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Objectives and questions: Although e-bike accidents are of growing clinical relevance, there is limited research comparing injury patterns and outcomes between e-bike (EB) and conventional bicycle (CB) accidents in large patient cohorts. This study performed comparative analyses of both groups to identify patients at risk and guide future prevention and clinical management strategies.

Material and methods: A retrospective analysis of the German TraumaRegister DGU^® was conducted. Patients aged 16 years or older who sustained severe injuries (AIS ≥ 3) in accidents involving conventional bicycles or e-bikes between January 2020 and December 2023 were included. Patient demographics, injury patterns, trauma severity, treatment characteristics, and clinical outcomes were analyzed.

Results: A total of 9,170 bicycle accidents cases were included in the present study (EB n = 1,160; CB n = 8,010). EB riders were older than CB riders and more often polytraumatized, with higher rates of head, face, and chest injuries. Primary ICU treatment was more frequent in the EB group. Age stratification revealed that younger EB patients were more likely to be involved in nighttime and alcohol-related accidents. Furthermore, across all age groups, mortality in the EB group increased significantly by a factor of seven.

Discussion and conclusions: E-bike accidents are associated with specific injury patterns and more severe injuries compared to conventional bicycle accidents, particularly among older riders. These findings highlight the importance of implementing targeted prevention strategies, enhancing protective measures, and improving age-specific risk communication in order to reduce the growing number of e-bike accidents and related morbidity and mortality.