Trends in Emergency Department Visits for Electric Scooter and Electric Bicycle Injuries in the United States, 2014–2023: A Retrospective Observational Study

Abstract

Importance: Electric scooters (e-scooters) and electric bicycles (e-bikes) have become increasingly common in US cities since 2017. However, national estimates of emergency department (ED) visits and severity trends using evaluated case definitions remain limited. Objective: To estimate national trends in ED visits, severity shares, and patient characteristics for e-scooter and e-bike injuries from 2014 to 2023, with conventional-bicycle injuries as a comparison series. Design, Setting, and Participants: Retrospective observational study of the National Electronic Injury Surveillance System (NEISS), a stratified probability sample of US hospital EDs, 2014–2023. Cases were ED visits for injuries involving a ridden e-scooter, e-bike, or conventional bicycle, with no age restriction. Exposures: Calendar year and device type. Main Outcomes and Measures: Trends in annual national estimates of ED visit counts, severity shares (admission, transfer, fracture), and patient characteristics. Results: The analysis included 5,514 e-scooter and 1,732 e-bike cases, representing an estimated 186,361 and 74,646 ED visits nationally from 2014 to 2023. From 2019 to 2023, estimated e-scooter visits increased from 14,714 to 50,209 (3.4-fold; 95% CI, 1.9-4.9), and e-bike visits increased from 2,076 (unstable 2019 baseline; n = 52; coefficient of variation, 36.7%) to 31,517 (absolute increase, 29,442; 95% CI, 18,246-40,638; 2022-2023 ratio, 1.39; 95% Fieller CI, 1.12-2.03). The proportion of e-scooter cases involving patients younger than 18 years decreased from 50.9% (95% CI, 36.0%-65.9%) in 2014-2018 to 19.4% (95% CI, 13.8%-25.0%) in 2019-2023. From 2019 to 2023, admitted-or-transferred proportions ranged from 10.9% to 15.4% (e-scooter) and from 7.4% to 14.9% (e-bike), and primary-diagnosis fracture proportions ranged from 27.1% to 30.2% and from 17.4% to 29.0%, respectively, with no statistically detectable annual trend. Over the decade, an estimated 31,640 visits resulted in admission or transfer. In contrast, conventional-bicycle visits decreased 23% from 2014 to 2023 (ratio, 0.77; 95% CI, 0.61-0.93). Consumer Product Safety Commission surveillance reported 381 e-scooter and e-bike deaths from 2017 to 2023. Conclusions and Relevance: In this retrospective observational study, US ED visits involving e-scooters and e-bikes increased substantially from 2019 to 2023, while conventional-bicycle visits declined from 2014 to 2023. No trend in admission-or-transfer or fracture proportions was detected from 2019 to 2023, although estimates were imprecise and do not establish that severity was unchanged. The scale of this growth represents a substantial and ongoing demand on emergency and inpatient care.