Abstract
BACKGROUND AND OBJECTIVES:
Electric scooters (ES) have become increasingly popular among children and adolescents in France. To date, very little is known about their impact on the incidence and severity of pediatric head trauma (HT).
METHODS:
We conducted a retrospective single-center study of patients aged 2 to 18 years admitted to a pediatric neurosurgery ward between 2021 and 2025 for HT related to ES, nonmotorized two-wheeled vehicles (bicycles, kick-scooters; NMTV), or motorbikes. Demographics, accident characteristics, helmet use, clinical and radiological severity, neurosurgical management, hospital course, and need for rehabilitation were collected. Injury severity was assessed using a multivariate model combining neurological, radiological, and in-hospital outcomes. A follow-up phone interview was conducted in a subset of ES patients to assess long-term functional outcome and postinjury behavior regarding mobility habits.
RESULTS:
ES-related HT rose from 1 case in 2021 to 25 in 2025, whereas the number of HT related to NMTV and motorbikes remained stable. Nearly half of injured ES riders were below the legal age, and helmet use was rare. The severity profile of ES-related HT was greater than that of bicycle and kick-scooter accidents, and comparable to that of motorbike accidents. Five ES patients required surgical intervention, most commonly for epidural hematoma evacuation. At follow-up, most patients had favorable functional outcomes, but nearly one-third experienced persistent disability, and helmet adoption after injury remained limited.
CONCLUSION:
ES have emerged as a high-severity mechanism of pediatric HT, comparable to motorbikes. Enhanced prevention strategies, including helmet enforcement, and age regulation, are urgently needed.
KEY WORDS: Pediatric head trauma, Electric-scooter, Micromobility, Helmet use, Traumatic brain injury
ABBREVIATIONS:
- ES
electric scooters
- GOS-E
Glasgow Outcome Scale-Extended
- HT
head trauma
- NMTV
nonmotorized two-wheeled vehicles.
Over the past decade, electric scooters (ES) have rapidly emerged as a major new mode of urban transportation in France and internationally. Their widespread adoption reflects convenience, affordability, and ease of access, particularly after market expansion around 2018. In 2023, approximately 2.5 million individuals were estimated to own an ES in France, compared with fewer than 700 000 in 2020,1 reflecting a major shift in urban mobility patterns. This evolution has been accompanied by changes in road traffic injury epidemiology.2,3
From a biomechanical standpoint, ES expose riders to a high risk of head injury.2,4 Trauma centers across Europe and North America have indeed reported a surge in emergency visits for ES-related craniofacial traumas, including fractures, epidural and subdural hematomas, and diffuse axonal injuries.5-10 Although ES-related head trauma (HT) has often been compared with bicycle or motorcycle injuries, helmet use among ES riders remains extremely low, particularly in urban settings where helmet use is recommended but not mandatory in France.
Children and adolescents represent a growing proportion of ES users, yet pediatric-specific data remain limited. This gap is concerning given the unique vulnerability of children to HT, related to proportionally larger head size, thinner skulls, and immature motor coordination.11-13 Despite regulations prohibiting ES use below 14 years of age in France, enforcement is inconsistent, and younger children frequently access privately owned ES often without adult supervision.3 Understanding the pediatric profile of ES-related HT in children is therefore essential to inform both clinical management and regulatory/preventive policy.
The goal of the present study was to characterize the demographic and clinical features of pediatric HT associated with ES managed in the pediatric neurosurgery ward of Lyon over the past 5 years. We aimed to document the evolution in the number of admissions, characterize the standard accident pattern, and describe the severity of head injuries among this population. To provide contextual insight, we also examined pediatric HT related to nonmotorized two-wheeled vehicles (kick-scooters and bicycles; NMTV) and motorbikes during the same period. Our objective was to capture an accurate snapshot of the changing epidemiology of pediatric HT within a single neurosurgical center, thereby contributing to the growing body of evidence on the risks associated with ES use among children, and the potential measures that could be implemented to prevent them.
METHODS
Study Design and Population
We conducted a single-center retrospective observational study using clinical records of all patients admitted to the Woman-Mother-Child hospital (HFME) between January 1, 2021 and December 31, 2025 for a HT requiring pediatric neurosurgical opinion at admission. The center serves as the only regional tertiary referral unit for pediatric neurosurgery.
