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

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

Eye and Orbit Injuries Caused by Electric Scooters and Hoverboards in the United States

Introduction

To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries.

Results

Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%).

Conclusion

There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.

Incidence and distribution of injuries associated with e-scooter use: a radiological perspective

OBJECTIVES

To investigate electric scooter (e-scooter)-associated radiological injury incidence and distribution of injuries.

METHODS

Retrospective cross-sectional study of radiological examinations related to e-scooter injuries at a major trauma centre in a small university city. The hospital radiology information system was searched for terms related to e-scooters between January 1, 2015, and October 31, 2022. E-scooter use was confirmed by review of the patients' electronic medical records. Specific injuries were divided based on site of injury using the Injury Severity Scale categorized groups.

RESULTS

A total of 568 radiological studies related to e-scooter injuries were identified on 340 distinct patients (56% male, with an average age of 28 years). Peak incidence of e-scooter-related injuries was seen in the summer months, after a local scooter sharing system was introduced in October 2020. A total of 149 patients had radiologically diagnosed injuries, with extremity injuries being most frequent (80%). Facial (8%), head/neck (8%), and thorax/abdomen (4%) were less common. Radial head fractures were the most common injury (n = 27). Thirteen patients had multiple sites of injury, four of which had both upper limb and facial bone fractures described.

CONCLUSIONS

We report a significant increase in radiological investigations and injuries in the context of e-scooter injuries, particularly since the introduction of an e-scooter sharing scheme. This study informs radiologists on common locations of injuries when reporting studies of patients that have had e-scooter-related injuries.

ADVANCES IN KNOWLEDGE

This is the first UK-based study providing a comprehensive radiological perspective of the impact of e-scooter use and associated distribution of injuries, adding important data for many cities that are currently undertaking review of their e-scooter sharing schemes.

'I mean, I wouldn't say I was sober': Exploring the psychosocial impact of e-scooter injuries and aligning a collaborative public health response

ISSUE ADDRESSED

E-scooters are sought after for their cost-effectiveness, sustainability, and efficiency in urban transportation. However, this popularity has been accompanied by a surge in injuries, prompting a deeper investigation into the factors influencing risk perceptions among e-scooter users.

METHODS

Using a qualitative approach, we conducted 19 interviews with those who attended an emergency department as a result of e-scooter injury. We aimed to understand the psychosocial effects of these incidents and employed thematic analysis to discern recurrent patterns in participants' experiences, focusing on alterations in daily life, community response, perception shifts, and avenues to enhance safety awareness.

RESULTS

The findings underscored significant disruptions to daily life due to injuries, demonstrating enduring impacts on lifestyle and wellbeing. Participants exhibited a perceptual shift, transitioning from perceiving e-scooters as enjoyable to viewing them as dangerous. Recommendations for enhancing safety awareness included accessible and clear safety education, pre-ride briefings, real-time safety guidance, temporal rental restrictions, and mandatory breathalysers before e-scooter use.

CONCLUSIONS

The study underscores the importance of considering not only the individual experiences and perceptions of e-scooter injuries but also the broader social context, including the night-time economy. Leveraging peer narratives and community engagement is vital to reshape risk perceptions and promote harm reduction messages. SO WHAT?: A comprehensive approach through proactive interventions and robust educational strategies is essential to foster responsible e-scooter usage and prioritise public safety.

Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme

The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.

Sensitivity of Mass Geometry Parameters on E-Scooter Comfort: Design Guide

E-scooter vibrations are a problem recently studied. Theoretical models based on dynamic simulations and also real measurements have confirmed the high impact of e-scooter vibrations on driver comfort and health. Some authors recommend improving e-scooter damping systems, including tyres. However, it has not been suggested nor has any research been published studying how to improve e-scooter frame design for reducing driver vibrations and improving comfort. In this paper, we have modelled a real e-scooter to have a reference. Then, we have developed a multibody dynamic model for running dynamic simulations studying the influence of mass geometry parameters of the e-scooter frame (mass, centre of gravity and inertia moment). Acceleration results have been analysed based on the UNE-2631 standard for obtaining comfort values. Based on results, a qualitative e-scooter frame design guide for mitigating vibrations and increasing the comfort of e-scooter driver has been developed. Some application cases have been running on the multibody dynamic simulation model, finding improvements of comfort levels higher than 9% in comparison with the e-scooter reference model. The dynamic model has been qualitatively validated from real measurements. In addition, a basic sensor proposal and comfort colour scale is proposed for giving feedback to e-scooter drivers.

