{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:03:24Z","timestamp":1784311404725,"version":"3.55.0"},"reference-count":19,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Electric bicycle (e-bike) sales are growing exponentially worldwide. These vehicles are faster and heavier, with younger riders using e-bikes more frequently, reports of inconsistent helmet use, and increased deaths and injuries. We hypothesized that California has experienced significant annual increases in e-bike rider injuries and injury severity compared with injured traditional bicyclists, using a transportation injury registry and geospatial mapping system, including socioeconomic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of the California Highway Patrol Statewide Integrated Traffic Records System (SWITRS) from 2018 to 2024, identifying e-bike collisions through reporter coding and vehicle brand names. We analyzed demographics, injury severity, fault status, traffic violations, and scene census tract Social Vulnerability Index (SVI). All non-e-bike traditional bicycle collisions served as the comparison group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 4035 e-bike and 58\u2009332 bicycle collisions. E-bike injuries increased sharply over the study period, from two incidents in 2018 to 1566 in 2024 (p&lt;0.001), while bicycle collisions remained stable. E-bike riders were younger (median 33 vs 36 years; p&lt;0.001), with a significantly greater proportion aged \u226414 years (15.6% vs 10.2%). Moderate-to-severe injuries were more common among e-bike riders (15.8% vs 11.9%; p&lt;0.001). Although overall mortality was similar (2.0% vs 1.7%), a significant divergence emerged in 2024, with higher e-bike mortality (p=0.027) and a significant interaction between year and vehicle type. E-bike collisions demonstrated more unsafe speed and improper turning violations and occurred in census tracts with lower social vulnerability. Spatial analysis showed tighter clustering of e-bike collisions relative to bicycles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>E-bike injuries are rapidly increasing in California and are associated with a higher severity of injuries compared with traditional bicycles. Urgent efforts are needed for targeted prevention, regulatory alignment, and rider education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level III, retrospective case-control study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2025-002099","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:20:30Z","timestamp":1784308830000},"page":"e002099","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["An exponential increase in e-bike injuries in California"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6394-7520","authenticated-orcid":false,"given":"John","family":"Austin","sequence":"first","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3136-5104","authenticated-orcid":false,"given":"Louis","family":"Perkins","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4088-2418","authenticated-orcid":false,"given":"Laura N","family":"Haines","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7299-453X","authenticated-orcid":false,"given":"Allison E","family":"Berndtson","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L","family":"Weaver","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarrett","family":"Santorelli","sequence":"additional","affiliation":[{"name":"Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Maa","sequence":"additional","affiliation":[{"name":"Department of Surgery, MarinHealth Medical Center, Greenbrae, California, USA"},{"name":"Chinese Hospital of San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romeo C","family":"Ignacio","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA"},{"name":"Rady Children\u2019s Hospital San Diego, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Burruss","sequence":"additional","affiliation":[{"name":"University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy E","family":"Liepert","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0215-5327","authenticated-orcid":false,"given":"Todd W","family":"Costantini","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9617-001X","authenticated-orcid":false,"given":"Jay J","family":"Doucet","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"2026071710201902000_11.3.e002099.1","unstructured":"United States Department of Energy . FOTW #1321, December 18, 2023: e-bike sales in the United States exceeded one million in 2022. Available: https:\/\/www.energy.gov\/eere\/vehicles\/articles\/fotw-1321-december-18-2023-e-bike-sales-united-states-exceeded-one-million [Accessed 10 Oct 2023]."},{"key":"2026071710201902000_11.3.e002099.2","unstructured":"eCycle Electric . How big is the USA e-bike market in 2024-25? 2025. Available: https:\/\/www.ecycleelectric.com\/blog\/2025\/2\/12\/how-big-is-the-usa-e-bike-market-in-2024-25 [Accessed 01 Jul 2025]."