E-scooter-related injuries in Antwerp, Belgium: a retrospective analysis of 1,580 patients

Introduction

Background

In the past decade, the introduction of electric scooters (e-scooters) and the emergence of shared e-scooter services have revolutionized commuting worldwide. Being low-cost, accessible, flexible, environmentally friendly and user-friendly, e-scooters constitute an attractive public transportation alternative with a widespread use, especially in cities. However, concurrent with the expanding number of e-scooter users, e-scooter-related accidents have seen a dramatic increase and represent an emerging cause of presentations at the emergency department (ED) (1). In the US, the National Electronic Injury Surveillance System reported a tremendous rise in age-adjusted injury incidence (+222%) and hospital admission (+365%) related to e-scooter trauma from 2014 to 2018 (2), and similar trends were observed elsewhere (3). E-scooter-related injuries range in severity from mild (contusion, abrasion, and lacerations) to severe (requiring intensive care or resulting in death) (4). The most common injuries are fractures (extremity and facial), soft-tissue injuries and head and neck injuries (5), and the most common mechanisms of injury are fall, collision with an object, and being hit by a moving vehicle or object (6).

Rationale and knowledge gap

Belgian cities have seen a rapid rise in e-scooter use and related injuries, but data on these injuries remain limited. One small-scale prospective observational study describes the demographic and clinical characteristics of patients with e-scooter-related injuries in Brussels (7). The Vias institute published several papers on e-scooters (8,9). In one report, an increase of 815% in injured people between 2019 and 2023 was reported (9).

However, insights about the public health risk of e-scooter usage in Belgium remain largely elusive. Despite this, the increase of e-scooter-related accidents have triggered a public debate about legislation and enforcement of safety precautions to reduce the incidence rate and severeness of e-scooter-related injuries.

Objective

With the current ongoing increase in e-scooter use and the emerging burden on the health care system, it is crucial to make this public debate data driven and to better understand the injury patterns, and the medical and economic implications.

This retrospective study aimed to provide a comprehensive descriptive analysis of the number of patients presenting with e-scooter-related trauma in Antwerp, Belgium (>0.5 million inhabitants), as well as the type and severity of injury. Gaining insights herein could accelerate the implementation of targeted safety measures and harm reduction precautions by the Belgian governments. We present this article in accordance with the STROBE reporting checklist (available at https://jeccm.amegroups.com/article/view/10.21037/jeccm-2026-0020/rc).

Methods

Relevant literature

The literature was searched using PubMed, Embase and the Cochrane Library to identify global data on e-scooter accidents and related injuries. Titles and abstracts were screened for relevance. In addition, the website of the Vias Institute was screened for e-scooter-related publications.

Data collection

Ziekenhuis aan de Stroom (ZAS) is one of the largest hospital networks in Belgium comprising six EDs in the city of Antwerp, Belgium: ZAS Cadix (formerly ZNA Stuivenberg), ZAS Middelheim, ZAS Sint-Jozef, ZAS Augustinus and ZAS Vincentius. The EDs involved collectively manage more than 188,000 visits annually. In addition, the network’s prehospital emergency medical services perform more than 20 physician-staffed mobile intensive care unit (MUG) interventions per day (10).

A retrospective analysis was performed on all medical records of patients who presented to these six EDs with e-scooter-related injuries between July 2022 and January 2024. Data collection and analysis were conducted using CTcue, a clinical data warehouse and text-mining platform which is part of the IQVIA Patient Finder Solution developed by IQVIA.

CTcue pseudonymized all data in accordance with general data protection regulation (GDPR) requirements to safeguard patient privacy. The Clinical Data Collector module of CTcue was applied.

Study design and patient selection

Using CTcue, data were retrospectively collected on individuals aged ≥16 years who were involved in e-scooter accidents and presented to one of the six ZAS EDs during the study period. Patient record selection was based on the Dutch equivalent key words “e-scooter” and “electrical”. Besides the age criterium, no other exclusion criterium was used.