Incidence, Management, and Hospital Costs of Orthopaedic Injuries of E-Scooter Riders in Western Australia

The use of electric scooters (e-scooters) is increasing in Australia and internationally. The increasing availability of e-scooters has led to a rise in the number of injuries, with most patients sustaining orthopaedic injuries. This retrospective case series describes the incidence, management, and hospital costs of the orthopaedic injuries, which presented to the emergency department (ED) of the major trauma center in Western Australia. Data on demographics, ED dispatch destination, management, follow-up clinics, and hospital costs were collected between 2017 and 2022. Since June 2020, there have been 61 e-scooter crashes, which resulted in orthopaedic injuries, with more than half of the crashes occurring after the introduction of regional e-scooter sharing schemes. Thirty-two patients (52%) were admitted to the hospital. The most common orthopaedic fracture was to the upper limb (44%), followed by the lower limb (41%) and the axial skeleton (15%). Fourteen (23%) patients sustained more than one fracture. Twenty-two patients (36%) required operative management. The median number of outpatient clinic attendances per patient was 3 (interquartile range (IQR): 1-5), with inpatients requiring twice the number of clinics as compared to those discharged from the ED. The median cost per presentation was AU$5880.60 (IQR: AU$1283.10-AU$21,150.90) with inpatient costs exceeding those discharged from the ED. The range of the total costs was AU$413.80 to AU$100,239.80. The rise in the accessibility of e-scooters in Western Australia has led to a rise in ED presentations with orthopaedic injuries. Considering the recent implementation of e-scooter sharing schemes in metropolitan areas, ongoing surveillance of e-scooter injuries by clinicians and policy makers is warranted to inform harm minimization strategies.

Using e-scooters: An easy way to get home or a nightmare? An orthopedic perspective on e-scooter accidents

BACKGROUND

The percentage of e-scooter use quickly escalated in our community due to its convenience, low cost, and eases of use. The number of accidents causing high-energy traumas has also increased. This study aims to describe the demographic char-acteristics and fracture patterns of patients admitted to the emergency department following an e-scooter accident and to identify common, correctable factors that increased the likelihood of accidents.

METHODS

Between January 2022 and August 2022, 43 patients (20 females and 23 males) who were admitted to the emergency department after an e-scooter accident and developed extremity fractures were included. The patients were divided into 2 groups those treated surgically and conservatively. Parameters such as the time of the accident, education level of the user, alcohol use, e-scooter malfunction, and compliance with traffic rules were evaluated.

RESULTS

Accidents that led to treatment by surgery mostly occurred between 11 pm and 7 am. Surgically treated patients were mostly high school graduates. Alcohol use and recreational scooter use rates were statistically higher in the operated patients when compared to patients who were treated conservatively. The number of patients who reported a malfunction in the e-scooter was significantly lower in the operated group than in the conservative group. The rates of accidents due to non-compliance with traffic laws, driving at full speed of the e-scooter, use on the driveway, and presence of wet ground at the time of the accident were higher in the surgically treated patient group. Surgically treated patients also had a higher rate of being 1st time e-scooter users.

CONCLUSION

Although governments have introduced many regulations regarding e-scooter use, the current situation seems insufficient in solving the problem. E-scooter users should be further educated about the associated risks. Authorities should tighten their supervision of scooter rental companies and drivers. Nighttime usage conditions should be reviewed, and the use of alcohol should be controlled. The use of helmets should be mandatory. If such regulations are tightened, accident rates can be reduced or high-energy impacts from existing accidents can be avoided. The results suggest that experienced, slow, non-alcoholic, and rule-abiding drivers require less operative treatment. This article will hopefully raise awareness and improve e-scooter regulations.

Craniofacial Trauma from Electronic Scooter Use

BACKGROUND

In 2018, the City of Providence introduced a program in which electronic scooters were deployed for public use. We aim to characterize the burden of craniofacial injuries associated with these scooters.

METHODS

A retrospective review was conducted of all patients consulted to the plastic surgery service for evaluation of craniofacial injury between September 2018 and October 2022. Data pertaining to patient sociodemographics, site and time of injury, and craniofacial trauma were recorded.

