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Siegel MA, Patetta MJ, Deshpande A, Orland MD, Hutchinson MR. Traumatic brain injuries in paediatric patients: individual vs. team sports-related hospitalizations. Res Sports Med 2024; 32:567-579. [PMID: 36647291 DOI: 10.1080/15438627.2023.2166412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
Paediatric sport participation continues to increase in the United States, with a corresponding increase in sports-related concussions or traumatic brain injuries (TBIs). It is important to recognize which sports are at elevated risk and identify risk factors for hospital admission and length of stay (LOS). Paediatric patients (ages 5-18) from 2008 to 2014 were identified from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). Eight hundred and ninety-four patients included those who were hospitalized with a TBI resulting from participation in an individual (451 patients) or team (443 patients) sport. We evaluated the differences in LOS and total charges between individual and team sports and found that compared to team sports, TBI patients in individual sports had significantly longer hospital stays compared to team sports (1.75 days versus 1.34 days, p < 0.001) and costlier ($27,333 versus $19,069, p < 0.001) hospital stays. This may be due to reduced awareness and reduced compliance with return-to-play protocols in individual sports. Safety education information at a young age, increased awareness of TBIs, and additional medical support for individual sports as well as team sports may help mitigate these findings.
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Affiliation(s)
- Matthew A Siegel
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael J Patetta
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Abhishek Deshpande
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark D Orland
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark R Hutchinson
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
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2
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Yendluri A, Hrabarchuk EI, Obana KK, Namiri NK, Plancher KD, Trofa DP, Parisien RL. Skiing Injuries in the US Pediatric Population: An Analysis of National Injury Trends and Mechanisms Between 2012 and 2022. Orthop J Sports Med 2024; 12:23259671241255704. [PMID: 38911123 PMCID: PMC11193339 DOI: 10.1177/23259671241255704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 06/25/2024] Open
Abstract
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.
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Affiliation(s)
- Avanish Yendluri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Eugene I. Hrabarchuk
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Kyle K. Obana
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Nikan K. Namiri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Kevin D. Plancher
- Plancher Orthopaedics and Sports Medicine, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - David P. Trofa
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Robert L. Parisien
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
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Kelley N, Pierpoint L, Saeedi A, Hellwinkel JE, Khodaee M. An Epidemiologic Comparison of Injuries to Skiers and Snowboarders Treated at United States Emergency Departments, 2000-2019. Int J Sports Med 2024; 45:382-389. [PMID: 38190979 DOI: 10.1055/a-2240-7747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Skiing and snowboarding are popular competitive and recreational sports that can be associated with significant injury. Previous studies of skiing and snowboarding injuries have been conducted, but studies evaluating injury types and patterns over long periods of time are needed to drive effective injury prevention efforts. We hypothesized that injury patterns would differ among snowboarders and skiers and that the number of injuries remained constant over time. This is a retrospective study of patients presenting with skiing or snowboarding injuries to the United States emergency departments from 2000 to 2019. A total of 34,720 injured skiers (48.0%) and snowboarders (52.0%) presented to US emergency departments over a 20-year period, representing an estimated 1,620,576 injuries nationwide. There is a decreasing trend of the number of injuries over the study period (p=0.012). Males represented the majority (65.7%) of injuries. Skiers were older than snowboarders (mean 30.1 vs. 20.0 years; p<0.001) and patients aged<18 represented more snowboarding (57.0%) than skiing (43.0%) injuries (p<0.001). Common diagnoses included fractures (33.0%) and sprains/strains (26.9%). Snowboarders primarily presented with upper extremity injuries, meanwhile, skiers primarily presented with lower extremity injuries. Most patients (93.2%), were treated and discharged from the emergency departments. Understanding the epidemiology of injuries presenting to emergency departments can help guide prehospital care and medical coverage allocation for resorts and event organizers, as well as identifying areas for targeted injury prevention efforts.
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Affiliation(s)
- Naomi Kelley
- Medicine, University of Colorado School of Medicine, Aurora, United States
| | - Lauren Pierpoint
- Physical Medicine and Rehabilitation, University of Utah Health, Salt Lake City, United States
| | - Anahita Saeedi
- Biostatistics, University of Massachusetts Amherst, Amherst, United States
| | - Justin E Hellwinkel
- Orthopaedics, Columbia University Irving Medical Center, New York, United States
| | - Morteza Khodaee
- Family Medicine, University of Colorado Denver School of Medicine, Aurora, United States
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Kelshaw PM, Kneavel ME, Bowman TG, Rainone C. Headgear safety attitudes: a national survey of collegiate women's lacrosse stakeholders. Res Sports Med 2024; 32:375-387. [PMID: 35996846 DOI: 10.1080/15438627.2022.2113880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (β = -0.38, p < 0.001) and Sports Development and Safety Practices (β = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (β = 0.51, p < 0.001) and Intention to Wear Headgear (β = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants.
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Affiliation(s)
- Patricia M Kelshaw
- Department of Kinesiology, Department of Psychology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham
| | - Meredith E Kneavel
- Department of Urban Public Health and Nutrition, School of Nursing and Health Sciences, LaSalle University, Philadelphia, PA, USA
- Director of Assessment and Research, Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
- Department of Public Health, LaSalle University, Philadelphia, PA, USA
| | - Thomas G Bowman
- Department of Athletic Training, University of Lynchburg, Lynchburg, VA, USA
| | - Cat Rainone
- Department of Public Health, LaSalle University, Philadelphia, PA, USA
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Van Tilburg C, Paal P, Strapazzon G, Grissom CK, Haegeli P, Hölzl N, McIntosh S, Radwin M, Smith WWR, Thomas S, Tremper B, Weber D, Wheeler AR, Zafren K, Brugger H. Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update. Wilderness Environ Med 2024; 35:20S-44S. [PMID: 37945433 DOI: 10.1016/j.wem.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/03/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023]
Abstract
To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.
