Craniofacial injuries related to motorized scooter use: A rising epidemic

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.

Unconventional mobility, conventional trauma: a comparative analysis of e-scooter-related fractures

PURPOSE

The present research aimed to compare the different types of fractures to those caused by e-scooter use as well as reveal the severity of e-scooter injuries via an epidemiological analysis of fractures over the course of 6 months.

METHODS

This retrospective study assessed medical records of patients with fractures or dislocations admitted to a Turkish level three trauma centre emergency orthopaedic department between June 2021 and January 2022. Using a two-group design, the first group encompassed all fractures and dislocations treated, while the second focused on e-scooter-related cases. Comparative analysis covered fracture patterns and factors within the e-scooter group, like demographics, injury mechanism, and timing. Surgical need and types were explored for e-scooter injuries.

RESULTS

Among 4481 upper extremity fractures, finger fractures (27.47%) and distal radius fractures (25.37%) were common, while e-scooter-related cases exhibited radius and ulna shaft fractures (23.07%). Of 2400 lower extremity fractures, toe fractures (30.2%) and metatarsal fractures (19.66%) predominated, with e-scooter-related injuries largely featuring metatarsal fractures (30%). The surgery rate in all patients was 8.92%, whereas the surgery rate specifically for e-scooter injuries was 48.2%. Significantly greater occurrence of lower extremity fractures was evident in e-scooter-related injuries compared to upper extremities (p = 0.011). Collisions involving stationary or moving objects were linked to injuries in the lower extremities, whereas falls were primarily associated with injuries in the upper extremities. Treatment included surgery (48.2%) and conservative management (52.8%), with ORIF (35.7%) and CRIF (10.7%) utilised.

CONCLUSION

E-scooter-related fractures and dislocations are typically more severe, often requiring surgery, compared to other fractures during the same period. The study emphasises the link between injury type and increased risk of lower extremity fractures or dislocations.

Head and Neck Injuries among Powered Scooter Users between 2010 and 2019

Powered scooters, including electric scooters (e-scooters), have become an increasingly available and popular mode of personal transportation, but the health risks of these devices are poorly explored. We aim to quantify the increase in frequency of powered scooter-associated head and neck region injuries occurring yearly from 2010 to 2019, and to compare the frequency and severity of injury with those involving unpowered scooters. Here we present a retrospective cross-sectional study of all patients with head and neck injuries associated with powered and unpowered scooters seen in emergency departments reporting to the National Electronic Injury Surveillance System (NEISS) database from January 1, 2010 to December 31, 2019. During this time frame, a total of 1,620 injuries associated with powered scooters and a total of 5,675 injuries associated with unpowered scooters were reported to the NEISS. The database estimates these to reflect a nationwide total of 54,036 powered scooter-related injuries and 168,265 unpowered scooter-related injuries. Powered scooter injuries have increased for both children and adults since 2014, and estimated powered scooter injuries (16,243) surpassed estimated unpowered scooter injuries (14,124) when including all age groups for the first time in 2019. In 2019, adults are estimated to have nearly twice as many powered scooter-related head and neck injuries as children (10,884 vs. 5,359, respectively). In 2019, a higher proportion of powered scooter-related injuries involving adults were severe injuries when compared with those involving children (13.3 vs. 5.2%, respectively). Interestingly, unpowered scooters still cause many more estimated injuries in children than powered scooters did during 2019 (11,953 vs. 5,083). We find that powered scooters are now associated with a greater number and severity of head and neck injuries among the adult population than the pediatric population. But unpowered scooters still cause more head and neck injuries than powered scooters in the pediatric population.

Electric personal mobility device driver behaviors, their antecedents and consequences: A narrative review

INTRODUCTION

Electric personal mobility devices (ePMDs), as well as crashes involving ePMDs, have been on the rise all over the world. The objectives of this study were: (a) to summarize the literature based on a narrow definition of ePMD (excluding e-bikes) and (b) to sort out the results to fit into a psychological and behavioral framework. The available literature was sorted into three main categories: the behaviors of ePMD drivers, their antecedents, and their consequences.

METHOD

A narrative review of the literature was carried out in 101 documents published between January 2018 and July 2021.

