Accident Mechanisms and Injury Patterns in E-Scooter Users
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MEDICINE
Original Article
Accident Mechanisms and Injury Patterns in
E-Scooter Users
A Retrospective Analysis and Comparison With Cyclists
Holger Kleinertz, Dimitris Ntalos, Fabian Hennes, Jakob V. Nüchtern, Karl-Heinz Frosch, Darius M. Thiesen
I
n June 2019, the rental of electrically powered scooters
Summary (e-scooters) was started in major German cities.
Studies from the USA, where for several years electric
Background: E-scooter sharing systems were initiated in Hamburg in June 2019.
scooters have already become part of city life, notably
The number of persons injured in Hamburg in e-scooter accidents rose thereafter.
show a large number of cases of associated fractures
The goal of this study was to determine the typical accident mechanisms and injury
(26–32 %) and head injuries (28–40%) (1–3). These
patterns after e-scooter accidents in Germany, and to compare these with bicycle
observations have also been confirmed in studies from
accidents.
Europe (Denmark, Copenhagen) and also, as of May
Methods: In a retrospective study, accidents with e-scooters and bicycles that oc- 2020, from Germany (Frankfurt) (4, 5).
curred from June 2019 to June 2020 were registered and analyzed with respect to However, the wide variety of regulations in force
demography, accident mechanisms, diagnostics, patterns of injury, emergency abroad makes comparison with the German road traf-
medical care, operations, and inpatient hospitalizations. fic situation difficult. Given the enormous popularity
and similar use of bicycles in Germany (6), a direct
Results: 89 persons sustained e-scooter accidents (mean age 33.9 years, standard comparison between e-scooter and cycle accidents
deviation [SD] 14 years); 435 persons who sustained bicycle accidents (mean age would appear worthwhile. A need for this study is jus-
42.5 years, SD 17 years) served as a comparison group. E-scooter accidents more
tified, firstly, by the fact that so far there has only
commonly occurred at night (37% versus 14%), and 28% of the persons who sus-
been limited research on the integration of e-scooters
tained them were under the influence of alcohol (cyclists: 6%). 54% of the injured
on German roads and, secondly, by the ongoing de-
e-scooter riders suffered trauma to the head or face; 14% had a severe head injury
bate about this form of transportation.
and 16% had a severe facial injury. Fractures of the upper limbs were more com-
The aim of this study is to analyze the frequency of
mon than fractures of the lower limbs (18% versus 6%). On initial assessment in the
dical cosultations, the circumstances of the accident
emergency room, injured cyclists were more frequently classified as needing
event, typical injury patterns, and accident severity
immediate treatment than injured e-scooter riders (7% versus 1%).
involving e-scooter users in an urban area in Germany
Conclusion: The head, face, and upper limbs are the most commonly affected parts and to compare these parameters with those of cyc-
of the body in e-scooter accidents. Compared to bicycle accidents, e-scooter acci- lists.
dents more commonly occur on weekends and in association with alcohol. From a
medical point of view, abstaining from alcohol consumption and wearing a helmet Method
when using an e-scooter is strongly recommended. Data on all visits to the Emergency Department or the
Outpatient Department of the University Medical
Cite this as:
Center Hamburg-Eppendorf associated with the use of
Kleinertz H, Ntalos D, Hennes F, Nüchtern JV, Frosch KH, Thiesen DM:
e-scooters were gathered retrospectively. The elec-
Accident mechanisms and injury patterns in e-scooter users—a retrospective
tronic patient records covering the period from
analysis and comparison with cyclists. Dtsch Arztebl Int 2021; 118: 117–21.
24.06.2019 up to and including 30.06.2020 were
DOI: 10.3238/arztebl.m2021.0019
searched using the key words “scooter”, “e-scooter”,
and the corresponding German terms “Roller” and
“E-Roller”. Similarly, the electronic patient records
covering the period from 01.07.2019 up to and includ-
ing 31.10.2019 were automatically searched using the
key words “bicycle” and “bike”.
Department of Trauma and Orthopedic Surgery, Details were recorded from patient records regard-
University Medical Center Hamburg-Eppendorf: Dr. med. Holger Kleinertz, Dr. med. Dimitris Ntalos,
Dr. med. Fabian Hennes, Prof. Dr. med. Karl-Heinz Frosch, Dr. med. Darius M. Thiesen ing the time of the accident, circumstances of the ac-
UKE Athleticum, University Medical Center Hamburg-Eppendorf: Dr. med. Dimitris Ntalos
cident event, diagnosis, and treatment. Where aspects
were not clear from the documentation, they were
Department of Trauma Surgery, Orthopedics and Sports Traumatology, Asklepios Klinik St. Georg,
Hamburg: PD Dr. med. Jakob V. Nüchtern listed as “not specified”. “Not specified” with respect
Department of Trauma Surgery, Orthopedics and Sports Traumatology, BG Klinikum Hamburg: to the variable “alcohol-intoxicated patient” was
Prof. Dr. med. Karl-Heinz Frosch regarded as a non-intoxicated patient.
