Article

Injuries of the Head, Face, and Neck in Relation to Ski Helmet Use

Harborview Injury Prevention & Research Center, School of Public Health & Community Medicine, University of Washington, Seattle, WA, USA.
Epidemiology (Impact Factor: 6.2). 04/2008; 19(2):270-6. DOI: 10.1097/EDE.0b013e318163567c
Source: PubMed

ABSTRACT

The extent to which helmet use reduces the risk of injury in ski- and snowboard-related accidents is unclear. We studied the association of helmet use with injuries of the head, face, and neck among skiers and snowboarders involved in falls and collisions.
We conducted a case-control study, using ski patrol injury reports for the years 2000-2005 from 3 ski resorts in the western United States. We identified all skiers and snowboarders involved in falls or collisions who received care from the ski patrol. Helmet use among persons with injuries of the head (n = 2537), face (n = 1122), or neck (n = 565) was compared with helmet use among those involved in falls and collisions who received care for injuries below the neck (n = 17,674). We calculated odds ratios for head, face, and neck injury among helmeted compared with unhelmeted persons.
The adjusted odds ratios were 0.85 for head injury (95% confidence interval = 0.76-0.95), 0.93 for facial injury (0.79-1.09), and 0.91 for neck injury (0.72-1.14).
Helmets may provide some protection from head injury among skiers and snowboarders involved in falls or collisions.

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    • "In four snowsport head injury studies (Hagel et al., 2005a,b; Sulheim et al., 2006; Mueller et al., 2008), none used biomechanical matching of controls to the head-injured cases (Finch et al., 2011). Controls could include people who did not experience either a head injury or a head impact; therefore, it was suggested that " the strong conclusions about the effectiveness of helmets must be treated with caution as the controls are not fully comparable to the cases " (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.
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    • "van Buuren and Groothuis-Oudshoorn [7] discuss the wide range of medical fields that have used chained equations imputation (e.g. addiction [8], epidemiology [9], infectious diseases [10], genetics [11], cancer [12], obesity and physical activity [13]), and a brief review of available software that have implemented chained equations imputation is given by [14]. Given the popularity of chained equations, among users of varying degrees of expertise, there is now guidance in its practical use (e.g. "
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    ABSTRACT: Chained equations imputation is widely used in medical research. It uses a set of conditional models, so is more flexible than joint modelling imputation for the imputation of different types of variables (e.g. binary, ordinal or unordered categorical). However, chained equations imputation does not correspond to drawing from a joint distribution when the conditional models are incompatible. Concurrently with our work, other authors have shown the equivalence of the two imputation methods in finite samples. Taking a different approach, we prove, in finite samples, sufficient conditions for chained equations and joint modelling to yield imputations from the same predictive distribution. Further, we apply this proof in four specific cases and conduct a simulation study which explores the consequences when the conditional models are compatible but the conditions otherwise are not satisfied. We provide an additional "non-informative margins" condition which, together with compatibility, is sufficient. We show that the non-informative margins condition is not satisfied, despite compatible conditional models, in a situation as simple as two continuous variables and one binary variable. Our simulation study demonstrates that as a consequence of this violation order effects can occur; that is, systematic differences depending upon the ordering of the variables in the chained equations algorithm. However, the order effects appear to be small, especially when associations between variables are weak. Since chained equations is typically used in medical research for datasets with different types of variables, researchers must be aware that order effects are likely to be ubiquitous, but our results suggest they may be small enough to be negligible.
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    • "In the design phase it has been suggested that sports injury research is plagued with the lack of consistent injury and exposure definitions [10], which is exacerbated by the inappropriate choice, or lack of adequate controls in the dominant case-control study design [4]. For example, Finch et al described four snowsport head injury studies assessing the effectiveness of helmet use [12] [13] [14] [15] none of which used biomechanical matching of controls to the head injured cases. The controls included people who did not experience either a head injury or a head impact. "
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    ABSTRACT: With the increasing concern about the long-term effects of concussive and sub-concussive head accelerations in sport, this research applies two technologies initially developed for team-based sports to snowsports to understand the characteristics of snowsport head acceleration. Results indicate that pediatric snowsports participants regularly achieved speeds over 23 km/h; snowsport head accelerations are rare and that when they do occur they are generally of low magnitude; and those most at risk were make snowboarders.
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