1: Epidemiology. 2004 May;15(3):279-86.
Injuries among skiers and snowboarders in Quebec.
Hagel BE, Goulet C, Platt RW, Pless IB. Department of Epidemiology and Biostatistics, McGill University, Montreal,Quebec, Canada.
BACKGROUND: Snow sports such as skiing and snowboarding are recognized as hazardous, but population-based injury rates or specific risk factors have been difficult to estimate as a result of a lack of complete data for both numerator and denominator. METHODS: We used data from 3 surveys to estimate the number of participants and annual number of outings in Quebec by age, sex, activity, and calendar year. Injuries reported by ski patrollers were used to estimate injury rates among skiers and snowboarders for the head and neck, trunk, upper extremity, and lower extremity. RESULTS: Head-neck and trunk injury rates increased over time from 1995-1996 to 1999-2000. There was a steady increase in the rate of injury with younger age for all body regions. The rate of head-neck injury was 50% higher in snowboarders than in skiers (adjusted rate ratio [ARR]= 1.5; 95% confidence interval = 1.3-1.8). Women and girls had a lower rate of head-neck injury (0.73; 0.62-0.87). Snowboarders were twice as likely as skiers to have injuries of the trunk (2.1; 1.7-2.6), and more than 3 times as likely to have injuries of the upper extremities (3.4; 2.9-4.1). Snowboarders had a lower rate of injury only of the lower extremities (0.79; 0.66-0.95). Snowboarder collision-related injury rates increased substantially over time. CONCLUSIONS:Except for lower extremity injuries, snowboarders have a higher rate of injuries than skiers. Furthermore, collision-related injury rates have increased over time for snowboarders. Targeted injury prevention strategies in this group seem justified.
2: Can J Public Health. 2003 Nov-Dec;94(6):458-62.
Trends in emergency department reported head and neck injuries among skiers and snowboarders.
Hagel BE, Pless B, Platt RW. Joint Department of Epidemiology and Biostatistics, McGill University, Montreal,QC.
BACKGROUND: Reports from the U.S. suggest increases in the proportion and rate of head and neck injuries in skiers and snowboarders. It is important to determine if the same is true in Canada. METHODS: Skiers and snowboarders (< 18years) presenting to 16 selected emergency departments from 1991 to 1999 were assigned one body region of injury in the following order: i) brain and spine-spinal cord, ii) head and neck, iii) face, iv) other body region (i.e.,controls). Crude and adjusted (age, gender, helmet use and hospital admission) odds ratios indicating the proportion of head, brain, face, and neck injury relative to controls by calendar year were estimated. Injury rates were examined for 12 to 17 year olds over the last 4 years of the study. RESULTS: Compared with 1997-1999, there was a lower proportion of skier head injuries from 1991-93 (adjusted odds ratio (AOR) = 0.16; 95% Confidence Interval (CI) = 0.09-0.30) and from 1995-97 (AOR = 0.71; 95% CI = 0.49-1.04). The proportion of skier brain injuries was lower from 1993-95 (AOR = 0.69; 95% CI = 0.44-1.07) and from 1995-97 (AOR = 0.56; 95% CI: 0.35-0.91). In snowboarders, however, compared with 1997-99, there was evidence that although the proportion of head injuries was lower from 1991-93 (AOR = 0.19; 95% CI = 0.05-0.80), the opposite was true for facial injuries. For 12 to 17 year olds, skier brain and snowboarder head and neck injury rates increased from 1995-99. CONCLUSIONS: The results suggest that head and brain injuries in skiers and head and neck injuries in snowboarders may be increasing, particularly in adolescents.
3: Inj Prev. 2004 Apr;10(2):99-102.
Downhill skiing injury fatalities among children.
Xiang H, Stallones L, Smith GA. Colorado Department of Public Health and Environment, USA.
OBJECTIVE: Young skiers are at increased risk for injury, however, epidemiological data on skiing related fatal injuries among child skiers are scarce. This study aimed to provide information needed to develop injury control and prevention programs. DESIGN AND SETTING: Study subjects came from Colorado, USA and were identified using a death certificate based surveillance system. Fatal injuries were limited to events that occurred at established commercial ski resorts in Colorado, and subjects were classified as child skiers (0-17years) or adult skiers (> or =18 years). MAIN OUTCOME MEASURE: Type and external cause, time, and week day of injury, gender and residency of the decedents. RESULTS: During the study period from 1980-2001, 149 fatal injuries associated with downhill skiing were identified; 21 (14.1%) occurred among child skiers aged < or =17 years. The age of the youngest decedent was 7 years. In females the proportion of fatal injuries among child skiers was nearly three times that of adults. Traumatic brain injuries were the leading cause of death (67% of all deaths) among children, while multiple internal injuries and traumatic brain injuries accounted for almost equal proportions of fatal injuries among adults. Collision was the leading external mechanism of fatal injuries, accounting for more than two thirds of fatal injuries in both child and adult skiers.CONCLUSIONS: Traumatic brain injury was the leading cause and collision was the leading external injury mechanism of fatal injuries associated with downhill skiing among child skiers. This underscores the importance of brain injury prevention strategies, including the use of ski helmets and prevention of collisions on ski slopes.
