Pediatric and adolescent injury in skiing

Skiing Injuries in the US Pediatric Population: An Analysis of National Injury Trends and Mechanisms Between 2012 and 2022

Background

While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions continue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may constitute up to 40% of skiing-related injuries.

Purpose

To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency departments in the United States.

Study Design

Descriptive epidemiology study.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age ≤18 years) skiing injuries between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were evaluated with linear regression analysis.

Results

Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 ± 3.5 years, with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism (NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains (NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876, 15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 (P = .17), with fluctuations apparent throughout the study period. Significant decreases were seen in strains/sprains (P < .01) and contusions/abrasions (P < .01), but not in concussions (P = .57) or fractures (P = .70).

Conclusion

Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis, followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.

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.

Slippery Slopes: Skiing-Related Facial Trauma in Adults

Study Design:

Retrospective, observational, cross-sectional study.

Objective:

To determine the incidence of skiing-related facial trauma and to identify their patterns in terms of potential risk factors, mechanism of injury, anatomical location, and degree of severity.

Methods:

Data was collected using the National Electronic Injury Surveillance System and included snow skiing-related incidents during the years 2009 to 2018. Specifically, injuries limited to the facial region including the head, face, eye(s), mouth, neck or ear(s) were reported. Patients with fractures were further classified by the study variables. Descriptive statistics were used to classify continuous variables while chi-square analysis was used to compare categorical variables.

Results:

A total of 514 (n = 514) patients met the inclusion criteria within the study period. The majority of injuries were due to concussions (59%), followed by lacerations (18%), fractures (11%), contusions (11%) and dental injuries (1%). Of the fractures seen, the majority were nasal (30%) and cervical spine (30%), followed by midface (27%), mandible (9%) and skull (4%). In our population, head injuries were more common in females (80%) than in males (60%), whereas, mouth injuries were more common in males (8%) than females (1%) [χ2 = 30.2, p < 0.001].

Conclusions:

Skiing-related craniofacial trauma remains a significant mechanism of injury. Our data illustrates a need to correlate these injuries to the use of personal protective equipment. Furthermore, this data calls for the strict implementation of such equipment and the development of safety protocols to further prevent deleterious injury.

A Nationwide Study of Skiing and Snowboarding-Related Facial Trauma

Study Design

Retrospective descriptive observational study.

Purpose

Skiing and snowboarding offers valuable opportunities for outdoor physical activity throughout the cold winter months, but these activities can result in substantial personally injury. This study aimed to analyze trends in skiing and snowboarding-related facial trauma epidemiology.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried for facial trauma related to skiing and snowboarding treated in United States (US) emergency departments between 2010 and 2019. These data and weighted estimates were used to analyze patient demographics, injury location, and etiology.

Results

A total of 361 skiing or snowboarding-related facial injuries were recorded. Lacerations were most common injury (165/361; 45.7%), and facial fractures occurred in 21.6% (78/261) of patients. The most common facial fracture locations are the nose (38/78; 48.7%), orbit (17/78; 21.8%), and mandible (15/78; 19.2%). Pediatric patients accounted for 52% (187/361) of these injuries and had higher rates of lacerations (51.9% vs 39.1%, P < 0.05) and hospital admission (4.8% vs 1.15%, P < 0.05) than adults. Adults had a higher rate of facial fracture (30% vs 13.9%, P < 0.001) than children.

Conclusions

Skiing and snowboarding-related facial trauma is relatively uncommon in the US. In general, these injuries are largely decreasing, but facial fractures still occur not infrequently during these activities. Based on our data, we strongly urge helmet manufacturers to increase the availability of recreational snowsport helmets that include nose, orbit, and mandible protections, which could help to prevent many of these injuries.

Injury Characteristics and Predisposing Effects of Various Outdoor Traumatic Situations in Children and Adolescents

Backgroud

Many studies have reported injury characteristics of individual traumatic situations. However, a comparative analysis of specific risks is meaningful to better understand injury characteristics and help establish injury-prevention measures. This study was conducted to investigate and compare injury characteristics in children and adolescents by various outdoor traumatic situations.