The study was approved by the local ethics committee, under the research involving non-personal data framework. Ethical approval was granted under Institutional Review Board number IRB00011687 by the Collège de Neurochirurgie, with the protocol reference IRB #1 2025/28. As approved by institutional ethics committee, the requirement for individual informed consent was waived. In compliance with the French data protection law (Loi Informatique et Libertés) and the General Data Protection Regulation, all patient data were anonymized before analysis to ensure confidentiality.
Inclusion criteria were: (1) HT related to a two-wheeled vehicle (ES, kick-scooter, bicycle, or motorcycle); (2) patient riding the vehicle at the time of injury (driver or passenger); (3) neurosurgical consultation requested at admission. Pedestrians struck by vehicles were excluded from analyses.
Clinical Data Collection
Data collected in medical records included:
Demographics: age (expressed in fractional years), sex;
Circumstances of the accident: helmet use, number of individuals on the vehicle, patient position, type of collision;
Clinical presentation: lowest Glasgow Coma Score within the first 24 hours, head imaging findings, associated lesions;
Medical management: intensive care unit (ICU) admission, endotracheal intubation, invasive intracranial pressure monitoring;
Neurosurgical management: number and type of neurosurgical intervention;
Outcome: duration of ICU stay and overall hospital stay, need for rehabilitation.
Vehicle Classification
Vehicle type was categorized as ES, NMTV (bicycle or kick-scooter), or motorbike. ES served as the reference group for analyses. ES were defined as standing kick-style ES, designed for a single standing rider. NMTV included bicycles and kick-scooters without electric assistance. The motorbike category included gasoline-powered motorcycles and mopeds, which differ from micromobility vehicles in speed, weight, and passenger capacity. Other vehicle types (eg, electric bikes, skateboards, and quad bikes) were excluded because of the very small number of cases (Figure 1).
FIGURE 1.
Patient flow chart. Flowchart describing patient selection and classification of pediatric head trauma cases admitted between 2021 and 2025. ES, electric scooter; NMTV, nonmotorized two-wheeled vehicles.
Follow-Up Phone Interview
A follow-up phone interview was conducted in a subset of ES patients (n = 33) to obtain information on (1) long-term functional outcomes, (2) ES ownership at the time of the accident, and (3) postinjury behavioral changes regarding helmet use and modes of transportation. Functional outcomes were evaluated using the pediatric version of the Glasgow Outcome Scale-Extended14 (GOS-E), a structured interview-based measure that rates overall recovery from 1 (death) to 8 (complete recovery). The GOS-E score was categorized into good (GOS-E 8 and 7), moderate (GOS-E 6 and 5), and severe (GOS-E 4, 3, 2) functional outcome. The interviews were conducted with a parent (n = 31) or the patient (n = 2) over the phone in November and December 2025.
Statistical Analysis
Temporal trends in HT counts were assessed separately for each vehicle type using Kendall's rank correlation coefficient (τ). Differences in proportions were analyzed using odds ratios (ORs).
Clinical severity was evaluated using 7 binary indicators reflecting neurological status, radiological findings, and in-hospital management: (1) severe initial neurological status (Glasgow Coma Score ≤12), (2) skull fracture, (3) intracranial bleeding, (4) ICU admission, (5) endotracheal intubation, (6) invasive intracranial pressure monitoring, and (7) neurosurgical intervention. They were jointly modeled using multivariate logistic regression with generalized estimating equations with vehicle type as the primary explanatory variable. This approach allowed estimation of the overall association between vehicle type and a multidimensional measure of clinical severity, while accounting for within-patient correlations between severity indicators, and avoided inflation of type I error associated with multiple separate statistical tests across individual endpoints. Given the limited sample size, no adjustment was made for potential confounders such as age, helmet use, or accident circumstances to avoid model overfitting.
A global Wald test assessed the effect of vehicle type on overall clinical severity. ORs with 95% CIs were derived from the model. Adjusted marginal probabilities of severe outcomes were estimated for each vehicle group.
Data management, visualization, and analysis were performed using R (version 4.5.2; R Foundation for Statistical Computing). Generalized estimating equation models were fitted using the geepack package, and marginal estimates were obtained using the emmeans package. Statistical significance was defined as a two-sided P-value <.05.
RESULTS
Temporal Trends
During the 5-year study period, a total of 499 pediatric patients aged 2 to 18 years required a neurosurgical opinion on admission for HT. Among these cases, 156 involved a rider or a passenger on a two-wheeled vehicle: 44 (28.2%) ES, 81 (51.2%) NMTV, and 31 (19.9%) motorbikes (Figure 1).
