Electric scooters (e-scooters) are a novel and rapid mode of transportation that have become increasingly popular for their convenience, low cost, and speed. While the environmentally friendly e-scooter may be ideal for short distance commuters, those who use e-scooters for expanded commutes may be at increased risk of injury. Since 2017, the growth of e-scooters use in high-traffic urban areas has resulted in an increase of e-scooter riders at level 1 trauma centers in the United States. Previous reports of the National Electronic Injury Surveillance System reported that one-third of e-scooter injuries involved the head. While many injuries sustained by e-scooters are mild, little research has been done on the outcomes and neurosurgical intervention related to severe traumatic brain injury (TBI) following e-scooter accidents.
A team of researchers designed a study to investigate this gap in literature by focusing on the incidence of severe TBI after e-scooter use, as well as injury mechanisms, neurosurgical treatment, and outcomes. The study evaluated 19 patients with severe TBI after e-scooter accidents who were admitted to level 1 trauma centers from 2018 to 2021. The researchers also considered 18 previous studies to assess the frequency of severe TBI occurrence.
The researchers found that the most common severe TBI injuries were brain contusions or intraparenchymal hemorrhage (52.6%), skull fractures (52.6%), and facial fractures (47.4%). Upon hospitalization, nearly 80% of patients required surgical intervention, with 65% requiring intracranial pressure management. A majority of patients (63.2%) were discharged to an acute rehabilitation facility, suggesting that many individuals did not experience a complete neurological recovery or return to their neurologic baseline.
From 2017 to 2018, when e-scooter use became popular in cities, hospital admissions related to e-scooters grew by 354% among individuals aged 18 to 34 years. This dramatic escalation in hospitalizations indicates that e-scooter falls and collisions are an increasingly common mechanism of injury. However, given the recency of e-scooters as a mode of transportation, there is not a widespread public awareness of these hazards. As research continues to emerge on the nature of e-scooter injuries, it is important for clinicians, as well as e-scooter users, to be aware of injury patterns and injury-prevention strategies.
What are the injuries most commonly associated with e-scooter accidents?
- Traumatic brain injury. One investigation of e-scooter injuries found that
56.6% of patients experienced traumatic brain injury and fractures. The incidence of severely morbid injury patterns among e-scooter accidents appears to be more common than reported previous studies. - Fractures and upper extremity injuries. Fractures alone accounted for more than 25% of e-scooter related injuries, according to the National Electronic Injury Surveillance System. Both traumatic brain injury and other fractures are important to consider, as they can increase the risk of long-term functional limitations such as mobility and return to work.
How can e-scooter related TBI and other injuries be prevented?
- Wear protective equipment. Helmet wearing is associated with reduced severity of head injuries. Previous studies have estimated helmet use for e-scooters to be as low as 2% percent, which calls attention to the need for public education and encouragement from e-scooter companies to promote helmet use.
- Adapt protective devices. With a top speed of 15-20 miles per hour, e-scooter users are at risk for high-velocity accidents, which is distinct from many other helmeted activities. E-scooter accidents experience a rate of head injury double that of bicycle accidents, suggesting the need for specialized protective equipment. This may involve adapting helmets to also protect the face and extremities during e-scooter use.
- Public policy. In addition to public education programs, public policy in relation to city planning may be a pathway for improved e-scooter safety. This may include more infrastructure for e-scooters, such as traffic lanes specific to e-scooter use.
References
Azab M, Gamboa N, Nadel J, et al. Case Series and Systematic Review of Electronic Scooter Crashes and Severe Traumatic Brain Injury. World Neurosurgery. (August 2022).
Namiri N, Lui H, Tangney T, et al. Electric Scooter Injuries and Hospital Admissions in the United States, 2014-2018. JAMA Surgery. (April 2020).
Störmann P, Klug A, Nau C, et al. Characteristics and injury patterns in electric-scooter related accidents—A prospective two-center report from Germany. Journal of Clinical Medicine. (May 2020).