Electric bicycle riding may be increasing the risk of severe injury in the pediatric population

A study published in the journal Surgery Open Science finds that children riding electric bicycles are more prone to injuries and related hospitalization than those riding pedal bicycles.

Background

The usage of electric bicycles (e-bikes) for commuting and recreation has increased significantly in recent years. E-bikes have many advantages over gas-powered vehicles, including being zero-emission, the ability to have more bicycle infrastructure and lower travel costs.

People riding e-bikes can achieve a speed of 20 miles per hour without pedal assistance. Moreover, e-bikes are not regulated as motor vehicles in most of the countries across the world.

Because of the provision of achieving higher speeds with less effort, e-bike riders are more prone to internal injuries, concussions, and hospitalization than pedal bicycle riders. Moreover, evidence indicates that pediatric e-bike riders less frequently wear helmets, leading to severe injuries, including facial fractures and intracranial hemorrhage.

In this study, scientists have compared the rates of pediatric injuries between e-bike, pedal bicycle, and moped (gasoline-powered bicycle) riders.

Study design

The data collected from the National Electronic Injury Surveillance System (NEISS), USA, was used to identify the incidence of e-bike, pedal bicycle, and moped injuries among children aged 2 to 18 years. The NEISS covers approximately 100 hospital emergency departments, including 20 pediatric emergency departments, located across the US and its territories.

The study comparisons were stratified by patient age and helmet usage and were conducted in two time periods, i.e., 2011 to 2015 and 2016 to 2020. Four age groups (2–5 years, 6–9 years, 10–13 years, and 14–18 years) were considered for the comparisons.   

Important observations

A significant variation in the frequencies of e-bike, pedal bicycle, and moped injuries was observed across age groups. During the entire study period (2011 – 2020), about 3,945 e-bike injuries, 2,048,826 pedal bicycle injuries, and 23,300 moped injuries were reported.

The majority of these injuries occurred in male patients. The average age of injury was 12 years, 7 years, and 14 years for e-bike, pedal bicycle, and moped riders, respectively.

A significant induction in the rate of injury due to e-bike usage was observed over the period of 10 years (2011 – 2020). In contrast, a significant reduction in pedal bicycle-related injuries was observed during the same period. No such change was observed for moped-related injuries.

The comparisons of the rate of severe injuries requiring hospital admission or transfer between two study periods revealed a reduction from 18.3% to 12.2% for e-bikes, an induction from 5.1% to 5.7% for pedal bicycles, and an induction from 4.0% to 11.0% for mopeds.

Among e-bike rides, the most common types of injuries were laceration, fracture, internal injury, and concussion. The most commonly affected anatomical sites were the head, neck, or face, lower extremity, upper extremity, and trunk.    

Among pedal bicycle riders, the most common types of injuries were contusion, laceration, fracture, and concussion. The most common sites of injury were upper extremity, head, neck, or face, lower extremity, and trunk.

For moped riders, the most common types of injuries were contusion, fracture, strain, internal injury, and concussion. The most common sites of injuries were the lower extremity, upper extremity, head, neck, face, and trunk.

Compared to pedal bicycle and moped riders, e-bike riders had significantly higher rates of internal injuries and fractures. Moreover, e-bike riders reported the highest rate of secondary injury at the second anatomical site.

Compared to pedal bicycle and moped riders, e-bike riders had significantly higher rates of severe injuries that required hospital admission or transfer. Specifically, e-bike riders showed 2.4 times and 1.7 times higher risks of severe injury compared to pedal bicycle riders and moped riders, respectively.

Because of the lack of information on helmet usage, the study could not conduct any statistical comparisons in this parameter. However, the analysis of available data indicated that about 97% of e-bike riders were without a helmet at the time of injury, compared to 82% of pedal bicycle riders and 87% of moped riders.   

Study significance

The study finds that the frequency of e-bike injuries among children has gradually increased over time. Pediatric e-bike injuries are associated with a higher risk of hospitalization than pedal bicycle injuries. Moreover, the frequency of helmet usage is lower among pediatric e-bike riders compared to that among pedal bicycle and moped riders.

The researchers urged for more attention to e-bike safety and helmet usage to improve pediatric public health.