ES-related HT admissions increased sharply over time (τ = 0.95, P = .023), rising from a single case in 2021 to 25 cases in 2025 (Figure 2A). Consequently, ES emerged as the leading cause of two-wheeled-related HT in the study population for the first time in 2025, accounting for approximately half of all such cases this year. By contrast, the number of cases involving NMTV or motorbikes remained stable throughout the study period (NMTV: τ = −0.32, P = .45; motorbikes: τ = 0.20, P = .82; Figure 2A). Injuries across all groups occurred predominantly during spring and summer months (Figure 2B).
FIGURE 2.
Temporal trends in pediatric head trauma requiring neurosurgical assessment. A, Annual number of pediatric HT admissions requiring neurosurgical assessment according to vehicle group (ES, NMTV [bicycle/kick scooter], and motorbike). Counts are shown within each stacked bar segment. ES-related HT cases showed a significant increase (τ = 0.95, P = .023), whereas the number of HT related to NMTV and motorbikes remained stable (both P > .45). B, Monthly distribution of admissions for each vehicle group, stratified by year (2021-2025). ES, electric scooter; HT, head trauma; NMTV, nonmotorized two-wheeled vehicles.
Patient Demographics
The mean age of HT patients injured in an ES accident was 14.0 years (SD: 2.65; Table 1), compared with 10.5 years (SD: 3.93) for NMTV and 15.4 years (SD: 2.38) for motorbike patients (Table 1). Notably, 19 (43.2%) ES patients were below the legal age for ES use of 14 years. Boys predominated in all groups (70%-77%).
TABLE 1.
Patient Demographics and Accident Circumstances
| ES (N = 44) | NMTV (N = 81) | Motorbikes (N = 31) | |
|---|---|---|---|
| Sex (%) | |||
| Female | 10 (22.7) | 24 (29.6) | 8 (25.8) |
| Male | 34 (77.3) | 57 (70.4) | 23 (74.2) |
| Age | |||
| Mean (SD) | 14.0 (2.65) | 10.5 (3.93) | 15.4 (2.38) |
| Median [Min, Max] | 14.3 [7.05, 17.6] | 11.3 [2.49, 17.8] | 15.9 [4.04, 17.8] |
| Helmet use (%) | |||
| Yes | 1 (2.3) | 14 (17.3) | 19 (61.3) |
| No | 43 (97.7) | 66 (81.5) | 9 (29.0) |
| Unknown | 0 (0) | 1 (1.2) | 3 (9.7) |
| No. on vehicle (%) | |||
| 1 | 31 (70.5) | 78 (96.3) | 23 (74.2) |
| 2 | 11 (25.0) | 3 (3.7) | 7 (22.6) |
| 3 | 2 (4.5) | 0 (0) | 0 (0) |
| Unknown | 0 (0) | 0 (0) | 1 (3.2) |
| Patient position (%) | |||
| Driver | 35 (79.5) | 79 (97.5) | 23 (74.2) |
| Passenger | 9 (20.5) | 2 (2.5) | 5 (16.1) |
| Unknown | 0 (0) | 0 (0) | 3 (9.7) |
| Accident characteristics (%) | |||
| Alone | 30 (68.2) | 61 (75.3) | 15 (48.4) |
| Other vehicle involved | 14 (31.8) | 20 (24.7) | 15 (48.4) |
| Unknown | 0 (0) | 0 (0) | 1 (3.2) |
ES, electric scooter; NMTV, non-motorized two-wheeled vehicles.
Accident Circumstances
Helmet use was rare among ES users (2.3%), compared with NMTV (17.3%) and motorbike riders (61.3%). Pairwise OR analyses confirmed a significantly lower helmet use among ES users (OR: 0.01, 95% CI: 0.00081-0.14, P = .0001) and NMTV users (OR: 0.094, 95% CI: 0.028-0.32, P < .0001) compared with motorbike riders. Although helmet use was numerically lower in the ES group than in the NMTV group, this difference did not reach statistical significance (OR: 0.11, 95% CI: 0.0095-1.33, P = .09).
Most ES injuries involved drivers (79.5%), but 20.5% involved passengers, and 29.5% involved multiple riders on the same vehicle. Most ES accidents (68.2%) occurred without another vehicle involved, suggesting loss of control or isolated falls as common mechanisms. Follow-up interviews indicated that most ES injuries (87.8%) occurred on privately owned vehicles (Table 2).
TABLE 2.
