Study reveals increase in severity and prevalence of scooter-related injuries that require surgery

USA: A recent study published in the Journal of the American College of Surgeons (JACS) has provided insights into national trends and clinical outcomes after scooter injury in the US from 2016 to 2020. 

The retrospective cohort study utilizing the 2016-2020 National Inpatient Sample for patients younger than 65 years old who were hospitalized following bicycle and scooter injuries revealed a significant increase in the prevalence and severity of scooter-related injuries. This contributes to a substantial cost burden on the healthcare system.

"Scooter riders, stay alert: this increasingly popular mode of transportation may put you at risk for more severe traumatic injuries that require surgery," the study stated. 

“As surgeons who work in an urban trauma center, we’ve seen an increase in scooter-related injuries in the emergency room and around the university campus,” said Peyman Benharash, MD, FACS, senior author of the study and an associate professor of surgery at the University of California, Los Angeles (UCLA) Health. “The question is: How do we manage them and why is there such a surge?”

Injuries involving e-scooters-many of them classified as moderate or severe-have doubled in recent years, coinciding with the boom of shared e-scooter programs in urban areas and college campuses.1,2 Considering the exponential rise of scooter programs and scooter-related injuries, researchers at UCLA and Loma Linda University sought to delve into the nuances of these injuries and associated health care costs.

“This study is important because it describes both an increasing frequency of hospital admissions for scooter crash-related injuries, and it also demonstrates that the severity of these injuries is increasing over time,” said Brendan T. Campbell, MD, MPH, FACS, chair of the Injury Prevention and Control Committee of the American College of Surgeons Committee on Trauma, which develops and implements programs that support injury prevention.

Dr. Campbell, a pediatric surgeon at Connecticut Children’s Medical Center in Hartford, Connecticut, was not involved with the JACS research study.

He added: “Future studies of scooter crashes should look for ways to lower injury risk, specifically what factors decrease crash risk and what incentivizes scooter riders to wear helmets.”

Study details

The team reviewed data on scooter-related injuries from 2016-2020 using the National Inpatient Sample (NIS), an administrative database maintained by the Agency for Healthcare Research and Quality. The team identified 92,815 patients who were admitted to hospitals on a non-elective basis with bicycle (86,690 patients) and scooter (6,125 patients) injuries using International Classification of Diseases, Tenth Revisions (ICD-10) codes. Before 2021, ICD-10 codes did not differentiate between electric and non-electric scooters, so the study focused on injuries related to all types of scooters.

Researchers reviewed several characteristics of the patients, including age, type of orthopedic injury, injury severity, length of stay in the hospital, and hospitalization costs.

Key study findings

• Hospitalizations for scooter-related injuries increased by nearly three-fold from 2016 to 2020, and more than half of those injured patients underwent major operations.

• Compared to bicycle injuries, patients who sustained injuries related to scooters were more likely to be under the age of 18 (26.7% vs. 16.4%), more frequently injured in winter months (24.2% vs. 20%), and more often insured by Medicaid (26.7% vs. 23.9%).

• Patients hospitalized with scooter-related injuries more often underwent major surgeries (55.8 vs 48.1%), in particular orthoplastic procedures and operations on the head.

• Scooter riders were more likely to sustain long bone fractures or paralysis compared to bicycle riders; risks associated with traumatic brain injury were similar among the two groups.

• During the study period (2016-2020), total annual costs of hospitalizations in patients with bicycle and scooter-related injuries increased by nearly 5-fold, from $6.6 million in 2016 to $35.5 million in 2020.

“I think it’s important for the public to recognize the significance of scooter-related injuries and the financial outcomes associated with them,” said first author Nam Yong Cho, a third-year medical student at UCLA and a research associate at the UCLA Cardiovascular Outcomes Research Laboratories. “The public should also know that while caution must be taken among scooter riders, vehicle riders should also be cautious where shared scooter systems are prevalent.”

Injury patterns related to scooter injuries are also unique, sometimes impacting the chest wall or cardiothoracic area more frequently than bicycle injuries, which may warrant further investigation, the authors added.

Recognizing these concerning patterns, the authors are calling for health care leaders to promote scooter-related injury prevention efforts and greater safety in the community.

“Considering the increasing popularity of scooters and the rise of associated injuries, it is crucial to elevate safety standards for riders and advocate for improved infrastructure,” Cho said. “Things such as enforced speed limits and dedicated lanes for scooters are vital to minimize the risk of injuries to vehicles, scooter riders, and pedestrians alike. We believe our findings should urge health care leaders to take a stand and empower themselves in championing prevention strategies for scooter-related injuries and promoting a safer community.”

The study is limited by the use of the NIS, an administrative database that may not reflect granular data on injuries. The authors noted they could not account for helmet use, the presence of multiple riders, and the use of intoxicants during the time of the incident, among other factors. Objects or vehicles involved in collisions, as well as the details of terrain and speed of the scooter riders, could also not be delineated.

Reference:

Cho, Nam Yong BS1; Kim, Shineui BA1; Tran, Zachary; Hadaya, Joseph MD PhD1; Ali, Konmal1; Kronen, Elsa1; Burruss, Sigrid MD, FACS2; Benharash, Peyman MD, FACS1,3. National Trends and Clinical Outcomes after Scooter Injury in the US: 2016-2020. Journal of the American College of Surgeons ():10.1097/XCS.0000000000000918, January 09, 2024. | DOI: 10.1097/XCS.0000000000000918.