During the 6-year study period, 1,467 pediatric patients were presented to the Pediatric ED following P-scooter and E-bike-related injuries. Of them, 217 (14.8%) were hospitalized, with a median age 14.0 years (IQR 10.5–16.0), median ISS 4 (IQR 1–9), 150 males (69.1%). The total number of patients who presented to the ED following those injuries increased 3.5-fold from 2018 to 2023 (specifically, from 89 cases in 2018 to 315 cases in 2023), with a parallel increase in the number of hospitalizations and surgical interventions (by 1.9-fold and 1.5-fold from 2018 to 2023, respectively) (Fig. 1). The annual rate of ED visits related to E-bike and P-scooter injuries among all annual ED visits increased significantly during the study period (from 0.1% in 2018 to 1.1% in 2023, p < 0.001, Fig. 2.1). In contrast, hospitalization rates among all E-bike and P-scooter injury-related ED visits decreased from 24.7% in 2018 to 13.3% in 2023 (Fig. 2.2), while E-bike and P-scooter injury-related hospitalizations among all pediatric trauma-related hospitalizations increased from 5.3% in 2018 to 10.7% in 2022 (Fig. 2.3).
The epidemiological, trauma-related and clinical characteristics of the 217 pediatric patients who were admitted to the hospital following E-bike and P-scooter injuries are described in Table 1. Of them, 168 (77.4%) were injured as operators, 26 (12.0%) as pedestrians, and 23 (10.6%) as pillions. Of those who were injured as operators, 68 (40.4%) were injured during an E-bike ride, and 100 (59.5%) during a P-scooter ride.
Table 1
Epidemiological, trauma related and clinical characteristics of the study cohort (n = 217)
| All patients (N = 217) |
Sex, male (n, %) | 150 (69.1) |
Age, mean (SD), years | 12.7 ± 4.4 |
Mechanism: P-scooter operator E-bike operator | 100 (46.0) 68 (31.3) |
Pedestrian injured by P-scooter/E-bikes Pillion | 26 (12.0) 23 (10.6) |
Injury severity score (ISS), median (IQR) | 4 (1–9) |
Glasgow coma scale [GCS]: 3–8 9–12 13–15 | 7 (3.4) 4 (1.9) 196 (94.7) |
Trauma team activation | 61 (28.1) |
Head injury | 15 (6.9) |
Vital signs (mean [SD]): Systolic BP Pulse Saturation | 124.5 ± 16.2 94.1 ± 19.1 98.6 ± 3.0 |
Surgical intervention: Total number Orthopedic surgery Neurosurgery Maxillofacial surgery Laparotomy Thoracotomy | 58 (26.7) 35 (16.1) 12 (5.5) 8 (3.6) 5 (2.3) 1 (0.4) |
Severe trauma (ISS > 15 and/or need for acute carea) ISS > 15 Need for acute carea Trauma bay acute interventionb Direct transport to OR ICU admission Mortality | 54 (24.8) 43 (19.8) 43 (19.8) 11 (4.8) 16 (7.4) 37 (17.0) 3 (1.3) |
Hospital LOS (days) [mean, SD] ICU LOS (days) [mean, SD] Ventilation days [mean, SD] | 3.8 ± 5.5 5.1 ± 7.5 0.5 ± 2.7 |
Discharge for rehabilitation care | 10 (4.6) |
ABBREVIATIONS: BP: Blood pressure, GCS: Glasgow coma scale, ICU: Intensive Care Unit, ISS: Injury Severity Score, LOS: length of stay, OR: operating Room |
Sixty-one patients (28.1%) activated the trauma team upon ED arrival. Fifty-four patients (24.8%) were defined as having sustained severe trauma: 43 with an ISS > 15, and 43 patients required acute care (with some overlaps) as follows: 11 (5.0%) required an urgent procedure in the trauma bay, 16 (7.3%) were transferred directly to the OR, 37 (17.0%) were admitted to an ICU and 3 patients (1.3%) who died during hospitalization.
Fifty-eight patients (26.7%) required surgical intervention: 36 patients underwent orthopedic surgery, 12 neurosurgery, 8 maxillofacial surgery, 4 laparotomy, and one thoracotomy. Two patients required more than one surgery type.
We then compared epidemiological, clinical, and severity characteristics between patients who were hospitalized during the early (2018–2019) versus the late (2020–2023) study period. Although hospitalization percentages (among all E-bike and P-scooter injury-related ED visits) decreased over time (Fig. 2.2), the actual number of hospitalizations increased sharply during the late period compared to the early one (from 60 to 172, respectively), as did the numbers of TTAs (from 15 to 49), surgical interventions (from 20 to 46), patients with ISSs > 15 (from 13 to 35), and need for acute care (from 13 to 35) (Fig. 3).
