E-bikes and E-scooters are not bicycles or motorcycles: The case for a dedicated trauma registry mechanism.

Abstract

Powered micromobility devices (PMDs), including electric scooters (e-scooters) and electric bicycles (e-bikes), can operate at speeds approaching those of low-speed motorcycles. Yet PMDs are treated as low-energy mechanisms in trauma surveillance systems and are not classified as distinct mechanisms of injury. Although prior studies report higher head injury rates in PMD crashes than bicycle crashes, injury severity and health care utilization relative to motorcycle crashes are not known. We hypothesized that e-scooter and e-bike crashes demonstrate distinct injury and resource utilization patterns compared with motorcycles and bicycles. We performed a retrospective cohort study using the 2023 Florida Agency for Health Care Administration emergency department and inpatient databases. Encounters for motorcycle, bicycle, e-scooter, or e-bike crashes were identified. Patients meeting National Trauma Data Standard criteria were classified as trauma registry-eligible. Multivariable regression evaluated associations between mechanism and severe head and facial injury. Of 50,889 encounters, 10,522 (20.7%) were trauma registry-eligible. Median ISS was highest for motorcyclists [10 (interquartile range: 4-22)], followed by bicyclists [9 (1-14)], e-bike [8 (2-17)], and e-scooter riders [6 (1-15)] (p<0.001). On adjusted analyses, e-scooter and e-bike crashes had no significant differences in adjusted odds ratios (aORs) of severe head injury relative to motorcycle crashes, while e-bike crashes were associated with a higher aOR of severe facial injury (aOR: 1.78, 95% confidence interval: 1.15-2.74). E-bike injuries demonstrated the second-highest intensive care unit utilization and per-encounter hospital charges after motorcycles (both p<0.001). E-scooter and e-bike crashes demonstrated injury and resource utilization patterns distinct from both traditional bicycles and motorcycles. Head injury risk among PMD riders was similar to that of motorcyclists, while facial injury risk among e-bike riders exceeded that of motorcyclists. Findings highlight the need for improved injury surveillance and evidence-based helmet standards for PMD users, including evaluation of whether full-face protection may be warranted. Prognostic/Epidemiological; Level III.