Are self-reported risk-taking behavior and helmet use associated with injury causes among skiers and snowboarders?

Is badger culling associated with risk compensation behaviour among cattle farmers?

BACKGROUND

Risk compensation theory suggests that behaviours are modified in response to interventions that remove risks by substituting them with other risky behaviours to maintain a 'risk equilibrium'. Alternatively, risk reduction interventions may result in spill-over behaviours that seek to minimise risks further. This paper assessed evidence for these behavioural risk responses among farmers in response to badger culling that seeks to remove the risk of bovine tuberculosis in cattle.

METHODS

Data from the UK's randomised badger culling trial were re-analysed, comparing farmers' cattle movement practices in proactive and reactive culling areas and control areas. Analysis compared cattle movements during and after the trial using zero-inflated negative binomial regression.

RESULTS

The analysis found no strong evidence of risk compensation behaviours among farmers who experienced proactive culling. However, strong evidence for a reduction in cattle movements in reactive culling areas was found. The results indicate high levels of inertia within farming systems in relation to cattle purchasing.

LIMITATIONS

Data do not account for the risk of cattle purchases and reflect previous policy regimens. Evidence from recent badger culling interventions should be analysed.

CONCLUSION

Proactive badger culling was not associated with risk compensation behaviours, while reactive badger culling was associated with decreased risk taking among farmers.

Ski and snowboard injury patterns in the United States from 2010 to 2020 in pediatric patients

BACKGROUND

Children and adolescents are at higher risk of injuries from winter sports like skiing and snowboarding which can cause severe lifelong debilitation and death.

PURPOSE

The objective of this study is to perform a nationwide analysis of pediatric skiing and snowboarding injuries to identify patterns regarding patient demographics, type of injuries, outcomes, and admission rates.

STUDY DESIGN

Descriptive Epidemiological Study.

METHODS

This was a retrospective cohort study of publicly available data. Cases were sourced from the National Electronic Injury Surveillance System (NEISS) from 2010 to 2020 and included 6421 incidents.

RESULTS

Even when the highest percentage of injuries was the head at 19.30%; the diagnosis of concussion was placed third while fractures were the most common diagnosis at 38.20%. The proportion of pediatric incidents by hospital type is changing with children's hospitals currently managing the majority of cases.

CONCLUSIONS

These findings can assist clinicians in the ED across different hospital types in understanding the patterns of injury to be better prepared for new cases.

Association of personal and equipment-related factors on ACL injury risk in alpine skiers with cautious or risk-taking behaviour: A case-control study

Background

In recreational alpine skiing ACL injury risk depends on the interaction of individual characteristics and behaviours as well as on equipment-related factors.

Aim

to evaluate if and to what extent personal characteristics and equipment-related parameters are associated with ACL injury risk in cautious and risk-taking recreational alpine skiers.

Methods

A retrospective questionnaire-based, case-control study of ACL-injured and uninjured in a cohort of cautious as well as risk-taking recreational skiers was conducted. Participants self-reported their demographics, skiing skill level, and risk-taking behaviour. Ski length, side-cut radius, widths of the tip, waist, and tail were recorded from each participant's skis. Standing heights at the front and rear components of the ski binding were measured with a digital sliding caliper, and a standing height ratio between the front and rear components was calculated. Ski boot sole abrasion at the toe and heel pieces was also measured with the digital sliding caliper.

Results

In total, 1068 recreational skiers (50.8% females) with a mean age of 37.8 ± 12.3 years participated, of whom 193 (22.0%) sustained an ACL injury, and 330 (30.9%) participants reported a risk-taking behaviour. Results of the multiple logistic regression analyses revealed that a higher age, a lower skill level, a higher standing height ratio, and greater ski boot sole abrasion at the toe as well as heel pieces were independently associated with an increased ACL injury risk in both the cautious and the risk-taking group. Among cautious skiers, a longer ski length was an additional significant risk factor for sustaining an ACL injury. In conclusion, the same personal and equipment related characteristics contribute to an increase in the ACL injury risk regardless of risk-taking behaviour, with the only difference that longer skis represent an additional risk factor in cautious skiers.

Collisions with another person while skiing and snowboarding: A 13-year national registry analysis

INTRODUCTION

Interindividual collisions while skiing or snowboarding occur regularly, they can be associated with severe injuries.

