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Figure.  Trends in Weighted Incidence of Electric Scooter Injuries Seen in Emergency Departments in the US From 2014 to 2019 by Select Age Groups
Trends in Weighted Incidence of Electric Scooter Injuries Seen in Emergency Departments in the US From 2014 to 2019 by Select Age Groups
Table.  Patient Demographic and Injury Characteristics Associated With Electric Scooter Injuries Seen in Emergency Departments in the US From 2014 to 2019
Patient Demographic and Injury Characteristics Associated With Electric Scooter Injuries Seen in Emergency Departments in the US From 2014 to 2019
1.
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.2019.03.049 PubMedGoogle ScholarCrossref
2.
Namiri  NK, Lui  H, Tangney  T, Allen  IE, Cohen  AJ, Breyer  BN.  Electric scooter injuries and hospital admissions in the United States, 2014-2018.   JAMA Surg. 2020;155(4):357-359. doi:10.1001/jamasurg.2019.5423 PubMedGoogle Scholar
3.
Ishmael  CR, Hsiue  PP, Zoller  SD,  et al.  An early look at operative orthopaedic injuries associated with electric scooter accidents: bringing high-energy trauma to a wider audience.   J Bone Joint Surg Am. 2020;102(5):e18. doi:10.2106/JBJS.19.00390 PubMedGoogle Scholar
4.
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.2018.7381 PubMedGoogle Scholar
5.
Chiland  E. California removes helmet requirement for electric scooters. Curbed. September 21, 2018. Accessed July 20, 2020. https://la.curbed.com/2018/9/21/17884220/bird-lime-scooters-rules-helmets-california
6.
Felton  R. 8 Deaths now tied to e-scooters: the reports come as a CR survey finds riders confused about where to use scooters, and some cities consider banning them. Consumer Reports. June 3, 2019. Accessed April 21, 2020. https://www.consumerreports.org/product-safety/deaths-tied-to-e-scooters/
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    Research Letter
    Emergency Medicine
    August 31, 2020

    Estimated Incidence of Electric Scooter Injuries in the US From 2014 to 2019

    Author Affiliations
    • 1Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
    • 2Department of Surgery, Mayo Clinic, Rochester, Minnesota
    JAMA Netw Open. 2020;3(8):e2014500. doi:10.1001/jamanetworkopen.2020.14500
    Introduction

    In late 2017, scooter-share companies began distributing electric scooters (e-scooters) in major cities, leading to an increase in their use.1-3 Data from the 2019 United States Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) have recently become available, allowing continued analysis of nationwide trends in e-scooter injuries since the widespread expansion of scooter-share services. The purpose of this cross-sectional study was to assess the incidence of and trends among e-scooter injuries in the US from 2014 to 2019.

    Methods

    This cross-sectional study used data from the NEISS, a statistically valid surveillance system designed to collect data on patients seen in emergency departments (EDs) with injuries related to consumer products by creating a probability sample from approximately 100 hospitals in the US. The NEISS has previously been used to examine e-scooter injuries.1,2 It was queried for cases with product code 5042 (scooters/skateboards, powered) and identified 5171 unweighted cases. Electric-scooter injuries were then isolated from the sample through a search with inclusion of the term scooter and exclusion of the terms hover, board, skate, wheelchair, motorbike, and motorcycle, leaving 1823 cases available for analysis. The Emory University institutional review board waived the requirement for review because the study did not meet the definition of human subjects research. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    Weighted estimates and 95% CIs were created within the complex samples function of SPSS Statistics, version 26.0 (IBM). Data from the US Census Bureau were used to create weighted incidences per 100 000 population. To evaluate trends from 2014 to 2019, regression with a log function was used while accounting for the standard error of the estimates. The significance level was set at P < .05 using a 2-sided test.

    Results

    There were an estimated 70 644 (95% CI, 53 838-87 448) ED visits for e-scooter–related injuries from 2014 to 2019. The mean (SD) age of those injured was 31.3 (21.24) years (95% CI, 29.4-33.2 years), and 63.9% were men. The estimated number of ED visits for e-scooter injuries increased from 4881 (95% CI, 4086-5676) in 2014 to 29 628 (95% CI, 14 919-44 338) in 2019, with an increase from 8269 visits (95% CI, 5409-11 130 visits) in 2017 to 15 522 visits (95% CI, 8280-22 763 visits) in 2018. The population-adjusted incidence increased from 1.53 per 100 000 capita (95% CI, 1.28-1.78 per 100 000 capita) in 2014 to 9.22 per 100 000 capita (95% CI, 4.64-13.79 per 100 000 capita) in 2019 (Figure). Incident ED visits for e-scooter–related injuries increased most substantially among individuals aged 15 to 24 years and 25 to 39 years (Figure, Table).

