AI generated E-Bike Related Injury Review

Projects E-Bikes
1

Electric Bicycle Injury Patterns: A Review of Current Research

Executive Summary

Electric bicycles (e-bikes) have seen explosive growth worldwide as a transportation and recreation option. This growth has been accompanied by a parallel increase in e-bike-related injuries presenting to emergency departments and trauma centers. This report synthesizes findings from a recent U.S. Level 1 trauma center study with the broader international literature to characterize injury patterns, identify risk factors, and inform potential interventions.

Key findings across the literature:

  • Head and facial injuries are the predominant concern, occurring in 50-70% of e-bike trauma patients
  • Helmet use among e-bike riders is consistently low (20-35%) across studies
  • E-bike injury patterns more closely resemble motorcycle injuries than pedal bicycle injuries
  • Older adults are overrepresented among e-bike crash victims
  • Injury rates are increasing faster than ridership growth in many regions
  • The evidence strongly supports helmet use for all bicycle types, not just e-bikes

1. Introduction

Electric bicycles occupy a unique position in the transportation landscape—faster than pedal bicycles (typical speeds of 15-28 mph) but largely unregulated compared to motorcycles or mopeds. This regulatory gap, combined with low helmet use and an older rider demographic, has created a distinct injury profile that trauma centers are increasingly encountering.

The rapid adoption of e-bikes has been driven by urbanization, environmental concerns, economic factors, and—particularly since the COVID-19 pandemic—changes in commuting patterns and public transit use. However, the safety implications of this shift have only recently begun to be systematically studied.

2. Index Study: UC Irvine Level 1 Trauma Center (2019-2022)

2.1 Study Design

Anderson et al. conducted a retrospective review of trauma patients presenting to an academic Level 1 trauma center between 2019 and 2022, comparing injuries across four transportation modes:

Mode Sample Size
Electric bicycle (EB) 100
Electric scooter (ES) 63
Motorcycle (MC) 1,086
Pedal bicycle (PB) 668

2.2 Key Findings

Demographics

  • E-bike riders were significantly older (mean 49.2 years) than e-scooter (40.5 years) and motorcycle riders (37.1 years)
  • 24% of e-bike riders were female, compared to only 7.6% of motorcycle riders
  • 21% of e-bike riders were aged 65 or older

Helmet Use and Head Injuries

Mode Helmet Use Head/Face Fractures Loss of Consciousness
E-bike 23% 54% 63%
E-scooter 35% 56% 44%
Pedal bicycle 35% 34% 38%
Motorcycle 95% 19% 24%

The inverse relationship between helmet use and head injuries is striking and consistent across all groups.

Orthopaedic Injury Patterns

Among e-bike riders, the most common fractures were:

  • Spine fractures: 11%
  • Acetabulum: 6%
  • Clavicle/Scapula/Radius: 5% each
  • Upper extremity injuries were more common than lower extremity (23% vs. 18%)

Healthcare Resource Utilization

  • 14% of e-bike patients presented as critical trauma activations (vs. 6% for pedal bicycles)
  • 25% required ICU admission (vs. 16% for motorcycles)
  • 100% received at least one CT scan
  • 19% required surgical intervention

Alcohol Involvement

  • 40% of e-bike riders tested positive for alcohol—significantly higher than all other groups (16-22%)
  • This finding appears unusually high compared to other published studies

2.3 Reference

Anderson A, McLellan M, Tedesco A, et al. Comparison of Characteristics, Injury Patterns, and Orthopaedic Injuries Between Electric Bicycle, Pedal Bicycle, Electric Scooters, and Motorcycle Accidents at a Level 1 Trauma Center. J Am Acad Orthop Surg Glob Res Rev. 2025;9(6):e25.00099. https://doi.org/10.5435/JAAOSGlobal-D-25-00099

3. International Literature Review

3.1 Head Injury and Helmet Effectiveness

The Netherlands

A 2025 study of 1,878 bicycle crash victims found e-bike usage was an independent predictor for severe traumatic brain injury (OR 1.64, 95% CI 1.20-2.22) and skull fractures (OR 1.50, 95% CI 1.08-2.08) after controlling for alcohol intoxication, anticoagulant use, helmet status, age, and gender.

van der Spek WR, et al. E-bikers at risk for severe traumatic brain injury and skull fractures. Injury. 2025;56(5):112306. https://doi.org/10.1016/j.injury.2025.112306

A separate Dutch study on orbital fractures (2011-2022) found that e-bike-related facial fractures increased most dramatically among patients aged 50-75 years.

van der Meeren SW, et al. Changes in the etiology of orbital fractures over 2011-2022: the role of age and electric bicycles. Orbit. 2025;44(6):783-788. https://doi.org/10.1080/01676830.2025.2516743

Switzerland

A Level 1 trauma center study (2009-2019) compared cranio-cervical and traumatic brain injury patterns across vehicle types. E-bikers’ injury patterns resembled motorcyclists more than bicyclists, with higher rates of cerebral bleeding—especially when no helmet was worn. Notably, helmeted e-bikers had comparable intracranial bleeding rates to helmeted bicyclists.