RESULTS

Regarding behavioral antecedents, regulations vary from country to country. ePMDs were found to be used primarily by males under 40 years of age. We found no studies on driving skills or learning, driver education or training, or on the effect of health messages on attitudes and behavior. Regarding the main behaviors themselves, the drivers' reasons for focusing on ePMDs were our main focus (use for short distances and mainly for commuting, shopping, and leisure). Few of the studies we reviewed explored the interactions between ePMD drivers and other road users in natural or simulated environments, and the influence of road infrastructure on behavior has rarely been studied. Regarding health consequences, reported ePMD crashes resulted in serious head and limb injuries, especially head and leg fractures. The lack of personal protective equipment (e.g., a helmet) increased the severity of crashes. The conclusion highlights gaps in the literature from a psychological and behavioral point of view.

The Importance of Headgear During Scooter Riding in the Pediatric Population, and Suggesting Recommendations

Objective

The authors analyzed the characteristics of pediatric patients who visited trauma center due to injuries sustained while riding scooters and suggested recommendations on our concerns about pediatric scooter use.

Methods

From January 2019 to June 2022, we collected data for those who visited due to accidents while riding scooters. And, the analysis was conducted by dividing it into pediatric (younger than 12 years) and adult (older than 20 years) patients.

Results

There were 264 children (<12 years), and 217 adults (>19 years). We observed 170 head injuries (64.4%), in the pediatric population and 130 head injuries (60.0%) in the adult population. There were no significant differences between pediatric and adult patients for all three injured regions. Among pediatric patients, only 1 reported the use of protective headgear (0.4%). The patient suffered a cerebral concussion. However, 9 of the pediatric patients who did not wear protective headgear suffered major trauma. Among 217 adult patients, 8 (3.7%) had used headgear. 6 suffered major trauma and 2 suffered minor trauma. Of the patients who did not wear protective headgear, 41 suffered major trauma and 81 suffered minor trauma. Since there was only one patient in the pediatric group who wore headgear, no statistical inferences could be calculated.

Conclusion

In the pediatric population, the head injury rate is as high as in adults. We were unable to statistically support the significance of headgear in the current study. However, in our general experience, the importance of headgear is overlooked in the pediatric population compared to adults. It is necessary to encourage the use of headgear actively publicly.

Characteristics of E-Scooter-Related Maxillofacial Injuries over 2019-2022-Retrospective Study from Poznan, Poland

Recently, there has been a considerable rise in the popularity and use of electric scooters. Because of this, the number of accidents involving them has also risen. Head and neck injuries are the most common. The aim of the study was to determine the most frequent craniofacial injuries resulting from accidents involving electric scooters, and to identify the risk factors directly related to their placement and severity. The study carried out a retrospective analysis of the medical records of patients of the Clinic of Maxillofacial Surgery over 2019-2022, in terms of craniofacial injuries suffered as a result of e-scooter-related accidents. In the study population (31 cases), of which 61.3% were men, the median age was 27 years. At the time of the accident, 32.3% patients were under the influence of alcohol. Accidents were most common in the 21-30 age group; more often than not, they occurred during warm months and on weekends. The study identified a total of 40 fractures in the patients. The most common craniofacial injuries were mandibular fractures (37.5%), zygomatic-orbital fractures (20%) and frontal bone fractures (10%). A multidimensional correspondence analysis was also performed, which showed that at an age of under 30, alcohol consumption and female gender were associated with a higher likelihood of mandibular fracture. Proper education on the risks associated with the use of e-scooters is essential, with particular emphasis on the impact of alcohol on the driver. It is important to develop diagnostic and therapeutic algorithms for doctors, both in ED and in specialised departments.

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.

Maxillofacial Injuries Sustained by Riders of Electric-Powered Bikes and Electric-Powered Scooters

OBJECTIVES

The purpose of our study is to retrospectively analyze and compare the patterns of maxillofacial-related injuries among rides of electric-powered bikes (E-bikes) and electric-powered scooters (E-scooters), the associated risk factors, and the required treatment.

