Comparison of Injury Patterns between Electric Bicycle, Bicycle and Motorcycle Accidents

Sex and age-related implications for preventive measures of intensive care admitted traumatic brain injury patients in Switzerland: an observational study

PURPOSE

Epidemiological studies of traumatic brain injury (TBI) in Switzerland have, to date, poorly investigated sex-related differences in causality and predisposing factors. This study examines differences in sex and age related TBI epidemiology in a high-volume trauma centre intensive care unit (ICU) cohort, aiming to identify potential targets for prevention.

METHODS

This retrospective, single centre study includes all consecutive TBI patients admitted to the ICU in a 4-year study period. Patient demographics, comorbidities, co-medication, trauma setting and associated risk behaviour were compared between sexes and age groups (over/under 65 years).

RESULTS

592 patients (73.3% male, 26.7% female) were included. The leading cause of TBI was falls (52.4%), followed by road traffic accidents (RTA) (35.8%). Overall, men were more likely to suffer from a road traffic accident, while women were more likely to suffer a low energy fall. No differences in injury severity and comorbidities between sexes were observed. Young patients most likely suffered from a RTA while older patients from a low energy fall irrespective of sex. Both sexes portrayed risk associated behaviors with higher rates of alcohol intoxication in males, while females were less likely to wear a helmet in two-wheeled RTAs.

CONCLUSIONS

We conclude that sex- and age-related epidemiologic differences in TBI exist. Our results suggest that sex and age-specific prevention measures might be advisable for optimal mitigation of TBI and its sequelae.

Is there a difference in crash self-reports between electric and conventional motorcycles in Vietnam?

OBJECTIVES

Understanding the risks associated with electric motorcycles (EMs) is essential for developing effective mobility and safety strategies in an era of increasing motorcycle use and the shift toward electric vehicles. In this research, we investigate the prevalence of crashes among EM and conventional motorcycle (CM) users, as well as factors contributing to the crashes.

METHODS

This study uses primary survey data from 972 motorcyclists (481 EM and 491 CM riders) collected in December 2023 in Hanoi, Vietnam. It compares the frequency of risky riding behaviors and crash types between the 2 groups. Additionally, 2 binary logit regression models are applied to identify factors associated with crashes in the past 12 months for EM and CM riders.

RESULTS

The results suggest that the prevalence of respondents who did not experience crashes (56.1%), minor crashes (68.8%), serious crashes with injury (80.9%), and hospitalization (91.1%) for EM riders was significantly higher than that for CM users. CM riders tend to engage in many risky riding behaviors more frequently than EM riders. Higher frequencies of speeding, smoking, and neglecting turn signals were related to greater crash risk in both groups. Red light running was a particular risk factor of crash prevalence for EMs only. Older EM users were more likely to experience a crash, and CM users traveling longer and living in urban districts were found to be linked to higher crash prevalence.

CONCLUSIONS

Transitioning from CMs to EMs in Vietnam may offer some safety benefits, such as cautious behavior by EM riders and lower speeds, but there are no major differences in crash prevalence between the groups. Risky behaviors like speeding, smoking, and neglecting turn signals increase crash risks for both; red light running is a particular concern for EM riders and longer travel distances and urban residency for CM users. Targeted interventions, proper training, and licensing are essential, with attention to older EM riders' vulnerabilities and the risks faced by CM users in urban areas and on long trips.

Cranio-cervical and traumatic brain injury patterns-do they differ between electric bicycle, bicycle, and motorcycle-induced accidents?

PURPOSE

With the growing technical options of power transmission and energy-saving options in electric drives, the number of E-bike-related accidents especially in an elderly population has increased. The aim of the current study was to compare if the increased velocity in comparison to conventional bikes translates into different injury patterns in the cranio-cervical and head region.

METHODS

A retrospective cohort study was performed in patients admitted to our level one trauma center between 2009 and 2019 after being involved in an accident with either an E-bike, bicycle, or motorcycle and suffered cranio-cervical or traumatic brain injury.

OUTCOMES

cranio-cervical/intracranial injury pattern. Data interpretation was conducted in an interdisciplinary approach.

