Doctors Sound Alarm Over Popular Outdoor Activity Linked to Devastating Brain, Facial Injuries
Pedestrians hit by e-bikes suffer brain injuries at nearly double the rate of the riders themselves. That finding comes from a five-year trauma study out of one of Manhattan’s busiest emergency rooms, and it points to a risk most people have not considered: when an e-bike or scooter crashes, the person with no helmet, no warning, and no ability to brace for impact often ends up the most severely injured.
The study, published in April 2026 in the journal Neurosurgery, examined what has been happening at NYC Health + Hospitals/Bellevue as electric bikes and scooters have flooded city streets. The researchers weren’t tracking minor scrapes. They were tracking trauma admissions, ICU stays, and neurosurgical cases. Researchers at NYU Langone Health found that e-bike and scooter crashes now account for nearly 7% of all trauma patients admitted to one New York City hospital.
Their analysis covered 914 patients treated for injuries linked to pedal-powered and electric micromobility devices at Bellevue over five years. That 7% may sound modest until you consider that trauma wards handle car crashes, stabbings, falls from height, and construction accidents. Claiming that share of caseload is a significant footprint for what many people still think of as a recreational vehicle.
A Surge That Didn’t Happen Overnight
E-bike and scooter crash cases at Bellevue increased from less than 10% of all bike- and scooter-related trauma in 2018 to more than 50% by 2023 – a fivefold rise in five years that tracks directly with the broader explosion in e-bike adoption across American cities.
The national picture reinforces that trend. Helmet use among e-bike riders declined by almost 6% each year between 2017 and 2022, while the number of e-bike riders seeking hospital care for head trauma shot up 49-fold to nearly 8,000 in 2022, according to research published in JAMA Surgery. Separately, a study of vehicular trauma between 2014 and 2019 found that e-bikes and powered scooters were responsible for 10.3% of all hospital admissions for dental and maxillofacial (jaw and facial) injuries.
A 2024 study published in JAMA Network Open analyzed data from 86,623 people between 2017 and 2022 and found that electric bicycle injuries nearly doubled every year, while electric scooter injuries increased by more than 45% annually. After a dip during the early COVID-19 pandemic, ER-worthy injuries related to powered scooters rose steadily, from just under 30,000 in 2020 to 118,485 as of 2024.
The Injuries Are Not Minor
The NYU Langone research team found that one-third of patients suffered traumatic brain injury (TBI), more than two-thirds required hospital admission, and roughly 30% needed intensive care. TBI refers to any disruption in brain function caused by an external force, ranging from concussion to bleeding inside the skull.
Most patients, nearly 69%, needed to be admitted to the hospital, and the majority stayed at least three days. Many required neurosurgical intervention, not quick ER visits followed by a discharge with an ice pack.
Dr. Hannah Weiss, a chief neurosurgery resident at NYU Langone Health/Bellevue Hospital and the study’s corresponding author, described the caseload in comments to NY1: “This is becoming a real burden on trauma centers in cities like New York and beyond. These are major injuries. They’re complex.”
The facial injury toll deserves separate attention. Researchers in Israel evaluating helmet use and oral and maxillofacial injuries caused by e-bikes and powered scooters found that helmets carry a protective benefit against oral injuries, though data at the time remained sparse. Emergency room records from the Bellevue study consistently show broken facial bones, knocked-out teeth, and deep lacerations – injuries that carry their own long-term consequences in terms of surgeries, recovery time, and permanent changes to appearance.
Who Gets Hurt, and When
The most common cause of serious outdoor activity brain injuries in the Bellevue dataset was a collision with a car or truck, accounting for about half of all cases. Popular discourse around e-bike crashes tends to focus on riders losing control or hitting a pothole. The Bellevue data tells a different story: in most serious cases, a motor vehicle was involved.
The timing of crashes follows a recognizable pattern. The early evening is a high-risk period, when lighting conditions change, roads grow busier, and both riders and drivers may be fatigued or distracted. The most severe injuries occur at dusk or after dark. The NYU Langone team specifically flagged 6 to 8 p.m. as the peak window, suggesting that heavy dinnertime delivery traffic on e-bikes may be a contributing factor.
The pedestrian risk is especially sobering. The 69 pedestrians in the study suffered the most severe outcomes, experiencing brain injuries at almost double the rate of riders. Nearly a third of those patients required intensive care. A person crossing the street has no helmet, no padding, no warning, and no ability to brace for impact.
