Orofacial injuries from powered scooters in United States emergency departments: a serial cross-sectional analysis of national estimates

INTRODUCTION

Electric scooters have become a widespread form of micromobility in United States cities since dockless rental programs expanded in 2017, and the devices now account for a large share of short urban trips.(1,2) Shared fleets have made the vehicles available without ownership, and municipal regulation has generally lagged behind their diffusion.(3) The same expansion has been followed by a well-documented increase in emergency department (ED) visits for injuries sustained while riding these vehicles.(4,5) Because powered scooters travel at speeds that can exceed 15 miles per hour and riders seldom wear protective equipment, falls and collisions frequently transfer energy to the unprotected head and face.(2,3) Injuries from these devices now constitute a measurable share of micromobility trauma in urban centers and impose costs on acute services, dental and maxillofacial departments, and patients whose treatment extends well beyond the index visit.(2,6)

The injury profile of powered scooters is dominated by the upper extremity, head and face. Farley et al.( 4) reported that the estimated incidence of e-scooter injuries in the United States increased sharply between 2014 and 2019, and Namiri et al.( 5) documented parallel growth in hospital admissions. Head and neck injuries account for a substantial share of e-scooter ED visits nationally,(7,8) and single-center series have described craniofacial fractures, soft-tissue injuries and dental trauma after e-scooter accidents.(9,10) A systematic review concluded that craniofacial trauma is among the most frequent consequences of e-scooter collisions and called for dedicated reporting of these anatomical regions.(11) Dental injuries have received less attention, although Korean and German series indicate that dentoalveolar trauma is a distinct and clinically relevant component of the e-scooter injury burden.(10,12) In other collision contexts, dental trauma carries long-term functional and aesthetic consequences that often require complex and costly restorative treatment, so even a modest proportion of dental injuries translates into a substantial demand for oral health services.(13) Craniofacial and dental injuries from e-scooters impose a particular burden because they frequently require staged surgical and restorative care that extends for months after the index visit.(6,10)

Most published reports on e-scooter facial trauma are single-center studies, cover short or early adoption windows, or combine the face with the head in a single category, which obscures the specific burden on the mouth, teeth and facial skeleton.(6,11) Nationally representative estimates of orofacial injuries, their evolution across the entire post-launch period through 2024, and the age groups most affected are not available. The distinction between the face and the mouth and the head matters clinically because it determines whether patients are managed by oral and maxillofacial, dental or neurosurgical teams, and because dental trauma requires timely intervention for a favorable prognosis.(13) Trend estimation is further complicated by a change in NEISS product codes: powered scooters moved from code 5042 to code 5022 in 2020, a transition that few national analyses have addressed explicitly.(4) Quantifying these injuries precisely matters for dental and maxillofacial services, for the design of protective equipment, and for age-targeted safety regulation.

This study aimed to estimate national trends between 2018 and 2024 and the age distribution of ED visits for orofacial (face and mouth) injuries associated with powered scooters in the United States, using a serial cross-sectional design and explicit sensitivity analyses for the product-code change.

METHODS

RESULTS

Sensitivity analyses

The magnitude of the increase was robust to the case definition (Table 5). Under S1 (product codes 5022 and 5042 without narrative exclusions), the estimated number of orofacial visits rose from 4,426 in 2018 to 27,974 in 2024, based on 109 and 669 unweighted cases, respectively. Under S2 (narrative-expanded definition), the corresponding estimates were 2,922 and 29,736, based on 68 and 748 unweighted cases. All three definitions produced an increase of more than sixfold over the period; the primary definition gave the smallest point estimates in both years and an intermediate percentage increase.

Year	Powered-scooter visits N (95% CI)	Orofacial visits N (95% CI)	Orofacial % (95% CI)	Unweighted n
2018	16683 (9287-24079)	2779 (1065-4493)	16.7 (11.1-22.2)	64
2019	31186 (16377-45996)	6182 (1830-10533)	19.8 (14.1-25.5)	180
2020	29055 (14457-43654)	6084 (2625-9543)	20.9 (17.0-24.9)	163
2021	50471 (32768-68174)	11092 (7389-14794)	22.0 (18.7-25.2)	348
2022	57115 (40460-73769)	12733 (9046-16420)	22.3 (19.9-24.7)	367
2023	63730 (48622-78837)	13663 (9912-17414)	21.4 (18.5-24.4)	464
2024	118051 (67372-168731)	27838 (11167-44510)	23.6 (18.4-28.8)	665

Note: CI = confidence interval. N = national estimate based on NEISS statistical weights. Source: Own elaboration from U.S. Consumer Product Safety Commission NEISS data, 2018-2024.