Deutsches Ärzteblatt International | Dtsch Arztebl Int 2021; 118: 117–21 117MEDICINE
TABLE 1 This is a descriptive analysis without alpha-error
adjustment reporting case numbers of a sample taken
Circumstances of the accident event* from the total population of Hamburg. 95%
E-scooter Bicycle p-value confidence intervals (CI) were calculated for a total
population of 1.8 million inhabitants of Hamburg
Total number of cases 89 435
with a sample size of 524. Continuous variables were
– Age, mean ± SD (years) 33.9 ± 14 42.5 ± 17MEDICINE
Injury pattern TABLE 2
Twelve percent of the e-scooter riders sustained a
traumatic brain injury (TBI) and 2% an intracranial Injury pattern*
hemorrhage (ICH). Apart from soft-tissue injuries in E-Scooter Number Bicycle Number (% p-value
33% of e-scooter accidents, injuries to the face also in- (% [CI]) [CI])
cluded fractures of the facial bones which were diag- Head 0.594
nosed in 16% of cases. Whereas head injuries were
– Contusion 9 (10 [4; 16]) 67 (15 [12; 18])
seen somewhat more often in cyclists, e-scooter riders
tended to have sustained more fractures and soft-tissue – TBI 11 (12 [5; 19]) 51 (12 [9; 15])
injuries to the facial bones (p = 0.058) (Table 2). – ICH 2 (2 [0; 5]) 13 (3 [1; 5])
Injuries to the chest, abdomen and spine did not – Soft-tissue injury 2 (2 [0; 5]) 23 (5 [3; 7])
occur to any clinically relevant degree in e-scooter
– Fracture 1 (2 [0; 5]) 10 (2 [1; 3])
riders, while chest injuries in particular were more
often seen in cyclists (p = 0.039)(Table 2). Face 0.058
Fractures of the upper extremities were consider- – Contusion 12 (14 [7; 21]) 87 (20 [16; 24])
ably more frequent in e-scooter riders and cyclists – Fracture 14 (16 [8; 24]) 40 (9 [6; 12])
than fractures of the lower extremities. The most
– Soft-tissue injury 29 (33 [23; 43]) 115 (26 [22; 30])
common fractures in e-scooter riders were clavicle
fractures, disruptions of the acromioclavicular joint Dental injury 11 (12 [5; 19]) 34 (8 [5; 11]) 0.165
(AC joint), fractures of the radial head and radial Chest injury 0.039
neck, and tibial plateau fractures. The shoulder was – Contusion 3 (3 [0; 7]) 26 (6 [4; 8])
the most commonly dislocated joint (Table 2).
More severe soft-tissue injuries of the extremities – Fracture 0 18 (4 [2; 6])
were seen in the malleolar region of the e-scooter – Pneumothorax 0 6 (1 [0; 2])
riders with partial (subtotal) division of the tibialis Spine 0.139
posterior tendon in 6% of cases.
– Contusion/sprain 2 (2 [0; 5]) 20 (5 [3; 7])
While 2% (8 cases) of the cyclists were severely
injured casualties, with two fatalities, no such severe – Fracture 0 7 (2 [1; 3])
injuries were seen among the e-scooter riders. Pelvic fracture 0 4 (1 [0; 2])
Upper extremity fracture 16 (18 [10; 26]) 106 (24 [20; 28]) 0.200
Diagnostics, treatment, and discharge modality
Lower extremity fracture 5 (6 [1; 11]) 25 (6 [4; 8]) 0.963
Wound care was required significantly more often in
e-scooter riders in 46% of cases than in cyclists in 27% Total fractures 31 (34 [24; 44]) 162 (37 [32; 42]) 0.679
of cases (p < 0.001). Plaster casts or braces were Total dislocations 5 (6 [1; 11]) 18 [4 (2; 6]) 0.536
applied to an equal extent in 30% and 31% of cases,
respectively (Table 3). *Data presented as case numbers and percent with 95% confidence interval [CI]
ICH, intracranial hemorrhage; TBI, traumatic brain injury
In the majority of cases, patients were discharged
into outpatient care after primary treatment. In both
groups, about one third of cases required hospital ad-
mission. There was an indication for surgery in 28%
of e-scooter and in 24% of cycling accidents. The Zealand, and Denmark present similar numbers
exact frequencies regarding diagnostics, treatment (eTable). The proportion of head and facial injuries in
and discharge modality are listed in Table 3. the foreign studies was also between 20 and 46% (3,
4, 8, 9). Whereas a helmet was worn in 4–6% of cases
Discussion in other countries (Denmark, USA, and New Zealand)
This study presents the largest study population to date (1, 4, 8), there was no documented helmet wearer
involving injuries to e-scooter users in Germany. Alto- among the e-scooter users in our patient population
gether, 89 patients were included in the study over a from Hamburg. In a study from Brisbane, Australia,
period of one year and compared with 435 cyclists in- published in 2019, 46% of the injured e-scooter riders
jured over a period of four months. A total of 50 had worn a helmet. A comparison of the subgroups
e-scooter-associated accidents were registered during demonstrated a significant reduction in the severity of
the corresponding four months, with accidents in- the head injuries among the helmet users (10). The
volving the use of cycles being unsurprisingly about difficulty here obviously lies in the provision of hel-
nine times more frequent. mets as part of the e-scooter hire scheme and the lack
A striking feature is the large number of clinically of compulsory helmet use in Germany.
