E-bike injuries and prevention strategies across social and built environments: A systematic review

Background Electric bicycle (e-bike) injury incidence and severity are increasing. While prior studies describe e-bike injuries and outcomes, there remains limited synthesis linking injury patterns and healthcare burden to contextual determinants such as the built and social environment, rider demographics, and e-bike safety policies. This review addresses this gap by integrating epidemiologic findings with prevention-relevant context using a Haddon Matrix framework. Methods We conducted a systematic review (PROSPERO-registered), searching MEDLINE, Embase, CINAHL, Scopus, and the Cochrane Library to June 2, 2025. Eligible studies reported e-bike-related injury data and at least three additional e-bike-specific elements drawn from these 4 domains: injury context, severity, treatment, and outcomes. Two reviewers independently screened records, extracted data, and assessed study quality using the Newcastle-Ottawa Scale (NOS). Findings were synthesized narratively and stratified by country, with pooled descriptive summaries reported where feasible. Results Thirty-five studies met inclusion criteria, representing 23 unique datasets (6107 cases) from six countries. Injuries predominantly involved the head (18%-65.7%) and extremities (6.4%-74%). Pooled outcome estimates indicated substantial healthcare utilization, including surgical intervention (31.6%), ICU admission (13.1%), and mortality (1.64%). Single-vehicle injuries were frequently reported. Helmet use varied widely by setting, ranging from 1% to 1.7% in the Netherlands to 63%-73.1% in Switzerland, reflecting differences in policy and cycling culture. Reported prevention strategies most commonly emphasized helmets/protective equipment, education and training, enforcement/legislation, and infrastructure-based interventions. Based on NOS, 48.6% of studies were considered good quality, 11.4% fair, and 40.0% poor. Discussion E-bike injury profiles vary substantially across countries, consistent with differing rider demographics, crash scenarios, infrastructure, and regulatory contexts. Prevention will likely require context-specific, multi-component strategies and stronger surveillance and standardized reporting to support rigorous intervention evaluation.