THE RISING TIDE OF ELECTRIC MICROMOBILITY TRAUMA: A FIVE-YEAR COHORT ANALYSIS OF POLYTRAUMA PRESENTATIONS AT A REGIONAL MAJOR TRAUMA CENTRE IN WALES

Electric micromobility trauma (e-bikes and e-scooters) is generating an escalating burden upon Major Trauma Centres across the UK. We present a five-year retrospective cohort analysis at Cardiff MTC (2021 to 2026), characterising injury severity, polytrauma, operative demand, and public health implications. 272 consecutive cases were identified from the institutional trauma registry. ISS was calculated from AIS coding; polytrauma was defined as injury to two or more regions. Multivariable logistic regression identified operative predictors (p < 0.05). The cohort was 84% male; mean age 28.7 years (SD 14.6; range 8 to 83); 19% paediatric. E-bike presentations rose 20-fold (2021 to 2025), outnumbering e-scooters more than 2:1 by 2025. Mean ISS was 11.1 (median 9); 28.3% had ISS of 16 or more and 10.7% ISS of 25 or more. Polytrauma occurred in 37.1%; injury to three or more regions was the strongest predictor of serious injury (OR 7.96, 95% CI 4.02 to 15.76). Spinal injuries (11.4%) carried a mean ISS of 19.3. The overall operative rate was 44.9%; lower limb injuries (40%) had a 69% conversion rate. Static-object collisions yielded the highest mean ISS (18.2); vehicle collisions drove 62% of severe cases. Median length of stay was 4 days, rising to 17 days for ISS of 25 or more; there was one fatality (0.4%). A helmet was confirmed in 2.9% overall and 5.8% of the paediatric cohort (head injury rate 31.4%). Substance use was unrecorded in 87%; substance-positive cases had a higher mean ISS (12.4 vs 11.0). E-bike trauma is a rapidly escalating, high-acuity challenge with substantial polytrauma, operative demand, significant spinal injury, and a one-in-five paediatric rate. The near-total absence of helmet use and under-documentation of substance misuse represent missed prevention opportunities. Mandatory helmet legislation, analogous to motorcycle regulation, is justified by the high head injury rate. Drink- and drug-riding provisions within the Road Traffic Act must be extended to powered micromobility, with standardised screening in MTC pathways. Urban planners should prioritise segregated infrastructure to mitigate high-severity collisions.