The rapid spread of electric scooters, e-bikes, and other micromobility vehicles is reshaping the patterns of road traffic injuries in Rome and other cities worldwide. Policies aimed at reducing the use of polluting vehicles have accelerated adoption, but healthcare systems are now facing a growing burden of trauma related to these vehicles. Two recent studies conducted in central Rome and New York City reported a sharp rise in serious injuries linked to electric micromobility, raising concerns among emergency and trauma specialists.
A recent retrospective multicenter study published in the Journal of Orthopaedic Reports examined injuries associated with electric scooter use between 2018 and 2024 at two major trauma centers in central Rome: Ospedale San Giovanni and Policlinico Umberto I.
Researchers analyzed 441 patients and found that injuries primarily affected younger individuals. The mean age was 29.9 years, with men accounting for 71% of cases. Most patients were aged 15-35 years.
Speaking with Univadis Italy, Andrea Fidanza, MD , PhD, orthopaedic surgeon and researcher from the Unit of Orthopaedics, Department of Life Health & Environmental Sciences, University of L’Aquila in L’Aquila, Italy, said, “Compared with northern Europe, we found more lower limb injuries than upper limb injuries. We recorded a few traffic collisions involving other vehicles and many accidents involving objects or caused by falls, partly because of uneven cobblestone streets and the lack of cycling lanes.” Fidanza is the study’s lead author and also the president of the Italian Orthopedic Surgeons Under 40 (O.T.O.D.I. Young).
According to the study, 78% of emergency department visits due to scooter-related accidents resulted from falls rather than collisions. Only 36 of 441 patients (about 8%) wore helmets at the time of the accident.
Researchers reported that 49% of patients requiring specialist care sustained fractures, totaling 170 fracture cases, and approximately 1 in 4 fractures required surgery. “The most common fracture areas were the wrist, head of the radius, clavicle, and proximal humerus in the upper limb and the ankle, tibial plateau, patella, and tibial shaft in the lower limb. Surgical treatment was needed in 27% of upper limb fractures and 25% of lower limb fractures,” Fidanza said.
Head Injuries
A complementary study published in Neurosurgery analyzed 914 patients treated at Bellevue Hospital, a Level I trauma center in New York City, between 2018 and 2023 after accidents involving e-bikes and scooters. These cases accounted for 6.9% of all trauma admissions.
Speaking with Univadis Italy, part of the Medscape Professional Network, Clotilde Balucani, MD, an Italian neurologist based in New York and co-author of the study, said, “Nearly one third of patients sustained head injuries, and more than 50% required surgery or another medical procedure.” “With the expansion of electric micromobility adoption, neurosurgical consultation for head, spinal, and craniofacial injuries has become a routine component of acute trauma care in densely populated metropolitan areas,” she added.
Balucani noted that electric micromobility cases accounted for less than 10% of admissions at the start of the study period but exceeded 50% by 2023. The highest number of accidents occurred between 6 PM and 8 PM, coinciding with the peak demand for meal delivery services, although the study could not specifically identify delivery riders. Helmets, which are not required in New York, were worn by only 1 in 3 riders.
Researchers also highlighted risks for pedestrians. “Pedestrians struck by these vehicles were found to be at a much higher risk for head injury than drivers: about 56% compared with 33% of drivers,” Balucani said.
Trends in Italy
National Italian statistics reflect the same pattern. Based on the data released by the Automobile Club d’Italia (ACI) and the Italian National Institute of Statistics, the 2024 report on road accidents documented 3751 injuries and 23 deaths among electric scooter users, along with one pedestrian death involving a scooter collision. E-bikes were linked to 20 deaths among riders and passengers.
Speaking with Univadis Italy, Alessia Grande, coordinator of ACI’s Professional Statistics Division, said, “E-bikes and scooters often exceed the speed limits for which they are certified. This contributes to the fact that while the absolute number of fatalities remains low, it continues to rise. With the introduction of license plates, perhaps enforcement of traffic violations will finally improve.”
Italy’s revised Highway Code introduced stricter rules, with some measures already in force since early 2025 and others scheduled to take effect in May 2026. These regulations require helmets for all riders, reflective vests or suspenders after sunset, approved lighting and braking systems, liability insurance, and license plates.
Scooter use is restricted to urban roads with speed limits of up to 50 km/h, with scooter speeds capped at 20 km/h on roads and 6 km/h in pedestrian zones. Riding on sidewalks, traveling against traffic or in the wrong direction, carrying passengers or animals, and using reserved lanes for buses, taxi buses, or taxis are prohibited.
However, its enforcement remains difficult. “The basic idea is a good one, but the rules are difficult to enforce and risk proving ineffective,” Fidanza said. He noted that the mayor of Florence recently suspended the city’s free-floating scooter service because authorities lacked effective tools to stop violators and instead aimed to expand bicycle use.
Fidanza called for actions to upgrade infrastructure and urged drivers to take personal responsibility. “Electric scooters can be an asset for sustainable mobility, but not at the expense of rider and pedestrian safety,” he concluded.
The speakers reported having no relevant conflicts of interest regarding the topics discussed.
This story was translated from Univadis Italy.