MATERIALS AND METHODS

The medical files of all riders presenting to the emergency department at the Tel Aviv Sourasky Medical Center between 2019 and 2020 with oral- and maxillofacial-related injuries due to E-bike and E-scooter accidents were reviewed.

RESULTS

A total of 320 riders sustained oral- and maxillofacial-related injuries due to trauma involving E-bikes and E-scooters during the study period. E-scooter riders were involved in 238 accidents (74.5%) while E-bike riders accounted for the remaining 82 accidents (27.5%). Eighty-four out of 320 riders (26.25%) were hospitalized and required surgical interventions. Most of the 232 riders (72.5%) who reported not wearing a protective helmet during the index accident were E-scooter riders. In addition, 39 riders (18.66%) were riding either of these electric-powered vehicles under the influence of alcohol.

CONCLUSIONS

E-bike riders are more likely to sustain a maxillofacial fracture than E-scooter riders. Not wearing a protective helmet and riding under the influence of alcohol are major risk factors for maxillofacial injuries.

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.

Surgical management of camel-related craniofacial injuries

Background

There are no studies focused on the types and management of camel-related craniofacial injuries.

Objectives

We aimed to analyze the pattern of injuries that required surgical management and their specific operative treatment.

Methods

We prospectively collected data of all patients who were admitted to Al Ain Hospital with camel-related craniofacial injuries that were treated operatively during the period of January 2015 to January 2020.

Results

Eleven patients were studied; all were males having a median (range) age of 29 (19-66) years. Falling from a camel was the most common mechanism of injury (45.5 %) followed by camel bite (36.4 %). The most common injured region was the middle third of the face, which accounted for 56.5% of the bony fractures. Zygomatico-maxillary complex fractures were present in 60% of patients who fell while riding a camel. The most common surgical procedure performed in our patients was an open reduction with internal fixation (54.5%). There was no mortality.

Conclusions

camel-related craniofacial injuries are complex. The main mechanism of injury is falling from a camel on the face causing fractures of the zygomatico-maxillary complex. These fractures usually need open reduction with internal fixation. Taking safety precautions may help in injury prevention.

The impact of e-scooter injuries

Aims

Due to the recent rapid expansion of scooter sharing companies, there has been a dramatic increase in the number of electric scooter (e-scooter) injuries. Our purpose was to conduct a systematic review to characterize the demographic characteristics, most common injuries, and management of patients injured from electric scooters.

Methods

We searched PubMed, EMBASE, Scopus, and Web of Science databases using variations of the term “electric scooter”. We excluded studies conducted prior to 2015, studies with a population of less than 50, case reports, and studies not focused on electric scooters. Data were analyzed using t-tests and p-values < 0.05 were considered significant.

Results

We studied 5,705 patients from 34 studies. The mean age was 33.3 years (SD 3.5), and 58.3% (n = 3,325) were male. The leading mechanism of injury was falling (n = 3,595, 74.4%). Injured patients were more likely to not wear a helmet (n = 2,114; 68.1%; p < 0.001). The most common type of injury incurred was bony injuries (n = 2,761, 39.2%), of which upper limb fractures dominated (n = 1,236, 44.8%). Head and neck injuries composed 22.2% (n = 1,565) of the reported injuries, including traumatic brain injuries (n = 455; 2.5%), lacerations/abrasions/contusions (n = 500; 7.1%), intracerebral brain haemorrhages (n = 131; 1.9%), and concussions (n = 255; 3.2%). Standard radiographs comprised most images (n = 2,153; 57.7%). Most patients were treated and released without admission (n = 2,895; 54.5%), and 17.2% (n = 911) of injured patients required surgery. Qualitative analyses of the cost of injury revealed that any intoxication was associated with higher billing costs.

Conclusion

The leading injuries from e-scooters are upper limb fractures. Falling was the leading mechanism of injury, and most patients did not wear a helmet. Future research should focus on injury characterization, treatment, and cost.

Cite this article: Bone Jt Open 2022;3(9):674–683.

A Comparison of Motorized and Nonmotorized Scooter Injuries in Pediatric Patients Seen in US Emergency Departments

OBJECTIVES

We sought to characterize and compare trends in pediatric injuries sustained on motorized and nonmotorized scooters across the United States, to assess the use of safety equipment in children presenting with scooter-related injuries, and provide strategies for injury prevention.