OBJECTIVE

To elucidate causes of accidents, injury patterns and potential risk factors for injury severity in interindividual collisions of skiers and snowboarders.

MATERIAL AND METHODS

Retrospective analysis of the Austrian Registry for Mountain Accidents within a 13-year timeframe (2005-2018) with regard to on- or off-piste collisions of skiers and snowboarders.

RESULTS

A total of 30,503 collisions, involving 52,430 (85.9%) skiers and 8,576 (14.1%) snowboarders were analysed. Denominators are lacking, since total numbers of skiers and snowboarders were not available. Compared to skiers, snowboarders were younger (23 vs. 42 years; p<0.001), predominantly male (77.4% vs. 61.0%; p<0.001) and less often severely injured (46.8% vs. 26.2%; p<0.001). Most accidents occurred on slopes (>95%). Collisions involving two snowboarders occurred proportionally more often in terrain parks (4.1% of 1,664 injured snowboarders; p<0.001) and while one victim was standing or sitting (9.7%; p<0.001). Contusions/strains/sprains were most prevalent (>23%), as were head injuries (>12%). In skiers, chest, shoulder, hip, thigh and knee injuries occurred more often, leading to fractures, dislocations, concussions and internal injuries more frequently. In snowboarders, spine/back, elbow, forearm, wrist and lower leg injuries were more prevalent. Female gender and standing or sitting prior to the accident was a risk factor for being more severely injured in collisions involving i) two skiers (OR: 4.02 (3.79-4.26) and 3.91 (3.26-4.68)), ii) a skier and a snowboarder (OR: 4.50 (3.95-5.14) and 11.49 (8.04-16.41)) or iii) two snowboarders (OR: 2.85 (2.12-3.84) and 12.47 (6.17-25.20)). Wearing a helmet increased the risk when two skiers collided (OR: 1.10 (1.03-1.17)). In skier vs. snowboarder collisions, the skier had a higher risk of being injured more severely (OR: 7.93 (6.98-9.01)).

CONCLUSIONS

In interindividual collisions of skiers and snowboarders, injury patterns and preceding causes differ substantially. Skiers are more likely to be severely injured. Awareness of an increased risk of injury should be raised particularly while standing or sitting on the slope.

Efficacy of Helmet Use on Head Injury Reduction in Snow Sports: A Critically Appraised Topic

Context: Review articles published in 2010 concluded that there was strong evidence to support the use of helmets as a way to decrease the risk of sustaining a head injury during snow sport participation. However, new research published over the last decade on this relationship warrants revisiting this primary injury prevention approach. Clinical Question: What is the effect of helmet use on the occurrence of head injuries in snow sports? Clinical Bottom Line: The results from the included studies did not consistently find a reduction in head injury occurrence with helmet use in snow sports. Rather, the collective findings were more supportive of a neutral relationship between helmet use and head injuries. Therefore, these heterogeneous findings indicate there is SORT Level B evidence to support the use of helmets as a primary head injury prevention approach in snow sports. Future initiatives should acknowledge the multifaceted nature of injury occurrence and seek to educate the public more clearly on the limitations of helmet use during skiing and snowboarding.

Gender differences in snowboarding accidents in Austria: a 2005-2018 registry analysis

OBJECTIVES

To elucidate gender differences in snowboarding accidents.

DESIGN

Retrospective registry analysis within the Austrian National Registry of Mountain Accidents.

SETTING

Snowboard-related emergencies between November 2005 and October 2018.

PARTICIPANTS

All injured snowboarders with documented injury severity and gender (3536 men; 2155 women).

PRIMARY AND SECONDARY OUTCOME MEASURES

Gender-specific analysis of emergency characteristics and injury patterns.