The collected dataset comprised the following variables:

• Demographics and presentation details: ED site, age, sex, day of the week/weekend (the weekend was defined as Friday 8 PM to Sunday 12 PM) and time of presentation, mode of arrival (including emergency medical services), helmet use, and alcohol or drug intoxication.
• Role and mechanism of injury: classification of the patient as an e-scooter rider (with distinction between falls and collisions), a non-rider (pedestrian or cyclist) struck by an e-scooter, or a pedestrian who tripped on an e-scooter.
• Imaging and diagnostics: performance of imaging studies, including conventional X-rays (RX), computed tomography (CT), and extended focused assessment with sonography for trauma (eFAST).
• Injury assessment: injuries were categorized by body region used in the Injury Severity Score (ISS), allowing multiple injuries per patient.
• Injury types: lacerations, sprains/contusions, fractures, dislocations, external or internal bleeding, intracranial hemorrhage, and concussion.
• Helmet use: yes, no, unknown and not relevant.
• Treatment and outcomes: surgical interventions, hospital admission [including intensive care unit (ICU) admission], mortality, permanent disability (assessed at 6 months post-injury), and temporary work incapacity.

Statistical analysis

Only descriptive analysis was performed. Categorical variables were summarized using frequencies and proportions. No inferential statistical analyses or hypothesis testing were conducted, as the study was intended to provide a descriptive overview of the collected data.

Ethical consideration

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the ethics committees of both Ziekenhuis Netwerk Antwerpen (ZNA) and Gasthuiszusters Antwerpen (GZA), prior to their institutional merge into ZAS (approval #240202RETRO and #5953). The requirement for informed consent was waived by the ethics committees due to the retrospective and observational nature of the study.

Results

Demographics and presentation details

A total of 1,580 patients were included. Patient demographics and presentation details are summarized in Table 1. A substantial proportion of patients were aged 16–34 years (64.1%) and male (62.2%). ZAS Vincentius and ZAS Cadix (ZNA Stuivenberg), the two EDs located in the city center, accounted for 61% of ED admissions. Most patients (76.5%) arrived via self-transport. At the time of their e-scooter accident, 11.5% of patients were intoxicated with alcohol and 1.3% with drugs. However, alcohol and drug use were assessed only by patient report, and data were missing for 81% of patients (Table 1).

The distribution of e-scooter-related accidents by day of the week and time of day is shown in Figure 1. Of the 1,098 weekday admissions, 49% occurred between 2 PM and 10 PM, indicating a peak during evenings. Weekend admissions were distributed more evenly in time (Figure 1).

Figure 1 Number of ED presentations by time of day, divided into weekday and weekend. Note: of the 119 non-helmeted patients that sustained a head injury 12 presented with injuries other than commotio cerebri or intracranial hemorrhage, which are not included in the figure. ED, emergency department.

Role and mechanism of injury

Patient distribution by role (rider versus non-rider) and injury mechanism (fall or collision) is presented in Table 2. Of the 1,580 patients, the vast majority (90.7%) were e-scooter riders, predominantly injured due to falls (74.5%) and, to a lesser extent, collisions (16.2%). The remaining patients (9.3%) were non-riders who were either struck by an e-scooter or stumbled over one (Table 2).

Imaging and diagnostics

Of the 1,580 patients, 1,174 (74.3%) underwent imaging, which included RX, CT scans, and eFAST ultrasounds. Some patients received multiple imaging modalities. A total of 1,001 RX were performed, reflecting a high incidence of suspected fractures or musculoskeletal injuries. Additionally, 275 CT scans and 50 eFAST examinations were conducted.

