Work

The rising ICU and neurosurgical burden of E-Scooter–Related Traumatic brain injury in a state major trauma system

Year: 2026

Type: article

Abstract: BACKGROUND: E-scooter related head trauma has emerged as a growing contributor to neurosurgical and critical care workload internationally, yet data describing injury patterns, resource utilisation and costs remain limited. This study characterises the epidemiology, clinical features and hospital costs of e-scooter related traumatic brain injury (TBI) within a state-wide Level 1 trauma centre. METHODS: A retrospective study was conducted using the trauma registry of a state-wide Level 1 tertiary trauma centre in Western Australia, identifying e-scooter-related head injuries from 1 January 2019 to 30 June 2024. The registry captures the majority of moderate to severe TBI, although less severe injuries managed at other hospitals may be under-represented. Cases were stratified into a primary TBI cohort (ICD-10-AM S06) and a secondary cohort of isolated calvarial or skull base fractures (S02). Temporal trends were analysed using negative binomial regression. All clinical, neurosurgical, ICU and cost analyses were restricted to the TBI cohort to ensure internal validity. Multivariable logistic regression identified predictors of ICU admission. Hospital costing data were obtained from activity-based management systems. RESULTS: 93 e-scooter related head injury admissions were identified. TBI accounted for 82 cases (88.2%). There was a steep rise in annual incidence (IRR 1.98; 95% CI 1.58-2.48) over the study period. Most patients were male (81.7%) and intoxication due to alcohol or drugs was common (53.8%). Of the primary TBI cohort, calvarial or skull base fractures occurred in 42.7% of patients. Only 9.8% required neurosurgical intervention, yet 50.0% were admitted to the ICU. In univariate analysis, lower GCS (p = 0.003) and concurrent skull fracture (p < 0.001) were associated with ICU admission. In multivariable analysis, both GCS (OR 0.66 per point; 95% CI 0.44-0.87) and concurrent fracture (OR 7.47; 95% CI 2.47-25.85) remained independent predictors. Total hospital costs increased from $16,103.88 (AUD) in the 2019-2020 financial year to $1,842,153.68 in the 2023-2024 financial year with an annual percent change of 194% (95% CI 105-323). The median cost per TBI admission was $17,720.11 (IQR $9,155.99-$50,311.89). ICU admitted patients incurred significantly higher costs than non-ICU patients (median $30,767.26 vs. $12,906.19). Ward nursing was the largest cost driver. CONCLUSION: This study documents a growing neurosurgical and critical care challenge in Western Australia. Despite low operative rates, e-scooter related TBI is associated with substantial economic impact, exceeding that reported in other Australian trauma series. These findings highlight opportunities for targeted prevention and policy intervention, including helmet compliance, alcohol riding restrictions and ride-share safety governance.

Source: Journal of Clinical Neuroscience

DOI: 10.1016/j.jocn.2026.111955

Authors: Andrew Y. Chang, Shreyas Thiruvengadam, Barry Ting Sheen Kweh, Dieter G. Weber, Gabriel Yin Foo Lee, Boyuan Khoo