The Impact of the City of Miami's Decision to Revoke Electric Scooter Company Permits on Orthopedic Trauma at a Level I Trauma Center

BACKGROUND

Since the introduction of electric-scooter (e-scooter) mobile applications, there has been a marked increase in e-scooter-related injury. On January 19, 2022, the City of Miami revoked permits to five major mobile applications for violation of safety protocols.

OBJECTIVES

The purpose of our study was to assess the effects of this notice on the orthopedic patients seen at our corresponding Level I trauma center.

METHODS

Institutional Review Board approval was obtained for this study. A retrospective chart review was performed including all patients with orthopedic injuries at our Level I trauma center between July 19, 2021 and July 19, 2022. These dates include 6 months prior to and after the major e-scooter operators ceased use in Miami. SPSS statistical software version 28.0.0 (SPSS, IBM, Armonk, NY) was utilized for all statistical analysis.

RESULTS

There were 2558 patients in the prenotice cohort, and 2492 patients in the postnotice cohort. After the notice, there was a significant decrease in the number of patients that presented to our institution due to injuries caused by e-scooters (2.8% vs. 1.8% patients; p = 0.021). Patients with injuries caused by e-scooters had a significantly lower age (38 vs. 42, respectively; p = 0.034) and were more likely to be male (79.3% vs. 67.4% male, respectively; p = 0.007) than patients with other orthopedic injuries.

CONCLUSION

This study demonstrates that the 2022 notice revoking the major mobile application operators from the City of Miami resulted in a significant decrease in the number of orthopedic cases due to e-scooter-related injury at the corresponding Level I trauma center.

Electric scooter-associated orthopedic injuries cause long absence from work, regret and are emerging as a major cause of hip fractures in young individuals: a comprehensive study from a regional trauma center in a densely populated urban setting

PURPOSE

This study aimed to give a full spectrum of orthopedic injuries associated with electric scooter (e-scooter) use and analyze related factors, report on follow-up data from the patient's perspective and make a comparative etiological analysis of young adult hip fractures.

METHODS

A total of 851 consecutive patients were admitted to the Emergency Department following e-scooter injuries between January 2021 and July 2022, of whom 188 had 214 orthopedic injuries. The demographics, injury, and incident characteristics of these patients were collected. All fractures were classified as per the AO/OTA classification. Two groups were created as operatively or conservatively treated patients and data were comparatively analyzed. Follow-up examination incorporated a survey using binary questions on patients' perspectives. An etiological comparative analysis of hip fractures in young adults admitted to the same center between 2016 and 2022 was conducted.

RESULTS

The median patient age was 25. Inexperienced drivers constituted 32% of the injured. The protective gear use rate was at 3%. Higher speed (p = 0.014) and age (p = 0.011) were significantly associated with operative treatment. A total of 39% of the operated patients could not return to preinjury physical function, while 74% regretted using an e-scooter. The most common etiological factor for traumatic young hip fractures was fall from a height between 2016 and 2020, whereas it became e-scooter accidents in 2021-2022.

CONCLUSION

The rate of e-scooter-related operative treatment is high and leaves the patient in regret (84%) and a physically limited condition (39%). A speed limit of ≤ 15 km/h could decrease the rate of operative injuries. The e-scooter was identified as the top etiological factor in the last 2 years for traumatic young hip fractures.

LEVEL OF EVIDENCE

II, Diagnostic cohort study.

Electric scooter injuries: Incidence and injury patterns at a level I trauma center

PURPOSE

Electric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan.

METHODS

Chart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021. All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics, injury characteristics including fracture pattern, and definitive injury management. Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded. Descriptive statistics are reported as frequency (percentage) for categorical variables and means for continuous variables.

RESULTS

Of the 1815 orthopedic consults requested, 1357 (74.8%) were for acute injury management. Of those with acute injuries, 119 (8.8%) sustained 136 e-scooter or e-bike related injuries. There were 92 (77.3%) males at an average age of (33.8 ± 15.7) years. Approximately one-fifth of all patients presented in June 2021 (26, 21.8%). There was a 9.2% rate of open fractures. The 136 injuries were evenly split between the upper and lower extremities, with 57 (47.9%) upper extremity, 57 (47.9%) lower extremity injuries, and 5 (4.2%) concomitant upper and lower extremity injuries. The most common fracture patterns were ankle fractures (16, 11.7%), followed by tibial shaft (14, 10.2%), tibial plateau (13, 9.5%), and radial head fractures (11, 8.0%). There was a 33.3% incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures, 31.0% of posterior malleolar involvement and 18.8% of isolated vertical medial malleolar fractures in the ankle fractures, and 61.5% of posterior comminution in the tibial plateau fractures.