RESULTS

Over time, the number of mild, severe and fatal injuries per season decreased in men but not in women. Accidents most frequently were interindividual collisions (>80%) and occurred when heading downhill on a slope. Men more often suffered injuries to the shoulder (15.1% vs 9.2%) and chest (6.8% vs 4.4%), were involved in accidents caused by falling (12.9% vs 9.6%) or obstacle impact (4.3% vs 1.5%), while on slopes with higher difficulty levels (red: 42.6% vs 39.9%; black: 4.2% vs 2.5%), while snowboarding in a park (4.8% vs 2.1%) and under the influence of alcohol (1.6% vs 0.5%). Women more often sustained injuries to the back (10.2% vs 13.1%) and pelvis (2.9% vs 4.2%), on easier slopes (blue: 46.1% vs 52.4%) and while standing or sitting (11.0% vs 15.8%). Mild injuries were more frequent in women (48.6% vs 56.4%), severe and fatal injuries in men (36.0% vs 29.7% and 0.9% vs 0.4%). Male gender, age and the use of a helmet were risk factors for the combined outcome of severe or fatal injuries (OR (99% CI): 1.22 (1.00 to 1.48), 1.02 (1.02 to 1.03) and 1.31 (1.05 to 1.63)). When wearing a helmet, the relative risk (RR) for severe injuries increased while that for mild injuries decreased in male snowboarders only (RR (95% CI): 1.21 (1.09 to 1.34) and 0.88 (0.83 to 0.95)).

CONCLUSIONS

Snowboard injuries are proportionally increasing in women and the observed injury patterns and emergency characteristics differ substantially from those of men. Further gender-specific research in snowboard-related injuries should be encouraged.

TRIAL REGISTRATION NUMBER

NCT03755050.

Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study

BACKGROUND

Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma.

MATERIALS AND METHODS

Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15).

RESULTS

We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury.

CONCLUSIONS

At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.

Injury-Related Behavioral Variables in Alpine Skiers, Snowboarders, and Ski Tourers-A Matched and Enlarged Re-Analysis

Behavioral variables might play an important role in explaining the differences in injury rates across winter sport disciplines and injury prevention programs might be more specifically designed based on this knowledge. On ski slopes, alpine skiing, snowboarding, and ski touring are the predominant winter sport disciplines. Therefore, the aim of the present study was to investigate possible differences in injury-related behavioral variables between practitioners of these disciplines. Using a matched re-analysis approach of a cross-sectional survey, 414 winter sport participants (alpine skiers, snowboarders, ski tourers, each n = 138) were analyzed on the differences in sensation seeking, treated injuries, and injury-related behavioral variables. Cochran-Mantel-Haenszel and Friedman tests revealed significantly higher sensation seeking, p < 0.001, and a significantly higher percentage of participants reporting to have consumed alcohol in the past five skiing days, p = 0.006, in snowboarders compared to alpine skiers. The participants with treated injuries showed higher sensation seeking, p < 0.050, and a higher percentage of snowboarders, p = 0.020, compared to participants without treated injuries. Injury prevention programs for snowboarders, who remain an important risk group for injury prevention, might benefit from considering a possibly higher percentage of alcohol-consuming participants and from providing information on injury-related risks of sensation seeking.

A Prospective Injury Surveillance Study on Ski Touring

Background:

Ski touring is an outdoor sport with growing popularity in alpine countries. Information about injuries in ski touring is limited.

Purpose:

To determine injury rates, mechanisms, causes, and risk factors in ski touring.

Study Design:

Descriptive epidemiology study.

Methods:

Between November 2015 and May 2016, a total of 191 participants from the Alps region were prospectively tracked via personalized online questionnaires. Injury rates were calculated per 1000 hours of sports exposure. Risk factors were assessed per multivariate logistic regression analysis.

Results:

A total of 3900 ski tours were performed, with 10,955 hours and 4,108,503 m in height ascension (uphill) recorded. The overall injury rate was 2.5 injuries per 1000 hours of ski touring. A total of 27 injury-events were reported, of which 18 (67%) were classified as mild, 7 (26%) as moderate, and 2 (7%) as severe. Hands (28%) and knees (16%) were the most commonly involved anatomic regions. Most injuries were limited to the soft tissue, such as bruises (31%) and abrasions (18%). Significantly more injuries happened during the descent (n = 17; 63%) than during the ascent (n = 6; 22%) (odds ratio, 5.96; P = .004), while poor weather conditions, icy surface, and inattentiveness were the most often reported reasons for injury. Sidecountry ski touring was identified as the only significant independent risk factor for injury (P < .001).

