Our results highlight the significant impact that E-scooter injuries can have on the head and neck region. Facial injuries represent a sizeable cohort of patients injured while using E-scooters.9 In the current literature prevalence of facial injuries has been reported between 58%-62.7%. 10,11,12 A study in Hamburg, Germany found that 46% of injuries associated with e-scooters involved the head/facial injuries.13 A study in Indianapolis, USA identified 89 patients that sustained facial injuries in a 6-month period.14 Given the nature of high-impact trauma associated with E-scooters it is not surprising that some patients sustain significant craniofacial injuries. Traumatic Brain injuries accounted for 18% of scooter-related admission in a case series in San Diego, California.15 One fatality was reported in our cohort.
Demographics of those injured have stark similarities to other studies in that the majority of patients in our cohort were male and aged under 30.14, 15, 16 In keeping with this the majority (72%) of those sustained injuries were due to falls.
UK legislation on E-scooters during the trial period mandated that the user must be 18 years or older and have a valid driver’s license with category Q entitlement. The speed is limited to a maximum of 15.5mph and in certain areas it can be further limited to 8mph. The use of a mobile phone or users being under the influence of alcohol or illicit substances is illegal and can lead to prosecution. Users cannot ride on the pavement. The carrying of passengers on an e-scooter is prohibited however the use of a helmet is not mandatory but recommended.5 There are however a number of safety issues identified namely poor compliance. Our study shows that 41% of patients were under the influence of alcohol or drugs and 34% of patients did not wear helmets. The use of a helmet and being under the influence of alcohol or drugs represents a significant factor in the likelihood of a rider sustaining an injury as shown by other studies.10, 14 The non-use of a helmet in research carried out in Brisbane, Australia showed that there was an associated risk of head injury.17 It remains to be seen if use of facial protections such as shields can reduce the incidence of facial trauma. Traumatic brain injury was also found to be associated with alcohol consumption.18 Research carried out in the United States at show that alcohol consumption amongst users can be between 5.2%-17.2%.15 Our study shows that 41% of patients were recorded as being under the influence, a large cohort in comparison.
Another problematic finding identified was that pedestrians can also be at risk of e-scooter related injuries. Data was not available if users were riding in pedestrianized areas. The silent nature of the devices presents other road users with no audible signals that an e-scooter rider is within the vicinity. This has been identified by the RNIB (Royal National Institute of Blind People).19 In response some e-scooters are being fitted with audible warning systems. The study period focused on the initial trial period by Birmingham City council. The report published by the council states in the trial period there have been 11 serious injuries and 107 minor injuries.6 This is likely to be an underestimate given the difficulty obtaining data from different health trusts. The report does not specifically mention or discuss the costs to the NHS in treating patients that have suffered injuries, but it is likely to be substantial as 69% of patients required operative management under local or general anesthetic. Recently it has been claimed that the cost to the health service is on average £1000 per patient.20 E-scooters can represent a significant personal injury burden to the user as well as having capacity and financial implications to the health service which have been amplified in the COVID-19 pandemic. In a study conducted in New Zealand the cost of treating facial injuries associated with e-scooters totaled $201,023.51 USD.16