Characteristic	Unweighted n	National estimate N	Percent (95% CI)
0-17	509	13951	17.4 (11.4-23.3)
18-34	975	36265	45.1 (40.9-49.3)
35-54	551	21139	26.3 (22.9-29.7)
55+	216	9016	11.2 (9.7-12.8)
Male	1501	52832	65.7 (60.4-71.0)
Female	748	27479	34.3 (29.0-39.6)
Hospitalized	202	7337	9.1 (6.7-11.6)
Dental injury	244	8026	10.0 (8.3-11.7)

Note: CI = confidence interval. N = national estimate based on NEISS statistical weights. Age groups in years. Source: Own elaboration from U.S. Consumer Product Safety Commission NEISS data, 2018-2024.

Age group	2018	2019	2020	2021	2022	2023	2024
0-17	1044	691	1028	1569	2060	2390	5168
18-34	1046	3064	2553	5358	5441	6505	12298
35-54	633	1594	1495	2604	3829	3339	7647
55+	56	833	1008	1562	1403	1429	2726

Note: N = national estimate based on NEISS statistical weights. Age groups in years. Source: Own elaboration from U.S. Consumer Product Safety Commission NEISS data, 2018-2024.

Diagnosis	Unweighted n	National estimate N	95% CI	Percent (95% CI)
Fracture	597	21713	12658-30768	27.0 (22.5-31.5)
Laceration	1043	36967	24978-48957	46.0 (44.1-47.9)
Contusion/abrasion	878	31262	22413-40111	38.9 (33.7-44.1)
Internal organ injury	417	14894	10923-18865	18.5 (15.0-22.0)
Dental injury	244	8026	4979-11073	10.0 (8.3-11.7)
Concussion	83	2819	1779-3859	3.5 (2.3-4.7)
Other/not stated	60	2267	1452-3082	2.8 (2.0-3.6)

Note: CI = confidence interval. N = national estimate based on NEISS statistical weights. Percentages may exceed 100 because a case can receive more than one diagnosis. Source: Own elaboration from U.S. Consumer Product Safety Commission NEISS data, 2018-2024.

Case definition	2018 N	2024 N	Change 2018-2024 %
Primary	2779	27838	901.8
S1 code-only	4426	27974	532.0
S2 narrative-expanded	2922	29736	917.5

Note: N = national estimate based on NEISS statistical weights. Source: Own elaboration from U.S. Consumer Product Safety Commission NEISS data, 2018-2024.

DISCUSSION

The principal finding of this study is that the national burden of orofacial injuries associated with powered scooters grew approximately tenfold in United States emergency departments between 2018 and 2024, faster than the growth of powered-scooter visits overall, and that adults aged 18-34 years bore nearly half of that burden. The direction and magnitude of the increase are consistent with the national rise in e-scooter injuries described for earlier periods by Farley et al.(4) and Namiri et al.,(5) and with more recent national analyses of motor-vehicle-related and rental scooter injuries.(16-18) The present estimates extend those reports in three ways: they isolate the face and mouth from the head, they cover the complete post-launch period through 2024, and they show that the orofacial share of all scooter visits increased rather than remaining constant, which indicates that the growth in orofacial injuries was not simply proportional to the growth in scooter use. Previous national studies either ended before the product-code change or began after it, whereas the present series bridges the two coding eras with a single, explicit case definition. This distinction is analytically important because it rules out the simple explanation that more scooter use alone explains the rising orofacial caseload and directs attention toward factors that specifically increase the risk of facial impact. The increase also spans the years before and after the pandemic, which suggests that it reflects the durable adoption of the device rather than a transient disruption of travel patterns. The present point estimates are of the same order as the facial-injury volumes implied by earlier national head-and-neck studies, which is reassuring given the different case definitions and periods used in those reports.(7,8)

The age distribution identified adults aged 18-34 years as the most affected group, a pattern that matches the demographics of shared scooter ridership and of e-scooter injury cohorts in the United States and Europe.(2,5,19,20) Children and adolescents accounted for a smaller but non-negligible share, consistent with pediatric e-scooter series that report facial and craniofacial involvement among younger riders.(21-23) The pediatric proportion is nonetheless large in absolute terms; because children have limited legal access to rental fleets in most jurisdictions, this suggests that privately owned devices and adult rentals used by minors contribute materially to the burden. The male predominance observed here agrees with virtually all published e-scooter injury studies.(2,18) The hospitalization proportion is broadly consistent with national analyses of admission risk after scooter trauma.(24) The finding that nearly half of all orofacial injuries occurred in adults aged 18-34 years has direct implications for prevention, because this group is also the most frequent user of shared fleets.(3) By contrast, injuries from nonmotorized scooters, which predominantly affect children, have followed a different and flatter trajectory, indicating that the powered devices carry a distinct epidemiology.(25)

