Neurosurgical trauma from E-Scooter usage: a review of early case series in London and a review of the literature

Background Electric (E-)scooters have become increasingly popular as a means of environmentally friendly and convenient urban transport since 2017. Private use and now ride-sharing schemes are seen in major cities across the world. However, safety data are still lacking especially with concerning reports of significant head injuries. We describe early case series from three hospitals, including a major trauma centre, in East London and review the literature describing neurosurgical trauma from E-scooter usage. Methods Electronic health records were retrospectively searched for terms related to E-Scooters between 2018 and 2021. Eight case series were included and described. A literature search of PubMed, Ovid MEDLINE and Embase for terms 'E-scooter or electric scooter' was also conducted from inception to 6 March 2021. A total of 825 articles were initially reviewed. Following the removal of duplicates and those meeting the exclusion criteria, 29 articles were analysed in full and included in this review. Results All cases described a head injury of some nature with over half suffering more severe injuries including cranial fractures (most commonly basal skull) or intracerebral haemorrhages (ICH). Spinal fractures were also seen. All required imaging and admission to the hospital. Only a minority required inpatient neurosurgical intervention above conservative measures but almost all required outpatient follow-up. On review of the literature, head injuries were present in 38.8% of all presentations. The majority of which were minor head injuries or concussions; however, approximately 15% involved ICH or skull fractures, respectively. Spinal injuries were less common. Riding while intoxicated and without a helmet was frequently seen within the literature. Conclusion This work offers a foundational text highlighting the frequency and severity of neurotrauma seen with E-scooter usage. Injury is seen in E-scooter riders, passengers and pedestrians alike with dangerous riding behaviours likely contributory. A neurosurgical-specific inquiry is recommended for future research.