relevant head and facial injuries diagnosed in 46% of The influence of alcohol also appears to be a risk
the e-scooter cases. In May 2020, Störmann et al. factor contributing towards the large number of head
from Frankfurt reported 38% head and facial injuries injuries in e-scooter riders. Among the 25 alcohol-
in their study population involving 76 injured intoxicated patients, 23 (92%) sustained an injury to
e-scooter users (5). Studies from the USA, New the head or face. In addition, 12 of 31 patients (39%)
Deutsches Ärzteblatt International | Dtsch Arztebl Int 2021; 118: 117–21 119MEDICINE
TABLE 3
Diagnostics/treatment in the emergency department/outpatient department and discharge modality*
E-Scooter Bicycle p-value
Number (% [CI]) Number (% [CI])
Specialist departments involved
– Trauma surgery 74 (83 [76; 90]) 398 (92 [89; 95]) 0.214
– Oral and maxillofacial surgery 44 (49 [39; 59]) 128 (30 [26; 34])MEDICINE
Conflict of interest statement 10. Mitchell G, Tsao H, Randell T, Marks J, Mackay P: Impact of electric scooters to
The authors declare that no conflict of interest exists. a tertiary emergency department: 8-week review after implementation of a scooter
share scheme. Emerg Med Australas 2019; 31: 930–4.
Manuscript received on 18 February 2020, revised version accepted on 11. Badeau A, Carman C, Newman M, Steenblik J, Carlson M, Madsen T: Emergency
13 October 2020. department visits for electric scooter-related injuries after introduction of an urban
rental program. Am J Emerg Med 2019; 37: 1531–3.
Translated from the original German by Dr. Grahame Larkin, MD
12. FindLaw‘s team: California DUI Laws. www.findlaw.com/dui/laws-resources/califor
nia-dui-laws.html (last accessed on 10 February 2020).
References
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scooter injuries in the era of scooter-shares: a review of the national electronic
surveillance system. Am J Emerg Med 2019; 37: 1133–8. 14. Zwipp H, Dahlen C, Amlang M, Rammelt S: Injuries of the tibialis posterior tendon:
diagnosis and therapy. Orthopade 2000; 29: 251–9.
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: 15. Authorities/Other Agencies of State: E-scooters (declaration not to be motor
357–9. vehicles) notice 2018. New Zeal Gaz 2018. https://gazette.govt.nz/notice/id/
3. Trivedi TK, Liu C, Antonio ALM, et al.: Injuries associated with standing electric scooter 2018-au4674 (last accessed on 10 February 2020).
use. JAMA Netw open 2019; 2: e187381.
4. Blomberg SNF, Rosenkrantz OCM, Lippert F, Collatz Christensen H: Injury from Corresponding author
electric scooters in Copenhagen: a retrospective cohort study. BMJ Open 2019; 9: Dr. med. Holger Kleinertz
e033988. Universitatsklinikum Hamburg-Eppendorf
Klinik und Poliklinik für Unfallchirurgie und Orthopädie
5. Störmann P, Klug A, Nau C, et al.: Characteristics and injury patterns in electric-scooter Martinistr. 52, 20246 Hamburg, Germany
related accidents - a prospective two-center report from Germany. J Clin Med 2020; 9: h.kleinertz@uke.de
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6. Statistisches Bundesamt: Kraftrad- und Fahrradunfälle im Straßenverkehr 2018. Cite this as:
Verkehrsunfälle 2019; 5462408–18700–4. Kleinertz H, Ntalos D, Hennes F, Nüchtern JV, Frosch KH, Thiesen DM:
7. Mackway-Jones K, Marsden J, Windle J: Emergency triage. Manchester Triage Group. Accident mechanisms and injury patterns in e-scooter users—
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3 edition. Hoboken, New Jersey, USA: Wiley-Blackwell 2014. a retrospective analysis and comparison with cyclists.
