E-bikers at risk for severe traumatic brain injury and skull fractures

The popularity of electric bicycles (E-bikes) in The Netherlands has surged in recent years. Simultaneously, bicycle-related traffic injuries in The Netherlands have reached record levels. Given the significant societal and individual impact of traumatic brain injury (TBI) we investigated the relationship between E-bike usage and the occurrence of severe TBI.

All bicycle crash victims aged twelve years and older admitted to the Isala Hospital from 1 January 2018 to 31 December 2022, were included from the National Trauma Registry. Data on bicycle type, anticoagulants, alcohol intoxication, and helmet use, was obtained from the hospitals' electronic patient record. The primary outcome variable was severe TBI verified on CT- or MRI-imaging. The secondary outcome variable was a skull fracture verified on X-ray or CT-imaging. Adjusted odds ratios (ORs) and 95 %-confidence intervals (CIs) were calculated using multivariable binary logistic regression analyses, adjusting for the risk factors alcohol intoxication, anticoagulant use, not wearing a helmet, health status before the accident, age and gender.

From 1 January 2018 to 31 December 2022, a total of 1878 patients were admitted following a bicycle crash. This group consisted of 1359 (73.4 %) regular cyclists and 519 (27.6 %) E-bikers. Multivariable regression analyses resulted in an OR of 1.64 (CI 1.20-2.22) for severe TBI and an OR of 1.50 (CI 1.08-2.08) for skull fractures.

In our study sample, E-bike usage was found to be an independent predictor for severe traumatic brain injury and skull fractures following a bicycle crash.