Rauer T, et al. Cranio-cervical and traumatic brain injury patterns—do they differ between electric bicycle, bicycle, and motorcycle-induced accidents? Eur J Trauma Emerg Surg. 2024;50(6):3039-3048. https://doi.org/10.1007/s00068-024-02510-1

United States (National Data)

A study using the National Trauma Data Standard (2018-2023) found helmet use among e-bike riders was associated with:

  • Fewer ventilator days (0.43 vs. 0.67, p=0.0148)
  • Higher Glasgow Coma Scale scores (13.98 vs. 13.75, p=0.0141)

Pitcher G, et al. The Impact of Helmet Use on Injury Severity and Clinical Outcomes in E-Bike Riders. Cureus. 2025;17(5):e85153. https://doi.org/10.7759/cureus.85153

3.2 Trends in Injury Incidence

United States

A 10-year analysis (2013-2022) using NEISS data found:

  • E-bike injuries increased exponentially over the study period
  • 90.9% increase from 2019 to 2022 alone
  • Over 10% of patients required hospitalization
  • 30% of injuries involved motor vehicle collisions

Locke AR, et al. The rise in electric biking (E-bike) injuries: a 10-year age and sex-specific analysis of national injury data. Phys Sportsmed. 2025;53(5):345-352. https://doi.org/10.1080/00913847.2025.2470104

A separate analysis focused on head injuries found:

  • E-bike head injuries increased significantly from 2013 to 2022
  • 40.8% of all head injuries occurred in 2022
  • 31% required hospital admission
  • Motor vehicle involvement accounted for 27.6% of head injuries

Koehne NH, et al. Increasing incidence of concussion and head injury due to electric biking: a 10-year sex- and age-specific analysis of national injury data. Phys Sportsmed. 2024;53(3):197-202. https://doi.org/10.1080/00913847.2024.2440309

A comparison of e-bikes to mopeds (2019-2023) found:

  • E-bike injury counts increased significantly faster than moped injuries
  • Head injuries were most common for both vehicle types
  • Alcohol involvement was lower for e-bikes (7.6%) than mopeds
  • E-bikes are comparatively under-regulated compared to mopeds

Atkinson E, Atkinson T. Injury patterns and safety implications for electric bikes compared to mopeds in the United States. Traffic Inj Prev. 2025;26(sup1):S132-S140. https://doi.org/10.1080/15389588.2025.2543497

Israel

A Level 1 adult trauma center (2017-2022) observed:

  • 21-fold increase in ED visits over the study period
  • Parallel increases in hospitalizations and surgical interventions
  • E-bike riders (vs. powered scooter riders) were independently associated with major trauma (aOR 1.5, 95% CI 1.1-2.0)
  • Male sex was also an independent predictor for severe trauma

Hashavia E, et al. Secular trends in the incidence and severity of injuries sustained by riders of electric bikes and powered scooters: The experience of a level 1 adult trauma center. Injury. 2023;55(5):111293. https://doi.org/10.1016/j.injury.2023.111293

Germany

A longitudinal analysis (2013-2021) of nearly 100,000 police-reported crashes found:

  • Crashed pedelec riders were significantly older than conventional cyclists
  • Mean age of pedelec riders decreased by 8 years over the study period
  • Single-vehicle crashes were more common for pedelec riders
  • Pedelec crashes had higher injury severity across all years

Schleinitz K, Petzoldt T. Development of German pedelec (and bicycle) crashes between 2013 and 2021. J Safety Res. 2023;87:187-201. https://doi.org/10.1016/j.jsr.2023.09.016

3.3 Pediatric Injuries

United States

A 2025 study using NEISS data (2019-2023) found:

  • National estimate of 15,121 pediatric e-bike injuries
  • Speed-related injuries had higher rates of head/neck/facial injuries (49% vs. 29%)
  • Internal organ injuries more common with speed-related crashes (24% vs. 10%)
  • Of internal injuries, 97% were head and neck
  • E-bike injuries increased from 4.2% in 2019 to 49.8% in 2023