Conclusion:

In this prospective injury surveillance study, the majority of ski touring injuries were mild and limited to the soft tissue. Ski touring injuries were more likely to happen during the descent of a tour, and sidecountry ski touring was the only significant independent risk factor for injury. Bad weather, icy surface, and inattentiveness were found to be the leading causes for an injury-event in this study.

Are Risk-Taking and Ski Helmet Use Associated with an ACL Injury in Recreational Alpine Skiing?

According to the risk compensation hypothesis, the use of a ski helmet might provide a false sense of security, resulting in a riskier behavior by skiing faster or more aggressively, which might lead to an increased injury risk. Injury of the anterior cruciate ligament (ACL) is a common diagnosis in downhill skiers. Thus, the aim of the study was to evaluate the potential impact of risk-taking and ski helmet use on ACL injury risk in recreational skiing. Eighty-two ACL injured and 446 uninjured skiers with a mean age of 37.3 ± 11.9 years (52% females) were surveyed during the winter season 2018/19 about age, sex, self-reported risk-taking behavior, self-reported skill level, perceived speed, and ski helmet use. Multiple regression analysis revealed that older age (OR: 1.3, 95% CI: 1.2–1.4), riskier behavior (OR: 5.4, 95% CI: 2.8–10.5), and lower skill level (OR: 6.7, 95% CI: 3.4–13.3) were found to be factors associated with ACL injury, while ski helmet use was not. In conclusion, no support for the risk compensation hypothesis was found with regard to ACL injuries. Therefore, we doubt that ski helmet use increases the risk for ACL injury and recommend wearing a ski helmet due to reported protective effects.

Effects of Visual and Auditory Perturbations on Ski-Specific Balance among Males and Females-A Randomized Crossover Trial

Injuries in skiing show sex-specific differences, especially when visual perception is reduced. Reduced visual perception impairs balance, which plays an important role in avoiding skiing injuries. However, males and females might cope differently with reduced visual perception. Thus, the aim of this study was to evaluate sex-related effects of environmental perturbations (reduced visual perception and listening to music) on ski-specific balance. Using a crossover design, ski-specific balance was tested in 50 young adults (50% female) in four conditions: with and without listening to music and/or with and without reduced visual perception (ski goggles with occlusion foil). A four × two (condition by sex) mixed ANOVA revealed a significant condition by sex interaction, partial η² = 0.06. Females showed an increase in balance from the condition without music/with normal visual perception to the condition with music/with normal visual perception, while males showed a decrease. Balance was significantly higher in females compared to males, partial η² = 0.31. The findings suggest that balance is affected differently by environmental perturbations in females and males. However, the differences observed were not in line with our initial hypotheses, which might be because the model was too simplistic for how visual/auditory perturbations may affect balance.

Alpine Skiing Injuries

Context:

Alpine skiing is a popular sport worldwide but has significant risk for injury. The epidemiology of skiing-related injuries has been described, which has led to the identification of risk factors for specific types of injuries.

Evidence Acquisition:

Pertinent literature from peer-reviewed publications was reviewed.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

The adoption of international standards for ski-boot-binding systems has changed the profile of skiing-related injuries over time, as has the widespread use of helmets. An understanding of mechanisms of injury, risk factors, and preventative measures may decrease the incidence of skiing-related injuries.

Conclusion:

Advances in standards for skiing equipment have been effective at decreasing both the frequency and severity of skiing-related injuries, but additional efforts are required to improve the safety of the sport.

Gender Disparities in Trauma Care: How Sex Determines Treatment, Behavior, and Outcome

Trauma data bank and other research reveal sex disparities in trauma care. Risk-taking behaviors leading to traumatic injury have been associated with sex, menstrual cycle timing, and cortisol levels. Trauma patient treatment stratified by sex reveals differences in access to services at trauma centers as well as specific treatments, such as venous thromboembolism prophylaxis and massive transfusion component ratios. Trauma patient outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient. Outcome after general trauma and specifically traumatic brain injury show mixed results with respect to sex disparity.