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Affiliation(s)
- Christopher Van Tilburg
- Occupational Medicine, Mountain Clinic, and Emergency Medicine, Providence Hood River Memorial Hospital, Hood River, OR
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | - Peter Paal
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Colin K Grissom
- Department of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT
| | | | - Natalie Hölzl
- International Commission for Alpine Rescue
- German Association of Mountain and Expedition Medicine, Munich, Germany
| | - Scott McIntosh
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | | | - William Will R Smith
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
- University of Washington School of Medicine, Seattle, WA
| | - Stephanie Thomas
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | | | - David Weber
- Intermountain Life Flight, Salt Lake City, UT
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
| | - Ken Zafren
- International Commission for Alpine Rescue
- Himalayan Rescue Association, Kathmandu, Nepal
- Stanford University Medical Center, Palo Alto, CA
| | - Hermann Brugger
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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Chesler KC, Howell DR, Khodaee M, Pierpoint LA, Comstock RD, Provance AJ. Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Characteristics? Wilderness Environ Med 2023; 34:45-54. [PMID: 36610917 DOI: 10.1016/j.wem.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Skiing and snowboarding are popular winter sports with significant youth participation and inherent potential for injury. We investigated the relationship between age and injury characteristics exhibited by youth skiers and snowboarders. METHODS In this cross-sectional study, we investigated injury characteristics among youth skiers and snowboarders at a ski resort, examining the association between age and injury type. We compared injury characteristics among young children (aged 3-6 y), school-aged children (aged 7-14 y), and older adolescents (aged 15-17 y) using χ2, and examined predictive variables for injuries at different anatomical locations using logistic regression. RESULTS Compared with snowboarding, skiing was associated with greater odds of lower extremity (adjusted odds ratio [aOR]=6.8, 95% confidence interval [CI]: 4.89, 9.47, P<0.001) and head/face/neck (aOR=1.63, 95% CI: 1.20, 2.21, P=0.002) injuries. Compared with skiing, snowboarding was associated with greater odds of upper extremity injury (aOR=5.9, 95% CI: 4.6, 7.6, P<0.001). Age group significantly affected injury mechanism (χ2 [df=12, n=1129]=42.882, P<0.0001) and diagnosis (χ2 [df=12, n=1129]=43.093, P<0.0001). Young child skiers had the highest proportion of injuries to the head/neck/face and lower extremities and a significantly higher proportion of collision injuries and fractures than older skiers. Young child skiers most frequently injured the lower leg/ankle, while older skiers most frequently injured the knee. CONCLUSIONS Youth skiers exhibited predominately lower extremity injuries, while snowboarders exhibited predominately upper extremity injuries. Age significantly affected injury mechanism and injury diagnosis in youth skiers. Specifically, younger skiers tended to suffer more fractures and collision injuries than older youth skiers.
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Affiliation(s)
| | - David R Howell
- University of Colorado School of Medicine, Aurora, CO; Children's Hospital of Colorado, Aurora, CO.
| | | | | | | | - Aaron J Provance
- University of Colorado School of Medicine, Aurora, CO; Children's Hospital of Colorado, Aurora, CO; University of Utah School of Medicine, Salt Lake City, UT
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Does receiving a SARS-CoV-2 antibody test result change COVID-19 protective behaviors? Testing risk compensation in undergraduate students with a randomized controlled trial. PLoS One 2022; 17:e0279347. [PMID: 36538498 PMCID: PMC9767325 DOI: 10.1371/journal.pone.0279347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Risk compensation, or matching behavior to a perceived level of acceptable risk, can blunt the effectiveness of public health interventions. One area of possible risk compensation during the SARS-CoV-2 pandemic is antibody testing. While antibody tests are imperfect measures of immunity, results may influence risk perception and individual preventive actions. We conducted a randomized control trial to assess whether receiving antibody test results changed SARS-CoV-2 protective behaviors. PURPOSE Assess whether objective information about antibody status, particularly for those who are antibody negative and likely still susceptible to SARS-CoV-2 infection, increases protective behaviors. Secondarily, assess whether a positive antibody test results in decreased protective behaviors. METHODS In September 2020, we enrolled 1076 undergraduate students, used fingerstick tests for SARS-CoV-2 antibodies, and randomized participants to receive their results immediately or delayed by 4 weeks. Two weeks later, participants completed a survey about their engagement in 4 protective behaviors (mask use, social event avoidance, staying home from work/school, ensuring physical distancing). We estimated differences between conditions for each of these behaviors, stratified by antibody status. For negative participants at baseline, we also estimated the difference between conditions for seroconversion over 8 weeks of follow-up. RESULTS For the antibody negative participants (n = 1029) and antibody positive participants (n = 47), we observed no significant differences in protective behavior engagement between those who were randomized to receive test results immediately or after 4 weeks. For the baseline antibody negative participants, we also observed no difference in seroconversion outcomes between conditions. CONCLUSIONS We found that receiving antibody test results did not lead to significant behavior change in undergraduate students whether the SARS-CoV-2 antibody result was positive or negative.
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Willmott C, Reyes J, K Nguyen JV, McIntosh A, Makovec-Knight J, Makdissi M, Clifton P, Harcourt P, Mitra B. A pilot case crossover study of the use of padded headgear in junior Australian football. Concussion 2022; 7:CNC99. [PMID: 36694693 PMCID: PMC9855304 DOI: 10.2217/cnc-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023] Open
Abstract
Aim To explore soft-shell padded headgear (HG) use, player behavior and injuries associated with HG in junior Australian football. Methods Prospective case-crossover with head impact measurement, injury surveillance and video review. Results 40 players (mean age: 12.43 years, standard deviation: 1.36) across 15 matches were observed. Frequency of head/neck (p = 0.916) or body (p = 0.883) contact events, and match incidents were similar between HG and no HG conditions. Without HG, females had higher frequency of body contacts compared with males (p = 0.015). Males sustained more body contacts with HG than without HG (p = 0.013). Conclusion Use of HG in junior football was not associated with injury or head contact rate. Associations between HG use and body contact may differ across sexes. (ID: ACTRN12619001165178).
