[Skip to Content]
[Skip to Content Landing]
Figure.  Triage Level Criteria for Trauma Activations
Triage Level Criteria for Trauma Activations

Patients are triaged according to physiologic, anatomic, mechanism of injury, and/or other criteria. Individuals meeting any one of the criteria are placed in that triage level. EDH indicates epidural hematoma; EMS, emergency medical services; GCS, Glasgow Coma Scale; GLF, ground-level fall; MVC, motor vehicle crash; RR, respiratory rate; SBP, systolic blood pressure; SCI, spinal cord injury; TBSA, total body surface area; and VS, vital signs.

Table.  Injuries, Injury Severity, and Emergency Department Disposition Following Motorized Scooter Accidents
Injuries, Injury Severity, and Emergency Department Disposition Following Motorized Scooter Accidents
1.
Siman-Tov  M, Radomislensky  I, Peleg  K; Israel Trauma Group.  The casualties from electric bike and motorized scooter road accidents.  Traffic Inj Prev. 2017;18(3):318-323. doi:10.1080/15389588.2016.1246723PubMedGoogle ScholarCrossref
2.
Kobayashi  LM, Williams  E, Brown  CV,  et al.  The e-merging e-pidemic of e-scooters.  Trauma Surg Acute Care Open. 2019;4(1):e000337. doi:10.1136/tsaco-2019-000337PubMedGoogle Scholar
3.
Trivedi  TK, Liu  C, Antonio  ALM,  et al.  Injuries associated with standing electric scooter use.  JAMA Netw Open. 2019;2(1):e187381. doi:10.1001/jamanetworkopen.2018.7381PubMedGoogle Scholar
4.
Trivedi  B, Kesterke  MJ, Bhattacharjee  R, Weber  W, Mynar  K, Reddy  LV.  Craniofacial injuries seen with the introduction of bicycle-share electric scooters in an urban setting.  J Oral Maxillofac Surg. 2019;77(11):2292-2297. doi:10.1016/j.joms.2019.07.014PubMedGoogle ScholarCrossref
5.
Badeau  A, Carman  C, Newman  M, Steenblik  J, Carlson  M, Madsen  T.  Emergency department visits for electric scooter-related injuries after introduction of an urban rental program.  Am J Emerg Med. 2019;37(8):1531-1533. doi:10.1016/j.ajem.2019.05.003PubMedGoogle ScholarCrossref
6.
Aizpuru  M, Farley  KX, Rojas  JC, Crawford  RS, Moore  TJ  Jr, Wagner  ER.  Motorized scooter injuries in the era of scooter-shares: a review of the national electronic surveillance system.  Am J Emerg Med. 2019;37(6):1133-1138. doi:10.1016/j.ajem.2019.03.049PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Research Letter
    Emergency Medicine
    March 31, 2020

    Traumatic Injuries Associated With Standing Motorized Scooters

    Author Affiliations
    • 1HonorHealth Scottsdale Osborn Medical Center, Scottsdale, Arizona
    • 2Independent Researcher, Scottsdale, Arizona
    JAMA Netw Open. 2020;3(3):e201925. doi:10.1001/jamanetworkopen.2020.1925
    Introduction

    Standing motorized scooters are increasingly used for personal transportation,1 yet such devices confer considerable risk for trauma, particularly to the head and extremities.2-5 As potential dangers are not widely known and training is often minimal, riders may often use these devices in an unsafe manner, eg, without protective gear and/or while intoxicated.2 This single-center study assessed the incidence and severity of traumatic injuries associated with motorized scooters and the associated use of protective devices and/or intoxicants.

    Methods

    Following HonorHealth Institutional Review Board approval, a retrospective, single-institution, cross-sectional study via review of deidentified medical records (deemed exempt from informed consent) was conducted to determine the number of patients with scooter-associated injury at the American College of Surgeons Level 1 HonorHealth Scottsdale Osborn Emergency Department (ED) from October 1, 2018, to October 1, 2019. Associated trauma activations were triaged according to severity of trauma (Figure) (red = high, yellow = moderate, and green = low or nonactivation). Data collected included demographic characteristics, medical history, injury type and location, Injury Severity Score, use of protective devices, alcohol and toxicology screening results, medical treatment, ED disposition, imaging and treatments required, and intensive care unit (ICU) care. Descriptive statistics included frequencies and percentages. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    Results

    We identified 61 patients (mean [SD] age, 33.6 [13.0] years; 26 women [43%]) with scooter-related injuries over the study duration (total number of trauma activations = 2070). No incidents involved the use of protective devices at time of injury. The mean (SD) Injury Severity Score was 6.3 (6.0); 2 deaths from traumatic brain injury were recorded. Injury characteristics and ED disposition are presented in the Table. The most common injuries were to the head, face, and/or neck (n = 51 [84%]); 22 of these patients also had extremity injuries. No visceral organ injuries or episodes of hemorrhagic shock were noted. Twenty patients received ICU care, all but 2 of whom had severe head, neck, and/or facial injuries and/or neurological injuries (15 were transferred directly from the ED, and 5 were transferred during their hospital stay). Although a majority of injuries (n = 59 [97%]) were associated with single-rider or single-vehicle incidents, 2 of the severe incidents involved automobiles. Thirty-seven patients tested positive for an intoxicating substance; specifically, 21 tested positive for alcohol, 7 for illicit drug use, and 9 for both.

