Lavanya Easwaran, MD, and Jose Diaz-Miron, MD, of the University of Colorado Anschutz Department of Surgery, are among the pediatric surgeons across the country concerned about an alarming new trend: children who need surgery after an accident involving an electronic bicycle (e-bike) or scooter (e-scooter).
“E-bikes and e-scooters started getting popular around COVID in 2020, and we started seeing injuries, and then a specific code was created for e-bike and e-scooter accidents in our inpatient coding system,” says Easwaran, a third-year surgery resident. “We saw all these kids coming in with e-bike and e-scooter injuries, and there was even one child who passed away. We realized it was a problem.”
To get a better idea of the scope and number of such injuries, Easwaran and Diaz-Miron analyzed data on pediatric trauma patients at Children’s Hospital Colorado who sustained injuries related to e-bike and e-scooter use, as well as injuries from non-motorized bicycles and scooters, between January 2021 and December 2024. The study was published in October in the Journal of Surgical Research.
“We found that e-bikes and non-motorized bikes didn't differ much in terms of how many CT scans they got, how much intervention they got, how severe the injuries were,” Easwaran says. “With electric scooters, however, we found that the patients had more frequent head injuries than with nonmotorized scooters. They had more frequent thoracic injuries, and they were coming back to the emergency room much more often.”
The study analyzed 11 different injury categories, including head injury, facial injury, and abdominal injury, and found that in some cases — including facial injury and upper extremity injury — numbers were higher for nonmotorized bicycles than for e-bikes. For scooters, numbers were higher for the motorized vehicles in nearly every category. E-scooter injuries also were associated with decreased helmet use, longer hospital admissions, and a greater number of emergency department visits after injury management.
Most importantly, Easwaran and Diaz-Miron saw a 267% increase in the incidence of injuries due to e-bikes and e-scooters from 2021 to 2024.
“The slope is almost vertical when we're talking about injury patterns,” says Diaz-Miron, associate professor of pediatric surgery. “We used to have very few, and they've gone up quite a bit in the past few years, even just at Children's Hospital Colorado.”
The numbers point to the need for more awareness around safety gear — including wraparound helmets designed specifically for e-bike and e-scooter use and more available helmets on rental vehicles — but Easwaran and Diaz-Miron are now expanding their research, conducting interviews with children who have been injured in e-bike or e-scooter accidents, as well as their parents, to better understand how and why such injuries are happening. They are also getting a better grasp on e-bike and e-scooter culture and why the vehicles are so important for many children’s mobility, social growth, and sense of independence.
“We are trying to get to the root of the problem: Are you wearing safety gear? If you're not, why not?” Diaz-Miron says. “Are you using traditional e-bikes? Are you altering your e-bikes to make them go faster? These are things that you can't grasp by just looking at the data. The qualitative metrics allow us to get into how people are thinking about this and why people are putting themselves in these risky situations.”
“The kids are telling us they love the community that comes with the e-bikes and e-scooters — that they feel left out if they're not able to use them,” Easwaran adds. “They like them because they're easy to ride, they're easy to modify, and they can go longer distances. It gives them a level of independence that regular bikes don't give them.”
Easwaran and Diaz-Miron pitched the research study to the Midwestern Pediatric Surgery Research Consortium, a group of 12 children’s hospitals that includes Children’s Colorado, and the project was picked up as one of the collective’s multidisciplinary, multi-institutional projects. The research the CU surgeons are conducting on e-bike and e-scooter riders and their parents will be combined with similar research at the other institutions to create a more comprehensive look at the growing problem — and eventually, formal recommendations to address it.
“The published articles on e-bike and e-scooter injuries are mostly about the growing numbers,” Diaz-Miron says. “This is going to be pretty eye-opening, to see how kids and their parents are thinking about these mobility devices. Hopefully, that can add quite a bit to the literature."