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Affiliation(s)
- Catherine Willmott
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia,Author for correspondence: Tel.: +61 431 545 495;
| | - Jonathan Reyes
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Jack V K Nguyen
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Andrew McIntosh
- McIntosh Consultancy and Research, Sydney, Australia,Monash University Accident Research Centre, Monash University, Melbourne, Australia,School of Engineering, Edith Cowan University, Joondalup, Australia
| | - Jennifer Makovec-Knight
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Michael Makdissi
- Florey Institute of Neuroscience & Mental Health, Austin Campus, Melbourne Brain Centre, Melbourne, Australia,Olympic Park Sports Medicine Centre, Melbourne, Australia
| | | | | | - Biswadev Mitra
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia,Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia,Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
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Lee LK, Flaherty MR, Blanchard AM, Agarwal M. Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports. Pediatrics 2022; 150:188764. [PMID: 35965276 DOI: 10.1542/peds.2022-058878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Bicycling, snow sports, and other recreational activities and sports are important activities to keep children and youth active as part of a healthy lifestyle. These activities can be associated with serious and fatal head and facial injuries. Helmets, when worn correctly, are effective in decreasing head injuries and fatalities related to these activities. Legislation for helmet use is effective in increasing helmet use in children and, ultimately, in decreasing deaths and head and facial injuries. A multipronged strategy employing legislation, enforcement of laws, and medical clinicians and community programs is important for increasing helmet use to decrease deaths and injuries from recreational sports.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michael R Flaherty
- Division of Pediatric Critical Care Medicine, Mass General for Children, Boston, Massachusetts
| | - Ashley M Blanchard
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Maneesha Agarwal
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Pirruccio K, Shin M, Ganley TJ, Kelly JD, Parisien RL. Rock climbing confers distinct injury risk in pediatric versus adult populations: an analysis of twenty-year national trends. PHYSICIAN SPORTSMED 2022; 50:343-348. [PMID: 34029496 DOI: 10.1080/00913847.2021.1932631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES The sport of rock climbing has recently gained in popularity due in part to its adoption by noncompetitive athletes as a physical activity with a level of intensity that can be self-regulated. However, the epidemiology of rock climbing injuries is poorly described at the national level. METHODS We report demographic and injury characteristics from 85,235 national weighted estimates of rock climbing injuries presenting to United States (US) emergency departments (EDs) between 2000 and 2019 in the National Electronic Injury Surveillance System, stratifying by whether patients were ≤18 years of age (A) or ≥19 years of age (B). RESULTS The national weighted estimate of patients presenting to US EDs with injuries associated with rock climbing rose significantly (p < 0.001) from 2000 (2,667, CI 1,777-3,557) to 2019 (7,087, CI 4,544-9,630). Patients ≤18 years of age were significantly less likely to be male (A: 56.3%, CI 52.0-60.6%; B: 64.7%; CI 60.4-69.0%; p = 0.003), sustain injuries on weekends (A: 29.8%, 24.5-35.1%; B: 64.7%, CI 60.4-69.0%; p = 0.002), or sustain injuries during summer seasons (A: 26.6%, CI 22.1-31.1%; B: 33.2%, CI 28.1-38.3%; p = 0.049). Multivariate logistic regression demonstrated that patients ≤18 years of age were significantly more likely to present to EDs with head and neck (OR: 1.52, CI 1.04-2.21; p = 0.032) or upper extremity (OR: 1.55; CI 1.24-1.93; p < 0.001) injuries associated with rock climbing. CONCLUSION We identified a significant increase in the annual estimated number of patients presenting to US EDs with rock climbing injuries compared to what has previously been reported. As the number of climbers continues to grow, standardized safety policies may be implemented that specifically target injury mechanisms and patterns unique to both adult and pediatric populations.
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Affiliation(s)
- Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Max Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Theodore J Ganley
- Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennylvania
| | - John D Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Harvard Medical School and Boston Children's Hospital, Boston, USA
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Galgano AC, Cohn JE, Licata JJ, Othman S, Stucker FJ, Bundrick P. Slippery Slopes: Skiing-Related Facial Trauma in Adults. Craniomaxillofac Trauma Reconstr 2022; 15:122-127. [DOI: 10.1177/19433875211020933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
| | - Jason E. Cohn
- Department of Otolaryngology—Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, LSU Health Sciences Center, Shreveport, LA, USA
| | - Jordan J. Licata
- Department of Otolaryngology—Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Sammy Othman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Fred J. Stucker
- Department of Otolaryngology—Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, LSU Health Sciences Center, Shreveport, LA, USA
| | - Paige Bundrick
- Department of Otolaryngology—Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, LSU Health Sciences Center, Shreveport, LA, USA
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Duralde XA. CORR Insights®: A 40-year Study of the Factors Associated with Diaphyseal Forearm Fractures in Skiers and Snowboarders. Clin Orthop Relat Res 2022; 480:571-573. [PMID: 34962493 PMCID: PMC8846346 DOI: 10.1097/corr.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 01/31/2023]
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Bohyn C, Flores DV, Murray T, Mohr B, Cresswell M. Imaging Review of Snowboard Injuries. Semin Musculoskelet Radiol 2022; 26:54-68. [PMID: 35139559 DOI: 10.1055/s-0041-1731702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Snowboarding and skiing remain the two most popular winter sports worldwide. Musculoskeletal (MSK) injuries are common in snowboarding, and the number has increased significantly since the advent of snow parks. The number of injuries is the highest for novice snowboarders; more experienced boarders generally sustain more severe injuries. Snowboarders can experience a wide array of MSK injuries, but some injury types are more frequently encountered because of the specific injury mechanism unique to snowboarding. This article reviews the most common snowboarding injuries with a focus on the current understanding of the injury mechanism and provides an approach to imaging.
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Affiliation(s)
- Cedric Bohyn
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dyan V Flores
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Institute of Radiology, St. Luke's Medical Center Global City, Metro Manila, Philippines
| | - Timothy Murray
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Mohr
- Whistler Health Care Center, Whistler, British Columbia, Canada
| | - Mark Cresswell
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Flores DV, Murray TÉ, Bohyn C, Mohr B, Cresswell M. Imaging Review of Alpine Ski Injuries. Semin Musculoskelet Radiol 2022; 26:41-53. [PMID: 35139558 DOI: 10.1055/s-0041-1731794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Skiing is a continuously evolving winter sport, responsible for a considerable number of musculoskeletal injuries. Specific injury patterns and mechanisms in the upper and lower extremities, head, and spine are influenced by skier expertise and skill, position during injury, and environmental conditions. Predilection for certain joints and injury patterns have changed over time, largely due to technological advancements in equipment, increased awareness campaigns, and preventive protocols. Knowledge and understanding of these trends and developments can aid the radiologist to reach a timely and accurate diagnosis, thereby guiding clinical management and potentially reducing the overall incidence of debilitation and death.