Flyer ZE, et al. Electric-bicycles and speed-related trauma in pediatrics: Risk of internal injury and hospitalization. Injury. 2025:112931. https://doi.org/10.1016/j.injury.2025.112931

A 2023 pediatric study found:

  • Hospitalization rate for e-bikes (11.5%) exceeded mopeds (7.0%) and pedal bicycles (4.8%)
  • 97.3% of injured e-bike riders were not wearing helmets
  • Age group most commonly affected: 10-13 years (44.3%)

Goodman LF, et al. Electric bicycles (e-bikes) are an increasingly common pediatric public health problem. Surg Open Sci. 2023;14:46-51. https://doi.org/10.1016/j.sopen.2023.06.004

Israel

A pediatric ED study (2018-2023) found:

  • 1,466 pediatric patients with e-bike and powered scooter injuries
  • ED visits increased 3.5-fold by study end
  • 3 patients died; 9 required rehabilitation care
  • Median age 14.0 years; 69% male

Moati S, et al. The Incidence and Severity of Pediatric Injuries Sustained by Electric Bikes and Powered Scooters: The Experience of an Urban, Tertiary Pediatric Emergency Department. Pediatr Emerg Care. 2024;41(2):77-85. https://doi.org/10.1097/PEC.0000000000003258

3.4 Neurosurgical Injuries

An Israeli study focused on neurosurgical injuries (2019-2020) found:

  • 58 patients with e-bike-related neurosurgical injuries
  • 94.5% of riders were not wearing helmets
  • Average GCS on admission was 13.2 (significantly lower in operated patients: 10.75)
  • 3 patients died; 1 remained in vegetative state
  • Patients who wore helmets had significantly higher GCS scores and shorter hospital stays

Richetta C, Karepov Y. E-Bikes (Electrical Bicycles and Scooters) Related Neurosurgical Injuries in the Adult Population: A Single-Center Experience. Neurotrauma Rep. 2023;4(1):797-804. https://doi.org/10.1089/neur.2023.0071

3.5 Regional Variations

China (Guangzhou)

A retrospective analysis (2011-2021) found:

  • E-bike accidents increased sharply after 2018
  • Three-quarters of accidents occurred in motorized vehicle lanes
  • Most occurred on roads without physically segregated nonmotorized vehicle lanes
  • 71.6% of e-bike accidents involved migrant workers
  • Riding in motorized vehicle lanes was the most common illegal behavior

Zhou N, et al. Analysis of road traffic accidents and casualties associated with electric bikes and bicycles in Guangzhou, China: A retrospective descriptive analysis. Heliyon. 2024;10(9):e29961. https://doi.org/10.1016/j.heliyon.2024.e29961

San Francisco, USA

An observational study of 5,365 riders found:

  • Helmet use was substantially lower among shared micromobility program riders
  • Shared e-scooter riders wore helmets 70% less frequently than personal e-scooter riders
  • Dockless e-bike riders used helmets 42% less than docked e-bike riders

Frye W, et al. Popular but precarious: low helmet use among shared micromobility program riders in San Francisco. Front Public Health. 2024;12:1477473. https://doi.org/10.3389/fpubh.2024.1477473

3.6 Ankle and Lower Extremity Injuries

A UK systematic review (2015-2025) on ankle fractures found:

  • Distinct injury pattern associated with e-scooters: isolated ankle rotational fractures from low-energy falls
  • E-bike crashes were less frequently linked to ankle fractures
  • Frequency and severity of e-scooter injuries are increasing
  • Significant and growing burden on Emergency Departments and Orthopaedic services

Rout S, et al. The Changing Landscape of Ankle Fractures in the Era of Electric Micromobility: A Systematic Review. Cureus. 2025;17(11):e96812. https://doi.org/10.7759/cureus.96812

4. Alcohol Involvement: A Closer Look

The 40% alcohol-positive rate reported in the index study appears unusually high compared to other literature:

Study Location Alcohol Rate
Anderson et al. (index study) California, USA 40% (e-bikes)
Burford et al. (NEISS national data) USA 9% (powered scooters highest)
Osti et al. Harlem, NYC 36% (drugs + alcohol combined)
Arbel et al. Tel Aviv, Israel 19%
Atkinson & Atkinson USA (national) 7.6% (e-bikes)

Burford KG, et al. The Burden of Injuries Associated With E-Bikes, Powered Scooters, Hoverboards, and Bicycles in the United States: 2019-2022. Am J Public Health. 2024;114(12):1365-1374. https://doi.org/10.2105/AJPH.2024.307820

Osti N, et al. E-scooter and E-bike injury pattern profile in an inner-city trauma center in upper Manhattan. Injury. 2023;54(5):1392-1395. https://doi.org/10.1016/j.injury.2023.02.054