METHODS

The National Electronic Injury Surveillance System was queried for motorized and nonmotorized scooter-related pediatric injuries from 2014 to 2018 in patients ages 6 to 12 years. Patient demographics, diagnosis, injury location, and narrative of the incident were collected. Bivariate and regression analyses were used to determine demographic and social associations of injury characteristics.

RESULTS

An estimated 146,000 (11,452 motorized and 134,548 nonmotorized) injuries occurred in children ages 6 to 12 years over the 5 years. Three of 4 injuries occurred in children younger than 10 years, and most injuries occurred in males (56%).From 2014 to 2018, the nationwide estimated incidence of motorized scooter injuries increased by 112.1%, while that of nonmotorized scooter injuries decreased by 40.3%.Upper extremity injuries were most common with nonmotorized scooters (44.4% of all injuries), while lower extremity injuries were most common with motorized scooters (39.5% of all injuries). Head and neck injuries accounted for 27.4% of nonmotorized scooter injuries and 23.4% of motorized scooter injuries. The number of concussions in motorized scooters increased from 0.4% in 2014 to 2.7% in 2018, while concussions in nonmotorized scooters decreased from 3.5% to 2.7%. Helmets were mentioned in the medical record in 6.6% of the cases. Of these, 60.5% reported no use of helmet at the time of injury.

CONCLUSIONS

From 2014 to 2018, the number of motorized scooter injuries increased by 112.1% in the pediatric population ages 6 to 12 years, whereas nonmotorized scooter injuries decreased by 40.3%. In more than 60% of the cases that mentioned a helmet, the child injured was recorded as not wearing a helmet. The rise in pediatric injuries associated with motorized scooters in contrast with the reduction of injuries associated with nonmotorized scooters highlights the need for novel public health policies and interventions promoting helmet use with motorized scooters in the pediatric population.

Motor vehicle-related electric scooter injuries in the US: A descriptive analysis of NEISS data

INTRODUCTION

The introduction of scooter-share programs across the United States has led to an increased incidence of electronic scooter (e-scooter) injuries presenting to emergency departments (EDs). As legislation begins to push scooters from the sidewalk to the street, injuries resulting from collisions between e-scooters and motor vehicles are an important, but poorly characterized consideration. This study leverages data from a national injury surveillance system to characterize e-scooter versus motor vehicle collisions resulting in ED presentation.

METHODS

This study utilizes data from the National Electronic Injury Surveillance System (NEISS). NEISS was queried for e-scooter-related injuries from January 1st, 2015 through December 31st, 2019. Injuries were characterized as motor vehicle-related (MV-involved) or non-motor-vehicle-related (MV-uninvolved) based on a manual review by the study investigators. Weighted tabular analyses were used to characterize both types of e-scooter injuries across demographic, diagnostic, and event-related factors.

RESULTS

Over the study period an estimated 60,554 (95% CI: 37,525-84,594) injuries were treated in US EDs. Approximately 19% of these injuries involved motor vehicles. Those sustaining MV-involved injuries were significantly younger (p = 0.01), with a higher proportion of males injured (p = 0.01). Additionally, when compared to MV-uninvolved injuries, a significantly higher proportion of those with MV-involved injuries were admitted to the hospital for treatment (8.8% vs. 14.6%, p < 0.01). MV-involved injuries occurred primarily in the street (96.3%), while MV-uninvolved injuries were split across streets (44.0%), at one's home (~20%), and on public property (~20%) (p < 0.01).

CONCLUSIONS

Electric scooter injuries involving a motor vehicle differed from those that did not across several key categories. As e-scooters and motor vehicles start to share the road more frequently, greater consideration should be made regarding how these two modes of transportation interact with each other. The promotion of thoughtful e-scooter legislation and infrastructure changes could help promote safer travel.

Injury patterns and circumstances associated with electric scooter collisions: a scoping review

BACKGROUND

Electric scooters are personal mobility devices that have risen in popularity worldwide since 2017. Emerging reports suggest that both riders and other road users, such as pedestrians and cyclists, have been injured in electric scooter-associated incidents. We undertook a scoping review of the current literature to evaluate the injury patterns and circumstances of electric scooter-associated injuries.