A comparison of epidemiological, clinical and severity characteristics between patients who were hospitalized during each study period is presented in Table 2. There were significantly higher percentages of P-scooter injuries in the late time period compared to the early one (56.1% vs. 23.3%, respectively, p < 0.001) and lower percentages of E-bike injuries (33.9% vs. 58.3%, p < 0.001). There were no significant differences in sex or age between the two time periods, nor in the total percentages of surgical interventions (26.9% vs. 26.1%, p > 0.99), in the subtypes of surgeries, in the percentage of patients who sustained severe trauma (ISS > 15 and/or need for acute care, p = 0.56), or in the percentages of the different components of “need for acute care” (ICU admission, p > 0.99), trauma bay acute interventions (p = 0.46), direct transport to the OR (p = 0.81), or mortality (p = 0.51). The mean LOS in the ICU and the mean number of ventilation days were significantly higher in the later time period (p = 0.02 and p = 0.04, respectively). No differences were observed in the mean hospital LOS or in the percentages of patients who were discharged to rehabilitation care between the two time periods (p = 0.36 and p > 0.99, respectively).
Table 2
Comparison of epidemiological and clinical characteristics between admitted pediatric patients who presented to the ED following E-bike/P-scooter injuries during the early (2018–2019) versus the late (2020–2023) study periods.
| Early period (N = 46) | Late period (N = 171) | p value |
Sex, male (n, %) | 29 (63.0) | 121 (70.8) | 0.36 |
Age, mean (SD), years | 12.0 ± 5.0 | 12.9 ± 4.2 | 0.20 |
Mechanism: P-scooter operator E-bike operator | 11 (34.4) 21 (65.6) | 89 (65.4) 47 (34.6) | 0.002 |
Pedestrian injured by P-scooter/E-bikes Pillion | 9 (19.6) 5 (10.9) | 17 (9.9) 18 (10.5) | 0.12 > 0.99 |
Injury severity score (ISS), mean (SD) | 8.1 ± 10.1 | 7.8 ± 9.9 | 0.85 |
Glasgow coma scale (GCS): 3–8 9–12 13–15 | 1 (2.3) 1 (2.3) 42 (95.5) | 6 (3.7) 3 (1.8) 154 (94.5) | 0.88 |
Trauma team activation | 12 (26.1) | 49 (28.7) | 0.85 |
Main head injury | 4 (8.7) | 11 (6.4) | 0.52 |
Vital signs (mean [SD]): Systolic BP Pulse Saturation | 120.6 ± 14.9 93.3 ± 23.4 98.4 ± 5.6 | 125.5 ± 16.4 94.3 ± 18.0 98.7 ± 5.0 | 0.14 0.83 0.80 |
Surgical intervention: Total number Orthopedic surgery Neurosurgery Maxillofacial surgery Laparotomy Thoracotomy | 12 (26.1) 7 (15.2) 1 (2.2) 4 (8.7) 1 (2.2) 0 (0.0) | 46 (26.9) 28 (16.4) 11 (6.4) 4 (2.3) 4 (2.5) 1 (0.6) | > 0.99 > 0.99 0.46 0.06 > 0.99 > 0.99 |
Severe trauma (ISS > 15 and/or need for acute carea) ISS > 15 Need for acute carea Trauma bay acute interventionb Direct to OR ICU admission Mortality | 13 (28.3) 8 (17.4) 11 (23.9) 1 (2.2) 4 (8.7) 8 (17.4) 1 (2.2) | 41 (24.0) 35 (20.5) 32 (18.7) 10 (5.8) 12 (7.0) 29 (17.0) 2 (1.2) | 0.56 0.83 0.41 0.46 0.81 > 0.99 0.51 |
Hospital LOS (days) [mean, SD] ICU LOS (days) [mean, SD] Ventilation days [mean, SD] | 4.6 ± 6.6 2.1 ± 1.8 0.1 ± 0.7 | 3.6 ± 5.2 6.0 ± 8.2 0.6 ± 3.0 | 0.36 0.02 0.04 |
Discharge for rehabilitation care | 1 (2.2) | 7 (4.1) | > 0.99 |
a Defined as: disposition to the OR within 90 minutes of ED arrival, ICU admission, acute interventions performed in the trauma room, in-hospital death. b Defined as: intubation, needle aspiration/finger thoracotomy/chest tube insertion, blood product administration, pericardiocentesis, central line insertion, performance of cardiopulmonary resuscitation, and resuscitative thoracotomy. |
ABBREVIATIONS: BP: Blood pressure, GCS: Glasgow coma scale, ICU: Intensive Care Unit, ISS: Injury Severity Score, LOS: length of stay, OR: operating Room. |
A univariable analysis was performed to assess the differences in epidemiological and trauma-related parameters between patients with and without severe trauma (Table 3a), followed by a binary logistic regression model to explore independent predictors for severe trauma, defined as an ISS > 15 and/or need for acute care. The following parameters were inserted: age, sex, study time period (late vs. early), and injury mechanism (pedestrian, pillion, E-bike operator, and P-scooter operator). Male sex emerged as the only independent predictor for severe trauma (adjusted odds ratio 3.3 [95% confidence interval: 1.3–8.1], p = 0.009] (Table 3b).