Personality differences amongst drag racers and archers: implications for sport injury rehabilitation

Personality trait of an athlete is a significant factor in sports injury rehabilitation. The aim of the present study is to investigate whether there are differences in personality traits between male and female, professional and amateur athletes from sports representing two ends of extreme to traditional namely; drag racing and archery. Overall 189 male and female, professional and amateur drag racers (n=144) and archers (n=45) took part in this study. Participants completed the personality traits of extroversion and neuroticism as measured by Eysenck's classic Personality Inventory dimensions and thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), boredom susceptibility (BS), and sensation seeking (SS) as measured by Zuckerman's Sensation Seeking Scale. The results showed that professionals scored significantly lower on neuroticism compared to amateurs. Drag racers scored significantly higher on TAS, DIS, and SS compared to archers and there were gender differences amongst archers on TAS and SS with males scoring higher than females. Such differences in personality factors and the readiness to take risks, lack of caution, and adventurous spirit can influence the risk of injury in athletes and indeed may influence the outcome of rehabilitation. Practitioners would need to recognise difference in personality traits associated with the type of sport and the choice of interventions strategies.

Tendencia al riesgo y lesión deportiva en fútbol y fútbol sala femenino

La relación entre determinados factores psicológicos y la vulnerabilidad que presenta un deportista para sufrir una lesión ha sido estudiada en los últimos años. Uno de los aspectos a considerar es la influencia de las conductas de riesgo del deportista en la probabilidad de sufrir una lesión. El presente estudio pretende estudiar si la tendencia al riesgo es un factor que está relacionado con la lesión deportiva. Por tanto, el objetivo es determinar si existen diferencias en los niveles de tendencia al riesgo entre jugadoras de fútbol y fútbol sala lesionadas y no lesionadas. Para ello, un total de 102 jugadoras de fútbol y fútbol sala femenino, de edades comprendidas entre los 12 y los 37 años y pertenecientes a clubes federados de la Región de Murcia participaron en esta investigación. Para la obtención de los datos, se empleó la versión española del cuestionario DOSPERT (Domain Specific Risk Taking) para adultos (Blais & Weber, 2006). Los resultados obtenidos en este estudio no muestran diferencias estadísticamente significativas entre los dos grupos analizados (lesionadas y no lesionadas), aunque parece existir una tendencia a presentar puntuaciones superiores en la variable tendencia al riesgo entre las jugadoras pertenecientes al grupo lesionado.

Epidemiology of Snow Skiing- Versus Snowboarding-Related Concussions Presenting to the Emergency Department in the United States from 2010 to 2014

OBJECTIVES

To examine the trend of concussions in skiers and snowboarders from 2010 to 2014; and to quantify and compare the incidence of concussions injuries in skiers and snowboarders who presented to emergency departments in the United States in 2014.

DESIGN

Cross-sectional study of concussions in skiers and snowboarders who were evaluated in emergency departments in the United States.

MAIN OUTCOMES MEASURE

Incidence of concussions.

RESULTS

The trend of the annual incidence of concussions for skiers and snowboarders remained stable from 2010 to 2014. An estimated total of 5388 skiing-related concussions and 5558 snowboarding-related concussions presented to emergency departments in the United States between January 1st, 2014, and December 31st, 2014. This represented an incidence of 16.9 concussions per 1 000 000 person-years for skiers and 17.4 concussions per 1 000 000 person-years for snowboarders. The incidence of concussions in the pediatric and young adult population of skiers was significantly higher than the incidence in the adult population. Similarly, the incidence of concussions in the pediatric and young adult population of snowboarders was significantly higher than the incidence in the adult population. The incidence of concussions was significantly higher in males compared with females in both skiing and snowboarding.

CONCLUSIONS

The incidence of concussions from 2010 to 2014 plateaued in both skiers and snowboarders. Pediatric and young adult skiers and snowboarders had significantly higher incidences of concussion than the adult population. In contrast to the higher incidence of concussions in females in several sports including ice hockey, soccer, and basketball, the incidence of concussions was higher in males compared with females in both skiing and snowboarding.

Cervical Spine Alignment in Helmeted Skiers and Snowboarders With Suspected Head and Neck Injuries: Comparison of Lateral C-spine Radiographs Before and After Helmet Removal and Implications for Ski Patrol Transport

OBJECTIVE

Current protocols for spine immobilization of the injured skier/snowboarder have not been scientifically validated. Observing changes in spine alignment during common rescue scenarios will help strengthen recommendations for rescue guidelines.