METHODS

A scoping review of literature published from 2010 to 2020 was undertaken following accepted guidelines. Relevant articles were identified in Medline, Embase, SafetyLit and Transport Research International Documentation using terms related to electric scooters, injuries and incident circumstances. Supplemental searches were conducted to identify relevant grey literature (non-peer-reviewed reports).

RESULTS

Twenty-eight peer-reviewed studies and nine grey literature records were included in the review. The current literature surrounding electric scooter-associated injuries mainly comprises retrospective case series reporting clinical variables. Factors relating to injury circumstances are inconsistently reported. Findings suggest that the head, upper extremities and lower extremities are particularly vulnerable in electric scooter falls or collisions, while injuries to the chest and abdomen are less common. Injury severity was inconsistently reported, but most reported injuries were minor. Low rates of helmet use among electric scooter users were noted in several studies.

CONCLUSION

Electric scooters leave riders vulnerable to traumatic injuries of varying severity. Future work should prospectively collect standardised data that include information on the context of the injury event and key clinical variables. Research on interventions to prevent electric scooter injuries is also needed to address this growing area of concern.

Orthopedic fracture hospitalizations are revving up from E-Scooter related injuries

INTRODUCTION

Due to market expansion of electric-scooter companies, a significant rise of personal e-scooter use in dense, urban communities has been observed. No literature has specifically focused on e-scooter fracture epidemiology and risk factors associated with direct hospital admission. The aims of this study were to evaluate the 1) patterns of e-scooter related orthopaedic fractures 2) risk factors associated with direct hospital admission.

MATERIALS AND METHODS

A retrospective review of National Electronic Injury Surveillance System (NEISS) from the United States between 2015 and 2019 was utilized to identify e-scooter fracture epidemiology. Uni/multivariable analyses were conducted to identify independent variables associated with direct hospital admission.

RESULTS

5,016 patients were identified. The most common fracture location was the upper extremity (25.4%). Multiple distinct fractures diagnoses (p < 0.001), fracture of the upper arm (p = 0.01), metacarpal (p = 0.03), skull(p < 0.001), and associated internal organ injury (p = 0.02) all had a statistical increase over time. Fracture of the upper leg (OR 58.31), lower trunk (OR: 47.04), and associated internal organ damage (OR: 37.82) had the greatest association with direct hospital admission.

DISCUSSION

This study highlights that e-scooter fracture related injuries continue to progress, and without appropriate educational and public health efforts, these injuries will continue to rise.

Traumatismes consécutifs aux accidents de trottinettes

Les trottinettes connaissent un engouement croissant avec la mise en place des trottinettes en libre-service. Toutefois, leur usage n’est pas sans conséquence sur le risque traumatique. Cette étude a pour objectif de décrire la population et les types de lésions des usagers de trottinettes.

Matériel et méthode : Les données proviennent du registre des victimes d’accident de la circulation du département du Rhône qui inclut toute personne blessée ou tuée à la suite d’un accident de la route survenu dans le département du Rhône et pris en charge dans une structure sanitaire privée ou publique. La période étudiée concerne l’année 2019. Les informations recueillies concernent les caractéristiques individuelles, accidentelles, lésionnelles de la victime ainsi que son devenir. Les lésions sont codées grâce à l’Abbreviated Injury Scale (AIS). Les blessés graves sont définis par des lésions d’AIS 3 et plus.

Résultats : Au total, 1 186 accidents de trottinette ayant entraîné 1 197 usagers blessés ont été recensés, dont 90 % dans l’hypercentre urbain, avec un nombre d’accidents de trottinettes multiplié par 7,3 entre 2018 et 2019. Cette augmentation a été observée depuis l’été 2018 avec l’introduction de sociétés proposant des locations de trottinettes. L’accident s’est produit seul, sans antagoniste dans 77 % des cas (n = 920). Le port du casque était rare (n = 72 ; 6 %). La grande majorité (n = 869 ; 73 %) des blessés était âgée de 10 à 34 ans, et les 20 à 24 ans (n = 301) représentaient le quart de l’effectif. Pour 11 accidents, il y avait deux blessés usagers de la même trottinette. Il y avait en moyenne deux lésions par victime. Les atteintes graves (MAIS 3 et plus) représentaient 3,8 % des lésions, et il n’y avait pas de différence statistiquement significative pour les lésions graves entre trottinette électrique et trottinette à propulsion humaine (p = 0,20). Comparées aux lésions des cyclistes dont les caractéristiques des accidents sont proches, les blessures de l’extrémité céphalique prédominent chez les usagers de trottinette (37 vs 27 % ; p < 0,001).