4: Injury. 2003 Dec;34(12):892-6.
Deaths associated with snow skiing in Colorado 1980-1981 to 2000-2001 ski seasons.
Xiang H, Stallones L. Health Statistics Section, Colorado Department of Public Health and Environment,Vital Statistics Unit, 4300 Cherry Creek Drive South, Denver, CO 80246-1530,USA.
OBJECTIVES: To investigate the trend and injury patterns of deaths associated with snow skiing in Colorado between 1980 and 2001. METHODS: Death certificates were searched electronically and reviewed manually. Total skier ticket sales were used to calculate death rates. Types of injuries and characteristics of those who died were investigated. RESULTS: A total of 274 skier deaths occurred between 1980 and 2001 in Colorado. Death rates ranged from 0.53 to 1.88 per million skier visits. The majority of deaths were among males (>81%). Ages ranged from 7 to 77 years with an average of 32 years. The greatest number of deaths associated with downhill skiing (76 deaths) occurred between 10:00 a.m.and 2:00 p.m. while the greatest number of deaths associated with cross-country skiing happened between 2:00 and 6:00 p.m. About 65% of deaths associated with downhill skiing (133 cases) died of traumatic injuries resulting from collisions. CONCLUSIONS: A slight increase in the rate of ski-related deaths was observed. The role of collisions in ski-related deaths warrants further investigation to reduce the risk of this activity for all skiers. Further work is needed to determine the efficacy of helmet use to reduce the risk of head injuries in the skiing population.
5: Am J Emerg Med. 2003 Mar;21(2):95-9.
Serious winter sport injuries in children and adolescents requiring hospitalization.
Skokan EG, Junkins EP Jr, Kadish H. Division of Pediatric Emergency Medicine, Department of Pediatrics, Universityof Utah School of Medicine, and the Intermountain Injury Control Research CenterSalt Lake City, Utah 84113, USA.
To describe the epidemiology of serious winter sports-related injuries resulting in hospitalization in children and adolescents, we prospectively collected and analyzed records of all winter sports-related injuries requiring hospitalization at our respective institutions from 1996 to 2000. We identified 101 patients with a mean age of 10.7 years, of whom 68% were male and 32% female. Skiers accounted for 71% and snowboarders 26% of injuries; 3% of injuries were snowmobile-or luge-related. Leading mechanisms of injury were ground level falls(50%), crashes into trees, (18%), and falls from ski lift (13%). Approximately 26% of the patients met criteria for trauma-team activation. Leading diagnoses were head injury (20%), femur fracture (18%), and concussion (11%). Five patients required admission to the intensive care unit. The median injury severity score (ISS) was 7; 8% of patients had an ISS score > 15. Abbreviated Injury Scale-1990 scores of > or = 3 were noted in 34% of the patients. We conclude that Injuries sustained through participation in winter sports may be severe, especially in the case of injuries involving the head. Injury-prevention strategies should focus on head injuries. Copyright 2003, Elsevier Science(USA). All rights reserved.)
6: Inj Prev. 2002 Dec;8(4):324-7.
Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders.
Macnab AJ, Smith T, Gagnon FA, Macnab M. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
PURPOSE: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. METHODS: During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified.On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. RESULTS: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk(RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. CONCLUSION: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.
7: Semin Neurol. 2000;20(2):233-45.
Neurologic injuries in skiers and snowboarders.
Levy AS, Smith RH. Intermountain Neurosurgery and St. Anthony Central Hospital, Denver, Colorado80204, USA.
Neurologic injures are the leading cause of death and disability in skiing and snowboarding accidents, despite accounting for only a small fraction of injuries overall. Head injuries make up 3 to 15% of all skiing and snowboarding related injuries, spinal injuries account for 1 to 13%, and peripheral nerve injuries constitute less than 1% of reported injuries. Improvements in equipment and technology, especially advances in binding technology, have resulted in decreased injury rates on the slopes overall, but neurologic injury rates have not decreased, and in fact appear to be increasing as a percentage of overall injuries and in absolute numbers. With advances in technology and slope maintenance, skiers and boarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in skiers and snowboarders, but until recently very little attention has been given to neurologic injury prevention on the slopes. Hopefully with increased awareness and the growing popularity of ski/snowboard helmets, we will begin to see head injury rates (and maybe even spine injury rates) decrease among skiers and snowboarders.