Arbel S, et al. Maxillofacial Injuries Sustained by Riders of Electric-Powered Bikes and Electric-Powered Scooters. Int J Environ Res Public Health. 2022;19(22):15183. https://doi.org/10.3390/ijerph192215183

Possible explanations for the discrepancy:

  1. Selection bias toward severe cases at Level 1 trauma centers
  2. Geographic and cultural factors specific to Southern California
  3. Variation in alcohol testing protocols across institutions
  4. Time period effects (pandemic-era changes in behavior)

5. The Case for Universal Helmet Use

The data consistently support helmet use across all bicycle types, not just e-bikes:

5.1 Evidence from the Index Study

Mode Helmet Use Head/Face Fractures
Motorcycle 95% 19%
Pedal bicycle 35% 34%
E-scooter 35% 56%
E-bike 23% 54%

5.2 Supporting International Evidence

  • Switzerland: Helmeted e-bikers had comparable intracranial bleeding rates to helmeted bicyclists
  • USA (National): Helmet use associated with fewer ventilator days and higher GCS scores
  • Israel (Neurosurgery): Patients with helmets had significantly higher GCS and shorter hospital stays
  • Netherlands: E-bike usage was an independent risk factor for TBI even after controlling for helmet use

5.3 Helmet Compliance Remains Low

Despite the evidence:

  • 77% of e-bike riders in the index study were unhelmeted
  • 65% of pedal cyclists were unhelmeted
  • 97% of injured pediatric e-bike riders were unhelmeted
  • Shared micromobility users have even lower helmet compliance

6. Policy Implications

6.1 Regulatory Gaps

  • E-bikes are under-regulated compared to motorcycles and mopeds in most jurisdictions
  • Helmet laws vary widely and are difficult to enforce
  • Age restrictions are inconsistent
  • Speed limits for e-bikes vary by jurisdiction and class

6.2 Potential Interventions

Based on the literature, potential interventions include:

Legislative:

  • Universal helmet laws for all bicycle and e-bike riders
  • Age restrictions for e-bike use
  • Speed limiting technology (geofencing)
  • DWI law enforcement for e-bikes

Infrastructure:

  • Physically separated bicycle lanes
  • Improved intersection design (especially roundabouts)
  • Dedicated micromobility corridors

Education:

  • Safety courses for e-bike riders
  • Public awareness campaigns about head injury risk
  • Healthcare provider education on injury patterns

Technology:

  • Helmet detection systems on shared vehicles
  • Speed governors on e-bikes
  • Pedestrian airbags and collision avoidance systems

7. Conclusions

The evidence is clear and consistent across international studies:

  1. E-bikes pose unique injury risks that more closely resemble motorcycles than pedal bicycles, particularly for head trauma

  2. Helmet use dramatically reduces head injury severity across all bicycle and micromobility types

  3. Current helmet compliance is unacceptably low, especially among e-bike and e-scooter riders

  4. Injury rates are rising faster than regulation, creating a growing public health burden

  5. The case for helmet use extends to all cyclists, not just e-bike riders—the 65% non-helmet rate among pedal bike trauma patients is nearly as concerning as the 77% rate for e-bikes

  6. Older riders face elevated risk due to both the demographics of e-bike adoption and physiological vulnerability to head trauma

  7. Motor vehicle interactions are a major factor in the most severe injuries, highlighting the need for infrastructure improvements

The consistent findings across diverse healthcare systems and regulatory environments suggest that e-bike safety is a global public health priority requiring coordinated action across legislation, infrastructure, and education.

References

  1. Anderson A, McLellan M, Tedesco A, et al. Comparison of Characteristics, Injury Patterns, and Orthopaedic Injuries Between Electric Bicycle, Pedal Bicycle, Electric Scooters, and Motorcycle Accidents at a Level 1 Trauma Center. J Am Acad Orthop Surg Glob Res Rev. 2025;9(6):e25.00099. https://doi.org/10.5435/JAAOSGlobal-D-25-00099

  2. Arbel S, Zrifin E, Mahmoud R, et al. Maxillofacial Injuries Sustained by Riders of Electric-Powered Bikes and Electric-Powered Scooters. Int J Environ Res Public Health. 2022;19(22):15183. https://doi.org/10.3390/ijerph192215183

  3. Atkinson E, Atkinson T. Injury patterns and safety implications for electric bikes compared to mopeds in the United States. Traffic Inj Prev. 2025;26(sup1):S132-S140. https://doi.org/10.1080/15389588.2025.2543497