CONCLUSION

E-scooter and e-bike related injuries have a high incidence of tibial shaft fractures, ankle fractures, tibial plateau fractures, and radial head fractures. There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes. Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.

E-scooter-related orthopedic injuries and the treatments applied: are these scooters a new means of transportation or a new source of trauma?

INTRODUCTION

E-scooters have become increasingly popular in Turkey due to easy accessibility. In parallel with this, the number of e-scooter-related injuries has increased gradually. The aim of this study was to determine the types of e-scooter-related orthopedic injuries, to evaluate hospitalization and surgical treatments, and to investigate the loss of work of patients and the burden incurred by the healthcare system.

MATERIALS AND METHODS

This retrospective multicentre study included all orthopaedic referrals, who were admitted to two major trauma departments in Diyarbakır from January 2022 to July 2022. Patient data were analyzed, including demographic characteristics, injury pattern, types of injury and subsequent treatment.

RESULTS

In a total of 62 patients, 105 orthopaedic injuries were identified, comprising 72.5% males and 27.5% females, with a median age of 34.21 years. Fifty-six (90.3%) patients were riders, and six were pedestrians. All associated e-scooters were rented. There were 44 fractures (41.9% of the total recorded injuries) including 8 (12.9%) open fractures. Surgery was required by 32 patients (51.6%) and 35 (56.4%) required hospital admission leading to hospitalization of 3.7 days on average. The average job loss of working patients after injury was determined as 2.4 months. Helmet use was detected in 6.4% of the e-scooter users, but no other protective equipment was detected in any of the patients. Furthermore, 19,3% of the patients had a blood alcohol level of > 10 mg/dl.

CONCLUSIONS

The injuries that may result from an e-scooter accident can have long-term hospitalization and long-term job loss in the community. This imposes a significant financial burden on the national healthcare system and adversely affects public health. There is a need for precautions to be implemented such as infrastructure organisation, increased awareness of motor vehicle riders and e-scooter riders, and increased enforcement of rule compliance including not using e scooters after alcohol consumption and the use of protective equipment.

Epidemiology of Fractures Following Electric Scooter Injury

Background

The incidence of injuries associated with the use of electric scooter (e-scooter) has consistently increased since the launch of the first shared e-scooter systems in late 2017. The aim with this review was to investigate the epidemiological characteristics of fractures related to e-scooter accidents.

Methods

A systematic review of the all published papers was conducted regarding epidemiologic characteristics of traumatic fractures following e-scooter-related injuries. Multiple databases of PubMed, Web of Science, EMBASE, and Cochrane library were searched and relevant clinical studies reporting incidence for traumatic fractures from e-scooter-related injuries were included. All other types of studies and those including patients with non-orthopedic injuries were excluded. The Methodological Index for Non-randomized Studies (MINORS) was used to assess the quality of the included studies. The characteristics of patients were analyzed by the mean and the standard deviation for continuous variables.

Results

Eleven published studies (6579 patients) were identified which have been reported from Nov, 2019 to Sep, 2021. Periods of research in each study were different from May, 2017 to July, 2020. In the majority of cases, the mechanism of injury was a fall from the scooter (84.8%), which was followed by e-scooter motor vehicle accident (7.4%) and collision (5.5%). Regarding the fractures, upper limb injuries were the most prevalent (65%) and radial fracture was the most common fracture type of the upper limb (28.2%). Lower limb fractures were recorded in 475 (25.3%) patients, the most common being tibial fractures (8.4%).

Conclusions

As e-scooter market continues to considerably rise, the incidence of major orthopedic traumas is also likely to increase. Despite potential selection and reporting biases, our systematic review suggested up-to-date guidelines for the epidemiology of fractures following e-scooter injury. According to the results found in the present study, we believe that it is reasonable to mandate helmet use and the obligation to wear other types of safety equipment such as elbow and knee pads should be discussed.

Electric personal MObility DEvices Surveillance (E-MODES) study: Injury presentations to emergency departments in Brisbane, Queensland

OBJECTIVE

The rapid increase in e-mobility globally, including in Australia, has seen a concurrent increase in e-mobility-related injuries. Monitoring and understanding the patterns of injuries is essential to preserving community safety and making responsive and effective policy decisions regarding their safe use.

