95%) of reporting a cycle crash, whereas men in the oldest age category (65+ years) had the lowest probability (9.99%) of reporting a cycle crash. No significant difference between age categories in women was observed.

CONCLUSION

This study indicates that within a cohort of middle aged and older adults living in regions with high to low cycling modal shares, cycle type, mental impairments while cycling, cycling frequency and region of residence play a significant role in the odds of reporting a (minor) cycle crash. Men in the age category 40-64 years have a significantly higher probability of reporting a cycle crash compared to men of 65+ years. Safety campaigns and instructions should pay particular attention to men in the age category 40-64 years and those with a mental impairment while cycling.

A Survey of Technologies and Recent Developments for Sustainable Smart Cycling

Among the problems resulted from the continuous urbanization process, inefficient urban mobility and high pollution levels have been complex challenges that have demanded a lot of public investments and research efforts. Recently, some alternative transportation means have been leveraged as sustainable options for such challenges, which has brought bicycles to a more relevant setting. Besides the sometimes obvious benefits of adopting bikes for transportation, technologies around the Internet of Things (IoT) paradigm have been advocated as important supportive tools to boost smart cycling initiatives. Actually, new technologies can be exploited to improve the efficiency of bike paths and parking spots, while reducing accidents and enhancing the cycling experience of the users. Therefore, in this highly vibrating scenario, this article facilitates the understating of current research trends and promising developments, surveying and classing recent works. Since there is a global interest for the promotion of cleaner and more sustainable solutions in large cities, this survey can be valuable when supporting new developments in this highly relevant research area.