RESULTS

From 3292 patients treated in this period, we included 1068 patients. E-bikers were significantly older than bicyclists (or motorcyclists) and lay between the other two groups in terms of helmet use. Overall injury patterns of E-bikers resembled those found in motorcyclists rather than in bicyclists. E-bikers had a higher incidence of different cerebral bleedings, especially if no helmet was worn. Helmet protection of E-bikers resulted in a comparable frequency of intracranial bleeding to the helmeted bicyclists.

CONCLUSION

The overall pattern of head and cervical injuries in E-bikers resembles more to that of motorcyclists than that of bicyclists. As they are used by a more senior population, multiple risk factors apply in terms of complications and secondary intracranial bleeding. Our study suggests that preventive measures should be reinforced, i.e., use of helmets to prevent from intracranial injury.

Trends in Head and Neck Injuries Related to Electric Versus Pedal Bicycle Use in the United States

OBJECTIVES

To describe the incidence of head and neck trauma related to electric bicycles and to characterize head and neck injury patterns seen in electric bicycle (eBike) users versus pedal bicyclists in the United States.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried from 2009 to 2020 for patients with head and neck injuries related to electric and pedal bicycles. Extracted data included patient demographics, injury patterns, hospital admission, and helmet use. Univariate chi-squared analyses were performed to compare demographics and injury patterns between bicycle groups. Effect sizes were reported with Cramer V values (V).

RESULTS

The incidence of eBike-related head and neck injuries increased from 2993 in 2009 to 9916 in 2020. Compared to pedal bicycle users, eBike users were more likely to have head injuries (60.4% vs. 52.0%) and fractures (10.9% vs. 6.0%), and were more likely to require hospitalization (20.6% vs. 10.4%). The effect size of helmet use was significantly greater in eBike users compared to pedal bicyclists when examining distributions of age group (V = 0.203 vs. V = 0.079), injury location (V = 0.220 vs. V = 0.082), and injury type (V = 0.162 vs. V = 0.059). Helmeted injuries in eBike users more commonly involved neck injuries and sprains, rather than head injuries and fractures.

CONCLUSION

Head and neck trauma related to eBike use is increasing in the United States. Injury patterns and admission rates reflect greater injury severity in eBike users compared to pedal bicyclists. Helmet use may be particularly beneficial in mitigating head and neck injury in eBike users.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2734-2740, 2024.

Orthopaedic injuries and the use of protective equipment in commercial motorcycle couriers during the Coronavirus Disease 2019 (COVID-19) pandemic: A single level 1 trauma center experience

BACKGROUND

The aim of our study is to analyze the orthopedic injuries and the use of protective equipment among commercial motorcycle couriers during the Coronavirus Disease 2019 (COVID-19) pandemic in a level 1 trauma center in Istanbul, to provide epidemiological data, and to serve as a baseline for future studies.

METHODS

Commercial motorcycle couriers involved in traffic accidents while working, and who were brought to the emergency department between April 2020 and April 2022, were included in our study. The protective equipment worn at the time of the accidents, including helmets, jackets, pants, gloves, and boots, were recorded. The orthopedic injuries and the applied treatments (both conservative and surgical) were documented, and injuries to other body regions and injury types were recorded in consultation with other medical departments. Additional data, including the duration of the driving license, the engine displacement of the motorcycle, any motorcyclist training, weather conditions, the estimated speed during the accident, and the time of the accident, were also noted.

RESULTS

A total of 255 commercial motorcycle couriers were included in the study. Most of the injuries (56.9%) involved major trauma, with the foot and ankle region being the most commonly affected body area (31.8%). Helmets were the most commonly used protective equipment (n=197, 77.3%), while motorcycle boots were the least used (n=54, 21.2%). Fifty participants (19.6%) did not use any protective equipment, including helmets, while 22.7% of commercial motorcycle couriers wore only helmets. Only 27 couriers wore full protective gear for motorcycle riding. There were 157 fractures, of which seven were open fractures (4.5%).

CONCLUSION

As wearing a helmet is mandatory when riding a motorcycle, the use of protective equipment other than helmets was relatively low, leading to a high prevalence of extremity injuries. Our study emphasizes the necessity of advanced motorcycle riding training for these professionals, raising awareness among motorcycle couriers about the importance of protective gear, and enhancing inspections through the implementation of legal regulations on this issue.