METHODS

This study reports on the first phase of the E-MODES study, a proactive injury surveillance initiative to examine the incidence and nature of injuries, their circumstances, contributing factors, and treatment, presenting to three hospital emergency departments (EDs) in Brisbane, the first Australian city to trial shared e-scooters.

RESULTS

During the 31-month study period, there were 1048 ED presentations related to e-mobility, the vast majority (90.8%) involving e-scooters, with males accounting for 64.3% of cases, the most common age group being 25-34 years, and weekends being the most common period of the week for presentations. The most common injury was fractures (37%), and the upper extremities and head/face were the most commonly injured body regions.

CONCLUSION

Contributing risk factors of alcohol use, not wearing a helmet, and speeding, were prevalent, though poorly recorded and only alcohol use proportions varied by age and gender, with males being more likely than females to have alcohol use reported. Recommendations to support e-mobility-related injury surveillance and safety outcomes include improved data standardisation and sharing.

Blind classification of e-scooter trips according to their relationship with public transport

E-scooter services have multiplied worldwide as a form of urban transport. Their use has grown so quickly that policymakers and researchers still need to understand their interrelation with other transport modes. At present, e-scooter services are primarily seen as a first-and-last-mile solution for public transport. However, we demonstrate that 50 % of e-scooter trips are either substituting it or covering areas with little public transportation infrastructure. To this end, we have developed a novel data-driven methodology that autonomously classifies e-scooter trips according to their relation to public transit. Instead of predefined design criteria, the blind nature of our approach extracts the city's intrinsic parameters from real data. We applied this methodology to Rome (Italy), and our findings reveal that e-scooters provide specific mobility solutions in areas with particular needs. Thus, we believe that the proposed methodology will contribute to the understanding of e-scooter services as part of shared urban mobility.

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.

The association between electric scooter riding position and injury characteristics

BACKGROUND

The popularity of electric scooters (e-scooters) and the shared e-scooter services as new means of transportation worldwide led to high numbers of injuries requiring emergency department (ED) visits. Private and rental e-scooters have different sizes and capabilities, offering several possible riding positions. While the rising use of e-scooters and their associated injuries have been reported, little is known about the influence of riding position on injury characteristics. The purpose of this study was to characterize e-scooter riding positions and their related injuries.

METHODS

E-scooters related ED admissions were retrospectively collected between June 2020 and October 2020, in a level-I trauma center. Demographics, ED presentation data, injury information, e-scooter design, and clinical course were collected and compared according to e-scooter riding position ("foot-behind-foot" vs "side-by-side").

RESULTS

During the study period, 158 patients were admitted to the ED with e-scooter related injuries. The majority of riders used the foot-behind-foot position (n = 112, 71.3 %) compared to the side-by-side position (n = 45, 28.7 %). Orthopedic fractures were the most common injuries (n = 78, 49.7 %). "Foot-behind-foot" group had a significantly higher fracture rate compared to "side-by-side" group (54.4 % vs 37.8 % within group, respectively; p = 0.03).

CONCLUSIONS

Riding position is associated with different injury types, with orthopedic fracture rates significantly higher in the more commonly used "foot-behind-foot" riding position.

PRACTICAL APPLICATION

These study findings suggest that the common e-scooter narrow-based design is considerably more dangerous, calling for further research to introduce safer e-scooter designs and update recommendations for safer riding positions.

Electric scooter-related triple cervical artery dissection

A 34-year-old female presented to the emergency department with neck pain, dysphonia and dysphagia ten days after a fall from an electric scooter. Subsequent computed tomography of the neck revealed bilateral vertebral artery and unilateral internal carotid artery non-occlusive dissections, which were managed with antiplatelet therapy. This case describes mechanisms of injury, clinical presentation, imaging appearances, and subsequent management of cervical artery dissection.

[One and a half years of e-scooters in Hamburg]

Background

Since electric scooters were introduced as an urban means of transportation in Hamburg in June 2019, a high number of violations of the current laws regarding alcohol consumption by e‑scooter riders have been recorded.

Objective

The aim of this study is to obtain an overview of traffic offences committed by e‑scooter drivers under the influence of alcohol, to classify their relevance in relation to other road user groups, and to draw a first interim balance with respect to their frequency after 1.5 years.

Material and methods

The data of all e‑scooter drivers (n = 342) examined concerning their blood alcohol values analyzed at the Institute of Legal Medicine of the University Medical Centre Hamburg-Eppendorf between 15.06.2019 and 31.12.2020 were retrospectively evaluated with respect to their demographic information and the medical examination results. These were brought into context with the total number of offences against the road traffic regulations with subsequent blood alcohol measurement.

