Neurocranial Trauma From Micromobility Vehicles: A Retrospective Cohort Study of Riders and Pedestrians at a Level 1 Trauma Center

Despite the increasing prevalence of micromobility vehicles, including bicycles, e-bikes, and e-scooters, the burden of neurocranial trauma sustained by pedestrians struck remains understudied. This retrospective observational cohort study compared injury patterns, management, and outcomes between vehicle riders and pedestrians admitted to a level 1 trauma center from 2020 to 2024 for neurocranial trauma. Presence of traumatic brain injury, intracranial hemorrhage, neurocranial fracture, surgical intervention, intensive care unit admission, intensive care unit length of stay, hospital length of stay, 30-day readmission, mortality, and focal neurological deficits on discharge were assessed. χ2 tests and independent-samples t tests were used for comparison between vehicle riders and pedestrians struck. Of the 250 total patients, 70 were pedestrians struck. Pedestrians exhibited significantly greater rates of moderate or severe traumatic brain injury (71.4% versus 56.7%, P=0.032), subdural hematoma (58.6% versus 37.8%, P=0.003), and frontal bone fracture (24.3% versus 13.9%, P=0.048), and were more likely to undergo burr hole evacuation (4.3% versus 0.6%, P=0.035), intracranial pressure monitor placement (5.7% versus 0.6%, P=0.009), and intensive care unit admission (82.9% versus 59.4%, P<0.001). The overall incidence of micromobility-related neurocranial trauma more than doubled (25 in 2020 and 59 in 2024), whereas pedestrian admissions tripled (6 in 2020 and 18 in 2024) during the study period. Pedestrians struck by micromobility vehicles exhibit a growing, underappreciated, and more severe burden of neurocranial trauma than vehicle riders, underscoring the need for targeted prevention strategies.