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Affiliation(s)
- Dyan V Flores
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy É Murray
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cedric Bohyn
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, AZ Monica, Antwerpen, Belgium
| | - Bruce Mohr
- Whistler Health Care Center, Whistler, British Columbia, Canada
| | - Mark Cresswell
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Liebst LS, Ejbye-Ernst P, de Bruin M, Thomas J, Lindegaard MR. No evidence that mask-wearing in public places elicits risk compensation behavior during the COVID-19 pandemic. Sci Rep 2022; 12:1511. [PMID: 35087100 PMCID: PMC8795403 DOI: 10.1038/s41598-022-05270-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Face masks have been widely employed as a personal protective measure during the COVID-19 pandemic. However, concerns remain that masks create a false sense of security that reduces adherence to other public health measures, including social distancing. This paper tested whether mask-wearing was negatively associated with social distancing compliance. In two studies, we combined video-observational records of public mask-wearing in two Dutch cities with a natural-experimental approach to evaluate the effect of an area-based mask mandate. We found no observational evidence of an association between mask-wearing and social distancing but found a positive link between crowding and social distancing violations. Our natural-experimental analysis showed that an area-based mask mandate did not significantly affect social distancing or crowding levels. Our results alleviate the concern that mask use reduces social distancing compliance or increases crowding levels. On the other hand, crowding reduction may be a viable strategy to mitigate social distancing violations.
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Affiliation(s)
- Lasse S Liebst
- Department of Sociology, University of Copenhagen, Copenhagen, Denmark
- NSCR: Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
| | - Peter Ejbye-Ernst
- NSCR: Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marijn de Bruin
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Josephine Thomas
- NSCR: Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
| | - Marie R Lindegaard
- Department of Sociology, University of Copenhagen, Copenhagen, Denmark.
- NSCR: Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands.
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands.
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16
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Motives for the Use or Not of Protective Equipment for the Recreational Practice of Skiing and Snowboarding in Spanish Winter Stations. Healthcare (Basel) 2021; 9:healthcare9121767. [PMID: 34946493 PMCID: PMC8701195 DOI: 10.3390/healthcare9121767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022] Open
Abstract
The objective of this research was to analyze the motives for using or not using protections by recreational ski and snowboard athletes, specifically regarding gender and age in the winter resorts of Sierra Nevada and Alto Campoo (Spain). A total of 520 users participated in Sierra Nevada (n = 306 (58,8%)) and Alto Campoo (n = 214 (42.2%)); 257 of them were men (49.4%) and 263 (50.6%) were women; from 6 to 50 years old; classified by 4 stages of development (Childhood (n = 106 (20.4%); Teenagers (n = 110 (21.2%); Young adults (n = 101 (19.4%); Adults (n = 203 (39.0%)). For the data collection an ad hoc questionnaire was used (socio-demographic data, use/no use of protection, motives for the use). The data revealed that 76.5% used protections equipment, with the women being more likely to use protective equipment than men. Regarding age, young adults and adults were the ones using less protection. In relation to the motives of using protective equipment, security was the main motive for using it, while the reason to avoid using it was, most of the time, discomfort. Additionally, the childhood and teenager groups were the ones who reported, as motivation, family obligation, showing the importance of the influence of the parents.
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17
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Turbans vs. Helmets: A Systematic Narrative Review of the Literature on Head Injuries and Impact Loci of Cranial Trauma in Several Recreational Outdoor Sports. Sports (Basel) 2021; 9:sports9120172. [PMID: 34941810 PMCID: PMC8703542 DOI: 10.3390/sports9120172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 12/28/2022] Open
Abstract
When in public, faith-based mandates require practising Sikh men to wear a turban which may not be covered by hats or caps. This makes it impossible for practising Sikhs to wear helmets and other protective headwear, mandatory in many countries and facilities for engagement in recreational pursuits (e.g., skiing) and on adventure outdoor recreation camps mandatorily run for school groups. The result is often social exclusion and ostracisation in the case of school children. Despite studies into the efficacy of protective helmets in some recreational outdoor activity settings, virtually nothing is known about the protective potential of turbans. This paper systematically reviews the extant literature on head injuries in several recreational outdoor activities and sports sectors (aerial, water, winter, wheeled and animal-based sports) and finds that the extant literature is of limited value when trying to understand the spatial distribution of trauma on the cranial surface. As the data do not permit to make inferences on the protective potential of turbans, future systematic, evidence-based epidemiological studies derived from hospital admissions and forensic examinations are required. Failure to do so perpetuates social exclusion and discrimination of religious grounds without an evidentiary basis for defensible public health measures.
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18
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Evans KHC, McAdams RJ, Roberts KJ, McKenzie LB. Sledding-Related Injuries Among Children and Adults Treated in US Emergency Departments From 2008 to 2017. Clin J Sport Med 2021; 31:e460-e466. [PMID: 33323755 DOI: 10.1097/jsm.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/16/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the epidemiology of sledding-related injuries among children and adults treated in US emergency departments (EDs). DESIGN The researchers performed a retrospective analysis using data from the National Electronic Injury Surveillance System (NEISS). SETTING The NEISS collects data on consumer products-related and sports-related injuries treated in US EDs from approximately 100 hospitals that represent a probability sample of >5000 hospitals. PATIENTS Children (≤19 years of age) and adults who were treated for sledding-related injuries in EDs from 2008 to 2017. INDEPENDENT VARIABLES The researchers analyzed characteristics that included sex, body part injured, injury diagnosis, disposition from the ED, injury locale, injury mechanism, and sled type. MAIN OUTCOME MEASURES All cases of sledding-related injuries were identified using NEISS product codes for sleds (1217), toboggans (1273), snow disks (1274), and snow tubes (1299). RESULTS An estimated 220 488 patients [95% confidence interval (CI): 169 839-271 137] were treated in EDs for sledding-related injuries. Overall, the injury rate decreased significantly for both children and adults. Children accounted for 69.7% of the injury cases. Fractures were the most common injury diagnosis for children (23.9%) and adults (27.4%). Compared to adults, children were more likely to sustain a head injury [relative risk (RR): 1.91 (95% CI: 1.73-2.13)] and be diagnosed with a concussion or closed-head injury (CHI) [RR: 1.58 (95% CI: 1.35-1.84)]. Most patients were injured by a collision (63.2%). Snow tube and disk riders were more likely to sustain a concussion or CHI compared to sled and toboggan riders [RR: 1.53 (95% CI: 1.18-1.99)]. Injuries predominantly occurred when patients collided with objects in the environment (47.2%). CONCLUSIONS Although sledding-related injuries decreased over the study period, more research and education to prevent these injuries is needed. The injury patterns and risk of injury type differed by age, with more head injuries sustained by children. Sledding should be performed in obstacle-free areas to reduce the risk of collision and while wearing helmets to mitigate head injuries.