Long-Term Functional Outcome in E-scooter-Related Head Trauma Patients and Changes in Mobility Habits
| ES (n = 33) | |
|---|---|
| Time postinjury (y) | |
| Mean (SD) | 1.20 (1.10) |
| Median [min, max] | 0.781 [0.0658, 3.55] |
| Good functional outcome (%) | 24 (72.7) |
| GOS-E 8 | 21 (63.6) |
| GOS-E 7 | 3 (9.1) |
| Moderate functional outcome (%) | 6 (18.2) |
| GOS-E 6 | 6 (18.2) |
| GOS-E 5 | 0 (0) |
| Severe functional outcome (%) | 3 (9.1) |
| GOS-E 4 | 2 (6.1) |
| GOS-E 3 | 1 (3.0) |
| GOS-E 2 | 0 (0) |
| Mortality (GOS-E 1) | 0 (0) |
| Ownership of the ES at the time of the injury (%) | |
| Privately owned | 29 (87.9) |
| Rented | 4 (12.1) |
| Adopted helmet use after injury (%) | |
| No | 21 (63.6) |
| Occasionally | 3 (9.1) |
| Yes | 9 (27.3) |
| New mobility habits after injury (%) | |
| No change | 7 (21.2) |
| Walking | 3 (9.1) |
| Public transport | 16 (48.5) |
| Car | 7 (21.2) |
ES, electric scooter; GOS-E, Glasgow Outcome Scale-Extended.
Clinical Severity
Multivariate logistic regression demonstrated a significant association between vehicle type and clinical severity (Wald F = 7.44, df = 2, P = .00062). Compared with ES, NMTV were associated with significantly lower overall severity across all modeled outcomes (OR: 0.46, 95% CI: 0.28-0.74, P = .0015). By contrast, motorbike accidents were not significantly different from ES accidents regarding overall severity (OR: 1.08, 95% CI: 0.57-2.05, P = .81). Adjusted marginal probabilities of severe outcomes were indeed lowest for NMTV (0.23, 95% CI: 0.18-0.29), and highest for ES (0.40, 95% CI: 0.30-0.50) and motorbikes (0.42, 95% CI: 0.30-0.54; Figure 3).
FIGURE 3.
Adjusted probability of severe outcomes by vehicle group. Dots represent model-based marginal probabilities of severe outcomes for each vehicle group, estimated from a multivariate logistic regression model fitted with generalized estimating equations jointly modeling 7 severity indicators (Glasgow Coma Score ≤12, skull fracture, intracranial hemorrhage, intensive care unit admission, orotracheal intubation, intracranial pressure monitoring, and neurosurgical intervention). Error bars indicate 95% CIs. ES, electric scooter; NMTV, nonmotorized two-wheeled vehicles.
Neurosurgical Management
Neurosurgical intervention was required in a minority of cases across all groups, ranging from 9.9% to 19.4% (all pairwise OR comparisons: P > .35; Table 3). Epidural hematoma evacuation was the most common procedure among ES patients (4 out of 5 operated patients). Other procedures—including dural breach closure, treatment of depressed skull fractures, and decompressive craniectomy—were less common and occurred sporadically. Subdural hematoma requiring surgical management was rare and observed in only one case in ES patients.
TABLE 3.
Clinical Characteristics
| ES (N = 44) | NMTV (N = 81) | Motorbikes (N = 31) | |
|---|---|---|---|
| Initial loss of consciousness (%) | |||
| No | 16 (36.4) | 42 (51.9) | 7 (22.6) |
| Yes | 26 (59.1) | 34 (42.0) | 17 (54.8) |
| Unknown | 2 (4.5) | 5 (6.2) | 7 (22.6) |
| Initial GCS (%) | |||
| Severe (3-8) | 5 (11.4) | 4 (4.9) | 6 (19.4) |
| Moderate (9-12) | 6 (13.6) | 10 (12.3) | 5 (16.1) |
| Mild (13-15) | 33 (75.0) | 67 (82.7) | 20 (64.5) |
| Median [min, max] | 14 [4, 15] | 15 [7, 15] | 13 [3, 15] |
| Skull fracture (%) | 37 (84.1) | 50 (61.7) | 15 (48.4) |
| Frontal | 14 (31.8) | 21 (25.9) | 5 (16.1) |
| Temporal | 16 (36.4) | 21 (25.9) | 6 (19.4) |
| Parietal | 16 (36.4) | 20 (24.7) | 5 (16.1) |