  4. Burford KG, Itzkowitz NG, Rundle AG, et al. The Burden of Injuries Associated With E-Bikes, Powered Scooters, Hoverboards, and Bicycles in the United States: 2019-2022. Am J Public Health. 2024;114(12):1365-1374. https://doi.org/10.2105/AJPH.2024.307820

  5. Flyer ZE, Giron A, Schomberg J, et al. Electric-bicycles and speed-related trauma in pediatrics: Risk of internal injury and hospitalization. Injury. 2025:112931. https://doi.org/10.1016/j.injury.2025.112931

  6. Frye W, Chehab L, Feler J, et al. Popular but precarious: low helmet use among shared micromobility program riders in San Francisco. Front Public Health. 2024;12:1477473. https://doi.org/10.3389/fpubh.2024.1477473

  7. Goodman LF, Birnbaum Flyer Z, Schomberg J, et al. Electric bicycles (e-bikes) are an increasingly common pediatric public health problem. Surg Open Sci. 2023;14:46-51. https://doi.org/10.1016/j.sopen.2023.06.004

  8. Hashavia E, Shimonovich S, Shopen N, et al. Secular trends in the incidence and severity of injuries sustained by riders of electric bikes and powered scooters: The experience of a level 1 adult trauma center. Injury. 2023;55(5):111293. https://doi.org/10.1016/j.injury.2023.111293

  9. Koehne NH, Locke AR, Alley AA, et al. Increasing incidence of concussion and head injury due to electric biking: a 10-year sex- and age-specific analysis of national injury data. Phys Sportsmed. 2024;53(3):197-202. https://doi.org/10.1080/00913847.2024.2440309

  10. Locke AR, Koehne NH, Ramey MD, et al. The rise in electric biking (E-bike) injuries: a 10-year age and sex-specific analysis of national injury data. Phys Sportsmed. 2025;53(5):345-352. https://doi.org/10.1080/00913847.2025.2470104

  11. Moati S, Tavor O, Capua T, et al. The Incidence and Severity of Pediatric Injuries Sustained by Electric Bikes and Powered Scooters: The Experience of an Urban, Tertiary Pediatric Emergency Department. Pediatr Emerg Care. 2024;41(2):77-85. https://doi.org/10.1097/PEC.0000000000003258

  12. Osti N, Aboud A, Gumbs S, et al. E-scooter and E-bike injury pattern profile in an inner-city trauma center in upper Manhattan. Injury. 2023;54(5):1392-1395. https://doi.org/10.1016/j.injury.2023.02.054

  13. Pitcher G, Mendoza M, McCague A, et al. The Impact of Helmet Use on Injury Severity and Clinical Outcomes in E-Bike Riders. Cureus. 2025;17(5):e85153. https://doi.org/10.7759/cureus.85153

  14. Rauer T, Klingebiel FKL, Lühring A, et al. Cranio-cervical and traumatic brain injury patterns—do they differ between electric bicycle, bicycle, and motorcycle-induced accidents? Eur J Trauma Emerg Surg. 2024;50(6):3039-3048. https://doi.org/10.1007/s00068-024-02510-1

  15. Richetta C, Karepov Y. E-Bikes (Electrical Bicycles and Scooters) Related Neurosurgical Injuries in the Adult Population: A Single-Center Experience. Neurotrauma Rep. 2023;4(1):797-804. https://doi.org/10.1089/neur.2023.0071

  16. Rout S, Rout S, Patidar R. The Changing Landscape of Ankle Fractures in the Era of Electric Micromobility: A Systematic Review. Cureus. 2025;17(11):e96812. https://doi.org/10.7759/cureus.96812

  17. Schleinitz K, Petzoldt T. Development of German pedelec (and bicycle) crashes between 2013 and 2021. J Safety Res. 2023;87:187-201. https://doi.org/10.1016/j.jsr.2023.09.016

  18. van der Meeren SW, Brand LS, Zamanipoor Najafabadi A, et al. Changes in the etiology of orbital fractures over 2011-2022: the role of age and electric bicycles. Orbit. 2025;44(6):783-788. https://doi.org/10.1080/01676830.2025.2516743

  19. van der Spek WR, Nijveldt RJ, van Helden SH, et al. E-bikers at risk for severe traumatic brain injury and skull fractures. Injury. 2025;56(5):112306. https://doi.org/10.1016/j.injury.2025.112306

  20. Zhou N, Zeng H, Xie R, et al. Analysis of road traffic accidents and casualties associated with electric bikes and bicycles in Guangzhou, China: A retrospective descriptive analysis. Heliyon. 2024;10(9):e29961. https://doi.org/10.1016/j.heliyon.2024.e29961

Report compiled January 2026