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Affiliation(s)
- Kris H C Evans
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Rebecca J McAdams
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Kristin J Roberts
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Lara B McKenzie
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, Ohio; and
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, Ohio
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19
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Protections in the Recreational Practice of Ski and Snowboard-An Age and Gender Discussion? A Case Study in Spain. J Funct Morphol Kinesiol 2021; 6:jfmk6040084. [PMID: 34698237 PMCID: PMC8544293 DOI: 10.3390/jfmk6040084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of this research was to evaluate the protections taken by ski and snowboard recreational athletes of the winter stations Sierra Nevada and Alto Campoo (Spain), regarding gender, age, and practiced sport. A total of 520 users participated, Sierra Nevada (n = 306 (58.8%)); Alto Campoo (n = 214 (42.2%)), 257 of them were men (49.4%) and 263 (50.6%) were women, from 6 to 64 years old, classified by 4 stages of development (Childhood (n = 106 (20.4%)); Teenagers (n = 110 (21.2%)); Youth (n = 101 (19.4%)); Adults (n = 203 (39.0%))). For the data collection, an Ad Hoc questionnaire was used (Socio-demographic data, use/no use of protection). The data revealed that 23.5% of the participants did not use any protection. Regarding the development stage, 1% of the children did not use any protection, neither did 3.1% of the teenagers, 6.7% of the youth, or 12.7% of the adults (p < 0.001). Regarding gender, a total of 17.1% of men did not use protection, and regarding women, 6.3% of them did not use it (p < 0.001). In relation to the practiced sport, 15.8% of the skiers did not use it against 7.7% of the snowboarders (p = 0.006). The use of protection for the practice in winter sports is not enough to reduce the injury risk in these sports and, in the worst cases, fatal accidents.
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20
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Tjønndal A, Austmo Wågan F. Athletes' and Coaches' Attitudes Toward Protective Headgear as Concussion and Head Injury Prevention: A Scoping Review. Front Sports Act Living 2021; 3:680773. [PMID: 34113846 PMCID: PMC8185014 DOI: 10.3389/fspor.2021.680773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 01/04/2023] Open
Abstract
The purpose of this article is to map existing research literature on athletes and coaches' attitudes toward protective headgear in sport in relation to concussion and head injury prevention, and to identify and analyse knowledge gaps in the field. A scoping review was conducted in three databases; PubMed, Scopus, SportDiscus, and reference lists were searched to identify relevant grey literature. This process lead to an in-depth analysis of 18 peer-reviewed journal articles. Of the 18 studies identified, the majority focused on athletes (n = 14), only two studies focused on coaches, and two studies included a sample of both athletes and coaches. The findings in this scoping review suggests that there is a discrepancy between attitudes and beliefs about the protective effects of headgear, athletes' behaviour as far as wearing protective headgear, and coaches' behaviour in terms of recommending use of protective headgear to their athletes. The majority of athletes in most of the reviewed literature believed that headgear had protective effects against concussion and other head injuries, however relatively few athletes report wearing this protective headgear unless it was mandatory by competition rules.
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Affiliation(s)
- Anne Tjønndal
- Faculty of Social Sciences, Nord University, Bodø, Norway
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21
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Letić M. Possible Indirect Adverse Effects to the Eyes in Skiers Wearing Helmets. Wilderness Environ Med 2021; 32:259-260. [PMID: 33839015 DOI: 10.1016/j.wem.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Milorad Letić
- Department of Biophysics, School of Medicine, University of Belgrade, Belgrade, Republic of Serbia
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22
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Eastern Association for the Surgery of Trauma (EAST) practice management guidelines and the perpetual quest for excellence. J Trauma Acute Care Surg 2020; 89:1-10. [PMID: 32251261 DOI: 10.1097/ta.0000000000002709] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Eleni Mantzari
- Department of Public Health and Primary Care, Behaviour and Heath Research Unit, University of Cambridge, Cambridge, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Theresa M Marteau
- Department of Public Health and Primary Care, Behaviour and Heath Research Unit, University of Cambridge, Cambridge, UK
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Comstock RD, Arakkal AT, Pierpoint LA, Fields SK. Are high school girls' lacrosse players at increased risk of concussion because they are not allowed to wear the same helmet boys' lacrosse players are required to wear? Inj Epidemiol 2020; 7:18. [PMID: 32418542 PMCID: PMC7232834 DOI: 10.1186/s40621-020-00242-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Boys' lacrosse (LAX), a full contact sport allowing body and stick checking, mandates hard shell helmets with full face masks. Girls' LAX, which prohibits body checking and whose sphere rule is supposed to prevent stick checking to the head, allows optional flexible headgear with/without integrated eye protection. Whether the required boys' LAX helmets should also be mandated in girls' LAX has been debated. METHODS In this retrospective cohort study we used LAX concussion data from a national high school sports-related injury surveillance study to determine if girls' LAX players were at increased risk of concussion from stick or ball contact due to differences in helmet regulations by calculating the attributable risk and attributable risk percent (AR%) for concussion resulting from ball or stick impacts. RESULTS From 2008-09 through 2018-19, boys' LAX players sustained 614 concussions during 1,318,278 athletic exposures (AEs) (4.66 per 10,000 AEs) and girls' LAX players sustained 384 concussions during 983,291 AEs (3.91 per 10,000 AEs). For boys, athlete-athlete contact was the most common mechanism of concussion accounting for 66.4% of all concussions, while stick or ball contact accounted for 23.5%. For girls, stick or ball contact accounted for 72.7% of all concussions, while athlete-athlete contact accounted for 19.8%. Concussion rates from stick or ball contact were significantly higher in girls vs. boys (RR = 2.60, 95% CI 2.12-3.18). The attributable risk associated with playing girls' vs. boys' LAX for concussion resulting from stick or ball contact was 1.75 concussions per 10,000 AEs (95% CI 1.37-2.12) and the AR% was 61.5% (95% CI 52.9-68.5). An estimated 44.7% of all girls' LAX concussions could have been prevented if girls' LAX players wore the helmet mandated in boys' LAX. CONCLUSIONS Girls' LAX players who are allowed, but not required, to wear a flexible headgear are at increased risk of concussions from stick or ball impacts compared to boys' LAX players, who are required to wear a hard shell helmet with full face mask. Additional research is needed to determine if there are any defendable arguments to continue justifying restricting girls' LAX players access to this effective piece of protective equipment.
