Text

Objectives and questions: E-bike trauma is often presumed to result in greater injury severity than conventional cycling, yet evidence remains inconsistent. Furthermore, the impact of factors such as Body Mass Index (BMI) on injury patterns is poorly understood. This study therefore evaluated whether e-bike trauma is characterized by increased overall severity or distinct regional injury patterns.

Material and methods: This retrospective single-center cohort study analyzed 261 adult trauma-bay patients (e-bike n = 37; conventional bicycle n = 224). Primary endpoints included Injury Severity Score (ISS) and regional maximum Abbreviated Injury Scale (AIS) scores. Secondary endpoints included physiological burden (SAPS II) and resource utilization (length of stay, TISS-10). Multivariate logistic regression was used to identify independent predictors of intracranial hemorrhage and extremity fractures.

Results: E-bike riders had a significantly higher BMI than conventional cyclists (26.1 vs. 24.6 kg/m²; p = 0.029), while age, ASA score, ISS, physiological burden, and resource utilization were comparable between groups. Conventional cyclist exhibited significantly higher Pelvic injury severity (AIS pelvis; p = 0.045), with no other regional AIS differences. Multivariate analysis identified ISS as the sole independent predictor of intracranial hemorrhage (OR 1.19; p = 0.003) and age as the only independent predictor of extremity fractures (OR 1.12; p = 0.013). BMI was not an independent predictor of injury type or severity.

Discussion and conclusions: E-bike trauma is not associated with increased overall injury severity or treatment burden compared to conventional cycling. Rather than being inherent to the bicycle type, injury patterns are shifted and driven by age and overall trauma severity. These findings suggest that the “e-bike risk” may be overestimated in clinical assumptions.