Development of German pedelec (and bicycle) crashes between 2013 and 2021

INTRODUCTION

The continuous growth in the use of e-bikes (in Germany mostly pedelecs that support pedaling up to 25 km/h) raises questions about the use of historic crash data for the development of road safety measures. The aim of this study was to address this issue, by conducting a longitudinal analysis of pedelec and bicycle crash data over a period of nine years to identify trends and to clarify whether such trends are specific to pedelecs.

METHOD

We analyzed 95,338 police reported pedelec and bicycle injury crashes from 2013 through 2021. The dataset consisted of crashes from three federal states of Germany: Brandenburg, Hesse and Saxony. Data were analyzed with respect to sex and age distribution, time, location and type of accident, conflict partner, cause of crash and injury severity.

RESULTS

Many of the analyzed variables showed a considerable degree of temporal stability, with differences as well as similarities between the two bicycle types staying quite consistent over the years. One notable difference was the mean age of the involved riders, with crashed pedelec riders being significantly older than conventional cyclists. At the same time, however, the mean age of these pedelec riders has decreased by eight years over time. Single vehicle crashes were consistently more common for pedelec riders than for cyclists. Similarly, pedelec rider crashes went with a higher injury severity over all the years.

CONCLUSIONS AND PRACTICAL APPLICATIONS

While, on a more detailed level, we found differences between the two bicycle types, overall crash characteristics were remarkably similar and consistent over time. Our findings provide no clear argument for road safety measures that are specifically designed to target pedelecs. Instead, the stable crash total, and the increases in ridership of both bicycles and pedelecs, highlight the demand for new, innovative solutions to improve cycling safety in general.

Electric bicycles (e-bikes) are an increasingly common pediatric public health problem

Purpose

Electric bicycles (e-bikes) achieve higher speeds than pedal bicycles, but few studies have investigated the impact on injury rates specific to the pediatric population. Utilizing the National Electronic Injury Surveillance System (NEISS), we compared rates of pediatric injury for e-bikes, bicycles, and gas-engine bicycles (mopeds) from 2011 to 2020.

Methods

Descriptive and bivariate inferential analyses were performed upon NEISS estimates of e-bike, bicycle, and moped injuries in children aged 2-18 years. Analyses were stratified by patient age and helmet usage. The Mann-Kendall test of trends was used.

Results

We identified 3945 e-bike, 23,389 moped, and 2.05 million bicycle injuries. Over time, the incidence of injury increased for e-bikes (Kendall's τ=0.73, p = 0.004), decreased for pedal bicycles (Kendall's τ= - 0.91, p = 0.0003), and did not change for mopeds (Kendall's τ = 0.06, p = 0.85). Males accounted for 82.5 % of e-bike injuries. The age group most commonly affected by e-bike injury (44.3 %) was 10-13 years old. The proportion of injuries requiring hospitalization was significantly higher for e-bikes (11.5 %), compared to moped and bicycle (7.0 and 4.8 %, respectively, p < 0.0001). In cases where helmet use or absence was reported, 97.3 % of e-bike riders were without a helmet at the time of injury, compared to 82.1 % of pedal bicycle riders and 87.2 % of moped riders.

Conclusions

The rate of pediatric e-bike injuries increased over the study period. Compared to riders on pedal bicycles or mopeds, children on e-bikes had infrequent helmet use and increased rate of hospitalization. These findings suggest that attention to e-bike safety and increasing helmet usage are important to public health among the pediatric population.

Level of evidence

IV.

Comparison of injury severity between E-bikes-related and other two-wheelers-related accidents: Based on an accident dataset

This study aims to compare the accident injury severity of e-bikes with that of other types of two-wheelers based on accident data and to analyze the factors influencing them. Using 1015 police accident records from Zhangjiakou City in 2020 and 2021, the accident injury severity of e-bikes was firstly compared with that of other two-wheelers based on five levels of accident injury severity classified according to the records. Two ordered Probit regression models were secondly used to compare the factors influencing the accident injury severity of e-bikes with that of other two-wheelers and the magnitude of their effects. At the same time, the contributions of each influential factor to the degree of accident injury of two-wheelers were estimated with the assistance of classification trees. Results show that e-bikes are closer to bicycles than motorcycles in terms of injury severities and the factors influencing them, in which the factors "accident configuration," "division of responsibility for the accident," and "collision with a heavy vehicle or four-wheeled vehicle" are significant. Based on the findings, potential measures are suggested to reduce e-bike accident casualties, such as improving rider education, ensuring speed limit enforcement, promoting safety equipment wearing, and making road design friendly to non-motorized and elderly riders. The results of this study can provide an essential reference for traffic management and rider education measures on e-bikes.

