An evidence-based review: Efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders

From the Center for Surgery Trials and Outcomes Research (A.H.H., T.S.), Johns Hopkins School of Medicine, Baltimore Maryland
The journal of trauma and acute care surgery 11/2012; 73(5):1340-1347. DOI: 10.1097/TA.0b013e318270bbca
Source: PubMed


Approximately 600,000 ski- and snowboarding-related injuries occur in North America each year, with head injuries accounting for up to 20% of all injuries. Currently, there are no major institutional recommendations regarding helmet use for skiers and snowboaders in the United States, in part owing to previous conflicting evidence regarding their efficacy. The objective of this review was to evaluate existing evidence on the efficacy of safety helmets during skiing and snowboarding, particularly in regard to head injuries, neck and cervical spine injuries, and risk compensation behaviors. These data will then be used for potential recommendations regarding helmet use during alpine winter sports.

The PubMed, Cochrane Library, and EMBASE databases were searched using the search string helmet OR head protective devices AND (skiing OR snowboarding OR skier OR snowboarder) for articles on human participants of all ages published between January 1980 and April 2011. The search yielded 83, 0, and 96 results in PubMed, Cochrane Library, and EMBASE, respectively. Studies published in English describing the analysis of original data on helmet use in relation to outcomes of interest, including death, head injury, severity of head injury, neck or cervical spine injury, and risk compensation behavior, were selected. Sixteen published studies met a priori inclusion criteria and were reviewed in detail by authors.

Level I recommendation is that all recreational skiers and snowboarders should wear safety helmets to reduce the incidence and severity of head injury during these sports. Level II recommendation/observation is that helmets do not seem to increase risk compensation behavior, neck injuries, or cervical spine injuries among skiers and snowboarders. Policies and interventions to increase helmet use should be promoted to reduce mortality and head injury among skiers and snowboarders.

Safety helmets clearly decrease the risk and severity of head injuries in skiing and snowboarding and do not seem to increase the risk of neck injury, cervical spine injury, or risk compensation behavior. Helmets are strongly recommended during recreational skiing and snowboarding.

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    • "While recent snowsport injury research has suggested that helmets be worn to reduce head injuries, there are some issues with the experimental design and analysis that is hampered by lack of consistent injury and exposure definitions (Finch, 2006; Haider et al., 2012). In the dominant case–control study design in sport injury research, this is exacerbated by either the inappropriate choice of, or lack of, adequate controls (Marshall, 2008; Finch et al., 2011). "
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    ABSTRACT: This research explored associations between helmet use and head injuries in snowsports by investigating reported snowsport injuries in Western Canada from 2008-2009 to 2012-2013. The key finding was that increased helmet use (from 69% to 80%) was not associated with a reduction in reported head injuries. Over the study period, the average rate of reported head injuries was 0.2/1000 skier visits, with a statistically significant variation (P < 0.001). The line of best fit showed an non-significant upward trend (P = 0.13). Lacerations were the only subcategory of head injuries that decreased significantly with helmet use. A higher proportion of people who reported a head injury were wearing a helmet than for injuries other than to the head. Skiers were more likely to report a head injury when wearing a helmet than snowboarders (P < 0.001 cf. P = 0.22). There were significant differences in characteristics of helmet and non-helmet wearers. Helmet wearers were more likely to be: young adults (P < 0.001); beginner/novices (P = 0.004); and snowboarders (P < 0.001), but helmet wearing was not associated with gender (P = 0.191). Further research is needed to explore the possible reasons for the failure of helmets to reduce head injuries, for example, increased reporting of head injuries and increased risk-taking combined with over-rating of the helmets' protection.
    No preview · Article · Dec 2015 · Scandinavian Journal of Medicine and Science in Sports
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    • "Extensive investigation into helmet use and prevention of TBI among skiers/snowboarders has been conducted over the years. This has recently prompted a practice management guideline established by the Eastern Association for the Surgery of Trauma which recommends the use of safety helmets to reduce the severity and incidence of head injuries during these activities [9]. In light of the similarities between snowboarding and longboarding and their resulting head injuries, this same recommendation may correspond to longboarding, though further research is indicated. "
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    ABSTRACT: As the popularity of longboarding increases, trauma centers are treating an increased number of high severity injuries. Current literature lacks descriptions of the types of injuries experienced by longboarders, a distinct subset of the skateboarding culture. A retrospective review of longboarding and skateboarding injury cases was conducted at a level II trauma center from January 1, 2006, through December 31, 2011. Specific injuries in addition to high injury severity factors (hospital and intensive care unit (ICU) length of stay (LOS), Injury Severity Score (ISS), patient treatment options, disposition, and outcome) were calculated to compare longboarder to skateboarder injuries. A total of 824 patients met the inclusion criteria. Skull fractures, traumatic brain injuries (TBI), and intracranial hemorrhage (ICH) were significantly more common among longboard patients than skateboarders (P < 0.0001). All patients with an ISS above 15 were longboarders. Hospital and ICU LOS in days was also significantly greater for longboarders compared with skateboarders (P < 0.0001). Of the three patients that died, each was a longboarder and each experienced a head injury. Longboard injuries account for a higher incidence rate of severe head injuries compared to skateboard injuries. Our data show that further, prospective investigation into the longboarding population demographics and injury patterns is necessary to contribute to effective injury prevention in this population.
    Full-text · Article · Feb 2014
    • "Abmilderung von Kopfverletzungen nachgewiesen und führt zu einer Reduktion der Kopfverletzungen zwischen 22 und 60%[1,13,14,16,24,33]. Die Befürchtung, dass durch das Tragen des Skihelms mehr Halswirbelsäulenverletzungen auftreten, konnte nicht bestätigt werden[15,16,24]. Vergleichbare Zahlen zur präventiven Wirkung von Rückenprotektoren wie auch für Protektoren einzelner oder mehrerer Körperregionen am Rumpf (z. "
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    ABSTRACT: Alpine skiing is the most popular winter sport discipline in Germany and is performed by more than 4 million recreational sportsmen and ski racing athletes. Compared to other sports, however, the injury rate in alpine skiing is quite high. Especially the knee joint is the most commonly injured area of the musculoskeletal system. Knee injuries are classified as severe in a high percentage of cases. In this review article, epidemiologic data and typical injury patterns in recreational alpine skiing and in competitive alpine ski racing are compared. In addition, the potentials of preventive methods in alpine skiing are presented and evaluated with a special focus on orthotic devices and protection wear as injury prevention equipment.
    No preview · Article · Jan 2014 · Der Unfallchirurg
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