Abstract
Introduction
Electronic bicycles (e-bikes) and scooters (e-scooters) have become increasingly popular throughout the United States (U.S.) in the past decade. With an increase in use, the number of injuries secondary to use of these devices has also sharply risen. The purpose of this study was to ascertain the frequency and types of craniofacial injuries associated with e-bike and e-scooter use in the pediatric population.
Methods
The National Electronic Injury Surveillance System (NEISS) database was queried from 2016 to 2025 for craniofacial injuries associated with e-bike and e-scooter use in pediatric patients ≤17 years of age. Cases were identified using dedicated e-bike/e-scooter product codes, with narrative-text keyword review for years predating consistent device-specific coding. Craniofacial injuries were identified by body part codes corresponding to the head, face, eye, mouth, and ear. Patient demographics, injury characteristics, disposition, season, and year of injury, as well as helmet use were extracted. National injury estimates were calculated using NEISS statistical sample weights.
Results
A total of 2,547 injuries were initially identified. After manual narrative review and exclusion of unrelated injuries, 722 patient encounters were ultimately included. NEISS sampling weights were applied to generate a weighted national estimate of 24,766 pediatric craniofacial e-bike/e-scooter injuries in the United States between 2016 and 2025. No cases were identified in 2016 and 2017. Case volume increased approximately 2.2-fold per year over the included study period of 2018 to 2025 (log-linear trend, R²=0.99, p0.0001). There were an estimated 55 cases in 2018, which rose to 2,313 by 2023 and ultimately reached 12,815 during 2025. 41.6% (N=10,294) of the injuries took place on the street/highway and 38.9% (N=9,639) took place during the summer months. Median age was 14 years and there was a predominance of males (N=20,174, 81.5%). Injuries were most frequently in the head (49.8%) and face (31.2%). 6.3% (N=1,558) sustained craniofacial fractures. The mouth (4.4%), ear (0.6%), and eye (0.06%) were rarely involved. Helmet use was documented as absent in 24.0% of cases (N=5,956). Most patients were treated and released from the emergency room (N=20,189, 81.5%), but 16.5% (N=4,131) were admitted or transferred.
Conclusion
Craniofacial injuries related to e-bike and e-scooter use among pediatric patients have increased substantially from 2016 to 2025. There is an ongoing need for pediatric-specific public health initiatives, including helmet-use counseling and age restrictions. Craniofacial and trauma surgeons, emergency physicians, and pediatricians should be aware of this evolving injury pattern to aid in prevention, counseling, and management of these injuries.