| Occipital | 4 (9.1) | 5 (6.2) | 5 (16.1) |
| Intracranial bleeding (%) | 34 (77.3) | 41 (50.6) | 23 (74.2) |
| Subarachnoid hemorrhage | 8 (18.2) | 10 (12.3) | 10 (32.3) |
| Intraparenchymal contusion | 12 (27.3) | 19 (23.5) | 11 (35.5) |
| Epidural hematoma | 21 (47.7) | 19 (23.5) | 11 (35.5) |
| Subdural hematoma | 11 (25.0) | 5 (6.2) | 4 (12.9) |
| Associated lesions (%) | 14 (31.8) | 28 (34.6) | 27 (87.1) |
| Maxillofacial | 7 (15.9) | 20 (24.7) | 12 (38.7) |
| Orthopaedic | 8 (18.2) | 11 (13.6) | 13 (41.9) |
| Spine | 1 (2.3) | 3 (3.7) | 7 (22.6) |
| Visceral | 6 (13.6) | 9 (11.1) | 12 (38.7) |
| ICU management (%) | |||
| ICU admission | 27 (61.4) | 34 (42.0) | 25 (80.6) |
| Orotracheal intubation | 8 (18.2) | 11 (13.6) | 9 (29.0) |
| ICP monitoring | 7 (15.9) | 5 (6.2) | 4 (12.9) |
| Neurosurgical intervention (%) | 5 (11.4) | 8 (9.9) | 6 (19.4) |
| Suture | 0 (0) | 1 (1.2) | 0 (0) |
| Dural breach closure | 0 (0) | 2 (2.5) | 3 (9.7) |
| Depressed skull fracture | 0 (0) | 2 (2.5) | 0 (0) |
| Epidural hematoma | 4 (9.1) | 4 (4.9) | 2 (6.5) |
| Subdural hematoma | 1 (2.3) | 0 (0) | 0 (0) |
| Decompressive craniectomy | 1 (2.3) | 0 (0) | 1 (3.2) |
| ICU stay (d) | |||
| Mean (SD) | 4.70 (7.59) | 2.66 (3.22) | 3.56 (4.05) |
| Median [min, max] | 1.0 [1.0, 34.0] | 1.0 [0.5, 18.0] | 1.0 [0.5, 14.0] |
| Overall hospital stay (d) | |||
| Mean (SD) | 7.98 (10.3) | 4.35 (3.52) | 12.6 (19.8) |
| Median [min, max] | 5 [0, 64] | 4.0 [0, 21.0] | 7 [1.0, 113] |
| Total occupancy (bed-days) | 351 | 352 | 391 |
| Physical rehabilitation (%) | 8 (18.2) | 5 (6.2) | 9 (29.0) |
GCS, Glasgow Coma Scale; ICP, intracranial pressure; ICU, intensive care unit.
Between 2021 and 2025, a total of 21 patients aged 2 to 18 years underwent surgical evacuation of an epidural hematoma at our center. Among these cases, 4 (19.0%) resulted from ES accidents (2 in 2024 and 2 in 2025), 4 (19.0%) from NMTV accidents (3 in 2022 and 1 in 2025), and 2 (9.5%) from motorbike accidents (1 in 2022 and 1 in 2025). The remaining 11 cases (52.4%) were mostly related to falls, making this mechanism the first cause of surgically treated epidural hematomas in this pediatric population, immediately followed by ES and NMTV accidents.
Hospitalization Burden
Mean hospital length of stay was 7.98 days (SD 10.3) for ES patients, compared with 4.35 days (SD 3.52) for NMTV patients, and 12.6 days (SD 19.8) for motorbike patients. Despite fewer admissions, ES injuries accounted for 351 inpatient bed-days, comparable to NMTV (352) and approaching motorbike-related occupancy (391). Nearly one in 5 ES patients (18.2%) required further rehabilitation, compared with 6.2% in NMTV and 29.0% in motorbikes patients (Table 3).
Long-Term Functional Outcome and Changes in Mobility Habits
Follow-up phone interviews were completed for 33 patients injured in ES-related accidents, at a mean of 1.20 years (SD: 1.10) postinjury (Table 2). Most patients demonstrated a favorable functional outcome (Figure 4A), with 24 (72.7%) achieving a good recovery (GOS-E 7-8). Moderate disability (GOS-E 5–6) was observed in 6 patients (18.2%), whereas severe disability (GOS-E 3-4) affected 3 patients (9.1%). No deaths were reported.
FIGURE 4.
Long-term functional outcomes and behavioral changes after electric scooter-related head trauma. A, Distribution of GOS-E categories at follow-up. B, Self-reported helmet adoption and change in mobility habit after injury among electric scooter patients. GOS-E, Glasgow Outcome Scale-Extended.