    The head was the most common site of injury (27.1% of all injuries). Approximately 50% of head injuries included diagnoses that suggested a traumatic brain injury (a head injury with a concomitant diagnosis of a concussion, internal organ injury, fracture, anoxia, or hemorrhage), constituting 14.5% of the total injury pool. Of patients presenting with a potential traumatic brain injury, 17.4% were admitted to the hospital compared with 7.7% of patients without this diagnosis (P < .001). In 2019, an estimated 2656 (95% CI, 494-4818) e-scooter injuries involved substance use, with 88.1% involving alcohol (Table).

    Discussion

    The estimated incidence of e-scooter injuries treated in EDs in the US nearly doubled between 2018 and 2019 despite various regulatory efforts and evidence highlighting this issue.1,2 Head injuries were the most common cause of visits to the ED, and traumatic brain injuries were prevalent among those injured. These results are troubling given that helmets are used by a minority of riders, helmet requirements have been eliminated in some areas, and riders often misunderstand road traffic laws that guide e-scooter use.1,4-6

    Limitations of this study include possible underestimation of injuries, a lack of data outside ED visits, and the absence of information on helmet use. Estimates with fewer than 1200 weighted cases may be unstable. Furthermore, the weighted estimates presented here may not represent the true national incidence of scooter injuries seen in the ED, because scooters are unlikely to be equally distributed across sampled areas. Strengths include the use of a nationally representative data set.

    The estimated incidence of e-scooter–related injuries seen in EDs increased between 2014 and 2019; thus, this appears to be an important public health issue. Continued efforts should be made to investigate strategies, such as required helmet use, enforcement of laws against riding under the influence of alcohol or drugs, and e-scooter safety education, to potentially mitigate the most serious injuries and keep riders safe.

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    Article Information

    Accepted for Publication: June 11, 2020.

    Published: August 31, 2020. doi:10.1001/jamanetworkopen.2020.14500

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

    Corresponding Author: Eric R. Wagner, MD, Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park S, Atlanta, GA 30329 (eric.r.wagner@emory.edu).

    Author Contributions: Mr Farley and Dr Wagner had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: Farley, Aizpuru, Wilson, Daly, Gottschalk.

    Drafting of the manuscript: Farley, Aizpuru, Wilson, Daly, Gottschalk, Wagner.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Farley, Aizpuru, Daly.

    Obtained funding: Farley.

    Administrative, technical, or material support: Farley, Daly, Xerogeanes, Gottschalk, Wagner.

    Supervision: Farley, Wilson, Daly, Xerogeanes, Gottschalk, Wagner.

    Conflict of Interest Disclosures: Dr Gottschalk reported receiving grants from Stryker, Konica Minolta, and Arthrex outside the submitted work. No other disclosures were reported.

    References
    1.
    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.2019.03.049 PubMedGoogle ScholarCrossref
    2.
    Namiri  NK, Lui  H, Tangney  T, Allen  IE, Cohen  AJ, Breyer  BN.  Electric scooter injuries and hospital admissions in the United States, 2014-2018.   JAMA Surg. 2020;155(4):357-359. doi:10.1001/jamasurg.2019.5423 PubMedGoogle Scholar
    3.
    Ishmael  CR, Hsiue  PP, Zoller  SD,  et al.  An early look at operative orthopaedic injuries associated with electric scooter accidents: bringing high-energy trauma to a wider audience.   J Bone Joint Surg Am. 2020;102(5):e18. doi:10.2106/JBJS.19.00390 PubMedGoogle Scholar
    4.
    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.2018.7381 PubMedGoogle Scholar
    5.
    Chiland  E. California removes helmet requirement for electric scooters. Curbed. September 21, 2018. Accessed July 20, 2020. https://la.curbed.com/2018/9/21/17884220/bird-lime-scooters-rules-helmets-california
    6.
    Felton  R. 8 Deaths now tied to e-scooters: the reports come as a CR survey finds riders confused about where to use scooters, and some cities consider banning them. Consumer Reports. June 3, 2019. Accessed April 21, 2020. https://www.consumerreports.org/product-safety/deaths-tied-to-e-scooters/
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