8. Mayhew LJ, Bergin C: Impact of e-scooter injuries on emergency department Dtsch Arztebl Int 2021; 118: 117–21. DOI: 10.3238/arztebl.m2021.0019
imaging. J Med Imaging Radiat Oncol 2019; 63: 461–6.
►Supplementary material
9. Trivedi B, Kesterke MJ, Bhattacharjee R, Weber W, Mynar K, Reddy LV:
Craniofacial injuries seen with the introduction of bicycle-share electric scooters eTable:
in an urban setting. J Oral Maxillofac Surg 2019; 77: 2292–7. www.aerzteblatt-international.de/m2021.0019
CLINICAL SNAPSHOT
An Incidental Finding of Renal
Arteriovenous Fistula and
Parapelvic Venous Aneurysm
A 46-year-old male patient presented to his primary care
provider for screening. The latter detected a perfused mass
in the right renal pelvis on routine ultrasound. Blood
pressure levels had been normal when previously
measured at the medical office and were 128/78 mmHg at
diagnosis. No auscultatory gap was found at the respective
renal location. Ultrasound examination (Figure a) revealed
an arteriovenous fistula in the renal parenchyma (arrows)
draining into a large, parapelvic venous aneurysm. The
volume of the fistula was determined on ultrasound to be
approximately 1000 mL/min. Following computed
tomography verification (Figure b) of the findings, the fistula a b
was catheterized during the angiography and occluded by
means of coil and onyx-based embolization. No changes in blood pressure were observed following the intervention. Kidney biopsy, which is the
most frequent cause of renal AV fistulas, had not been performed in this patient. In terms of medical history, the patient had suffered a motorcycle
accident 20 years previously and sustained bruising to the abdominal area, making a traumatic etiology appear likely.
Prof. Dr. med. Markus Meier, Nierenzentrum Reinbek und Geesthacht, Reinbek, markus.meier@dialyse-reinbek.de
Universitätsklinikum Schleswig-Holstein, Medizinische Klink I, Campus Lübeck
PD Dr. med. Jan Peter Goltz, Sana Kliniken Lübeck GmbH
PD Dr. med. Martin Nitschke, Universitätsklinikum Schleswig-Holstein, Medizinische Klink I, Campus Lübeck
Conflict of interest statement: Conflict of interests: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Meier M, Goltz JP, Nitschke M: An incidental finding of renal arteriovenous fistula and parapelvic venous aneurysm.
Dtsch Arztebl Int 2021; 118: 121. DOI: 10.3238/arztebl.m2021.0098
Deutsches Ärzteblatt International | Dtsch Arztebl Int 2021; 118: 117–21 121MEDICINE
Supplementary material to:
Accident Mechanisms and Injury Patterns in E-Scooter Users
A Retrospective Analysis and Comparison With Cyclists
by Holger Kleinertz, Dimitris Ntalos, Fabian Hennes, Jakob .V Nüchtern, Karl-Heinz Frosch, and Darius M. Thiesen
Dtsch Arztebl Int 2021; 118: 117–21. DOI: 10.3238/arztebl.m2021.0019
eTABLE
Legislation and study results in comparison with various countries
Maximum speed allowed
Compulsory helmet use
Influence of alcohol (%)
Extremity fractures (%)
Minimum age (years)
Surgery required (%)
hospitalization (%)
Facial fracture (%)
Alcohol limit (‰)
Helmet worn (%)
Driving license
TBI/ICH (%)
Immediate
Cases (n)
Country
Study
New 18 yes no none 20 km/h Mayhew et 64 19 / 5 13 42 40 *3 25 n.s. 6
Zealand*1 al. (8)
USA, 16 yes yes, < 18 years; 0.0 under 21 years, 15 mph = Trivedi et 249 38*4 / 2 5 25 5 n.s. 5 4
California no, 18 years 0.08 21 and older 24 km/h al. (3)
and older)
Denmark 15 no no 0.5 20 km/h Blomberg 112 21*4 / 1 n.s. 12*5 n.s. n.s. 37 4
et al. (4)
Germany 14 no no 0.5 20 km/h Kleinertz 89 12 / 2 16 24 20 28 28 0
et al.
Australia, 16 (12 no yes 0.5 25 km/h Mitchell et 54 19*4 / 0 n.s. 30 13 17 28 46
Brisbane*2 under al. (10)
supervi-
sion)
*1 In New Zealand e-scooters are not considered to be motorized means of transport, so an alcohol ban does not apply (15)
*2 Banned in public areas in most states, only Brisbane listed here
*3 Total inpatient admissions
*4 Mild head injuries included
*5 All fractures
ICH, intracranial hemorrhage; n.s., not specified; TBI, traumatic brain injury
6 Deutsches Ärzteblatt International | Dtsch Arztebl Int 2021; 118: 117–21 | Supplementary materialYou can also read