RESULTS

Twenty-five patients sustaining craniofacial trauma were identified over a four-year period. Most patients required soft tissue repair (64%) and bony fractures were sustained by approximately half of all patients (52%). Admission to ICU was uncommon (16%), and there were no fatalities.

CONCLUSIONS

The incidence of craniofacial injury from electronic scooter use is low. However, these injuries may involve extensive surgical reconstruction and ICU admission. We advise the City of Providence to optimize best safety practices and monitoring to minimize risk.

Western Australian State Trauma Registry analysis of incidence and injury patterns associated with e-Scooter injuries: 5-year retrospective case series

BACKGROUND

Electric scooters (e-Scooters) are a form of motorized vehicle that offers cheap, efficient and environmentally friendly transportation. Increased e-Scooter utilization has been accompanied by increases in e-Scooter related injuries in multiple countries. This project describes the incidence, injury pattern, injury severity and patient factors associated with e-Scooter use from the Western Australian State Trauma Registry.

METHODS

Retrospective cohort of all trauma patients captured by the Western Australian State Trauma Registry between 01 July 2017 and 30 June 2022 were analysed. Patient demographics, helmet use, reported drug use, and injury details (including principal and additional diagnoses, ISS) were collected.

RESULTS

Eighty-one patients sustained e-Scooter related injuries between 2017 and 2022. Fifty-four (66%) of hospital admissions were recorded in 2021-2022, an annual percent change of 385.7% from the previous year. Most patients were male (80%). Median age was 40 years (IQR: 32-50). Helmet use was reported in 43% of patients. Helmet use was associated with a significantly lower odds of head injury (OR = 4.42, CI: 1.38-14.21; P = 0.01). Thirty-five percent of patients were intoxicated with either alcohol or drugs. Forty-four (54%) patients required surgery.

CONCLUSION

E-Scooter crashes are a new mechanism of injury affecting patients captured by the Western Australian State Trauma Registry. Helmet use correlated with a reduced risk of head injury.

E-scooters and maxillofacial fractures: a seven-year multi-centre retrospective review

BACKGROUND

Standing electric scooters (e-scooters) are a cost-effective and environmentally-friendly transport alternative, but also elicit substantial concern regarding associated craniofacial injuries. This study aims to describe the patient factors, procedural factors and post-operative outcomes of maxillofacial fractures caused by e-scooter accidents.

METHODS

Retrospective chart review of patients aged 18 years or older who were surgically treated for these injuries in 2014-2020 at two Australian tertiary hospitals.

RESULTS

There were 18 cases included. Most cases were male (66%). The mean age was 35 years. Common risk factors were alcohol use (86%) and lack of helmet use (62%). The most common fracture pattern was zygomatico-maxillary complex (ZMC) fractures (50%). There were no associated systemic injuries. Mean operation timing was 12 days post-injury for ZMC fractures and 3 days post-injury for condyle fractures. For ZMC fractures, the most common method of fixation was 2-point fixation (66%). For condyle fractures, the most common surgical approach was arch bars only (83%). Post-operative complications were reported in six cases, with malocclusion being the most common (n = 3). Revision surgeries were performed in two cases.

CONCLUSIONS

Maxillofacial fractures associated with e-scooter accidents appear to be increasing in incidence. Robust longitudinal evaluations with larger sample sizes are required to better understand associated presentations, surgical approaches and post-operative complications.

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

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

Electric Scooter-Related Upper Limb Fractures: Analysis of 458 Cases

PURPOSE

To perform an analysis of electric scooter (e-scooter)-related upper limb fractures (ULFs), which have increased dramatically in parallel with the rapid rise in the use of e-scooters and shared e-scooter services in recent years.

METHODS

We retrospectively reviewed the medical charts of e-scooter-related emergency department visits between January 2017 and January 2020 at a level I trauma center. All patients with ULFs were included in the study, and their data were analyzed for demographics, fracture diagnosis, associated injuries, and required surgical treatment.

RESULTS

This study included 356 patients (50% men) with 458 ULFs, of which 23 (5%) were open fractures. The mean age of the cohort was 32.9 years (standard deviation, 10.1 years). The most common mechanism of injury was rider fall (92.1%). The nondominant hand was injured in 53.1% of cases, and 32.1% of all fractures were treated with surgery. A total of 120 (33.7%) patients sustained more than 1 ipsilateral ULF, and 27 (7.6%) patients had a concomitant contralateral ULF. Radial head fracture was the most common fracture type (n = 123, 26.8%), of which 16 (13%) were bilateral. The fifth ray was injured most frequently among the metacarpal and phalangeal fractures (n = 33, 47.1%). Most of the nonextremity-associated injuries were those of the head and maxillofacial bones.

