Introduction: Our aim was to examine differences of head injury severity, patterns of head injury, helmet efficacy and outcomes in snowboarders and skiers.
Methods: A retrospective review of all patient notes and CT-scans of patients admitted to our Level 1 Trauma centre 03/2000 - 03/2011 due to head trauma sustained from skiing and snowboard acidents. Head trauma severity was determined by the lowest documented GCS (severe <9, modest 9-12, minor 13-15). Patient outcomes were measured by the Glasgow Outcome Scale (GOS).
Results: A total of 2053 patients were admitted for skiing (n=1362) and snowboarding (n=691) accidents, 362 of them for head trauma (n-snowboarders= 117 /n-skiers= 245). 52.7% of snowboarders and 51.7% of skiers wore helmets. 20% (50) of Skiers sustained moderate to severe head injuries compared to 8% (9) of snowboarders (p =0.003*). The mean injury severity scores (ISS) of head injured snowboarders was 5.6 ±6 and of skiers 10 ±11 (p=0.001*). Four (3.4%) snowboarders and 21 (8.5%) skiers sustained an open head injury (p=0.052). Traumatic subarachnoid hemorrhage was found in 5 (4.3%) snowboarders and 24 (10%) skiers (p=0.051). Calvarial fractures, contusion, intracerebral hemorrhage, subdural haematoma and epidural hematoma were equally prevalent in skiers and snowboarders. 28 (11.4%) skiers and 5 (4.3%) snowboarders needed neurosurgical interventions (p=0.018*). The mean GOS of snowboarders was 4.85±0.7 and of skiers 4.75±0.9 (p=0.497). Wearing a helmet had no association with less severe head injury and outcome of skiers/snowboarders. However of both skiers and snowboarders open head injuries were less frequent in helmet wearers ( 2.6% vs. 9.3.%; p=0.030*).
Conclusions: Snowboarders had significantly less severe head injuries and were less likely to need neurosurgical interventions. Skiers with a head injury also had a higher overall injury severity (ISS). Helmets currently on the market proved to have some beneficial effect, however it was not detectable in the overall outcome.
Patient Care: - Improvements in head trauma prevention are warranted
- Helmet designs should be adapted to higher speeds in skiers
- More research toward more effective helmet designs will improve patient outcomes
Learning Objectives: - Skiers admitted for head injuries have more severe injuries than snowboarders.
- Helmets provide very limited protection in skiers and snowboarders