E-scooter users broke bones from head to toe, and a third were so banged up, they were in-hospital for an average of 11 days, a researcher reported.

In a study that tracked and compared the growth of e-scooter injuries from August 2016 to February 2018 — and from August 2018 to February 2020 after e-scooters became widespread — the number of injuries grew from 23 to 197, and the cost of care skyrocketed from $1.8 million to $7.6 million, according to Nicole Look, MD, of Denver Health Medical Center.

In the second period, most injured patients were male (63%) and 73% of the 28% who were tested for alcohol/drugs were found to be intoxicated. About a third of patients (34%) were admitted to the hospital, while 40% required surgery, and 6% had open fractures, Look and colleagues stated in poster session at the American Academy of Orthopaedic Surgeons annual meeting.

“Injuries due to e-scooters are severe and expensive,” Look told MedPage Today. “These are high-energy traumas with increased injury severity scores and increased likelihood of requiring operative intervention. Therefore, they should be treated similar to car or motorcycle accidents.”

Look’s group launched the study at their institution after noticing “all the crazy injuries” due to e-scooters — “highly comminuted, intra-articular complex type fractures that what we would see in high-energy traumas rather than with ground-level falls.” When they saw the trend, “we wanted to collect this concrete data to show the community that e-scooters can be quite dangerous when riding in a city [Denver],” she noted.

“We also confirmed what we typically saw in the emergency department [ED] and operating room,” Look said. “Many of these injuries involve the upper extremity as patients fall on their outstretched hands and the tibia as these patients attempt to brace themselves from a fall by placing their foot on the ground and sustaining a twisting injury. Additionally, head injuries and facial fractures are not uncommon during the fall.”

About two-thirds (64%) of orthopedic injuries were to the upper extremities, most commonly distal radius (14%), proximal radius (12%), and metacarpal (7%) injuries. The most common lower extremity injuries were proximal tibia fractures (8%), ankle fractures (7%), and tibial shaft fractures (3%).

Other e-scooter-related orthopedic injuries were tooth injury (n=3), chest injury (n=12), double forearm fractures (n=5), patellar tendon rupture (n=2), Achilles tendon rupture (n=1), tarsal fractures (n=7), and spine fracture (n=3).

Look said that, in general, the injuries are similar to those in bicyclists. “It’s important for the public to understand that riding an e-scooter must be done with caution and awareness,” she stressed. “And improved enforcement of sobriety while using an e-scooter should be a high priority in cities.”

She added that there’s no sign that injuries are trending downward as users figure out how to safely use e-scooters, but “Many of the patients we see are visiting the city as tourists so I’m not quite sure they have gained experience from riding e-scooters.”

The majority of e-scooter injuries in the study were due to falls and not collisions. A 2021 review in Injury Prevention examined 10 e-scooter studies with relevant data and found that “92.8% of riders were injured in single road user events, while 7.1% were injured in multiple road user events. Single user events included falls, collisions with objects, excessive speed and unfavorable road conditions, with falls (94.6%) being the most common,” according to the Vancouver-based authors.

Those researchers also looked at 16 studies that had data about helmets in e-scooter injuries, and found that only 4.5% of electric scooter riders wore a helmet at the time of their injury, and “A protective effect of helmets on the incidence of head injuries was noted in the sole study where this association was examined.”

ED physician Stephanie VandenBerg, MD, of Calgary Zone and the University of Calgary in Alberta, said the findings from the Denver study were consistent with patterns seen in her city. Her group found that e-scooter injuries made up 3.6% of all traumas that presented to EDs and a single urgent care center in Calgary from 2019 to 2020. In addition, an estimated one in each 1,200 e-scooter trips resulted in an injury requiring treatment, most commonly lower limb injuries. The average age of the injured patients was 34 and 52% were male.

VandenBerg, who was not involved in the Denver study, told MedPage Today that factors contributing to injuries include the challenges of using e-scooters on the road — when they can be too slow for conditions — and on the sidewalk, when they can be too fast. Inappropriate or missing equipment, like helmets, can also spell trouble, she said.

VandenBerg noted that there is a gap in the understanding of the full risk of e-scooter injuries and the ways to reduce it. “We are missing information from the [e-scooter] companies themselves on the [physical] location of the injuries as well as the frequency of injuries that do not present to emergency medical services or emergency departments,” she stated. In 2019, Consumer Reports successfully fought several e-scooter manufacturers to obtain data on company-recorded user injuries.