CONCLUSIONS

The most common ULF associated with e-scooters was the radial head fracture. Physicians should be alert to and seek associated fractures during initial assessments of e-scooter-related upper limb injuries. Further investigation may be warranted to evaluate the effectiveness of protective measures in reducing the number of injuries.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

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.

Case Series and Systematic Review of Electronic Scooter Crashes and Severe Traumatic Brain Injury

OBJECTIVE

Electric scooters (e-scooters) are an increasingly popular form of transportation, but their use has also resulted in increased incidence of traumatic brain injury (TBI). Previous reports have predominantly described mild TBI with limited attention to other injury patterns. Our objective was to evaluate the impact of e-scooter use on rates of severe TBI.

METHODS

We performed a multicenter retrospective case review of patients who presented with severe TBI (Glasgow Coma Scale score 3-8) related to e-scooter use and undertook a systematic literature review to identify other reports of severe TBI related to e-scooter use.

RESULTS

Of the 19 patients (mean age, 38 ± 16 years; 73.7% male) included in the case series, 13 (68.4%) experienced a fall and 6 (31.6%) were involved in a collision. Various cerebral injury patterns, associated craniofacial fractures, and cervical spine injuries were also seen. Twelve patients (63.2%) underwent intracranial pressure monitor placement and 6 (31.6%) underwent a decompressive hemicraniectomy. Most patients (n = 12; 63.2%) were discharged to acute rehabilitation, with a median modified Rankin Scale score of 2 at 4.9 ± 7.7 months follow-up (52.6% had a good outcome of modified Rankin Scale score ≤2), but 4 patients died of primary injuries. The systematic review identified 18 studies with 77,069 patients between 2019 and 2021, with 37 patients who required intensive care and 6 patients who had neurosurgical intervention.

CONCLUSIONS

Severe TBI after e-scooter use is associated with high morbidity and is likely underdiagnosed in the literature. Awareness and public policies may be helpful to reduce the impact of injury.

Characteristics of outdoor motorized scooter-related injuries: analysis of data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP)

INTRODUCTION

The use of motorized scooters is gaining popularity in Canada and elsewhere. This study aims to summarize characteristics of injuries related to use of motorized scooters using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) and to analyze trends. The eCHIRPP collects information associated with the injury event and clinical information related to treatment (the injured body part, the nature of the injury, injury intent and treatment received) from 11 pediatric and 9 general hospitals across Canada.

RESULTS

A free-text search using keywords identified 523 cases related to motorized scooter injuries between January 2012 and December 2019. Most of the injuries reported were among males (62.7%). Fracture/dislocation was the most frequent injury (36.9%), and 14.3% of all patients were admitted to hospital. Joinpoint regression showed a statistically significant increase in injuries related to motorized scooter use between 2012 and 2017 (annual percent change of 18.4%).

CONCLUSION

Study findings indicate the need for continued preventive efforts and improved educational messages on safe riding and the importance of the use of protective equipment to prevent injuries among riders.

Intermodal use of (e-)scooters with train in the Provence-Alpes-Côte d’Azur region: towards extended train stations areas?

Featuring rapid adoption rates in recent years, personal standing scooters, as a micromobility, represent a missing complement to the first and last mile of public transport. This paper examines intermodal trips involving private (e-)scooters and trains with the objective to investigate the influence of this intermodal combination on station catchment areas. The methodology is based on the analysis of existing scientific research and empirical evidences. The case study focuses on access data from 12 railway stations collected by SNCF Réseau in the Provence-Alpes-Côte d’Azur region in September and October 2020. Main findings of this secondary analysis, based on 53 passengers using this personal device, suggest an over-representation of male and younger users, with very frequent intermodal practices mainly dedicated to work or study, and a feeder distance between combined walking and cycling. There appears to be similarities between bike-and-ride and scoot-and-ride but also clear distinctions that characterize this emerging mode, among which the fact that scooter is almost always used both during access and egress stages. This article advocates that station areas should be better considered by redesigning the surrounding public spaces to better balance the space of each mode, in favour of alternatives to the car and sustainable cities.