Despite the injury, helmet adoption remained limited: only 9 patients (27.3%) reported consistent helmet use when appropriate after the accident, whereas 21 (63.6%) reported no change in helmet behavior (Table 2; Figure 4B).
Regarding mobility habits, more than half of the sample (48.5%) reported a shift toward public transportation after the injury, whereas smaller proportions reported no change (21.2%), increased car use (21.2%), or a shift toward walking (9.1%).
DISCUSSION
Key Results
This single-center retrospective study highlights the rapid emergence of ES as a major contributor to pediatric HT requiring neurosurgical evaluation. Over the 5-year study period, ES-related HT increased sharply and became the leading cause of two-wheeled vehicle-related neurosurgery admissions by 2025.
ES accidents were associated with a level of clinical severity comparable to motorbike accidents and substantially higher than NMTV. Although most patients achieved favorable functional outcomes, nearly one-third experienced persistent moderate or severe disability, underscoring the clinical relevance of these injuries in the pediatric population.
Limitations
This study has several methodological limitations. First, its single-center, neurosurgery-focused design limits generalizability to real-world settings. By excluding both the least severe cases managed without neurosurgical input, and the most severe cases resulting in prehospital mortality, this study likely underestimates the true burden of pediatric ES-related injuries at the hospital and societal level. Nevertheless, it provides a relevant snapshot of the burden and severity of these injuries from a neurosurgical perspective.
Second, the observed rise in ES-related HT may at least in part reflect growing awareness among emergency physicians of the potential severity of injuries associated with these vehicles, leading to a lower threshold for hospital admission and neurosurgical consultation. However, the substantial severity profile and hospitalization burden observed in ES injuries support the interpretation of a genuine increase in clinically significant HT, rather than a mere change in triage practice.
Third, because of its retrospective design, our study relied on routinely collected medical records, leading to reporting bias and partial ascertainment. For example, detailed accident circumstances were not consistently documented. Follow-up phone interviews enabled partial verification and completion of this information in the ES group, although these data remained subject to recall bias.
Finally, potential confounders such as age, helmet use, and specific accident mechanisms were not included in the multivariate analysis of clinical severity due to sample size constraints and the risk of overfitting. Such factors may partly drive the differences in clinical severity observed between groups. Unfortunately, the extremely low prevalence of helmet use among ES riders in our cohort precluded meaningful analysis of its protective effect in this population. In larger multicenter studies, propensity score-based approaches or other adjusted comparative analyses may help better characterize the drivers of clinical severity across vehicle categories.
Interpretation
The rapid increase in ES-related HT contrasts with the stable number of NMTV and motorbike injuries, indicating that ES represents a distinct additional source of HT rather than a substitute for existing mobility-related traumas. This is consistent with the 2024 Registre du Rhône report,3 which reported a sharp increase in overall ES-related accidents after shared ES services were deployed in the area between 2018 and 2019. Our findings suggest that this epidemiological shift is now translating into a meaningful pediatric neurosurgical burden.
Our analysis of clinical severity challenges the common perception of ES as relatively benign micromobility devices and aligns with studies highlighting biomechanical properties (high speeds, small wheels, limited stability, etc.) exposing to high-energy impacts, particularly to the head.4,15,16 For neurosurgeons and trauma teams, ES-related pediatric HT should therefore be regarded as a potentially high-severity mechanism, warranting vigilance comparable to that applied to motorbike trauma.
Although most patients achieved a favorable functional outcome at follow-up, nearly 30% experienced persistent moderate to severe disability. Given the young age of this population, even moderate functional deficits may have long-term consequences for academic performance, social development, and quality of life. The absence of mortality in our cohort should therefore not obscure the substantial morbidity associated with these injuries.
Although helmet use exceeded 60% among motorbike riders, it was almost nonexistent among ES users. This discrepancy partly reflects regulatory differences: in France, helmet use is mandatory for motorbike riders but only recommended for ES and NMTV users. However, because our study includes only patients requiring neurosurgical evaluation, the relatively high proportion of helmet use among motorbike riders may also reflect the higher-energy mechanisms involved in motorbike crashes, which may produce severe HT despite protective gear. Nevertheless, given the well-established protective effect of helmets in two-wheeled vehicle accidents4,10,17-19—particularly when mandated20—mandatory helmet regulation represents a clear opportunity to reduce the burden of severe, neurosurgically relevant HT in children.