Injury assessment

To assess injury patterns in e-scooter accidents, the number and anatomical location of injuries were mapped for patients presenting to the ED after an e-scooter accident, as shown in Figure 2A. In total, 2,282 injuries were recorded among the 1,580 patients. These injuries were widely distributed across the body, with most patients sustaining multiple injuries. The upper (35.7%) and lower extremities (24.8%) were most frequently affected, followed by the face (15%) and head (8.8%). Less frequent injuries included thoracic (8%), pelvic (3.5%), spinal (2.2%), abdominal (1.1%), and neck (1%) trauma. Overall, e-scooter accidents can result in a wide range of injuries affecting both extremities and core body regions (Figure 2A).

Figure 2 The distribution, severity, and types of injuries sustained in e-scooter-related accidents, showing that injuries predominantly involved the extremities, were mostly minor to moderate in severity, and consisted mainly of soft tissue injuries such as sprains, contusions, and superficial wounds. (A) Distribution of injuries by body region among 1,580 e-scooter patients. (B) ISS classification among e-scooter-related emergency department presentations. (C) Distribution of injury types among 2,282 documented injuries in e-scooter patients. ISS, Injury Severity Score.

Injury severity, assessed using the ISS, is summarized in Figure 2B. Of the 1,580 recorded cases, 20 were excluded: 11 patients with psychological but no physical trauma (ISS 0) and 9 patients who left the hospital before physician evaluation. Among the remaining 1,560 patients, the majority presented with very minor (ISS 1–2) or minor (ISS 3–5) injuries (95,3%). Major trauma (ISS 6–14) occurred in 3.9% of patients, while severe trauma (ISS ≥15) was rare, affecting 13 patients (0.8%) (Figure 2B).

Injury types

Among a total of 2,282 documented injuries (allowing multiple injuries per patient), the most frequent type was sprains or contusions (36.9%), followed by external injuries such as abrasions or superficial wounds (19%) and fractures (17.8%). Lacerations requiring sutures accounted for 16.7%, while commotio cerebri (concussion) occurred in 6.4% of cases. Less frequent but clinically significant injuries included dislocations (2.5%), intracranial hemorrhage (0.6%), and internal non-cranial bleeding (n=1). These results highlight the predominance of blunt trauma and skeletal injuries in e-scooter-related accidents (Figure 2C).

Helmet use

To assess helmet use, 72 patients were excluded (pedestrians struck by or tripping over an e-scooter, and one car occupant). Helmet use was undocumented in 1,096 cases. Among the remaining patients, 389 were confirmed non-helmeted and 23 helmeted. Helmet use was rare in more severe trauma: of 41 patients with ISS 6–14 or 15, 40 were not wearing a helmet while only one helmeted patient sustained major injury (Figure 3A).

Figure 3 Helmet use patterns and associated injury outcomes, demonstrating that helmet use was uncommon and was associated with a lower proportion of severe head injuries compared with non-helmeted patients. (A) Helmet use in relation to ISS. In 1,096 cases, helmet use was not documented by the attending physician. (B) Head, face and neck injuries in helmeted versus non-helmeted patients. (C) Head injury severity in helmeted versus non-helmeted patients. ISS, Injury Severity Score.

Head injuries occurred in 9.1% of helmeted patients versus 31.2% of non-helmeted patients. Facial injuries were observed in 27.3% and 38.3%, respectively. No neck injuries occurred in helmeted patients, compared with 2.9% in non-helmeted patients (Figure 3B). Next, the type and severity of head trauma were analyzed among helmeted and non-helmeted patients (Figure 3C). Among 165 patients with head injury, 2 were helmeted and 119 non-helmeted (44 undocumented). Both helmeted patients sustained commotio cerebri without intracranial hemorrhage. In contrast, 13 (10.9%) non-helmeted patients had intracranial hemorrhage, and 94 (78.9%) sustained commotio cerebri. These findings suggest a protective effect of helmet use against severe head injury.

