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E-bike and classic bicycle-related traumatic brain injuries presenting to the emergency department
  1. Anna J M Verbeek1,
  2. Janneke de Valk1,
  3. Ditmar Schakenraad1,
  4. Jan F M Verbeek2,
  5. Anna A Kroon1
  1. 1Department of Emergency Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
  2. 2Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands
  1. Correspondence to Anna J M Verbeek, Department of Emergency Medicine, Noordwest Ziekenhuisgroep, Alkmaar 1815 JD, Noord-Holland, The Netherlands; ajm.verbeek{at}


Background E-bike usage is increasingly popular and concerns about e-bike-related injuries and safety have risen as more injured e-bikers attend the emergency department (ED). Traumatic brain injury (TBI) is the main cause of severe morbidity and mortality in bicycle-related accidents. This study compares the frequency and severity of TBI after an accident with an e-bike or classic bicycle among patients treated in the ED.

Methods This was a prospective cohort study of patients with bicycle-related injuries attending the ED of a level 1 trauma centre in the Netherlands between June 2016 and May 2017. The primary outcomes were frequency and severity of TBI (defined by the Abbreviated Injury Scale head score ≥1). Injury Severity Score, surgical intervention, hospitalisation and 30-day mortality were secondary outcomes. Independent risk factors for TBI were identified with multiple logistic regression.

Results We included 834 patients, of whom there were 379 e-bike and 455 classic bicycle users. The frequency of TBI was not significantly different between the e-bike and classic bicycle group (respectively, n=56, 15% vs n=73, 16%; p=0.61). After adjusting for age, gender, velocity, anticoagulation use and alcohol intoxication the OR for TBI with an e-bike compared with classic bicycle was 0.90 (95% CI 0.56 to 1.45). Independent of type of bicycle, TBI was more likely if velocity was 26–45 km/hour, OR 8.14 (95% CI 2.36 to 28.08), the patient was highly alcohol intoxicated, OR 7.02 (95% CI 2.88 to 17.08) or used anticoagulants, OR 2.18 (95% CI 1.20 to 3.97). TBI severity was similar in both groups (p=0.65): eight e-bike and seven classic bicycle accident victims had serious TBI.

Conclusion The frequency and severity of TBI among patients treated for bicycle-related injuries at our ED was similar for e-bike and classic bicycle users. Velocity, alcohol intoxication and anticoagulant use were the main determinants of the risk of head injury regardless of type of bicycle used.

  • trauma
  • head
  • trauma
  • neurology
  • accidental falls
  • emergency department

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Handling editor Caroline Leech

  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors AJMV and AAK had full access to all the data in the study and take responsibility for the integrity of the data. Study concept and design: AJMV and AAK. Acquisition of data: AJMV, AAK, JdV and DS. Analysis and interpretation of data: JFMV, AJMV and AAK. Drafting of the manuscript: AJMV and AAK. Critical revision of the manuscript for important intellectual content: AAK, JdV and DS. Statistical analysis: JFMV, AJMV and AAK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.