Increased injury severity and age-related mortality in trauma victims after e-bike versus conventional bicycle accidents: a concerning call to action!

Abstract

Background: Although e-bike accidents are of growing clinical relevance, there is limited large-scale research comparing injury patterns and outcomes between e-bike (EB) and conventional bicycle (CB) accidents in large patient cohorts. This study performed comparative analyses of both groups to identify patients at risk and guide future prevention and clinical management strategies.

Methods: A retrospective analysis of the TraumaRegister DGU^® was conducted. Patients aged 16 years or older who sustained severe injuries (AIS ≥ 3 in minimally one body region) in accidents involving conventional bicycles or e-bikes between January 2020 and December 2023 were included. Patient demographics, injury patterns, trauma severity, treatment characteristics, and clinical outcomes were analyzed.

Results: A total of 9,170 bicycle accident cases were included (EB n = 1,160; CB n = 8,010). EB riders were significantly older than CB riders (median age 63 years; IQR 53-73 vs. 57 years IQR 44-69; p < 0.001) and more frequently sustained polytrauma (16.7% vs. 12.3%; p < 0.001). Compared with CB riders, EB riders more often suffered injuries to the head (67.2% vs. 56.2%; p < 0.01), face (22.7% vs. 17.8%; p < 0.001), and chest (55.2% vs. 51.8%; p = 0.030), and were more likely to sustain injuries affecting multiple body regions (p < 0.001). Primary ICU treatment was required more frequently after EB accidents (70.3% vs. 63.5%; p < 0.001). Age-stratified analyses showed that younger EB riders were more frequently involved in nighttime and alcohol-related accidents, whereas mortality increased significantly with age, from 2.7% in patients aged 16-59 years to 18.6% in those aged ≥ 80 years.

Conclusions: E-bike accidents are associated with a higher prevalence of head, face, and chest injuries, increased rates of polytrauma and multi-region injuries, and a greater need for ICU treatment compared with conventional bicycle accidents. These differences are particularly relevant in older riders, who represent the majority of severely injured e-bike users and experience substantially higher mortality rates. Targeted prevention strategies, improved protective measures, and age-specific risk communication may help reduce the burden of e-bike-related injuries.