Treatment and outcomes

Despite the predominance of minor injuries, a notable proportion of patients required further medical care, as shown in Table 3. In total, 125 individuals (7.9%) were hospitalized, 109 (6.9%) to a normal unit and 16 (1%) to the ICU due to the severity of their condition. The other 1,455 patients (92.1%) were discharged home. Furthermore, 116 patients (7.3%) required surgical intervention; 62 (3.9%) for upper limb fractures, 39 (2.5%) for lower limb fractures, and 15 (1%) for clavicle fractures, facial fractures, or intracranial hemorrhages.

E-scooter accidents had a substantial impact on work capacity and long-term outcomes. Of 1,580 patients, 789 (50%) required medical certification for work absence, ranging from same-day to multiple days. Six patients (0.4%) sustained permanent disabilities, including persistent hearing loss, chronic headaches, and lasting orthopedic impairments, while one patient deceased due to his injuries after the accident (Table 3).

Discussion

Whilst several retrospective and prospective studies worldwide have analyzed the impact of e-scooters and e-scooter-related injury patterns, this is the first large analysis with data from Belgium. Antwerp is the largest city agglomeration in Flanders, with a population of 565,707 (11). The six acute care hospitals participating in this study cover most of the city agglomeration with a combined capacity of 3,300 beds (10). The only other Belgian study was a prospective observational study of 170 patients with e-scooter-related injuries admitted to the ED of Saint-Pierre Hospital (Brussels) (8).

The results presented here largely correspond with previous studies, including research conducted in Belgium, Austria, Canada, the United States, and Australia (8,12-15). Male patients and young adults were more frequently involved in e-scooter accidents. Two of the six included hospitals that were both located in the city center treated more patients, reflecting higher e-scooter use and accident rates in these areas. Most patients used private transportation rather than an ambulance service. The primary accident mechanism was fall, whereas collisions or injuries to non-riders were less frequent. The peak of e-scooter injured patients presenting at the ED was in the evening during weekdays and at night during weekends, which is similar to what was observed previously (16).

In our study, helmet use was very low (1.2%) compared with other studies (Gan-Et et al. 6.4%, Frank et al. 16.7%, and Singh et al. 32%) (5,7,12). However, because helmet use was frequently undocumented in our cohort, this percentage is likely an underestimation. Previous research demonstrated a correlation between head–neck injuries and overall trauma severity, suggesting that helmet use may reduce overall injury severity (17). Similarly, we observed reduced injury severity among helmeted riders, and found that head and facial injuries seem to be less common among helmeted riders. The protective effect was greater for head than facial injuries, which may relate to the type of helmet. Bicycle helmets provide limited frontal and chin protection, and previous research has shown that impacts are typically oblique in e-scooter falls, with 78% involving the forehead (18). Hence, full-face helmets offer superior protection for the head and face and are therefore recommended for e-scooter riders.

Approximately 13% of riders were under the influence of alcohol or psychoactive substances, although underreporting is likely. Liu et al. found higher alcohol use among nighttime riders, associated with increased head and facial injuries (19). Gan-El et al. reported a higher alcohol intoxication rate (30%) and observed that none of the intoxicated patients wore helmets. Alcohol use was also linked to significant head and neck injuries, possibly due to impaired protective reflexes (7). The high incidence rate and severe impact of injuries related to alcohol and drugs reported in the literature and the limited data collection around this topic in this retrospective study, highlights the need for a dedicated, controlled study in a Belgian context around this topic.