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Affiliation(s)
- R Dawn Comstock
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, 13001 E. 17th Place, Mail Stop B119, Fitzsimons Building, Room W3145, Aurora, CO, 80045, USA.
| | - Alan T Arakkal
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | - Sarah K Fields
- Department of Communication, University of Colorado Denver, Denver, CO, USA
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Azar A, Bhagavathula KB, Hogan J, Ouellet S, Satapathy S, Dennison CR. Protective Headgear Attenuates Forces on the Inner Table and Pressure in the Brain Parenchyma During Blast and Impact: An Experimental Study Using a Simulant-Based Surrogate Model of the Human Head. J Biomech Eng 2020; 142:041009. [PMID: 31539422 DOI: 10.1115/1.4044926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 07/25/2024]
Abstract
Military personnel sustain head and brain injuries as a result of ballistic, blast, and blunt impact threats. Combat helmets are meant to protect the heads of these personnel during injury events. Studies show peak kinematics and kinetics are attenuated using protective headgear during impacts; however, there is limited experimental biomechanical literature that examines whether or not helmets mitigate peak mechanics delivered to the head and brain during blast. While the mechanical links between blast and brain injury are not universally agreed upon, one hypothesis is that blast energy can be transmitted through the head and into the brain. These transmissions can lead to rapid skull flexure and elevated pressures in the cranial vault, and, therefore, may be relevant in determining injury likelihood. Therefore, it could be argued that assessing a helmet for the ability to mitigate mechanics may be an appropriate paradigm for assessing the potential protective benefits of helmets against blast. In this work, we use a surrogate model of the head and brain to assess whether or not helmets and eye protection can alter mechanical measures during both head-level face-on blast and high forehead blunt impact events. Measurements near the forehead suggest head protection can attenuate brain parenchyma pressures by as much as 49% during blast and 52% during impact, and forces on the inner table of the skull by as much as 80% during blast and 84% during impact, relative to an unprotected head.
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Affiliation(s)
- Austin Azar
- Biomedical Instrumentation Lab, Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada
| | | | - James Hogan
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada
| | - Simon Ouellet
- Weapons Effects and Protection Section, Defence R&D Valcartier Research Center, Quebec, QC G3J 1X5, Canada
| | - Sikhanda Satapathy
- Chief(A) with Impact Physics Branch, U.S. Army Research Labs, Aberdeen Proving Ground, Aberdeen, MD 21005-5066
| | - Christopher R Dennison
- Biomedical Instrumentation Lab, Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada
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Abstract
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.
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Affiliation(s)
- Sarah Weinstein
- Primary Care Sports Medicine Fellow, University of Colorado School of Medicine, Denver, CO
| | - Morteza Khodaee
- Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, CO
| | - Karin VanBaak
- Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, CO
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27
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Kemler E, Valkenberg H, Gouttebarge V. Stimulating injury-preventive behaviour in sports: the systematic development of two interventions. BMC Sports Sci Med Rehabil 2019; 11:26. [PMID: 31649824 PMCID: PMC6805664 DOI: 10.1186/s13102-019-0134-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022]
Abstract
Background In addition to the beneficial health effects of being active, sports are also associated with a risk of sustaining injuries. To avoid the occurrence of sports injuries, preventive measures can be applied. The aim of the current article is to provide insight into the systematic developmental process of two evidence-based interventions designed to stimulate injury-preventive behaviour in runners and skiers, in which Intervention Mapping (IM) and Knowledge Transfer Scheme (KTS) are used as developmental protocols. However, the ultimate steps in the process are adjusted to meet requirements of the intervention and the target group. Methods Using a three-step process, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. Sports participants, sports experts and behaviour experts contributed throughout steps two and three of the developmental process. Results In step one we started with a problem statement in which we used information about the number and the burden of running-related and skiing-related injuries in the Netherlands. In step two, in-depth research was performed using four research strategies. During this step we tried to answer the following question: Which preventive measures or actions should be executed to prevent what injuries by whom, and how should we do that? A desk research/systematic review of the literature, expert meetings, target user surveys, and target user focus group meetings were conducted. In step three of product development, both interventions were developed. During the developmental process, co-creation sessions with target users were held. Before finalizing the interventions, pre-tests of the interventions were performed with target users. Conclusions Through a three-step approach, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. To develop an intervention that fits the needs of the target population, and will be used by them, it is necessary to involve this population as soon and as much as possible. Several steps in the IM and KTS protocols have thus been adjusted in order to establish an optimal fit between intervention and target group.