However, regulation alone seems insufficient to promote safe practices, as violations were frequent, particularly regarding the legal minimum age of 14 years and the prohibition of multiple riders. Indeed, in the ES group, nearly half of patients were below the legal minimum age, and more than one-quarter of accidents involved multiple riders on the same vehicle. This gap between regulations and real-world use underscores the need for complementary prevention strategies—particularly education and risk-awareness initiatives targeting adolescents, parents, schools, and the broader community. Given the strong influence of social media on adolescent behavior,21,22 digital prevention campaigns and partnership with trusted influencers may also represent valuable tools to promote safer riding practices and normalize helmet use. Shared ES systems also provide an opportunity to embed safety directly into the user experience through helmet availability, digital prompts, incentive-based programs, and technological adaptations designed to reduce speed and loss-of-control events.
Beyond clinical severity, ES injuries were associated with substantial hospital resource use, including prolonged hospitalization and frequent need for rehabilitation, highlighting a disproportionate impact on pediatric neurosurgical and inpatient resources. From a health system perspective, ES now represent a growing source of clinically and economically meaningful pediatric neurotrauma.
Taken together, our findings support a dual response: clinically, greater awareness that ES-related HT is not a minor injury mechanism; and, at the public health level, coordinated strategies to promote safer ES use in children through regulation, education, and safety-by-design interventions.
Generalizability
Although this study was conducted in a single tertiary pediatric neurosurgical center, the rapid growth of micromobility devices in many urban environments suggests that similar injury patterns may emerge elsewhere. However, differences in infrastructure, traffic conditions, and regulatory enforcement may influence the external applicability of these findings. Coordinated multicenter studies are therefore needed to assess the generalizability of these findings across diverse health care, infrastructure, and regulatory settings.
CONCLUSION
The combination of increasing incidence, very low helmet use, frequent unsafe riding practices, and persistent morbidity highlights an urgent need to improve safety around pediatric ES use. Prevention efforts should focus on promoting helmet adoption, improving risk awareness among adolescents and caregivers, and integrating safety-by-design measures within shared e-scooter systems. Such coordinated strategies may help reduce the clinical and health-system impact of this rapidly evolving mode of transport while preserving its benefits for urban mobility.
Declaration of AI-Assisted Technologies
During the preparation of this work, the authors used CHATGPT (version 5-2) to improve the readability of the manuscript. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.
Acknowledgments
We thank the medical and nursing staff of the Pediatric Neurosurgery Unit at the Woman-Mother-Child Hospital (HFME), Hospices Civils de Lyon, for their contribution to the care of the patients included in this study. We also thank the Pediatric Emergency Department, Pediatric Intensive Care Unit, and Radiology teams for their collaboration in the acute management of these patients. We thank Charlyn Bliault-Paradiso for their help conducting follow-up phone interviews. Finally, we are grateful to the patients and their families who participated in the follow-up phone interviews. Author contributions: P.P. conceived and designed the study, coordinated data collection, performed the statistical analyses, and drafted the manuscript. A.M. contributed to data acquisition and revised the manuscript. C.D.L. designed the study, contributed to data acquisition and critically revised the manuscript. P.-A.B. contributed to data acquisition and critically revised the manuscript. A.S. contributed to data acquisition and critically revised the manuscript. M.V. contributed to data acquisition and critically revised the manuscript. S.G. contributed to data acquisition and follow-up assessment and critically revised the manuscript. E.J. contributed to data acquisition of the acute care and ICU-related outcomes and critically revised the manuscript. F.D.R. supervised the project, contributed to study design and interpretation, and data collection, and critically revised the manuscript.
Contributor Information
Alessandra Musarra, Email: musarra.alessandra01@gmail.com.
Camilla de Laurentis, Email: camilla.de-laurentis@chu-lyon.fr.
Pierre-Aurélien Beuriat, Email: pierre-aurelien.beuriat@chu-lyon.fr.
Alexandru Szathmari, Email: alexandru.szathmari@chu-lyon.fr.
Matthieu Vinchon, Email: mvinchon@yahoo.fr.
Sofia Guernouche, Email: sofia.guernouche@chu-lyon.fr.
Etienne Javouhey, Email: etienne.javouhey@chu-lyon.fr.
Federico Di Rocco, Email: federico.dirocco@chu-lyon.fr.
Funding
Open access funding provided by Hospices Civils de Lyon. This research received no external funding.
