Background: Spinal cord injury (SCI) remains a profound medical challenge, with limited therapeutic options available. Studies focusing on individual molecular markers have limitations in addressing the complex disease process. Methods: This study utilizes RNA-sequencing (RNA-seq) to investigate the differentially expressed genes (DEGs) in spinal cord tissue from a rat SCI model at 1 and 21 days post-injury (dpi). After data processing and analysis, a series of biological pathway enrichment analyses were performed using online tools DAVID and GSEA. Interactions among the enriched genes were studied using Cytoscape software to visualize protein–protein interaction networks. Results: Our analysis identified 595 DEGs, with 399 genes significantly upregulated and 196 significantly downregulated at both time points. CD68 was the most upregulated gene at 21 dpi, with a significant fold change at 1 dpi. Conversely, MPZ was the most downregulated gene. Key immune response processes, including tumor necrosis factor (TNF) production, phagocytosis, and complement cascades, as well as systemic lupus erythematosus (SLE)-associated pathways, were enriched in the upregulated group. The enriched pathways in the downregulated group were related to the myelin sheath and neuronal synapse. Genes of interest from the most significantly downregulated DEGs were SCD, DHCR24, PRX, HHIP, and ZDHHC22. Upregulation of Fc-γ receptor genes, including FCGR2B and FCGR2A, points to potential autoimmune mechanisms. Conclusions: Our findings highlight complex immune and autoimmune responses that contribute to ongoing inflammation and tissue damage post-SCI, underscoring new avenues for therapeutic interventions targeting these molecular processes.

E-scooter related head trauma has emerged as a growing contributor to neurosurgical and critical care workload internationally, yet data describing injury patterns, resource utilisation and costs remain limited. This study characterises the epidemiology, clinical features and hospital costs of e-scooter related traumatic brain injury (TBI) within a state-wide Level 1 trauma centre. A retrospective study was conducted using the trauma registry of a state-wide Level 1 tertiary trauma centre in Western Australia, identifying e-scooter-related head injuries from 1 January 2019 to 30 June 2024. The registry captures the majority of moderate to severe TBI, although less severe injuries managed at other hospitals may be under-represented. Cases were stratified into a primary TBI cohort (ICD-10-AM S06) and a secondary cohort of isolated calvarial or skull base fractures (S02). Temporal trends were analysed using negative binomial regression. All clinical, neurosurgical, ICU and cost analyses were restricted to the TBI cohort to ensure internal validity. Multivariable logistic regression identified predictors of ICU admission. Hospital costing data were obtained from activity-based management systems. 93 e-scooter related head injury admissions were identified. TBI accounted for 82 cases (88.2%). There was a steep rise in annual incidence (IRR 1.98; 95% CI 1.58-2.48) over the study period. Most patients were male (81.7%) and intoxication due to alcohol or drugs was common (53.8%). Of the primary TBI cohort, calvarial or skull base fractures occurred in 42.7% of patients. Only 9.8% required neurosurgical intervention, yet 50.0% were admitted to the ICU. In univariate analysis, lower GCS (p = 0.003) and concurrent skull fracture (p < 0.001) were associated with ICU admission. In multivariable analysis, both GCS (OR 0.66 per point; 95% CI 0.44-0.87) and concurrent fracture (OR 7.47; 95% CI 2.47-25.85) remained independent predictors. Total hospital costs increased from $16,103.88 (AUD) in the 2019-2020 financial year to $1,842,153.68 in the 2023-2024 financial year with an annual percent change of 194% (95% CI 105-323). The median cost per TBI admission was $17,720.11 (IQR $9,155.99-$50,311.89). ICU admitted patients incurred significantly higher costs than non-ICU patients (median $30,767.26 vs. $12,906.19). Ward nursing was the largest cost driver. This study documents a growing neurosurgical and critical care challenge in Western Australia. Despite low operative rates, e-scooter related TBI is associated with substantial economic impact, exceeding that reported in other Australian trauma series. These findings highlight opportunities for targeted prevention and policy intervention, including helmet compliance, alcohol riding restrictions and ride-share safety governance.