Neurological outcomes and risk factors for traumatic brain injury in two-wheeled vehicles users: A comparative study of motorcyclists, bicyclists, and scooter riders admitted to the intensive care unit.

Road traffic injuries (RTIs) involving two-wheeled vehicles are a leading cause of traumatic brain injury (TBI). The increasing popularity of short-term rental bicycles and e-scooters has raised public health concerns. We aimed to compare neurological injuries and neurosurgical utilization between scooter and bicycle (S/B) users and motorcyclists and to identify risk factors associated with TBI and its severity. A retrospective single-center study including all two-wheeler RTI patients admitted to the intensive care unit (ICU) of a trauma center between 2011 and 2022. Variables included demographics, injury circumstances, clinical data, radiological findings, neurosurgical interventions, and outcomes. Statistical analyses were performed to compare S/B users with motorcycle users and to identify variables associated with TBI. The study included 1605 patients (1420 motorcyclists, 29 scooter users, and 156 bicyclists). S/B users were older, more often female, and more frequently on antiplatelet or anticoagulant treatment. TBI was more common in S/B users (50.3% vs. 23.6%), with higher rates of abnormal head CT and neurosurgical interventions. S/B users wearing a helmet (33%) had a decreased likelihood of TBI (OR 0.38, 95% CI 0.17-0.80; p = 0.012). ICU mortality was higher in S/B users (13.3% vs. 4.7%, p < 0.001), with TBI being the most frequent cause of death. Increased age (OR 1.04 per year, 95% CI 1.00-1.08, p = 0.041) and preinjury anticoagulation (OR 20.65, 95% CI 1.99-531.32, p = 0.021) were associated with ICU mortality. The incidence and severity of TBI were greater in S/B users than in motorcyclists. These findings highlight the need for targeted prevention.