The Rapid Escalation of Fractures and Hospital Admissions from Electric Bicycle Injuries in the United States: An Analysis of National Injury Data from 2019 to 2023

Objectives To examine the characteristics, trends, and attributes of fractures sustained by electric bicycle riders and assess the recent healthcare burden in terms of hospital admissions. Methods Design: Retrospective review. Setting: National sample of 100 emergency departments (EDs) in the United States (US). Patient Selection Criteria: The National Electronic Injury Surveillance System (NEISS) was queried for ED presentations with fractures related to e-bicycles between January 1^st 2019 and December 31^st 2023. The clinical narrative associated with each case was reviewed to exclude cases unrelated to fractures sustained by e-bicycle riders. Outcome Measures and Comparisons: NEISS data is a probability sample of US hospitals; each observed sample has an associated weight enabling a population estimate for each individual sample. Sample weights were determined by NEISS using factors that influence likelihood of selection such as hospital size and geographic locations. US population projections (weighted cases) of fractures and admissions were obtained by summing the weights of raw, unweighted NEISS sampled injuries. Pearson’s chi-squared tests were applied to determine differences in injury characteristics among subjects who were admitted to the hospital and those who were not admitted. Results A total of 22,432 e-bicycle fractures occurred in the US from 2019 to 2023, which was a weighted population estimate from 520 raw, unweighted NEISS samples. The number of fractures and admissions increased by 2,371% and 3,146% in 2023, respectively, compared to 2019. Collision with a motor vehicle occurred in nearly one-fourth of fractures, and motor vehicle involvement was significantly associated with hospital admission (36.4% v. 25.1%; p=0.01). Overall, 27.7% of e-bicycle fractures were admitted to the hospital. Upper leg fractures had the highest association with admission (90.7% admission rate) but only consisted of 2.7% of all fractures. The most common fracture location in riders aged <18 was the wrist, while the 35-55 age group and >55 age group were most likely to possess upper trunk fractures (cervical spine, thoracic spine, ribs, sternum). The 18-34 age group and 35-55 age group most commonly sustained fractures involving motor vehicles (29.7% and 28.7%, respectively), but the 18-34 age group possessed a significantly higher rate of overall admission among all age groups (p=0.04). Conclusions There has been a substantial increase in fractures and resource utilization as a result of hospital admissions from e-bicycle riding from 2019-2023. The majority of fractures occurred above the waist, although lower extremity injuries more commonly resulted in admission, and riders aged 35-55 sustained the largest proportion of injuries.