Additional imaging was required in 74.3% of patients, primarily RX, but also CT scans. These advanced diagnostics for e-scooter injuries generate significant societal costs. Strikingly, e-scooter-related injuries have been identified as high-energy trauma comparable to road traffic accidents, based on radiological imaging (20). In our cohort, injuries mainly affected the extremities and head/face and were most often sprains, contusions, superficial injuries, or fractures, resulting in generally low ISS scores. However, our data show that even in patients with seemingly minor injuries the impact can be substantial: 7.3% of fractures required surgery, half of patients were unable to return to work, one patient died, and six sustained permanent disabilities. Hence, our and previous findings highlight the considerable healthcare and public burden of e-scooter-related injuries and the need for targeted prevention strategies. In a limited number of countries, safety measures have already been implemented to reduce e-scooter-related injuries. For example, Helsinki prohibited the use of shared e-scooters between midnight and 5 AM on weekends and imposed a speed limit of 20 km/h during the day and 15 km/h during weekday nights. These measures reduced the overall number of e-scooter injuries, with a profound reduction of maxillofacial injuries (up to 88% in certain months) (21-23). Similarly, in Atlanta, Georgia, a nighttime ban on e-scooter rentals reduced the proportion of patients presenting with e-scooter injuries during the restricted hours (24). In Belgium, a legal framework for e-scooter use was established in 2022. Whereas e-scooter riders were previously allowed to use sidewalks at walking speed, as of 2022 e-scooters are legally equal to bicycles and are obliged to use the bicycle path or the road to improve pedestrian safety. Furthermore, a minimum age of 16 years and a maximum speed of 25 km/h were set. The legislation also states that only one person is allowed per e-scooter, and that e-scooters must comply with well-defined technical requirements, including working brakes, lights, the presence of reflectors, and a sound signal. Moreover, the Brussels-Capital Region enforces an automatically restricted speed limit for shared e-scooters, based on location through built-in global positioning system (GPS) systems. To date, the impact of this measure has not yet been reported. Based on this and previous studies, we recommend the implementation of targeted safety measures to improve public health and to reduce e-scooter-related health care costs. These measures include the mandatory use of a helmet (preferably full-facial), a strict prohibition of alcohol or drug consumption for e-scooter riders, and a stricter enforcement of speed limits (20 km/h), with consideration for lowering maximum speeds in the city centers (15 km/h). Furthermore, restrictions on the use of shared e-scooters during late evening and nighttime hours, as well as a ban on mobile phone use while riding, may further enhance rider safety.

Despite being a large-scale retrospective analysis, this study has several limitations. Data regarding helmet use and alcohol and/or drug consumption are largely lacking. Minors (<16 years old) were excluded from our cohort, although e-scooter use has been gaining popularity in this age group as well (25). We did not differentiate between privately owned and shared e-scooters. Previous research has demonstrated behavioral differences between these groups. For example, riders of shared e-scooters were reported to be 70% less likely to wear a helmet compared to riders of privately owned e-scooters (26). Future research, including a larger study population and more detailed patient records might help closing these knowledge gaps.

Conclusions

This study presents the first large-scale analysis of e-scooter-related injuries in Belgium, providing insights into usage patterns, injury mechanisms, and risk factors. While most injuries were minor, a notable proportion involved severe trauma, hospital admissions, and long-term consequences, including permanent disability and death, underscoring the significant public health burden posed by e-scooter use. The findings highlight the need for evidence-based preventive strategies, including helmet use and speed regulation, to mitigate injury severity and incidence. Besides speed limitations and helmet use, more rigorous data collection around alcohol and drugs is needed. As regulatory frameworks continue to evolve, this study provides a valuable foundation for informed policy development aimed at enhancing the safety of e-scooter users within urban environments.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jeccm.amegroups.com/article/view/10.21037/jeccm-2026-0020/rc

Data Sharing Statement: Available at https://jeccm.amegroups.com/article/view/10.21037/jeccm-2026-0020/dss

Peer Review File: Available at https://jeccm.amegroups.com/article/view/10.21037/jeccm-2026-0020/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jeccm.amegroups.com/article/view/10.21037/jeccm-2026-0020/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the ethics committees of both Ziekenhuis Netwerk Antwerpen (ZNA) and Gasthuiszusters Antwerpen (GZA), prior to their institutional merge into ZAS (approval #240202RETRO and #5953). The requirement for informed consent was waived by the ethics committees due to the retrospective and observational nature of the study.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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