Disclosures
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
REFERENCES
- 1.Fédération des professionnels de la micromobilité. Accessed January 1, 2026. https://www.francemobilites.fr/observatoire-micro-mobilite/tableau-bord [Google Scholar]
- 2.Benhamed A, Gossiome A, Ndiaye A, Tazarourte K. Characteristics and comparison between e-scooters and bicycle-related trauma: a multicentre cross-sectional analysis of data from a road collision registry. BMC Emerg Med. 2022;22(1):164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Tardy HA, Ndiaye A, Gadegbeku B. Caractéristiques des accidentés à trottinettes électriques ou autres engins de déplacement personnel et comparaison avec les accidentés à vélo. Registre du Rhône des victimes d’accidents de la circulation routière 2015-2019 Saint-Maurice: Santé publique France; 2024. [Google Scholar]
- 4.Wei W, Petit Y, Arnoux P-J, Bailly N. Head-ground impact conditions and helmet performance in E-scooter falls. Accid Anal Prev. 2023;181:106935. [DOI] [PubMed] [Google Scholar]
- 5.Trivedi TK, Liu C, Antonio ALM, et al. Injuries associated with standing electric scooter use. JAMA Netw Open. 2019;2(1):e187381. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Goh EZ, Beech N, Johnson NR. E-scooters and craniofacial trauma: a systematic review. Craniomaxillofac Trauma Reconstr. 2023;16(3):245-253. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Clough RA, Platt E, Cole E, Wilson M, Aylwin C. Major trauma among E-scooter and bicycle users: a nationwide cohort study. Inj Prev. 2023;29(2):121-125. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Saulitis A, Kocane E, Dolgopolova J, et al. Characteristics and injury patterns in traumatic brain injury related to E-scooter use in Riga, Latvia: multicenter case series. Medicina (Kaunas). 2024;60(4):540. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.James A, Harrois A, Abback P-S, et al. Comparison of injuries associated with electric scooters, motorbikes, and bicycles in France, 2019-2022. JAMA Netw Open. 2023;6(6):e2320960. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Frank S, Sator T, Kinsky RM, et al. Continuously increasing e-scooter accidents and their possible prevention in a large European city. Eur J Trauma Emerg Surg. 2024;50(6):2895-2904. [DOI] [PubMed] [Google Scholar]
- 11.Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Br J Neurosurg. 2002;16(3):220-242. [DOI] [PubMed] [Google Scholar]
- 12.Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TAGM. The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings—part 2. J Neuroimaging. 2012;22(2):e18-e41. [DOI] [PubMed] [Google Scholar]
- 13.Parker KN, Donovan MH, Smith K, Noble-Haeusslein LJ. Traumatic injury to the developing brain: emerging relationship to early life stress. Front Neurol. 2021;12:708800. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Beers SR, Wisniewski SR, Garcia-Filion P, et al. Validity of a pediatric version of the Glasgow outcome scale-extended. J Neurotrauma. 2012;29(6):1126-1139. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Fournier M, Bailly N, Schäuble A, Petit Y. Head impact kinematics and injury risks during E-scooter collisions against a curb. Heliyon. 2023;9(9):e19254. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Bailly N, Schäuble A, Guesneau M, Wei W, Petit Y. Assessing bicycle helmet protection for head and neck in E-scooter falls. Traffic Inj Prev. 2025;26(7):866-873. [DOI] [PubMed] [Google Scholar]
- 17.Thompson DC, Rivara F, Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev. 2000;1999(2):CD001855. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Høye A. Bicycle helmets – to wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries. Accid Anal Prev. 2018;117:85-97. [DOI] [PubMed] [Google Scholar]
- 19.Alfrey EJ, Tracy M, Alfrey JR, et al. Helmet usage reduces serious head injury without decreasing concussion after bicycle riders crash. J Surg Res. 2021;257:593-596. [DOI] [PubMed] [Google Scholar]
- 20.Hoye A. Recommend or mandate? A systematic review and meta-analysis of the effects of mandatory bicycle helmet legislation. Accid Anal Prev. 2018;120:239-249. [DOI] [PubMed] [Google Scholar]
- 21.Sherman LE, Payton AA, Hernandez LM, Greenfield PM, Dapretto M. The power of the like in adolescence: effects of peer influence on neural and behavioral responses to social media. Psychol Sci. 2016;27(7):1027-1035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Chung A, Vieira D, Donley T, et al. Adolescent peer influence on eating behaviors via social media: scoping review. J Med Internet Res. 2021;23(6):e19697. [DOI] [PMC free article] [PubMed] [Google Scholar]