For the craniofacial literature, the findings are concordant in direction but differ in scale and anatomical scope. Single-center and multicenter series from Finland, Italy, Switzerland, Germany, the United Kingdom, Slovakia and Korea reported that maxillofacial and dental injuries are frequent outcomes of e-scooter accidents.(10,19,20,26-30) Those studies generally describe proportions of facial injuries within a single trauma center or a short window, whereas the present design provides national, weighted estimates with quantified uncertainty, and it does so with the face and mouth treated as a distinct outcome rather than as a subcategory of head injury. Some multicenter work suggests that e-scooter trauma produces facial fractures of greater severity than other transport mechanisms, a pattern that would magnify the clinical consequences of the rising volumes observed here.(31) Differences in the proportion of orofacial involvement across studies likely reflect variation in case definitions, in the availability and regulation of rental fleets, and in helmet legislation.(32,33) Studies that compared e-scooter with bicycle facial trauma found more severe or more frequent midface involvement after e-scooter accidents,(12,20,34) and a national comparison of electric and conventional scooters and bicycles likewise indicated a distinct injury profile for electric devices.(35) European centers operate under stricter helmet mandates in several jurisdictions, and their reported facial injury proportions are generally lower than single-center estimates from the United States, a difference consistent with a protective effect of head and face protection rather than with a lower intrinsic risk of the device.(19,20,27) The United Kingdom experience is instructive because e-scooter trials were introduced city by city; series from Oxford and Birmingham documented a rapid accumulation of facial and oral injuries once rental fleets began operating, paralleling the national pattern observed here.(28,29)

Dental injuries deserve separate emphasis. In the present data they accounted for one in ten orofacial visits, and this proportion is almost certainly conservative because NEISS records only injuries treated in hospital emergency departments, whereas most dental trauma is managed in dental offices and therefore never enters the surveillance system. Direct comparisons are scarce: Kim et al.(10) found that dental and craniofacial injuries were a leading consequence of stand-up e-scooter accidents in Korea, and Aydin et al.(12) reported that dentoalveolar trauma was more frequent after e-scooter than after bicycle accidents in a German urban setting. Taken together with the mechanisms described in the dental trauma literature,(13) these observations indicate that scooter crashes should be regarded as a growing and largely preventable cause of dental trauma, and that dental screening should be part of the initial assessment of any rider who has sustained a facial impact.

The exclusion of the eyeball and ear from the present outcome is a deliberate boundary rather than an oversight. National estimates for eye and orbital injuries from e-scooters and hoverboards have risen in parallel with the pattern described here,(36) which suggests that the orofacial estimates capture only part of a broader craniofacial syndrome and that surveillance definitions should eventually align across these adjacent anatomical regions so that prevention can address the face as a whole.

The mechanisms recorded in NEISS narratives, together with prior biomechanical and epidemiological work, suggest that e-scooter crashes produce orofacial injury chiefly through forward falls in which riders strike the face and mouth on the ground or on street furniture.(2,37) The standing posture places the head forward during deceleration, and the low rates of helmet use documented among e-scooter riders leave the face and teeth unprotected, which plausibly increases the transfer of energy to the orofacial region.(3,33) Vehicle design contributes as well: small wheels and an upright handlebar make e-scooters unstable over curbs, cracks and uneven pavement, and at the moment of impact the rider's hands are usually occupied with steering rather than protecting the face.(37) Night riding and riding against the direction of traffic are additional circumstances documented in crash studies, and both increase the likelihood of an unexpected fall with facial impact.(37) Alcohol and drug involvement, which are common in e-scooter injuries and are associated with more severe craniomaxillofacial trauma, may also concentrate injuries in the orofacial region.(38,39) Younger riders may additionally be less likely to perceive the risk and to use protective equipment, which would reinforce the age gradient observed here.(3) The dominance of the 18-34 age group is therefore best explained by exposure rather than by age-specific fragility: young adults ride more, ride faster and ride under the influence more often, and these behaviors concentrate crashes and facial impacts in that group.(37,39) The mechanisms of dental injury, chiefly direct impact with tooth fracture or avulsion, mirror those described for other collision sports and conveyances.(13)

The product-code change from 5042 to 5022 in 2020 does not explain the observed rise. The sensitivity analyses showed increases of more than sixfold under code-only and narrative-expanded definitions, and the primary definition produced an intermediate percentage increase. The temporary plateau in 2020 is consistent with reduced shared micromobility use during the first year of the COVID-19 pandemic, after which growth resumed. The agreement among the three definitions also matters for future surveillance: as long as the narrative fields remain available, retrospective harmonization across the 2020 transition remains feasible, and the choice of definition changes the level but not the direction of the trend. Because the case definition and its robustness are transparent, the trend estimates can be compared directly with studies that used only the later code or that relied on narrative text.

