We are seeing more e-scooters on our streets and more patients presenting after coming off them. They are readily available, often ridden without helmets, and quite commonly ridden by children. If you work in emergency medicine, there is plenty here to be concerned about. I’ve seen some horrendous injuries, including deaths in adults and children coming off e-scooters and e-bikes. I’d say it’s getting worse in my part of the world, but the issue is patchy as better regulation and enforcement comes into some areas (see Derbyshire project here).
There is also a slightly odd legal situation in which you can buy something that you cannot legally ride on the road. I’m not sure everyone buying an e-scooter, particularly as a present for a child, understands that. In reality this means that every e-scooter that you see (apart from the official hire schemes in some areas) is almost certainly an illegal vehicle. This paper in Scientific Reports looks at the injuries associated with e-scooters in England and Wales. It is worth reading, although some of the headline numbers need careful interpretation. It also raises questions about what we should be asking these patients beyond where it hurts.
One qualification, my impression of increasing presentations is not the same as demonstrating a continuing national rise. Police-recorded casualties involving e-scooters were broadly unchanged between 2023 and 2024. Those figures will miss ED attendances, but we should be careful about claiming that injuries are increasing everywhere. DfT figures.
The abstract is below, and as usual I’d say read the full paper, but be warned,…… it is 13 pages long!
Abstract
Electric scooters are increasingly used across the United Kingdom, yet national evidence on injury patterns, severity and exposure-adjusted risk remains limited. This study combined the National Major Trauma Registry for England and Wales (trauma admissions, 2020–2022) with operator-reported rental incident data from 18 cities (2020–2024), covering more than 33 million rides and 77.8 million kilometres. The two sources were analysed separately, not linked; across 38,440 records combined (15,247 registry trauma patients and 23,193 operator-reported incidents), e-scooter trauma showed a distinct injury profile, with higher adjusted relative risks than motorcyclists of traumatic brain injury (RR 3.45, 95% CI 3.19–3.75), internal organ injury (1.46, 1.35–1.57) and vascular trauma (3.24, 2.72– 3.86), but lower fracture risk (0.80, 0.74–0.85); traumatic brain injury risk also exceeded that of cyclists (1.74, 1.61–1.88). Traumatic brain injury accounted for over one third of adult injuries, and paediatric riders formed a larger share of the trauma burden than in comparator groups. Helmet use was rare, female sex was associated with higher injury severity, and exposure-adjusted collision rates varied with area-level deprivation. A standardised severity framework enables clearer comparison across transport modes and suppoevidence-based regulation, infrastructure planning and targeted public health interventions.
What did they find?
The researchers used two datasets. One came from the trauma registry for England and Wales, covering 2020–2022. It included 580 e-scooter riders, alongside 7,027 motorcyclists and 7,640 cyclists. The other came from rental company Voi and contained 23,193 incident reports across more than 33 million journeys during 2020–2024. These included near misses and events without injury. The datasets were analysed separately; the researchers could not link an operator report to a hospital attendance. Read the paper here.
Ninety-four of the 580 e-scooter patients were under 18. That is 16.2%, compared with 8.9% of cyclists and 6.2% of motorcyclists. Only 34 e-scooter patients had documented helmet use: 5.9%.
There was also a greater proportion of traumatic brain injury among adult e-scooter injuries than among motorcycle or bicycle injuries. Internal organ and vascular injuries were proportionally more frequent too, while fractures were less frequent. Overall median Injury Severity Scores were fairly similar across the groups. The authors report a relative risk of 3.45 for traumatic brain injury in adult e-scooter injuries compared with motorcycle injuries. That sounds dramatic, and I suspect it is the number most likely to be picked up when people discuss the paper. But it does not mean that riding an e-scooter is three times more dangerous than riding a motorcycle.
The analysis uses the total number of recorded injuries in each transport group as its denominator. It describes the mix of injuries in patients who have already reached a trauma registry. It does not tell us the risk of brain injury per journey or per kilometre. Nor can we simply translate it into the proportion of patients with a brain injury, because one patient may have several recorded injuries.