Characteristics and Risk Factors for Electric Scooter-Related Crashes and Injury Crashes among Scooter Riders: A Two-Phase Survey Study

Electric scooters (or e-scooters) are among the most popular micromobility options that have experienced an enormous expansion in urban transportation systems across the world in recent years. Along with the increased usage of e-scooters, the increasing number of e-scooter-related injuries has also become an emerging global public health concern. However, little is known regarding the risk factors for e-scooter-related crashes and injury crashes. This study consisted of a two-phase survey questionnaire administered to a cohort of e-scooter riders (n = 210), which obtained exposure information on riders' demographics, riding behaviors (including infrastructure selection), helmet use, and other crash-related factors. The risk ratios of riders' self-reported involvement in an e-scooter-related crash (i.e., any crash versus no crash) and injury crash (i.e., injury crash versus non-injury crash) were estimated across exposure subcategories using the Negative Binomial regression approach. Males and frequent users of e-scooters were associated with an increased risk of e-scooter-related crashes of any type. For the e-scooter-related injury crashes, more frequently riding on bike lanes (i.e., greater than 25% of the time), either protected or unprotected, was identified as a protective factor. E-scooter-related injury crashes were more likely to occur among females, who reported riding on sidewalks and non-paved surfaces more frequently. The study may help inform public policy regarding e-scooter legislation and prioritize efforts to establish suitable road infrastructure for improved e-scooter riding safety.

New Micromobility Means of Transport: An Analysis of E-Scooter Users' Behaviour in Trondheim

Negative effects of a massive use of cars, such as congestion, air pollution, noise, and traffic injuries, are affecting the cities everywhere. Recently introduced shared vehicles, such as e-scooters and electric bicycles, could potentially accelerate the transition towards sustainable mobility. Although these vehicles are becoming increasingly common and accepted within regulatory frameworks, some local governments are not yet ready to integrate e-scooters into their transport systems. Indeed, the legislation is unclear as it is not easy to determine whether the e-scooter is more like a bicycle or a vehicle. Moreover, it is difficult to predict the impact of e-scooters on road traffic, as well as the type of road infrastructure chosen by e-scooter drivers or the possible interaction of such vehicles with weak road users, such as pedestrians or cyclists. This study showed an analysis of speed and behaviour of e-scooter drivers in the city of Trondheim (Norway) to investigate how to manage this mode of transport. A total of 204 e-scooters were observed on six different roads in the city centre. The speed of e-scooter drivers was measured by a speed tracker (average value 15.4 km/h) and their behaviour recorded by a hidden observer in the field. Gender, age, distance from pedestrians, speed adaptation to the environment, and type of vehicle used were registered for each e-scooter. Through a Binomial Logit analysis, the data obtained were used to analyse the type of road infrastructure preferred by e-scooter drivers. Results showed that the cycle path is more widely used with percentage value from 60% to 90% of users. In addition, the probability of choice depended mainly on the road environment. The aim of this analysis was to assist local authorities in regulating the safe use of e-scooters and developing appropriate policies for their integration into cities.

E-scooter accidents: A rising cause of kidney injury

INTRODUCTION

E-scooters recently gained mass expansion, leading to increased use-related injuries, most commonly head trauma, facial, and extremity fractures, while abdominal trauma with kidney involvement is less frequent. Here we present two cases of e-scooter-related high-grade blunt kidney trauma.

CASE REPORTS

The first case was a 24-year-old male presenting with right abdominal pain after e-scooter autonomous right fall. Focused assessment with sonography for trauma (FAST) was negative, while abdominal CT showed a 3 cm middle-renal laceration. Six-day CT showed minimal urinary extravasation. Neither anemization nor impaired kidney function was observed; the patient was discharged after 9 days. The second case was a 42-year-old male presenting with right flank pain and ipsilateral chest pain after autonomous right fall. Thoracic X-ray revealed multiple rib fractures, while abdominal echography showed a non-homogeneous right kidney with a 1.5 cm perirenal fluid layer. Abdominal CT revealed 2.5 × 4 × 3.5 cm full-thickness middle-upper renal parenchyma laceration and confirmed the perirenal hematoma, while demonstrating two hepatic lesions. A series of CT and ultrasounds confirmed the stability of the aforementioned lesions and reduction of the perirenal hematoma; laboratory findings didn't show anemization nor impaired renal function. The patient was discharged after 10 days.