The main strengths are the nationally representative, design-based estimates; the seven-year post-launch window; the separation of the face and mouth from the head; the explicit handling of the product-code transition with two sensitivity analyses; and the reporting of confidence intervals for every estimate, including proportions obtained with a linearized ratio estimator. These features address the principal criticism of earlier craniofacial studies, namely that small or short samples cannot support national inference.

From a service perspective, the rising volume has two consequences. Emergency departments and maxillofacial units must be prepared to manage a growing number of facial lacerations and fractures that require specialist repair, and dental services should expect an increase in avulsed and fractured teeth in otherwise healthy young adults. Because ED records capture only the acute visit, the full restorative burden falls on dental services that are not represented in the surveillance system, so linking ED and dental records, or adding dental injury to trauma registries, would close this gap.

The tenfold growth in orofacial injuries, and their concentration in young adults, support preventive action at three levels: helmet use with face protection and consideration of mouthguards for high-risk riders, age-appropriate restrictions and speed controls for rental fleets, and public education on the orofacial consequences of e-scooter crashes. Policy evaluation should treat orofacial injury as a measurable and sensitive outcome, because it is common, clinically serious and directly linked to the absence of facial protection. Dental and maxillofacial services should anticipate a rising caseload of scooter-related trauma, and clinicians treating a scooter injury should examine the dentition even when the presenting complaint is elsewhere in the face. Educational campaigns aimed at young adult riders should emphasize that a helmet protects the head but not the teeth, and that full-face protection is the only equipment that reduces orofacial impact in a forward fall. Finally, because the underlying data are updated annually and are freely available, orofacial injury from micromobility devices could be tracked prospectively as a sentinel indicator of the safety of these vehicles, allowing the effect of future regulation to be evaluated in near real time. Such monitoring would give dental and maxillofacial societies an evidence base for advocacy that is currently available only in retrospect.

Stydy limitations

NEISS counts ED visits rather than riders or exposure, so the estimates are counts and not risk rates; studies that link ED visits to ridership data would quantify per-trip risk and should be encouraged.(17) The rising counts therefore reflect a combination of more riders and any change in the risk per rider, and the present design cannot separate the two without external exposure data.

The case definition for 2018-2019 depends on narrative keywords because code 5042 also captured hoverboards; misclassification is possible, although the sensitivity analyses bounded its influence, and the direction of any residual misclassification is likely toward undercounting because some powered scooters recorded under the legacy code without an explicit keyword may have been removed, which would make the reported tenfold increase conservative.

The face and mouth codes exclude adjacent structures such as the ear, eyeball and neck, so the true craniofacial burden is larger than the orofacial estimates reported here, and broader anatomical definitions are warranted.

NEISS does not capture injuries treated outside the ED, and most dental trauma treated in dental offices or by general practitioners is invisible to the system, so the dental estimates are conservative. Fifth, helmet and protective-equipment status is not systematically coded, although automated extraction from narratives is emerging and could refine prevention research.(36)

Estimates for the smallest subgroups, and for 2024 given its wider design variance, should be interpreted with caution. The 2024 file is also the most recently released, and its estimates are subject to revision if CPSC reweights the annual sample in subsequent data releases. A further consideration is generalizability: the estimates describe the United States, where rental fleets, infrastructure and regulation differ from European and Asian settings, so the absolute volumes should not be transferred to other countries even though the direction of the trend is consistent internationally.(27,30)

The face and mouth outcome also relies on the coder's assignment of body part, and some soft-tissue injuries of the lips or cheeks may be coded elsewhere; validation against chart review in a subset of hospitals would quantify this source of error.

CONCLUSIONS

Orofacial injuries associated with powered scooters increased approximately tenfold in United States emergency departments between 2018 and 2024, with an annual percent change of about one third and a rise in the orofacial share of all scooter visits. Adults aged 18-34 years were the most affected age group and contributed nearly half of all orofacial injuries, followed by adults aged 35-54 years. Dental injuries represented one in ten orofacial visits and about one in eleven required hospitalization. The trend was robust to alternative definitions of the powered-scooter case across the 2020 product-code change.

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