Electric bike and scooter use causes surge in brain injuries

The growing use of electric bikes and scooters has caused a surge in brain and spine injuries among urban riders and pedestrians, a new study shows.

Led by NYU Langone Health researchers, the study found that these injuries now account for nearly 7 percent of trauma patients admitted into one New York City hospital.

Published online April 15 in Neurosurgery, a publication of the Congress of Neurological Surgeons, the work analyzed 914 patients treated for injuries linked to both pedal-powered and electric micromobility devices at NYC Health + Hospitals/Bellevue over five years. The research team found that one-third of patients suffered traumatic brain injury, more than two-thirds required hospital admission, and roughly 30 percent needed intensive care. The share of trauma cases seen in the emergency room (whether patients were admitted or not) that involved such devices increased from less than 10 percent in 2018 to more than 50 percent by 2023.

The most common cause of injury was a collision with a car or truck, accounting for about half of cases, said the study authors. Fewer than one-third of riders wore helmets, and this was linked to significantly higher rates of brain and facial injuries. About one in five patients tested positive for alcohol, which was tied to both worse brain injuries and lower helmet use.

Importantly, the 69 pedestrians analyzed in the study, when struck by electric vehicles, suffered brain injuries at nearly double the rate of the riders, said the authors. Injuries peaked between 6 and 8 p.m., suggesting that heavy dinnertime e-bike delivery traffic may play a role.

Our study shows that micromobility injuries are producing serious brain and spinal trauma that demands neurosurgical care at a scale we haven't seen before. In a busy urban setting, we are seeing more and more of these injuries firsthand. The data point to actionable solutions—helmet use, safer bike lane design, and enforcement—that could prevent many of these injuries and better protect both riders and pedestrians, who in our study often sustained even more severe brain injuries than the riders themselves."

Hannah Weiss, MD, corresponding author, resident in the Department of Neurosurgery at NYU Grossman School of Medicine

For the study, researchers reviewed records of every patient treated by the trauma team at NYC Health + Hospitals/Bellevue between January 2018 and August 2023 for injuries involving bikes or scooters. The patients included riders of both electric and pedal-powered bikes and scooters, as well as pedestrians struck by these devices. The team collected information on helmet use, alcohol levels, injury type, brain scans, surgeries performed, and length of hospital stay.

"Our findings make clear that urban infrastructure must continue to improve to keep pace with the rapid rise of electric bikes and scooters," said Paul P. Huang, MD, associate professor in the Department of Neurosurgery at NYU Grossman School of Medicine and chief of neurosurgery at NYC Health + Hospitals/Bellevue. "Future studies should track these injuries across multiple cities and measure whether protected bike lanes, helmet programs, and speed enforcement actually reduce the number of brain and spine surgeries we perform."

Along with Drs. Weiss and Huang, study authors in the Department of Neurosurgery at NYU Langone were Nora Kim, MD, and Cordelia Orillac, MD. Additional authors were Roee Ber, MD, in the neurosurgery department at Maimonides Medical Center in Brooklyn; Mason Blacker, MD, of Barrow Neurological Institute at St. Joseph's Hospital in Phoenix; and Clotilde Balucani, MD, PhD, in the Department of Neurology at Northwell Health in Manhattan.