},{"key":"2026071710201902000_11.3.e002099.3","doi-asserted-by":"crossref","first-page":"108065","DOI":"10.1016\/j.amepre.2025.108065","article-title":"Injuries From Electric Bikes and Scooters: Illinois, U.S., 2021-2023","volume":"69","author":"Shannon","year":"2025","journal-title":"Am J Prev Med"},{"key":"2026071710201902000_11.3.e002099.4","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1080\/00913847.2025.2470104","article-title":"The rise in electric biking (E-bike) injuries: a 10-year age and sex-specific analysis of national injury data","volume":"53","author":"Locke","year":"2025","journal-title":"Phys Sportsmed"},{"key":"2026071710201902000_11.3.e002099.5","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.2105\/AJPH.2024.307820","article-title":"The Burden of Injuries Associated With E-Bikes, Powered Scooters, Hoverboards, and Bicycles in the United States: 2019\u20122022","volume":"114","author":"Burford","year":"2024","journal-title":"Am J Public Health"},{"key":"2026071710201902000_11.3.e002099.6","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.sopen.2023.06.004","article-title":"Electric bicycles (e-bikes) are an increasingly common pediatric public health problem","volume":"14","author":"Goodman","year":"2023","journal-title":"Surg Open Sci"},{"key":"2026071710201902000_11.3.e002099.7","first-page":"34","article-title":"Electric Bikes Are Emerging as Public Health Hazard","volume":"109","author":"Maa","year":"2024","journal-title":"Bull Am Coll Surg"},{"key":"2026071710201902000_11.3.e002099.8","doi-asserted-by":"crossref","first-page":"100061","DOI":"10.1016\/j.jcmr.2025.100061","article-title":"Comparing injuries from e-scooters, e-bikes, and bicycles in the United States","volume":"4","author":"Younes","year":"2025","journal-title":"J Cycling Micromobil Res"},{"key":"2026071710201902000_11.3.e002099.9","unstructured":"United States Department of Transportation National Highway Traffic Safety Administration . MMUCC guideline model minimum uniform crash criteria. 5th edn. Washington, DC, 2017."},{"key":"2026071710201902000_11.3.e002099.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0137402","article-title":"The Use of Kernel Density Estimation to Examine Associations between Neighborhood Destination Intensity and Walking and Physical Activity","volume":"10","author":"King","year":"2015","journal-title":"PLoS One"},{"key":"2026071710201902000_11.3.e002099.11","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/TA.0000000000003075","article-title":"Enhancing trauma registries by integrating traffic records and geospatial analysis to improve bicyclist safety","volume":"90","author":"Doucet","year":"2021","journal-title":"J Trauma Acute Care Surg"},{"key":"2026071710201902000_11.3.e002099.12","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1477473","article-title":"Popular but precarious: low helmet use among shared micromobility program riders in San Francisco","volume":"12","author":"Frye","year":"2024","journal-title":"Front Public Health"},{"key":"2026071710201902000_11.3.e002099.13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00140139.2025.2550346","article-title":"Evaluation of risk perception among young electric bike riders","volume":"2025","author":"Cai","year":"2025","journal-title":"Ergonomics"},{"key":"2026071710201902000_11.3.e002099.14","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1007\/s00068-025-02941-4","article-title":"Injury severity and traumatic brain injuries in youth and adolescents using conventional and electronic bicycles; a retrospective cohort study","volume":"51","author":"Kroes","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026071710201902000_11.3.e002099.15","unstructured":"Safe RIDE Act, H.R. 5265, 118th Cong., 2nd Sess; 2025."},{"key":"2026071710201902000_11.3.e002099.16","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2019-000337","article-title":"The e-merging e-pidemic of e-scooters","volume":"4","author":"Kobayashi","year":"2019","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026071710201902000_11.3.e002099.17","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2024-001440","article-title":"From Peril to Protection: an evaluation of regulations impacting eScooter injuries","volume":"10","author":"Black","year":"2025","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026071710201902000_11.3.e002099.18","unstructured":"PeopleForBikes Staff . The E-bike problem is an E-moto problem. 2025. Available: https:\/\/www.peopleforbikes.org\/news\/the-e-bike-problem-is-an-e-moto-problem [Accessed 19 Sep 2025]."},{"key":"2026071710201902000_11.3.e002099.19","doi-asserted-by":"crossref","unstructured":"Agrawal AW , Fang K . Exploring e-bike safety performance data and policy options for California. Report No.: MTI Project 2423. San Jos\u00e9 (CA) Mineta Transportation Institute, San Jos\u00e9 State University; 2025. Available: https:\/\/transweb.sjsu.edu\/sites\/default\/files\/2423-Agrawal-Electric-Bicycle-Safety-Data-Policy.pdf","DOI":"10.31979\/mti.2025.2423"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2025-002099","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:20:32Z","timestamp":1784308832000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2025-002099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,17]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/tsaco-2025-002099"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2025-002099","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}