Methods

Outdoor traumatic situations were determined and classified into physical activity-related injury (n = 3,983) and pedestrian (n = 784) and passenger (n = 1,757) injuries in traffic accidents. Home injury (n = 16,121) was used as the control group. Then, the characteristics of each outdoor trauma were compared with 1:1 matched indoor trauma (among home injuries); each outdoor traumatic situation's predisposing risk for the injured body part, injury type, and injury severity were analyzed; and changes by age of frequency ranking among physical activity-related injuries were investigated.

Results

Outdoor trauma showed higher risks for limb injuries (injured body part), fracture and muscle/tendon injuries (injury type), and severe injuries (severity) than indoor trauma. Various outdoor traumatic situations presented different predisposing effects on injury characteristics. Among physical activity-related injuries, bicycle injury was commonest across all ages, and playing activities were common causes for injury for individuals of age < 9 years, whereas sports activities overwhelmed the common causes thereafter.

Conclusions

The findings would help to better understand the specific injury risk of various outdoor traumatic situations and may potentially facilitate the establishment of more effective injury-prevention measures.

Pediatric snow sport injuries differ by age

BACKGROUND

Unintentional injury is the leading cause of death among pediatric patients. There were 13,436 injuries related to snow sports in those younger than 15 in 2015, with 4.8% requiring admission. These sports are high-risk given the potential for injury even when using protective equipment. We hypothesized that snow sport injury patterns would differ based on patient age.

METHODS

A cross-sectional analysis of the 2009 and 2012 Kids' Inpatient Database was performed. Cases of injuries were identified and analyzed using ICD-9 codes. National estimates were obtained using case weighting. Multivariable logistic regression was used to assess for confounders.

RESULTS

Within 745 admissions, there was a statistically significant decrease in skull/facial fractures with increasing age and a statistically significant increase in abdominal injuries with increasing age. Children in early and middle childhood were at increased odds of being hospitalized with skull/facial fractures, while older children were more likely hospitalized with abdominal injuries.

CONCLUSIONS

Within the pediatric snow sport population, younger children are more likely to experience head injuries, while older children are more likely to experience abdominal injuries. Further research is needed to determine the origin of this difference, and continued legislation on helmets is also necessary in reducing intracranial injuries.

LEVEL OF EVIDENCE

III.

Injury patterns in a large-scale ski resort in the host city of 2022 Winter Olympic Games: a retrospective cross-sectional study

OBJECTIVES

The aims of the study are to describe the injury patterns among recreational skiers and snowboarders in China and to provide primary data to guide the reconstruction of regional healthcare facilities to deal with the increasing number of participants in snow sports.

DESIGN

Retrospective cross-sectional study.

METHODS

A retrospective study was performed in Wanlong Ski Resort in Chongli, China. Data of all injured skiers and snowboarders treated in the resort clinic during the 2018-2019 season were collected. Patients' information, including sex, age, equipment, skill level and injured body part, was analysed.

RESULTS

A total of 753 sports injuries were recorded. The estimated incidence of injury was 1.98 per 1000 skier days. 453 cases (60.2%) were associated with skiing. The mean age of skiers was older than snowboarders (35.1±14.5 vs 29.0±8.9, p<0.01). Injury not involving others constituted 67.9% of all injuries. The most common injured body part among skiers was lower extremity, contrary to injury in the upper extremity among snowboarders. Head and cervical injury was identified in 13.7% of skiers and 13.6% of snowboarders.

CONCLUSION

The incidence of skiing/snowboarding injury in China was similar to other countries. Injury pattern differed among different sports and causes of injury.

Common Skiing and Snowboarding Injuries

Participation in skiing, and especially snowboarding, continues to rise. As participation and level of competition in these winter sports increases, the number of injuries increases as well. Upper-extremity injuries are more common in snowboarding, whereas lower-extremity injuries are more common in skiing. Head injuries, particularly concussions, are common in both sports. Special consideration in these sports should be given to environmental conditions, such as high altitude and ultraviolet radiation. The purpose of this review is to discuss the most common musculoskeletal injuries seen in skiing and snowboarding, as well as considerations for initial assessment of these injuries and triage to the appropriate level of care. It is important for sports medicine physicians covering these sports to understand initial assessment and treatment of these injuries. Due to the potential for severe injuries in these sports, it is important to be able to quickly recognize an injury that needs to be assessed and treated urgently or emergently. With the increased participation and number of injuries in these sports, it also is important to consider prevention strategies that may minimize risk of injury.