DISCUSSION

Widespread usage of e-scooter is accompanied by an uptick in traumatic events. The chance of renal trauma increases when lateral fall occurs. In our cases patients were hemodynamically stable, the kidney injury severity was high-grade, and non-operative management was effective.

CONCLUSION

E-scooter accidents could lead to high-grade renal injuries, amenable of non-operative management; these events are expected to raise.

Association of scooter-related injury and hospitalization with electronic scooter sharing systems in the United States

INTRODUCTION

We used interrupted time series (ITS) analysis to determine whether e-scooter shares' introduction in September 2017 increased serious scooter-related injury across the United States.

METHODS

Using the National Electronic Injury Surveillance System, we queried emergency department visits involving motorized scooter-related injuries from January 2010-December 2019. Cases originating where e-scooter shares launched between September 1, 2017-December 1, 2019 (intervention period) were considered exposed. The first month of launch (September 2017) was chosen as the time point for pre- and post-intervention analysis. The primary outcome was change in hospitalizations following scooter injury in association with the month/year launch.

RESULTS

This analysis includes 2754 unweighted encounters, representing 102614 estimated injuries involving motorized scooters nationwide. Hospitals within 20 miles of e-scooter shares also experienced a significant monthly increase of 0.24 scooter-related injury hospitalizations/1000 product-related injury hospitalizations ([0.17,0.31]) compared to a non-significant change in hospitalizations of 0.02 [-0.05,0.09] for control hospitals.

CONCLUSION

An increase in serious motorized scooter injuries coincides with e-scooter shares' introduction in the US. Future works should explore effective polices to improve public safety.

Comparison of motor vehicle-involved e-scooter and bicycle crashes using standardized crash typology

INTRODUCTION

The market share of e-scooters in the United States has proliferated in cities: 86 million trips were made on shared e-scooters in 2019, a more than 100% increase compared to 2018. However, the interaction of e-scooters with other road users and infrastructure remains uncertain.

METHOD

This study scrutinized 52 e-scooter and 79 bicycle police-reported crashes in Nashville, Tennessee, from April 2018 to April 2020 from the Tennessee Integrated Traffic Analysis Network (TITAN) database. We used descriptive analysis and a recent prototype version of the Pedestrian and Bicycle Crash Analysis Tool (PBCAT) to classify crashes based on the locations of the crashes relative to roadway segments or intersections, as well as the maneuver of the motor vehicle and e-scooter/bicycle relative to the motor vehicle.

RESULTS

Two crash typologies can explain the majority of e-scooter crashes, while bicycle crashes are distributed over several crash typologies. Additionally, 1 in 10 e-scooter- and bicycle-motor vehicle crashes leads to the injury or fatality of the e-scooter rider or bicyclist. Furthermore, we noted statistically significant differences in spatial and temporal distribution, demographics, lighting conditions, and crash distance from home for e-scooter and bicycle crashes.

CONCLUSIONS

The police crash report provides a comprehensive picture of e-scooter safety complementing existing literature. We found that e-scooter crash characteristics do not fully overlap with features of bicycle crashes.

PRACTICAL IMPLICATIONS

A generalized engineering, education, and enforcement treatment to reduce and prevent e-scooter and bicycle crashes, injuries, and fatalities might not result in equal outcomes for each mode. More rigorous enforcement could be implemented to deter e-scooters riders under the age of 18 years and e-scooter safety campaigns could target female riders.

Injuries related to electric scooter and bicycle use in a Washington, DC, emergency department

OBJECTIVE

E-scooter use has grown rapidly in the United States. Its rise in popularity has coincided with the promotion of cycling in many cities, but more needs to be known about how these transportation modes compare to determine if cycling should serve as an appropriate benchmark for policy decisions and safety expectations regarding e-scooters.

METHODS

We examined characteristics of adults seeking treatment in a Washington, DC, emergency department (ED) for injuries associated with riding e-scooters during 2019 (n = 99) or bicycles during 2015-2017 (n = 337).

