Injury Characteristics in Pedelec Users: A 7-Year Study Highlighting Risks in the Elderly Male Population at an Urban University Hospital in Germany.

Abstract

To analyze characteristics, accident mechanisms, injury patterns, and treatment of pedelec accidents, focusing on older riders (≥65 years) and those requiring intensive care. This descriptive single-center study included all patients presenting after a pedelec accident at a level I trauma center (January 2017-December 2023). Data included demographics, accident mechanisms, injuries, and treatments. A subgroup analysis was performed for patients requiring intensive care. Between 2017 and 2023, 103 pedelec riders were injured, with annual cases rising steadily, peaking at 45 in 2023. Patients were predominantly male (57 %) with a mean age of 53 ± 19 years; 30 % were ≥65 years. Helmet use was documented in 34 %, alcohol in 10 %, and anticoagulant therapy in 15 %. Most accidents occurred during warmer months (66 %), in the afternoon (47 %), and were caused by rider errors (36 %) or car collisions (17 %). A total of 229 injuries were recorded (2.2 per patient), mainly affecting the head (33 %) and upper extremities (29 %). Thirty patients (30 %) required surgery, 41 (40 %) were hospitalized, and 11 (11 %) needed ICU care. The predominant reason for ICU admission was severe traumatic brain injury (TBI) with intracranial hemorrhage, present in 91 % of ICU patients. These patients were significantly older (mean 77 ± 13 years; OR 1.11 per year, 95 % CI [1.05-1.20]; p = 0.002), more often on anticoagulants (45 %; OR 5.33, 95 % CI [1.37-20.80]; p = 0.022), and none wore a helmet (0 %; OR 0.07, 95 % CI [0.00-1.23]; p = 0.015, Haldane correction). Males ≥65 years had a 25-fold increased ICU admission risk (OR 25.07, 95 % CI [4.89-128.53]; p < 0.001). Helmet use was associated with a 16.4 % absolute risk reduction (ARR) for ICU admission with a Number Needed to Treat (NNT) of 6. In-hospital mortality was 1.9 %. Pedelec accidents have sharply increased, with injuries to the head and upper extremities most common. Older adults, especially men ≥65, face the highest risk of severe outcomes, including traumatic brain injury requiring ICU admission. Two-thirds of riders did not wear a helmet; helmet use significantly reduced critical injury risk. Focused prevention efforts-particularly promoting helmet use and rider safety education-are urgently needed.