The wording in the paper is not always helpful here. It moves between “per 100 injuries” and “per 100 incidents”, although the methods specify total injuries as the denominator. The rental data do have journey and distance information, but they come from one operator and depend on voluntary reporting. They cannot tell us how private scooters compare with motorcycles or bicycles per mile travelled. The hospital data also include the pandemic years, when travel patterns were rather different.
Being able to buy one doesn’t mean you can ride it to school
The current position in England and Wales is that privately owned e-scooters cannot legally be ridden on public roads, pavements or other public spaces. They can be used on private land with the landowner’s permission. Buying or owning one is not itself illegal.
Authorised rental scooters are different. They can be used on roads and permitted cycle routes within official trial areas, subject to the scheme’s rules. Riders need an appropriate driving licence, and the operator provides insurance. They cannot be ridden on pavements or motorways. The current government list contains trial locations in England and none in Wales. Helmets are recommended, but are not legally compulsory for rental users. So it is worth asking what the patient was riding and where they were using it. We cannot assume that every e-scooter presentation followed an illegal journey. Equally, a privately owned scooter does not become legal on the road because rental scooters operate nearby. The paper did not measure illegality, and the number of patients under 18 does not establish it either.
We need to ask about the circumstances
Nearly one in six e-scooter patients in this registry was a child. How did they get access to it? Who knew where they were going? Were they riding alone, with friends, or carrying someone else? What did their parent or carer understand about its use? Was there a helmet?
A young child riding a powerful scooter in traffic presents a different set of concerns from an older teenager injured in different circumstances. We need enough information to understand the situation. These are clinical questions prompted by the paper. The study itself did not investigate safeguarding, neglect or exploitation.
Illegal riding does not automatically mean neglect, and a safeguarding referral should not be a punishment for breaking the law. Sometimes a family needs a clear explanation of the rules and a sensible discussion about preventing another injury. In Virchester my colleagues in PED have developed a range of interventions from posters to leaflets, to structured conversations, to specific data collection reports to help us understand the problem and to make some interventions with patients and families. to In other cases, the history may leave us concerned about supervision, repeated exposure to danger, coercion or exploitation.
Adults are different, but the same principles apply. An adult making a decision we consider unwise does not necessarily lack capacity. Explore the concern, involve the patient, and consider consent and confidentiality when sharing information. Where someone may be at risk of serious harm, use the appropriate safeguarding advice and procedures.
What would I take into practice?
The low recorded helmet use is not surprising, but is a worry as we see a lot of head injuries, although we cannot assume that everyone without documentation was unhelmeted. This study also cannot tell us how much of the head injury pattern was caused by not wearing one (Ed – best not get into a conversation on bike helmets as it’s super controversial in social media for some reason).
Take a proper history, so things like speed, surface, collision, how the patient landed, and whether they struck the handlebars (handlebar injuries are, as you know a particular worry and indication for further investigation, often CT in kids if thoraco-abdominal impact). Before discharge find out what happens next. How are they getting home? Will the child be back on the same scooter tomorrow? Does the patient or family understand the advice, and can they act on it?
The bottom line for me is that e-scooters are a real worry. Anecdotally I see it, and there is now increasing (imperfect) evidence that we are seeing this in national trauma databases. What happens next will be more of a legislation/legal question, but whatever happens I suspect we will see more of these patients in the near future.
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References
- Kungwengwe G, et al. E-scooter riders sustain more head and internal injuries than motorcyclists and cyclists in England and Wales. Scientific Reports. 2026;16:23470. doi:10.1038/s41598-026-59829-5.
- Department for Transport. Reported road casualties Great Britain: e-scooter factsheet 2024.
- GOV.UK. Riding an electric scooter: the rules; Using a rental e-scooter. Accessed 8 October 2026.
- General Medical Council. Protecting children and young people: confidentiality and sharing information; Disclosures for the protection of patients and others.