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Affiliation(s)
- E Kemler
- 1Dutch Consumer Safety Institute, Overschiestraat 65, 1062 Amsterdam, XD the Netherlands
| | - H Valkenberg
- 1Dutch Consumer Safety Institute, Overschiestraat 65, 1062 Amsterdam, XD the Netherlands
| | - V Gouttebarge
- 1Dutch Consumer Safety Institute, Overschiestraat 65, 1062 Amsterdam, XD the Netherlands.,2Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,3Amsterdam Collaboration for Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands.,4Division of Exercise Science and Sports Medicine (ESSM), University of Cape Town, Cape Town, South Africa
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28
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Helmet use is associated with higher Injury Severity Scores in alpine skiers and snowboarders evaluated at a Level I trauma center. J Trauma Acute Care Surg 2019; 87:1205-1213. [DOI: 10.1097/ta.0000000000002447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Whyte T, Stuart C, Mallory A, Ghajari M, Plant D, Siegmund GP, Cripton PA. A review of impact testing methods for headgear in sports: Considerations for improved prevention of head injury through research and standards. J Biomech Eng 2019; 141:2728551. [PMID: 30861063 DOI: 10.1115/1.4043140] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Indexed: 11/08/2022]
Abstract
Standards for sports headgear were introduced as far back as the 1960s and many have remained substantially unchanged to present day. Since this time, headgear has virtually eliminated catastrophic head injuries such as skull fractures and changed the landscape of head injuries in sports. Mild traumatic brain injury (mTBI) is now a prevalent concern and the effectiveness of headgear in mitigating mTBI is inconclusive for most sports. Given that most current headgear standards are confined to attenuating linear head mechanics and recent brain injury studies have underscored the importance of angular mechanics in the genesis of mTBI, new or expanded standards are needed to foster headgear development and assess headgear performance that addresses all types of sport-related head and brain injuries. The aim of this review is to provide a basis for developing new sports headgear impact tests for standards by summarizing and critiquing: 1) impact testing procedures currently codified in published headgear standards for sports and 2) new or proposed headgear impact test procedures in published literature and/or relevant conferences. Research areas identified as needing further knowledge to support standards test development include defining sports-specific head impact conditions, establishing injury and age appropriate headgear assessment criteria, and the development of headgear specific head and neck surrogates for at-risk populations.
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Affiliation(s)
- Tom Whyte
- Orthopaedic Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics, The University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | - Cameron Stuart
- Orthopaedic Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics, The University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | - Ann Mallory
- Transportation Research Center Inc., OH, USA; The Department of Mechanical Engineering, Ohio State University, OH, USA
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College London, South Kensington Campus, SW7 2AZ, UK
| | - Daniel Plant
- Rheon Labs Ltd., 11S Hewlett House, Havelock Terrace, London, SW8 4AS, UK
| | - Gunter P Siegmund
- MEA Forensic Engineers & Scientists, 11-11151 Horseshoe Way, Richmond, BC V7A 4S5, Canada; School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Peter A Cripton
- Orthopaedic Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics, The University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
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McLoughlin RJ, Green J, Nazarey PP, Hirsh MP, Cleary M, Aidlen JT. The risk of snow sport injury in pediatric patients. Am J Emerg Med 2019; 37:439-443. [DOI: 10.1016/j.ajem.2018.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022] Open
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Russell KW, Katz MG, Short SS, Scaife ER, Fenton SJ. Longboard injuries treated at a level 1 pediatric trauma center. J Pediatr Surg 2019; 54:569-571. [PMID: 30593338 DOI: 10.1016/j.jpedsurg.2018.10.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/09/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Recreation on longboards is gaining in popularity. The purpose of this study is to detail the injury patterns, treatment and management of children with longboarding injuries seen at a level 1 pediatric trauma center. METHODS A retrospective review using our trauma registry from 2006 to 2016 of pediatric patients who sustained injuries while riding a longboard. RESULTS Of 12,920 injured children, 64 (0.5%) were treated for injuries that occurred while riding a longboard. Median age was 14.5 years (IQR 13.6, 15.4) and 84% were male. Fifty-one (80%) suffered a traumatic brain injury (TBI) including 32 intracranial hemorrhages (ICH), 17 concussions, and 31 skull fractures. Seven (11%) were wearing helmets. Three patients required neurosurgical intervention. Extremity fractures were the most common reason for surgery. Ninety-six percent of patients were admitted to the hospital with a median length of stay of 1 day (IQR 1, 3). All children survived to discharge. Compared with skateboard injuries during the same period, TBI, ICH, concussion, and skull fractures were all greater. CONCLUSIONS TBI ranging from concussion to ICH requiring craniotomy is common in children injured while riding a longboard, and greater than rates after skateboarding injuries. Extremity fracture was the most common reason for operative intervention. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katie W Russell
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - Micah G Katz
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott S Short
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Eric R Scaife
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Abstract
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.
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Affiliation(s)
- Annabelle Davey
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Nathan K Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Robert J Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
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Preventive effects of seat belts on traumatic brain injury in motor vehicle collisions classified by crash severities and collision directions. Eur J Trauma Emerg Surg 2019; 47:1437-1449. [PMID: 30798345 DOI: 10.1007/s00068-019-01095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to measure the preventive effect of seat belt on traumatic brain injury (TBI) and to compare the effect according to the crash severities and collision directions. METHODS Korea In-Depth Accident Study (KIDAS) has collected vehicle and demographic data on injured occupants involved in motor vehicle collisions (MVCs) who visited three emergency medical centers for calendar years 2011-2016. Primary and secondary end points were TBI (abbreviated injury score 2+) and in-hospital mortality. Crush extent (CE) was classified into 1-2, 3-4, 5-6, and 7-9 according to the crash severity. We calculated adjusted odds ratios (ORs) of seat belts and CE for study outcomes and developed an interaction model in each collision direction using multivariate logistic regression analysis. RESULTS Of the 2,245 occupants who were injured in MVCs, 295 (13.1%) occupants sustained TBI. In univariate analysis, old age, unbelted status, lateral collision, and higher CE were factors associated with TBI in MVCs. Occupants with belted status was less likely to have TBI and in-hospital mortality compared with those with unbelted status [AORs (95% CI) 0.48 (0.37-0.62) and 0.49 (0.30-0.81), respectively]. In interaction analysis, preventive effects of seat belts on TBI from MVCs were retained within CE 5-6 in frontal MVCs and within CE 1-2 in near side lateral MVCs, and those of seat belts on in-hospital mortality were reserved within CE 3-4 in frontal and rollover MVCs. CONCLUSIONS The preventive effects of seat belts on TBI and in-hospital mortality are preserved within a limited crash severity in each collision direction.