Conclusion : Devant l’utilisation grandissante des trottinettes parmi les modes de déplacement, une évaluation scientifique des victimes de traumatismes est nécessaire pour proposer des recommandations visant à limiter les traumatismes graves. Ce travail constitue une première étape vers la surveillance épidémiologique tant en termes de recommandations que d’évolution.

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.

Head and Neck Injury Patterns among American Football Players

IMPORTANCE

American football is a popular high-impact sport, leading to 2.7 million injuries in the United States annually. Recent evidence in football-related neurological damage has spurred national interest in player-safety. Football players injure their head and neck in up to 26% of total injuries. Variation in injury patterns between age groups and correlated hospitalizations for football-related head and neck injury has yet to be characterized.

OBJECTIVE

Our aim is to evaluate injury patterns among American-football related head and neck trauma.

METHODS

A retrospective cohort study of patients with football-related head and neck injury in the National Electronic Injury Surveillance System (NEISS).

RESULTS

Nearly 100 000 ED visits for football-related head and neck injuries occur annually. Males comprised 95% of patients, with a median age of 13. The head comprised 70% of injuries followed by the face (13%). The most common diagnoses were concussions (39%), internal organ injury (26%), and lacerations (11%). Pediatric patients were more likely to sustain concussions while adults experienced more lacerations (P < .05%). Fractures and nerve damage were rare injuries but caused a disproportionate share of hospitalizations.

CONCLUSION

Pediatric males are most likely to present for emergency care from football-related injury to the head and neck. Evaluating physicians can anticipate concussions, internal organ injury, and lacerations among presenting patients. Concussions, facial fractures, and nerve damage are injuries most likely to lead to hospitalization.

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.

CSF Leaks due to Electric Scooter Injury

BACKGROUND

There has been a rapid increase in electric motorized scooter (e-scooter) usage after the introduction of dockless, shareable devices.

METHODS

Case series from three tertiary hospitals in Los Angeles between May-September 2019.

RESULTS

Five patients had skull base fractures and CSF leaks or pneumocephalus after e-scooter accident, none wore helmets. Two patients were treated with observation alone, two patients were treated with lumbar drain or external ventriculostomy placement, and one patient died of their injuries prior to definitive management.

CONCLUSION

Without appropriate safety policies in place, the number of such injuries may increase as the use of e-scooters increase. Laryngoscope, 131:E1035-E1037, 2021.

Spatial associations of dockless shared e-scooter usage

In this study, we explore the usage of e-scooter sharing services in Austin, Texas over about a six-month period. The study is based on trip records of all the shared e-scooter operators in Austin and includes trip start and end locations. We use both analysis of trip patterns and spatial regression techniques to examine how the built environment, land use, and demographics affect e-scooter trip generation. Our findings show that people use e-scooters almost exclusively in central Austin. Commuting does not seem to be the main trip purpose, and usage of e-scooters is associated with areas with high employment rates, and in areas with bicycle infrastructure. People use e-scooter sharing regardless of the affluence of the neighborhood, although less affluent areas with high usage rates have large student populations, suggesting that students use this mode of travel. Implications for planners suggest that better bicycle infrastructure will facilitate e-scooter usage, college towns are a ready market for e-scooter sharing services, and e-scooters may be a substitute for some short non-work trips, reducing car usage, and benefiting the environment.

