E-bike head trauma soars as helmet use falls, study finds

E-bike injuries have surged, sending thousands of Americans to hospitals in recent years, new research shows.

Electronic bicycle accidents were particularly hard on riders' heads, especially the majority of those injured who didn't wear helmets.

Helmet use declined by almost 6 percent each year between 2017 and 2022, while the number of e-bike riders with head trauma seeking hospital care shot up 49 fold to nearly 8,000 in 2022, according to research published in JAMA Surgery on Wednesday.

"It's a really significant public health problem," said Dr. Laura Goodman, a pediatric surgeon and trauma medical director of the Children's Hospital of Orange County, who was not involved with the study.

Senior author Dr. Benjamin Breyer, chair and professor of urology at the University of California, San Francisco, said he did not want to discourage people from riding e-bikes because they provide green transportation with exercise benefits.

But he said in a phone interview, "I'd love to see more people wearing helmets. And I really do think that as a society, cities and towns can produce real changes on the road that impact safety and prevent these kinds of injuries."

The study found only 44% of injured e-bike riders wore helmets.

Breyer and his team examined data from the National Electronic Injury Surveillance System (NEISS), a nationally representative sample of about 100 hospital emergency departments throughout the U.S.

The researchers analyzed 1,038 NEISS cases of e-bike injuries and extrapolated that about 46,000 children and adults showed up in U.S. hospital emergency departments with injuries from the motorized bicycles between 2017 and 2022. The number reflected a 43-fold rise in hospitalizations during the period.

At the same time, e-bikes took off as a form of recreation and a way to commute, the authors write. Imports of e-bicycles grew from 437,000 in 2020 to more than 1.1 million in 2022, they note.

The research did not include e-bike accident fatalities. But they do happen. Molly Steinsapir, 12, was riding on the back of her friend's e-bike in 2021 when it crashed driving down a steep Los Angeles road. Molly's helmet failed to save her from fatal head trauma.

Helmetless riders were almost twice as likely to suffer head injuries as helmeted ones, the study found.

Breyer is concerned about the increase in head trauma coupled with the decrease in helmet use, especially given that traumatic brain injuries tend to be more severe in e-bicyclists than in pedal-powered bicyclists.

Dr. Goodman has treated so many children with e-bike injuries that she felt compelled to do similar research, which identified the same trend of skyrocketing injuries and hospitalizations in kids.

"E-bikes are dangerous," she said in a phone interview. "It requires a lot of education to ride them, and we're letting kids go out and ride them as if they're traditional bikes, and they're not."

E-bikes are not considered motor vehicles under U.S. law, and states govern their licensing and whether riders must wear helmets under a mish-mash of evolving laws. E-bikes travel at twice the speed of pedal-powered bicycles, moving at 20 to 28 miles per hour without pedal assistance.

"This near doubling of speeds coupled with pretty dismal rates of helmet use translates into an exponentially increased risk of head injuries," said Charles DiMaggio, a surgery professor and director of injury research at New York University School of Medicine.

Urban design changes, helmet laws and enforcement, avoiding alcohol use while riding, and education, including e-bike riding lessons, could help prevent injuries, said DiMaggio, who was not involved with the study, in an email.

"You have high speeds and a heavy e-bike that kids can't control," Goodman said. "We need education, training, enforcement, development of good e-bike training for kids and engagement with parents so they are aware of the risks and how to keep kids safe."