The Fast and the Fragile: Neurosurgical Trauma in the Age of Micromobility

BACKGROUND AND OBJECTIVES: The rapid rise of electric and mechanical bikes and scooters has transformed urban transportation, but their neurosurgical consequences remain underexplored. This study aimed to evaluate micromobility-related injuries over time, examining mechanisms of injury, patient risk factors, injury patterns, and associated clinical outcomes at a Level-1 trauma center over a 5-year period. METHODS: We performed a retrospective review of patients who sustained micromobility-related injuries and presented to the Bellevue Hospital Center between 2018 and 2023. The cohort included riders of electric or mechanical bikes and scooters, as well as pedestrians struck by these devices. Key clinical variables and outcomes were compared across device types, both before and after propensity score matching. Unlike national database studies, this hospital-based analysis provides detailed clinical and neurosurgical outcome data. RESULTS: A total of 914 patients presented with micromobility-related injuries, accounting for 6.9% of all trauma admissions. Annual case volume and electric device involvement increased over time. The most common mechanism was collision with a motor vehicle (49.9%). Most patients (68.7%) required admission; 30.2% required intensive care. The median length of hospital stay was 3 days [IQR 1-5]. Half underwent a surgical intervention or procedure, and the overall mortality was 1.2%. Helmet use was low (31.7%). Pedestrians experienced the most severe outcomes, particularly when struck by electric devices. Injuries clustered during evening hours, suggesting modifiable environmental and behavioral risk factors. CONCLUSION: Micromobility-related trauma imposes a substantial neurosurgical burden, with frequent traumatic brain injury, intensive care unit utilization, and operative intervention. Unlike previous database studies, this hospital-based analysis provides detailed neurosurgical outcome data and identifies prevention targets-including helmet use, intoxication, and urban infrastructure-to reduce morbidity and resource utilization.