RESULTS

E-scooter incidents less frequently involved moving vehicles (13.1% vs. 37.7%) or occurred on roads (24.5% vs. 50.7%) than cycling incidents. A smaller proportion of injured e-scooter riders were ages 30-49 (32.3% vs. 48.4%) and a larger proportion were 50 and older (34.3% vs. 22.6%) or female (45.5% vs. 29.1%). Distal lower extremity injuries were more common among e-scooter riders (13.1% vs. 3.0%; RR, 2.76; 95% CI, 1.79-3.54), and injuries to the proximal upper extremity (9.1% vs. 20.5%; RR, 0.49; 95% CI, 0.24-0.92) or chest, abdomen, and spine (3.0% vs. 14.0%; RR, 0.24; 95% CI, 0.07-0.70) were less common. Head injury rates were similar, but e-scooter riders more often experienced concussion with loss of consciousness (4.0% vs. 0.6%; RR, 3.03; 95% CI, 1.20-4.09) and were far less likely to wear helmets (2.0% vs. 66.4%). Estimated ED presentation rates per million miles traveled citywide were higher among e-scooter riders than cyclists (RR, 3.76; 95% CI, 3.08-4.59).

CONCLUSIONS

E-scooters and bicycles are both popular forms of micromobility, but the characteristics of riders injured on them, the ways in which they become injured, and the types of injuries they sustain differ substantially. E-scooter rider injury rates, though currently high, may decrease as they gain experience; however, if the number of new users continues to climb, they will persist in using the ED more often than cyclists per mile that they travel.

Common Injury Patterns from Standing Motorized Scooter Crashes

PURPOSE OF REVIEW

With the rising popularity of standing motorized scooters in major cities in the United States, many hospitals are experiencing a surge of traumatic injuries associated with this new mode of transportation. The impact and characteristics of injuries associated with standing motorized scooters are evolving, and safety regulations for the riders are poorly defined. There is a need for a review for healthcare providers and policy makers on this topic.

RECENT FINDINGS

Since its market introduction of rentable standing motorized scooters in late 2017, there has been an exponential rise in emergency department visits and hospitalization due to scooter-related trauma in urban hospitals. There have been a number of independent hospital-based and national-level studies describing demographics and trends of injury patterns in the last 2 years.

SUMMARY

Patients presenting to the hospital with injuries tend to be young male between 20 and 40 years of age, presenting at night. Head and extremity injuries are common, and patients often do not comply with helmets and other protective gears. Intoxication is a major risk factor for injuries requiring hospital admission and surgical interventions. These findings increase awareness for (1) healthcare providers to recognize and triage high-energy injuries, and (2) policy makers to advocate universal helmet use, increase public safety education, and enforce road safety regulations to minimize the impact of these injuries.

E-scooter injuries referred to the oral and maxillofacial surgical service at Christchurch Hospital: a retrospective observational study and cost analysis of 17-months of data

Personal and shared stand-up electronic scooters (e-scooters) have rapidly increased in popularity, leading to an increase in the number of patients with e-scooter-related trauma presenting to hospital Emergency departments. This study aimed to assess the patterns of oral and maxillofacial trauma directly related to e-scooter use and provide a cost-analysis related to the management of these patients. A retrospective, controlled interval study was conducted to examine all patients referred to the oral and maxillofacial surgical service at Christchurch Hospital, New Zealand, who sustained facial injury as a result of e-scooter accidents between 15 October 2018 and 15 April 2020. A total of 30 patients with e-scooter-related facial injuries were referred to the maxillofacial service and required a total of 23 operative procedures. The majority of patients (70%) were aged between 20-39 years and 63.3% were male. Two-thirds reported having consumed alcohol before the e-scooter accident. The total estimated cost for the treatment of patients was $298,054 NZD. E-scooter-related maxillofacial trauma represents an emerging mechanism of injury that is associated with significant facial trauma and results in a treatment cost that adds significant burden on the health care system.

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.

The characteristics of dockless electric rental scooter-related injuries in a large U.S. city

OBJECTIVE

To describe the characteristics of dockless electric rental scooter ("e-scooter")-related injuries presenting to two emergency departments in one large U.S. city.

METHODS

This observational cohort study utilized the city's public health syndromic surveillance system to prospectively identify patients with e-scooter-related injuries presenting between September and November 2018. The medical records for all adult patients treated at the two participating emergency departments were manually reviewed to extract demographic and clinical data. Cases involving mobility scooters or non-electric scooters were excluded.

RESULTS

For the 124 included adult patients with e-scooter-related injuries, the median age was 30 years (IQR: 22-43), they were predominantly male (59.7%), and approximately half (51.6%) arrived by ambulance. Falling from the scooter (84.7%) was the most common mechanism; twelve patients (9.7%) had collided with a motor vehicle. Head and face injuries (45.5%) were common; only 2 patients (1.6%) were documented as wearing a helmet at the time of injury. Most patients (n = 112, 90.3%) required imaging, more than half (n = 78, 62.9%) required an emergency department procedure, and 26 (21.0%) required surgical intervention. Most patients were discharged home, but 35 (28.2%) were admitted to hospital. Two patients (1.6%) were admitted to the intensive care unit.