Table 3
A Demographic and clinical characteristics of pediatric patients according to their trauma severity (ISS > 15 and/or need for acute care. a)
| No severe trauma (n = 163) | Severe trauma (n = 54) | p-value |
Sex, male | 104 (63.8%) | 46 (85.2%) | 0.004 |
Age, years (median, IQR) | 14 (10.0–16.0) | 14 (12.0–16.0) | 0.70 |
Age ≥ 11 years | 110 (67.5) | 42 (72.8) | 0.17 |
E-bike operator P-scooter operator Pillion Pedestrian | 47 (37.6) 78 (62.4) 15 (9.2) 23 (14.1) | 21 (48.8) 22 (51.2) 8 (14.8) 3 (5.6) | 0.21 0.21 0.30 0.14 |
Late study period (2020–2023) | 130 (79.8) | 41 (75.4) | 0.56 |
Table 3
B. Binary logistic regression for severe trauma (ISS > 15 and/or need for acute care. a)
aOR | 95% C.I. | | |
Lower | Upper | p-value | |
Sex, male | 3.317 | 1.348 | 8.161 | 0.009 |
Age, years | 1.015 | .902 | 1.143 | 0.80 |
Late study period (2020–2023) | .689 | .299 | 1.587 | 0.38 |
P-scooter vs. E- bike operator | .825 | .412 | 1.649 | 0.58 |
Pedestrian/pillion vs. operator | 2.363 | .574 | 9.726 | 0.23 |
a. Defined as: disposition to the OR within 90 minutes of ED arrival, ICU admission, acute interventions performed in the trauma room, in-hospital death |
Three patients (1.4%, age range 13–16 years) died during their hospital stay following E-bike and P-scooter-related injuries. Two of them were presented during the late study period. Two of them were E-bike operators and one was a P-scooter operator. All three sustained a head injury, and one had a concurrent intraabdominal injury. Eight patients (3.7%, age range of 12–17 years) were discharged for rehabilitation care. They had all sustained head injuries. None of these 11 patients had been wearing a helmet. Their injury-related characteristics are presented in Table 4.
Table 4
Epidemiological and clinical characteristics of pediatric patients who died or needed rehabilitation as the result of E-bike- and P-scooter-related injuries (2018–2023).
Pt.# | Age, yr | Sex | Study period (early/late) | Injury circumstances | ISS | Helmet | ED GCS | On-scene interventions | ED interventions | Surgery | Main injury | Hospital LOS, days | Outcome | Rehabilitation details |
1 | 14 | M | late | P-scooter operator | 43 | No | 3 | Intubation and resuscitation | ED thoracotomy, Direct to OR | / | Head injury | 6 | Died | |
2 | 16 | M | Early | E-bike operator | 50 | No | 3 | LMA insertion | None | Explorative laparotomy & splenectomy | Head abdominal injuries | 4 | Died |
3 | 13 | M | Late | E-bike operator | 25 | No | 10 | None | Intubation | Craniotomy for ICP monitor insertion | Head injury | 4 | Died |
4 | 15 | M | Late | P-scooter operator | 34 | No | 14 | IV fluids | Intubation | Craniotomy for epidural hematoma | Head injury | 13 | Rehab | Tracheostomy, Dysphagia |
5 | 14 | M | Late | E-bike operator | 29 | No | 15 | None | External fixation of femur fracture. | Internal fixation of femur | Head and orthopedic injuries | 9 | Rehab | Multidisciplinary rehabilitation: 1. Oculo-visual disability, 2. Orthopedic injury. |
6 | 17 | M | Late | P-scooter operator | 24 | No | 3 | Intubation | None | 1.ICP monitor insertion 2.Closed reduction of mandibular fracture 3.Reduction intramedullary of the tibia | Head and orthopedic injuries | 42 | Rehab | Tracheostomy, multi disciplinary rehabilitation. |
7 | 15 | M | Late | P-scooter operator | 41 | No | 4 | None | Intubation | Craniectomy for epidural hematoma | Head injury | 14 | Rehab | Multidisciplinary rehabilitation, Dysphagia. |
8 | 15 | M | Early | E-bike operator | 43 | No | 5 | None | Intubation | 1. Craniotomy for subdural hemorrhage evacuation. 2. Open reduction internal fixation of the femur. 3.Closed reduction & internal fixation of metacarpal bone | Head and orthopedic injuries | 16 | Rehab | Physiotherapy and hydrotherapy d/t disability. |
9 | 12 | M | Late | P-scooter operator | 29 | No | 12 | IV fluids | None | Craniotomy for epidural hematoma evacuation | Head injury | 13 | Rehab | Emotional, cognitive and behavioral difficulties. |
10 | 16 | M | Late | E-bike operator | 29 | No | 3 | Intubation IV fluids | None | Decompressive craniotomy | Head injury | 31 | Rehab | Tracheostomy, feeding tube. |
11 | 14 | M | Late | E-bike operator | 26 | 0 | 3 | None | Intubation | Decompressive craniotomy. | Head injury | 26 | Rehab | Tracheostomy, gastrostomy, multi disciplinary rehabilitation. |
FIGURES AND TABLES |