Alcohol compounds the risk significantly. The NYU Langone team found that about one in five patients tested positive for alcohol, which was tied to both worse brain injuries and lower rates of helmet use.
The Helmet Gap Is the Central Problem
Dr. Weiss stated in the study press release that “micromobility injuries are producing serious brain and spinal trauma that demands neurosurgical care at a scale we haven’t seen before.” Her team’s data on helmet use shows why that trauma burden keeps rising.
Fewer than one-third of riders in the Bellevue study wore helmets, and helmet absence was linked to significantly higher rates of brain and facial injuries. In clinical terms, a helmet’s protective effect is not theoretical. According to the 2026 Neurosurgery study, helmet use among e-bike riders was associated with higher Glasgow Coma Scale scores – the clinical measure of consciousness and neurological function – and fewer days on a mechanical ventilator. The Glasgow Coma Scale (GCS) runs from 3 to 15; a higher score means the patient is more alert and coherent after injury, and fewer ventilator days means the brain injury was less likely to have suppressed the body’s ability to breathe independently.
A separate study in trauma research found that overall injury patterns in e-bikers more closely resembled those seen in motorcycle accidents than bicycle accidents. E-bikers had a higher rate of cerebral bleeding, particularly when no helmet was worn, but helmet use brought that rate down to levels comparable to helmeted conventional cyclists. An e-bike, despite looking like a bicycle, carries injury risk closer to a motor vehicle – and should be treated as one when it comes to protective gear.
Children and Racial Disparities in the Injury Data
The injury surge is not affecting all groups equally. A study from Johns Hopkins Medicine found that e-scooter injuries rose by 80% from 2020 to 2024, climbing from 29,344 to 115,713 cases nationwide. Within that data, the racial disparity in pediatric injuries stands out. Black and Hispanic children experienced the highest rates of e-scooter injury, at 16% and 15.7% respectively, during the study period from 2020 to 2024.
Those disparities across neighborhoods in infrastructure, enforcement, and access to safety equipment are factors that state-level policy can directly address through helmet distribution programs, protected lane investment, and age-based enforcement.
What Regulators Are Starting to Do
New Jersey enacted a law that took effect in January 2026 requiring e-bike riders to be at least 15 years old and mandating that all e-bikes be registered with the state Motor Vehicle Commission. The law also makes helmets mandatory for all e-bike riders, regardless of age, according to the New Jersey MVC. Legal analysts have described it as the most restrictive e-bike law in the country, stricter than those in New York or California.
Dr. Paul P. Huang, chief of neurosurgery at NYC Health + Hospitals/Bellevue and a co-author of the Bellevue study, called for systematic action in comments reported by Philly Voice: “Our findings make clear that urban infrastructure must continue to improve to keep pace with the rapid rise of electric bikes and scooters. Future studies should track these injuries across multiple cities and measure whether protected bike lanes, helmet programs, and speed enforcement actually reduce the number of brain and spine surgeries we perform.”
The call for protected bike lane infrastructure is grounded in the Bellevue data showing that collisions with motor vehicles drive roughly half of all serious injuries. Separating e-bikes and scooters physically from car traffic would address the single biggest mechanism of harm.
What to Do Now
Wearing a helmet every ride – including short trips – is a direct response to data showing that one in three serious e-bike or scooter crash patients ends up with a traumatic brain injury, and that helmet users consistently fare better on every clinical measure. Riders should also note that standard bicycle helmets may not be sufficient: specialized e-bike helmets carry more robust interior padding designed for higher speeds and different impact angles.
Riding after drinking is a distinct and measurable risk factor. The NYU Langone data tied alcohol use to both more severe brain injuries and a lower likelihood of helmet use, making it a double compounding factor. The peak danger window runs from late afternoon into the evening, when delivery traffic is heavy and light is fading. Adjusting route timing and adding front and rear lighting is a concrete response to the crash timing data.
For parents, the age restrictions now appearing in state law reflect what emergency physicians have been seeing firsthand. Pediatric e-scooter injuries are rising fastest among younger children, and the consequences of a TBI at a young age can affect development, schooling, and cognition well beyond the initial hospital stay. Treating an e-bike like a conventional bicycle when it comes to supervision and safety gear is a mismatch the trauma data no longer supports.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