CONCLUSIONS

E-scooters are an emerging transportation technology associated with a wide range of potentially serious injuries that consume substantial emergency department and hospital resources. Head injuries are a particular concern, as few e-scooter riders are wearing helmets at the time of injury.

Impact of the Rising Number of Rentable E-scooter Accidents on Emergency Care in Berlin 6 Months After the Introduction: A Maxillofacial Perspective

Study Design

Retrospective study of all patients presented at our emergency department after an accident while riding an e-scooter between 15 June 2019 and 15 December 2019. Out of this group, we subgrouped all patients with injuries to the head and neck area.

Objective

Shared e-scooter systems have recently been introduced in many big cities worldwide and are becoming increasingly popular. This retrospective study aimed to give a detailed overview of clinical data on consequences of e-scooter accidents, with particular attention to the maxillofacial point of view.

Methods

We performed a single-center retrospective study of all patients presented at our emergency department after an accident while riding an e-scooter between June 15, 2019 and December 15, 2019.

Results

Within the observation period, 43 patients (mean age of 32 years; range: 17-64 years) suffered from an accident while riding an e-scooter. Of these, 25 patients (58%) required maxillofacial treatment whereby 9 patients (36%) suffered a fracture (56% fracture of the mandible; 33% fracture of the nasal bone; 11% fracture of the maxilla). Six patients required maxillofacial surgical treatment. Twelve patients (28%) stated to have been driving under the influence of alcohol at the time of the accident (blood alcohol level between 0.77 g/L and 2.32 g/L). None of the patients used body protection, and only one patient wore a helmet (2%).

Conclusions

With the introduction of shared e-scooter systems, health-care facilities are faced with an increasing number of accidents related to the use of e-scooters, suffering from a high percentage of injuries in the maxillofacial region. Facial injuries might be reduced by the mandatory use of a helmet with faceguard. The trauma mechanism, in particular, seems to differ from other common trauma cases and needs to be examined more closely.

Characteristics and Injury Patterns in Electric-Scooter Related Accidents-A Prospective Two-Center Report from Germany

Since the introduction of rental E-scooters in Germany in mid-June 2019, the safety of this new means of transport has been the subject of extensive public debate. However, valid data on injuries and usage habits are not yet available. This retrospective two-center study included a total of 76 patients who presented to the emergency department following E-scooter-related accidents. The mean age was 34.3 ± 12.4 years and 69.7% of the patients were male. About half of the patients were admitted by ambulance (42.1%). Fractures were found in 48.6% of patients, and 27.6% required surgical treatment due to a fracture. The upper extremities were the most commonly affected body region, followed by injuries to the lower extremity and to the head and face. Only one patient had worn a helmet. In-hospital treatment was necessary for 26.3% of the cases. Patients presented to the emergency department mainly during the weekend and on-call times. This is the first report on E-scooter-related injuries in Germany. Accidents with E-scooters can cause serious injuries and, therefore, represent a further burden to emergency departments. The use of E-scooters appears to be mostly recreational, and the rate of use of protective gear is low.

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.

Comparative analysis of risky behaviors of electric bicycles at signalized intersections

OBJECTIVE

The primary objective of this study was to compare the risky behaviors of e-bike, e-scooter, and bicycle riders as they were crossing signalized intersections.

METHODS

Pearson's chi-square test was used to identify whether there were significant differences in the risky behaviors among e-bike, e-scooter, and bicycle riders. Binary logit models were developed to evaluate how various variables affected the behaviors of 2-wheeled vehicle riders at signalized intersections. Field data collection was conducted at 13 signalized intersections in 2 cities (Nanjing and Kunming) in China.

RESULTS

Three different types of risky behaviors were identified, including stop beyond the stop line, riding in motorized lanes, and riding against traffic. Two-wheeled vehicle riders' gender and age and traffic conditions were significantly associated with the behaviors of 2-wheeled vehicle riders at the selected signalized intersections.

CONCLUSIONS

Compared to e-bike and bicycle riders, e-scooter riders are more likely to take risky behaviors. More specifically, they are more likely to ride in motorized lanes and ride against traffic.