Fractures of the Lower Extremity after E-Bike, Bicycle, and Motorcycle Accidents: A Retrospective Cohort Study of 624 Patients

Electric bicycles (e-bikes) have gained enormous popularity in recent years, and as a result, they have successively become more involved in traffic accidents. The aim of the present study was to assess differences in severity and localization of injuries to the lower extremities after accidents with e-bikes, conventional bicycles, and motorcycles. A retrospective cohort-analysis of patients who sustained traumatic accidents with two-wheeled vehicles transferred to a level 1 trauma center in Switzerland was performed. We assessed patient demographics, injury pattern, and trauma severity (ISS), with a subgroup analysis of outcomes stratified by vehicle. In total, 624 patients (71% male) with injuries to the lower extremities after bicycle (n = 279), electric bike (n = 19), and motorcycle (n = 326) accident were included. The mean age of all assessed patients was 42.4 years (SD 15.8), with a significantly higher age in the e-bike cohort (p = 0.0001). High-velocity injuries were found significantly more often in the motorcycle and e-bike group. The motorcycle group had a significantly higher mean ISS (17.6) than the other groups (p = 0.0001). E-bike accidents produce a different injury profile to the lower extremities compared to motorcycle or bicycle accidents. Higher age, higher velocity, and different protective equipment seem to have an impact on these fracture patterns.

Micromobility Vehicles, Obstructions, and Rider Safety Behaviors in New York City Bike Lanes

Micromobility vehicles (MMVs) have become increasingly popular, particularly in urban areas where infrastructure has improved in recent years to facilitate their use. The purpose of this study was to observe protected bike lanes in 10 zones of Manhattan, NYC to: (1) describe the MMVs in bike lanes by type, phone and helmet use; and (2) document MMV users' responses to obstructions. Approximately 1 in 4 of all riders (260/998) were wearing a helmet. Fewer than 2% were observed using a phone while moving. Fewer than 9% of Citi Bike users were wearing a helmet. In contrast, over one-third of non-Citi Bike users were wearing a helmet (228 of 670, 34.03%). This difference was determined to be significant by a chi-squared test (a = 0.05) with a p-value less than 0.0001. Of the 988 MMVs observed in this study, 398 (40.28%) were motorized and 590 (59.72%) were non-motorized. A similar proportion of users of motorized riders versus non-motorized vehicles were wearing a helmet (28.14%, 112/398 versus 24.41%, 144/590). A total of 232 riders (23.50%) encountered an obstruction in their bike lane. Of these obstructions in a bike lane, 82.33% (191/232) were a car/vehicle and 17.67% (41/232) was garbage. A large majority of riders (87.93%) reacted by riding into the traffic lane. These findings suggest that further research and local education, enforcement, and legislative efforts are needed to examine and implement best practices in the safe operation of MMVs, decreasing bike lane obstructions, promoting helmet use, and raising awareness of MMV legislation.

Injuries to Users of Single-Track Vehicles

INTRODUCTION

Single-track vehicles (including, among others, scooters, bicycles, mopeds, and motorcycles) are becoming increasingly popular means of transport, especially in large cities. A significant disadvantage of single-track vehicles is the low level of protection of users' bodies during road accidents, which causes life-threatening injuries. The aim of this study is to characterize the injuries of users of single-track vehicles.

MATERIAL AND METHODS

An analysis of medical documentation of the ambulance service in the region of central Poland covered cases in 2019-2020. Out of 17,446 interventions, a group of 248 road incidents involving single-track vehicles was selected. The data included the scene of the event, the sociodemographic data of the casualties, the injuries suffered, and the clinical diagnoses. Analyses of the correlation of variables with the chi-squared and Spearman's Rho tests were applied. All results were considered significant at p < 0.05.