Results

9.6% of the total number of offences against the road traffic regulations in connection with subsequent determination of the blood alcohol concentration were committed by e‑scooter drivers. 87.7% of those examined were male. The blood alcohol concentration was above the limit of 1.10 ‰ for absolute driving incapacity when using a passenger car in 76.9% of those examined. An accumulation of cases was particularly noticeable at night and at weekends.Due to imprecise records, a certain number of unreported e‑scooter incidents can be assumed among the unspecified motor vehicles.

Conclusion

As e‑scooter drivers make up a considerable proportion of drunken road users and the accidents mostly occur at night and at weekends, increased education and, if necessary, a driving ban at these times would seem to make sense.

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.

Increasing Incidence of Hand and Distal Upper Extremity Injuries Associated With Electric Scooter Use

PURPOSE

Electric scooters (e-scooters) have seen an increase in popularity in cities across the United States as a form of recreation and transportation. The advent of ride-sharing applications allows anyone with a smartphone to easily access these devices, without any investment or experience required. In this study, the authors analyze scooter-related injuries of the hand and upper extremity.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried to look for injuries related to the use of e-scooters between 2010 and 2019. Data collected included demographic information, the location of the injury, the injury diagnosis, and disposition. National estimates (emergency room visits in the United States) were calculated using the weight variable included in the NEISS database. Miscoded reports were excluded. As a corollary, Google Trends data were utilized to establish a correlation between e-scooter-related injuries and the relative number of e-scooter hits on the Google search engine.

RESULTS

From 2010 to 2019, there were 730 e-scooter-related injuries reported to the NEISS database. This corresponds to an estimated 26,412 injuries nationally during this time period. The incidence of scooter-related injuries increased by over 230% (2,130 national injuries in 2010; 7,213 national injuries in 2019; relative difference 5,083). Injuries most commonly occurred in patients aged 10 to 18 years (30.3%). The most frequent site of injury was the wrist (41.9%). The most common injury diagnosis was fracture (55.3%). Additionally, there was a correlation between the number of Google Trends e-scooter hits and the number of injuries during this time period.

CONCLUSIONS

The incidence of e-scooter-related upper extremity injuries increased dramatically in the United States between 2010 and 2019.

CLINICAL RELEVANCE

As novel e-scooter-sharing apps become increasingly popular, it is imperative that users are educated about the risk of injury and that use of proper protective equipment is encouraged.

Alcohol intoxication and lack of helmet use are common in electric scooter-related traumatic brain injuries: a consecutive patient series from a tertiary university hospital

PURPOSE

Clinicians have increasingly encountered traumatic brain injuries (TBI) related to electric scooter (ES) accidents. In this study, we aim to identify the modifiable risk factors for ES-related TBIs.

METHODS

A retrospective cohort of consecutive patients treated for ES-related traumatic brain injuries in a tertiary university hospital between May 2019 and September 2021 was identified and employed for the study. The characteristics of the accidents along with the clinical and imaging findings of the injuries were collected from the patient charts.

RESULTS

During the study period, 104 TBIs related to ES accidents were identified. There was a high occurrence of accidents late at night and on Saturdays. In four cases, the patient's helmet use was mentioned (3.8%). Seventy-four patients (71%) were intoxicated. At the scene of the accident, seventy-seven (74%) of the patients had a Glasgow Coma Scale score of 13-15, three patients (3%) had a score of 9-12, and two patients (2%) had a score of 3-8. The majority (83%) of TBIs were diagnosed as concussions. Eighteen patients had evidence of intracranial injuries in the imagining. Two patients required neurosurgical procedures. The estimated population standardized incidence increased from 7.0/100,000 (95% CI 3.5-11/100,000) in 2019 to 27/100,000 (95% CI 20-34/100,000) in 2021.

CONCLUSIONS

Alcohol intoxication and the lack of a helmet were common in TBIs caused by ES accidents. Most of the accidents occurred late at night. Targeting these modifiable factors could decrease the incidence of ES-related TBIs.

Injury patterns of e-scooter-related orthopaedic trauma in central London: a multicentre study

PURPOSE

Electric scooters (E-Scooters) are being increasingly used in urban areas as a new means of transport. E-scooter sharing schemes have recently been piloted in the United Kingdom; however, there are no published data on orthopaedic injuries and user behaviour patterns in the UK. We aim to identify the patterns and severity of orthopaedic injuries related to e-scooter use.