METHODS

Twenty-eight healthy volunteers (18 men, 10 women) age 47±17 (range 20-73) (mean ±SD with range) underwent a mock rescue in which candidate patrollers completing an Outdoor Emergency Care course performed spine immobilization and back boarding in 3 scenarios: 1) Ski helmet on, no c-collar; 2) helmet on, with c-collar; and 3) helmet removed, with c-collar. After each scenario, a lateral radiograph was taken of the cervical spine to observe for changes in alignment.

RESULTS

Compared with the control group (helmet on, no collar), we observed 9 degrees of increased overall (occiput-C7) cervical extension in the helmet on, with collar group (P < .001), and 17 degrees in the helmet off, with collar group (P < .001). There was increased extension at the occiput-C2 intersegment in the helmet on, with collar group (9 degrees, P < .001) and at both the occiput-C2 (9 degrees, P < .001) and C2-C7 (8 degrees, P < .001) intersegments in the helmet off, with collar group.

CONCLUSION

Ski helmet removal and c-collar application each leads to increased extension of the cervical spine. In the absence of other clinical factors, our recommendation is that helmets should be left in place and c-collars not routinely applied during ski patrol rescue.

Is decision making in hypoxia affected by pre-acclimatisation? A randomized controlled trial

INTRODUCTION

Decision making is impaired in hypoxic environments, which may have serious or even lethal consequences for mountaineers. An acclimatisation period prior to high altitude exposures may help to overcome adverse effects of hypoxia. Thus, we investigated possible effects of short-term pre-acclimatisation on decision making in hypoxia.

METHODS

In a randomized controlled study design, 52 healthy participants were allocated to a hypoxia group (HG: short-term pre-acclimatisation by the use of intermittent hypoxia 7×1h at F_iO₂=12.6%, equivalent to 4500m) or a control group (CG: sham pre-acclimatisation 7×1h at F_iO₂=20.9%, equivalent to 600m). The number of risky decisions was assessed using the Game of Dice Task at four time points during a 12-hours stay in hypoxia (F_iO₂=12.6%).

RESULTS

42 (HG: 27, CG: 25) participants completed the study. The number of risky decisions was significantly (p=0.048 as determined by 4×2 ANCOVA) reduced in the hypoxia group compared to the control group, partial η²=0.11, when the age-effect on decision making was controlled. Self-reported positive affective valence prior to decision making was negatively related to the number of risky decisions, r<-0.38.

CONCLUSION

Short-term pre-acclimatisation might influence decision making in hypoxia in a positive way and might be considered as a risk-reducing preparation method prior to exposures to hypoxic environments. Positive affective states seem to have a medium-sized protective effect against risky decision making.

Cohort Study on the Association Between Helmet Use and Traumatic Brain Injury in Snowboarders From a Swiss Tertiary Trauma Center

BACKGROUND

Since the introduction of helmets in winter sports there is on-going debate on whether they decrease traumatic brain injuries (TBI).

METHODS

This cohort study included 117 adult (≥ 16 years) snowboarders with TBI admitted to a level I alpine trauma center in Switzerland between 2000/2001 and 2010/2011. The primary objective was to examine the association between helmet use and moderate-to-severe TBI. Secondary objectives were to describe the epidemiology of TBI during the past decade in relation to increased helmet use.

RESULTS

Of 691 injured snowboarders evaluated, 117 (17%) suffered TBI. Sixty-six percent were men (median age, 23 years). Two percent of accidents were fatal. Ninety-two percent of patients sustained minor, 1% moderate, and 7% severe TBI according to the Glasgow coma scale. Pathologic computed tomography findings were present in 16% of patients, 26% of which required surgery. Eighty-three percent of TBIs occurred while riding on-slope. There was no trend in the TBI rate during the studied period, although helmet use increased from 10% to 69%. Comparing patients with and without a helmet showed no significant difference in odds ratios for the severity of TBI. However, of the 5 patients requiring surgery only 1 was wearing a helmet. Off-piste compared with on-slope snowboarders showed an odds ratio of 26.5 (P = 0.003) for sustaining a moderate-to-severe TBI.

CONCLUSIONS

Despite increased helmet use we found no decrease in TBI among snowboarders. The possibility of TBI despite helmet use and the dangers of riding off-piste should be a focus of future prevention programs.