RESULTS

In the analyzed period, trips of men accounted for 83.5% of all of the interventions (n = 207), while trips of women accounted for 16.5% (n = 41). The mean age of the victims was 45.66 years (SD ± 20.45). Taking into account the division of single-track vehicles, individual cases were recorded with the participation of bicycles (n = 183), motorcycles (n = 61), and scooters (n = 4). Taking into account the type of event, the following were distinguished: deductions (n = 62), falls (n = 179), and sickness (n = 7). The most common injuries were to the heads of cyclists (n = 101, which constitutes 55.19% of all injuries), lower limb injuries in motorcyclists (n = 35; 57.38%), and head injuries in scooter users (n = 3; 75%). The locations of sustained injuries significantly correlated with the type of vehicle in the cases of head injuries (p = 0.046), spine/back injuries (p = 0.001), pelvis injuries (p = 0.021), and lower limb injuries (p = 0.001).

CONCLUSIONS

The users of single-track vehicles injured in road accidents were more often men than women. The characteristics of the injuries depended on the type of vehicle. The lack of adequate body protection significantly increases the likelihood of death or damage to health. It is advisable to promote safety rules among users of single-track vehicles, with a particular emphasis on the protection of individual parts of the body.

Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review

Introduction

Unintentional injuries remain a leading cause of disability among children. Although most of the pediatric patients suffering blunt liver injury can be successfully treated with non-operative therapy, the diagnosis and management of delayed life-threatening hemobilia following severe blunt liver injury, especially in the pediatric population, remain a challenge for clinicians.

Case Presentation

A previously healthy 2-year-old girl suffered a severe blunt liver injury related to an electric bike, which was inadvertently activated by herself. She initially received non-operative therapy and was in a stable condition in the first 2 weeks. On the 16th and 22nd postinjury days, the patient presented with life-threatening massive hemobilia, which was confirmed via repeat emergent gastroscopy and hepatic arterial angiography. An emergency selective transarterial embolization of the involved branch of the left hepatic artery was successfully performed. The patient recovered uneventfully, and long-term follow-up was needed owing to a mild dilatation of the left intrahepatic bile duct.

Discussion

Incidental injury in children should be considered as a major public health issue and preventive measures should be taken to reduce its occurrence. Delayed massive hemobilia after severe blunt liver trauma is rare, and its accurate and timely diagnosis via emergency hepatic arterial angiography and selective angioembolization may allow prompt and optimal management to achieve good outcomes in the pediatric population.

Increased injury severity and hospitalization rates following crashes with e-bikes versus conventional bicycles: an observational cohort study from a regional level II trauma center in Switzerland

Background

As electric bicycles (e-bikes) become increasingly popular, reports of injuries associated with e-bike usage are also rising. Patterns, characteristics, and severity of injuries following e-bike crashes need further investigation, particularly in contrast to injuries from conventional bicycle crashes.

Methods

This prospective observational study included 82 patients treated at a Level II trauma center for injuries resulting from an electric or conventional bicycle crash. Data were collected over one year (05.09.2017–19.09.2018) during in- and outpatient visits. A study-specific case report form was used to identify the bicycle type, cycling behavior (e.g., use of a helmet, safety gear, alcohol), and circumstances of the crash (e.g., road conditions, speed, cause of the incident, time of day, season). Additional information about patient demographics, treatment, and injury characteristics, such as the Injury Severity Score (ISS) and body region injured, were documented. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Simple logistic or linear regression models were used to estimate associations.

Results

Of the 82 patients, 56 (67%) were riding a conventional bike and 27 (33%) were using an e-bike. Most incidents were either single-bicycle crashes (66%) or automobile collisions (26%), with no notable difference in prevalence rates between groups. Although a higher proportion of conventional bikers were male (67% vs. 48%), the difference was not significant. E-bikers were older (median 60 years (IQR 44–70) vs. 45 years (IQR 32–62); p = 0.008), were hospitalized more often (48% vs. 24%, p = 0.025), and had worse ISS (median 3 (IQR 2–4) vs. 1 (IQR 1–3), p < 0.001), respectively. Body regions most affected were the extremities (78%) and external/skin (46%), and these were distributed similarly in both groups. Concomitant injury patterns of the thorax/chest with external/skin were higher among e-bikers (p < 0.001). When we controlled for the difference in the median age of the two groups, only the injury severity score of e-bikers remained significantly worse.

Conclusions

Hospitalization and chest trauma rates were higher among e-bikers. After controlling for the older age of this group, the severity of their injuries remained worse than in conventional cyclists. Initial clinical assessments at trauma units should include an evaluation of the thorax/chest, particularly among elderly e-bikers.

Level of evidence

Level III.