Electric Bicycle Injuries at a Level 1 Major Trauma Centre in London - Patterns of Trauma Severity and Economic Burden: A Retrospective Cohort Study

Abstract Purpose: With electric biking (E-biking) becoming an increasingly popular mode of recreation and transportation in England, its rapid growth has been linked to a significant rise in high-impact injuries. The purpose of this study was to identify the most common injuries, trauma severity and the financial impact of e-bikes on the National Health Service. Methods: Over a six-month period, sociodemographic data, injury characteristics, resource utilisation, interventions, and outcomes were reviewed. Injury severity was quantified using the Injury Severity Score (ISS). Statistical analyses were performed using non-parametric tests. Results: Fifty-one patients were included (median age 27 years, IQR 22–34; 72.5% male). Median ISS was 16 (IQR 9–20). Most injuries arose from e-bike vs environment (62.7%) or road traffic collisions (29.4%). Limb trauma predominated (84.3%), followed by head (47.1%) and facial injuries (33.3%). Higher ISS correlated with greater limb injury severity (ρ = 0.34, p < 0.001) and longer hospital stay (ρ = 0.55, p = 0.001). Helmet non-use was common (64.7%) but did not correlate with ISS (p = 0.563). Severe injuries required more imaging, multi-specialty input, and operative intervention. Total estimated costs exceeded £298,000 across the cohort; ward-based admissions represented the largest expenditure (£171,000), despite higher per-patient ICU costs (£35,000). E-bike collisions generated multi-regional, high-energy injuries with considerable surgical and financial burden. Conclusion: E-bike collisions in London cause substantial major trauma in young adults, with severe limb and head injuries and prolonged hospitalisation. These findings highlight the rising burden of micromobility trauma on the NHS and the need for targeted prevention and rider safety strategies.