METHODS

We performed a retrospective review of all orthopaedic referrals relating to e-scooter use from 1 March to 30 November 2020 at three hospitals, including one major trauma centre in central London. Data including patient demographics, mechanism of injury, diagnosis and treatment were collected.

RESULTS

One hundred and five orthopaedic injuries were identified in 83 patients. The median age was 32 years and 83% were male. Seventy-nine (95.2%) patients were riders, four were pedestrians. All e-scooters were privately owned. There were 93 fractures (88.6% of total injuries noted) including 12 (12.9%) open. Fifty-two (56.0%) were upper limb fractures, 39 (41.9%) lower limb and 2 (2.1%) spinal and rib fractures. Twenty-five patients (30.1%) required an operation and 29 (34.9%) required hospital admission. Helmet use was present in 34.1%. The most common place of injury was the road (65.1%) followed by pavement (32.9%).

CONCLUSION

E-scooters can cause serious injury, most commonly in males. There was an equal distribution of upper and lower limb injuries, with many associated with high-energy trauma requiring operative intervention. Helmet use was seen in one third of riders. As e-scooter use continues to increase across the UK, additional steps should be taken to ensure the safety of the riders and public.

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.

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.

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.

Incidence and severity of electric scooter related injuries after introduction of an urban rental programme in Vienna: a retrospective multicentre study

PURPOSE

Electric scooters (e-scooters) are an emerging way of mobility in cities around the world. Despite quickly rising numbers of e-scooters, limited studies report on incidence and severity of e-scooter-associated injuries. The aim of our study was to report on these injuries and identify potential protective measures to ultimately decrease e-scooter-associated morbidity.

METHODS

We performed a retrospective multicentre study including all patients, who were admitted to three major trauma departments in Vienna from May 2018 to September 2019. We analysed patients' data, including demographics, injury pattern, types of injury and subsequent treatment.

RESULTS

A total number of 175 patients (115 males, 60 females) sustained e-scooter-associated injuries. Patients' mean age was 34.4 years [4-74]. While the mean Injury Severity Score (ISS) was 3.4, 11 patients presented with an ISS ≥ 9 and 2 patients with an ISS ≥ 16. ISS increased with age. Older patients (≥ 40 years) presented a significantly higher ISS than younger patients (< 40 years) (P = 0.011). Seventy-one patients (40.6%) sustained major injuries affecting head (35.2%) and upper extremities (36.6%). Twenty-three patients (13.1%) required surgery leading to hospitalization of 11 days on average [1-115]. E-scooter-associated injuries increased during late afternoon plateauing at 8.00 pm. However, the largest share of patients (39.2%) sustained their injuries during early night (8.00 pm to 1.59 am) with especially young adults (19-39 years) being at risk.

CONCLUSION

The popularity of rideshare e-scooters across cities worldwide seems to be on the rise, so are e-scooter-associated injuries. These injuries should be considered high-energy trauma affecting primarily head and upper extremity; indeed, 17.7% sustained major head injuries. Therefore, the mandatory use of a helmet seems to be adequate to decrease head injury-associated morbidity. Ultimately, given the remarkably high rates of nighttime injuries, an e-scooter ban during night could further cut injury numbers in half.

Are electric scooters promoted on social media with safety in mind? A case study on Bird's Instagram

Electric scooter (e-scooter) companies are growing in popularity across the United States looking to take advantage of the rideshare economy by providing an independent alternative to cars and bicycles. While e-scooter transportation could reduce emissions, and automobile congestion in local areas, powered two-wheeler drivers are extremely vulnerable to road risks. News reports of e-scooter crashes and fatalities have started to accumulate. Earlier research has demonstrated that the ways in which companies promote and demonstrate use of their product or service through social media influences consumer behavior. In the U.S. in 2018, this study examined the official Instagram account of Bird, the e-scooter market share leader with over 66,000 followers, to determine how much it emphasized safety in its posts. All posts to Bird's official Instagram account were collected from 22 September 2017 to 9 November 2018 (n = 324) and rules for coding content were developed. Among all posts, 69.14% contained a person visible with a Bird e-scooter, 6.17% contained persons wearing protective gear, 6.79% had protective gear somewhere in the post, and 1.54% of posts mentioned protective gear in the comment box. About 69.44% of the posts were reposts, and among reposts, 7.11% had persons wearing protective gear. Posts to Bird's official Instagram rarely showed e-scooters being used with protective gear. Photos of customers' experiences with Bird, via reposts, rarely featured protective gear potentially normalizing these behaviors among customers. Public health practitioners may need to establish interventions to promote use of protective gear while operating escooters.