Considering the Potential Health Impacts of Electric Scooters: An Analysis of User Reported Behaviors in Provo, Utah

Electric scooters (e-scooters) are an increasingly popular form of transportation in urban areas. While research on this topic has focused primarily on injuries, there are multiple mechanisms by which e-scooter share programs may impact health. The aim of this study is to explore the health-related behaviors of e-scooter users and to discuss their implications for public health. Data were collected using an online survey emailed to registered e-scooter users. A total of 1070 users completed the survey. Descriptive variable statistics and chi-squared analysis were performed to determine variable dependent relationships and equality of proportions. The most common destinations reported were “just riding around for fun”, home, and dining/shopping. The two most common modes of transportation that would have been used if e-scooters were not available were walking (43.5%) and using a personal vehicle (28.5%). Riding behavior was equally mixed between on the street, on the sidewalk, and equal amounts of both. e-Scooters in Provo are likely having both positive (e.g., air pollution) and negative impacts on health (e.g., injuries, physical inactivity). Future research should further explore patterns of e-scooter use and explicitly examine the linkages between e-scooters and areas of health beyond just injuries.

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.

Sparking the Debate: Facial Injury Patterns from Fireworks

The objective of this article is to estimate the incidence, injury patterns, and demographics of patients presenting to emergency departments (EDs) for facial injury sustained from fireworks. This was an analysis of a nationwide database. The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from fireworks from 2013 to 2017. Relevant entries were examined for incidence, patient characteristics, location of injury, and type of injury. There were 509 NEISS entries, extrapolating to an estimated 19,816 ED visits for head and neck injuries due to fireworks from 2013 to 2017. The number of visits per year due to fireworks has been relatively stable over the past 5 years with an average of 3,963 cases per year. Greater than 90% of injuries occurred in July. Males comprised the majority of patients (67%), with the median age of 16 years. Most common sites of injury were the eyeballs (41%), followed by midface including eyelids, periorbita, and nose (31%), ears (12%), and only minor incidence of oral injuries (2%). After burns, contusions were the second most common injury from fireworks, followed by lacerations and foreign body injuries. The majority of firework injuries occurred in teenagers, reinforcing the importance of greater safety regulations and age limits for purchasing fireworks. Nearly half the incidents were eye injuries, necessitating greater public education in protective eyewear and mandating their use during festive holidays. Furthermore, injury patterns reported in this analysis may serve as a valuable adjunct for enhancing clinical history taking and physical examination to look for concurrent injuries.

Electric scooter craniofacial trauma

OBJECTIVE

The use of standing electronic scooters associated with micromobility applications (e-scooters) has risen nationally. The aim of this study was to obtain a detailed view of soft tissue and bony craniofacial injury associated with e-scooter-related trauma.

METHODS

Single-institution retrospective case series of patients presenting to a level 1 trauma center emergency department or trauma unit with documented e-scooter-related craniofacial injury.

RESULTS

Of 203 included patients, 188 (92.6%) patients sustained craniofacial injury. One hundred thirty-one (64.5%) had exclusively soft tissue injury, 3 (1.5%) exclusively bony injury, 51 (25.1%) both soft and bony injuries, and twenty-five (12.3%) patients sustained dental injury. Aesthetic units most frequently sustaining acute soft tissue injury were the forehead (n = 106, 34.6%), scalp (n = 36, 11.8%), chin (n = 34, 11.1%), upper lip (n = 32, 10.5%), and cheek (n = 31, 10.1%). Aesthetic subunits most often sustaining acute soft tissue injury included the brow (42, 13.7%), central forehead (39, 12.7%), lateral forehead (n = 25, 8.2%), and upper lip vermillion (n = 23, 7.5%). Craniofacial osseous fracture most often occurred in the orbit (n = 42, 24.6%) and maxilla (n = 40, 23.4%). Individual osseous segments most frequently sustaining acute fracture included the anterior maxillary sinus wall (n = 22, 12.9%), nasal bone (n = 20, 11.7%), lateral orbital wall (n = 16, 9.4%), orbital floor (n = 15, 8.8%), and zygomatic bone (13, 7.6%).

CONCLUSIONS

Our analysis demonstrates that most patients presenting to our center with craniofacial trauma sustained acute bony fracture, most often to the midface. Our data of common injuries associated with e-scooter trauma could inform implementation in the form of facial safety equipment or safety skills training for e-scooter riders.

LEVEL OF EVIDENCE

4.

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.