    Discussion

    Standardized motorized scooters are an increasingly popular mode of transportation,6 but emerging evidence suggests that their use may be associated with an increased risk of injury.3-6 The present study found that scooter-related injuries are highly associated with lack of protective devices and that many injuries occur in the context of alcohol and/or illicit drug use. Although predominantly mild in severity, a minority of injuries were severe and life threatening.

    This study has some limitations. Of note, this was a single-center, retrospective study with a short time frame, including only patients seen by a trauma surgeon in the ED, and therefore may undercount injuries, particularly if minor in severity. This limitation, along with the fact that our institution does not have an intermediate care unit, may explain the relatively high number of patients admitted to the ICU. In line with previous studies,2,3 we found that the use of protective devices appears to be exceedingly rare; indeed, no individuals were found to be using a protective device at time of injury. Furthermore, the use of alcohol and/or illicit drugs was a significant risk factor for injury, consistent with previous findings.2 Taken together, these findings suggest a gap in public awareness of the potential dangers of standing motorized scooters.

    We believe further study is warranted to help formulate public policy and that public awareness of the risk associated with these vehicles needs to be expanded. Furthermore, trauma activation criteria may need to be updated to reflect an increasingly common mechanism of injury.

    Back to top
    Article Information

    Accepted for Publication: January 16, 2020.

    Published: March 31, 2020. doi:10.1001/jamanetworkopen.2020.1925

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Bauer F et al. JAMA Network Open.

    Corresponding Author: Jeffrey D. Riley, MD, (c/o Frank Bauer, MD), HonorHealth Scottsdale Osborn Medical Center, 7351 E Osborn Rd, Ste 200B, Scottsdale, AZ 85251 (jeffriley.md@gmail.com).

    Author Contributions: Dr Bauer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Bauer, Najafi, Markowski.

    Acquisition, analysis, or interpretation of data: Bauer, Riley, Lewandowski, Najafi, Kepros.

    Drafting of the manuscript: Bauer, Riley, Lewandowski, Markowski.

    Critical revision of the manuscript for important intellectual content: Bauer, Lewandowski, Najafi, Kepros.

    Statistical analysis: Bauer, Riley.

    Administrative, technical, or material support: Bauer, Lewandowski, Kepros.

    Supervision: Bauer, Kepros.

    Conflict of Interest Disclosures: None reported.

    References
    1.
    Siman-Tov  M, Radomislensky  I, Peleg  K; Israel Trauma Group.  The casualties from electric bike and motorized scooter road accidents.  Traffic Inj Prev. 2017;18(3):318-323. doi:10.1080/15389588.2016.1246723PubMedGoogle ScholarCrossref
    2.
    Kobayashi  LM, Williams  E, Brown  CV,  et al.  The e-merging e-pidemic of e-scooters.  Trauma Surg Acute Care Open. 2019;4(1):e000337. doi:10.1136/tsaco-2019-000337PubMedGoogle Scholar
    3.
    Trivedi  TK, Liu  C, Antonio  ALM,  et al.  Injuries associated with standing electric scooter use.  JAMA Netw Open. 2019;2(1):e187381. doi:10.1001/jamanetworkopen.2018.7381PubMedGoogle Scholar
    4.
    Trivedi  B, Kesterke  MJ, Bhattacharjee  R, Weber  W, Mynar  K, Reddy  LV.  Craniofacial injuries seen with the introduction of bicycle-share electric scooters in an urban setting.  J Oral Maxillofac Surg. 2019;77(11):2292-2297. doi:10.1016/j.joms.2019.07.014PubMedGoogle ScholarCrossref
    5.
    Badeau  A, Carman  C, Newman  M, Steenblik  J, Carlson  M, Madsen  T.  Emergency department visits for electric scooter-related injuries after introduction of an urban rental program.  Am J Emerg Med. 2019;37(8):1531-1533. doi:10.1016/j.ajem.2019.05.003PubMedGoogle ScholarCrossref
    6.
    Aizpuru  M, Farley  KX, Rojas  JC, Crawford  RS, Moore  TJ  Jr, Wagner  ER.  Motorized scooter injuries in the era of scooter-shares: a review of the national electronic surveillance system.  Am J Emerg Med. 2019;37(6):1133-1138. doi:10.1016/j.ajem.2019.03.049PubMedGoogle ScholarCrossref
    ×