E-scooter riders sustain more head and internal injuries than motorcyclists and cyclists in England and Wales

Electric scooters are increasingly used across the United Kingdom, yet national evidence on injury patterns, severity and exposure-adjusted risk remains limited. This study combined the National Major Trauma Registry for England and Wales (trauma admissions, 2020-2022) with operator-reported rental incident data from 18 cities (2020-2024), covering more than 33 million rides and 77.8 million kilometres. The two sources were analysed separately, not linked; across 38,440 records combined (15,247 registry trauma patients and 23,193 operator-reported incidents), e-scooter trauma showed a distinct injury profile, with higher adjusted relative risks than motorcyclists of traumatic brain injury (RR 3.45, 95% CI 3.19-3.75), internal organ injury (1.46, 1.35-1.57) and vascular trauma (3.24, 2.72-3.86), but lower fracture risk (0.80, 0.74-0.85); traumatic brain injury risk also exceeded that of cyclists (1.74, 1.61-1.88). Traumatic brain injury accounted for over one third of adult injuries, and paediatric riders formed a larger share of the trauma burden than in comparator groups. Helmet use was rare, female sex was associated with higher injury severity, and exposure-adjusted collision rates varied with area-level deprivation. A standardised severity framework enables clearer comparison across transport modes and supports evidence-based regulation, infrastructure planning and targeted public health interventions.