Alcohol as a risk factor for downhill skiing trauma

Injury patterns and risk factors for orthopaedic trauma from snowboarding and skiing: a national perspective

PURPOSE

Alpine skiing and snowboarding are both popular winter sports that can be associated with significant orthopaedic injuries. However, there is a lack of nationally representative injury data for the two sports.

METHODS

The National Trauma Data Bank was queried for patients presenting to emergency departments due to injuries sustained from skiing and snowboarding during 2011 and 2012. Patient demographics, comorbidities, and injury patterns were tabulated and compared between skiing and snowboarding. Risk factors for increased injury severity score and lack of helmet use were identified using multivariate logistic regression.

RESULTS

Of the 6055 patients identified, 55.2 % were skiers. Sixty-one percent had fractures. Lower extremity fractures were the most common injury and occurred more often in skiers (p < 0.001). Upper extremity fractures were more common in snowboarders, particularly distal radius fractures (p < 0.001). On multivariate analysis, increased injury severity was independently associated with age 18-29, 60-69, 70+, male sex, a positive blood test for alcohol, a positive blood test for an illegal substance, and wearing a helmet. Lack of helmet use was associated with age 18-29, 30-39, smoking, a positive drug test for an illegal substance, and snowboarding.

CONCLUSIONS

Young adults, the elderly, and those using substances were shown to be at greater risk of increased injury severity and lack of helmet use. The results of this study can be used clinically to guide the initial assessment of these individuals following injury, as well as for targeting preventive measures and education.

LEVEL OF EVIDENCE

Prognostic Level III.

Drunk, drowsy, doped: skiers' and snowboarders' injury risk perceptions regarding alcohol, fatigue and recreational drug use

The objective was to investigate perceptions of snowfield resort visitors about injury risk regarding alcohol, fatigue and recreational drug use. Visitors to a resort village in a large Australian snowfield region completed a brief survey about fatigue, alcohol and recreational drug use and injury risk perception. Participants stated their ability to ski or snowboard and drive safely following a lack of sleep, alcohol and recreational drug use. Intoxicated snowfield resort visitors were compared with non-intoxicated visitors. Safety beliefs across snow sport and transport were compared. Participants reported that they generally slept less than usual and 30% reported both drinking alcohol and using drugs more than usual while visiting the snowfields. Participants perceived driving as a greater injury risk than skiing/snowboarding (p < 0.001). Fatigue was perceived as a relatively weak injury risk factor, particularly whilst skiing and snowboarding. Awareness needs to be raised among snowfield resort visitors about the contribution of alcohol, fatigue and recreational drug use to snow sport and transport-related injury risk.

Deaths associated with snow skiing in Colorado 1980-1981 to 2000-2001 ski seasons

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.

Paralysis from sport and diving accidents

OBJECTIVE

To examine the causes of sport-related spinal cord injuries that developed into paraplegia or tetraplegia, and to compare data from different sports with previous studies in the same geographical region.

DESIGN

A retrospective epidemiological study and comparison with previous studies.

SETTING

The Orthopedic Department, specializing in the treatment and rehabilitation of paralyzed patients, at the University of Heidelberg, Germany.

PARTICIPANTS

Between 1985 and 1997, 1,016 cases of traumatic spinal cord injury presented at the Orthopedic Department at the University of Heidelberg: 6.8% were caused by sport and 7.7% by diving accidents.

MAIN OUTCOME MEASURES

Sport-related spinal cord injuries with paralysis.

RESULTS

A total of 1.016 cases of traumatic spinal cord injury were reviewed. Of these, 14.5% were caused by sport accidents (n = 69) or diving accidents (n = 78). Age of patients ranged from 9 to 52 years. 83% were male. 77% of the patients developed tetraplegia, and 23%, paraplegia. 16 of the sport accidents resulted from downhill skiing, 9 resulted from horseback riding, 7 from modern air sports, 6 from gymnastics, 5 from trampolining, and 26 from other sports. Previous analyses had revealed that paraplegia had mainly occurred from gymnastics, trampolining, or high diving accidents. More recently, however, the number of serious spinal injuries caused by risk-filled sports such as hang gliding and paragliding has significantly increased (p = 0.095), as it has for horseback riding and skiing. Examinations have shown that all patients who were involved in diving accidents developed tetraplegia. An analysis of injury from specific sports is still under way.

CONCLUSIONS

Analysis of accidents resulting in damage to the spinal cord in respect to different sports shows that sports that have become popular during the last 10 years show an increasing risk of injury. Modern air sports hold the most injuries. Injury-preventing strategies also are presented.

Eight nonavalanche snow-immersion deaths a 6-year series from british columbia ski areas

The non-avalanche-related snow immersion death (NARSID) appears to be an emerging fatality pattern in Alpine skiing and snowboarding in western North America. Of 32 skiing fatalities that occurred in British Columbia from 1993 to 1998, 8 were NARSIDs. Six deaths occurred when victims suffocated after falling into tree wells around conifers; two victims asphyxiated after falling into a deep snowbank. Seven were Alpine skiers and one was a snowboarder; all had advanced skiing or snowboarding skills. All recorded NARSIDs occurred during or immediately after heavy snowstorms. The patterns found here suggest prevention strategies and show the importance of using avalanche rescue dogs as early as possible in the search for missing skiers and snowboarders.