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Lunde A, Tellefsen C. Patient and rescuer safety: recommendations for dispatch and prioritization of rescue resources based on a retrospective study of Norwegian avalanche incidents 1996-2017. Scand J Trauma Resusc Emerg Med 2019; 27:5. [PMID: 30642369 PMCID: PMC6332597 DOI: 10.1186/s13049-019-0585-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avalanche emergency response should address current accident scenarios to optimize survival chances of victims and to keep rescuers safe. The purpose of this article is to present a basis for evaluation and necessary adjustments in dispatch, prioritization, and management of Norwegian avalanche rescue operations. METHODS This is the first peer-reviewed retrospective study of all Norwegian avalanche incidents registered by the two Joint Rescue Co-ordination Centers (JRCCs) in the period 1996-2017 that describes the characteristics and trends of rescue missions and victims. RESULTS The Norwegian JRCCs have registered 720 snow avalanche events, with a total of 568 avalanche victims, of which 120 (21%) died. Including those fatally injured, a total of 313 avalanche victims in 209 accidents were treated as patients (55%), and we saw > 1 patient in 24% of these operations. Norwegian avalanche victims were partially or completely recovered prior to the arrival of rescuers in 75% (n = 117) of all rescue operations. In the remaining 25% of cases, the rescue service located 62% (n = 55) of the avalanche victims visually or electronically. In 50% of the 720 incidents, rescuers spent time searching in avalanches with no victims. CONCLUSIONS This survey indicates that we have experienced a shift in Norwegian avalanche rescue: from search for missing persons in the avalanche debris to immediate medical care of already-located patients. The findings suggest that a stronger focus on both patient and rescuer safety is necessary. The patients must be ensured the right treatment at the right place at the right time and the allocation of rescue resources must reflect a need to reduce exposure in avalanche terrain, especially in cases with no affirmed victims. We present a flowchart with a recommended rescue response to avalanche accidents in Norway.
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Affiliation(s)
- Albert Lunde
- University of Stavanger, 4036, Stavanger, Norway.
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Abstract
Youth have very high participation and injury rates across sport and recreational activities, including in adventure and extreme sports. Sport and recreation is the leading cause of injury in youth and may lead to lower levels of physical activity, higher adiposity, and long-term consequences such as overweight/obesity, post-traumatic osteoarthritis, and post-concussion syndrome which can adversely affect future health. Injuries are predictable and preventable in youth sport, including adventure and extreme sport. However, injury prevention strategies can have a significant impact in reducing the number and severity of injuries in many sports. This article provides an evidence-informed overview on what is known about injury prevention strategies which have been evaluated in youth adventure and extreme sports. Recommendations to contribute to effective and sustainable injury prevention in youth adventure and extreme sports have been summarized.
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Affiliation(s)
- Carolyn A Emery
- a Sport Injury Prevention Research Centre, Faculty of Kinesiology and Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine , University of Calgary , Calgary , Canada
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Polites SF, Mao SA, Glasgow AE, Moir CR, Habermann EB. Safety on the slopes: ski versus snowboard injuries in children treated at United States trauma centers. J Pediatr Surg 2018; 53:1024-1027. [PMID: 29729772 DOI: 10.1016/j.jpedsurg.2018.02.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Skiing and snowboarding are popular winter sports. The purpose of this study was to determine differences in injury patterns and severity between children participating in these sports treated at trauma centers in the United States. METHODS Ski and snowboard injuries in children <15 identified from the 2011-2015 National Trauma Data Bank were compared using t tests, chi squared tests, and multivariable analyses. Time trends were evaluated using the Cochran Armitage trend test. RESULTS We identified 1613 injured snowboarders and 1655 skiers. Snowboarders were older (12 vs. 11years, p<.001) and more likely to be male (84 vs. 68%, p<.001). The proportion of ski to snowboard injuries increased over time (p<.001). Skiers had greater median ISS than snowboarders (5 vs. 4, p<.001) but similar severe injuries ISS ≥16 (9 vs. 8%, p=.31). Head injuries were more frequent among snowboarders (26 vs. 23%, p=.013). Helmet use was greater in skiers (46 vs. 34%, p<.001). Skiers were more likely to sustain face, chest, and lower extremity injuries. Snowboarders had more abdominal and upper extremity injuries (p<.05). Snowboarders were more likely to undergo CT (20 vs. 16%, p=.008), and skiers were more likely to undergo surgery (25 vs. 22% p=.021). Need for intensive care (12 vs. 13%, p=.43) and mortality (0.3 vs. 0.3%, p=.75) were similar. Median length of stay was greater for skiers (2 days vs. 1day, p<.001). CONCLUSION Many children are treated at United States trauma centers for ski and snowboard injuries. One in 10 is severely injured. Different injury patterns between sports can be used to tailor prevention efforts. However, avoiding head injury and improving helmet use should be a priority for all children on the slopes. LEVEL OF EVIDENCE III TYPE OF STUDY: Prognostic.
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Affiliation(s)
| | - Shennen A Mao
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | | | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Provance AJ, Daoud AK, Tagawa A, Rhodes J. Pediatric and adolescent injury in skiing. Res Sports Med 2018; 26:150-165. [DOI: 10.1080/15438627.2018.1438282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Aaron J. Provance
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ariel K. Daoud
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alex Tagawa
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason Rhodes
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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Siesmaa EJ, Clapperton AJ, Twomey D. Hospital-Treated Snow Sport Injury in Victoria, Australia: A Summary of 2003-2012. Wilderness Environ Med 2018; 29:194-202. [PMID: 29602608 DOI: 10.1016/j.wem.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION To determine the incidence rate and changes over time for ice and snow sports injury in Victoria, Australia, from 2003 to 2012 and describe the most common types and causes of these injuries. METHODS Retrospective data from the Victorian Injury Surveillance Unit describing hospital admissions and emergency department presentations were extracted for the 10-year period of 2003 to 2012 for all ice- and snow-related injury. Descriptive injury data and participation-adjusted trend analyses using log-linear regression modelling of data (statistical significance, P<0.05) from the Exercise, Recreation and Sport Survey 2003 to 2010 are presented. RESULTS Overall, there were 7387 ice- and snow-related injuries, with a significant increase in hospital-treated snowboard injuries and a (nonsignificant) decline in hospital-treated ski injuries over the 10 years. Skiing (39%) and snowboarding (37%) had the highest incidence of hospital-treated injury, with males aged 15 to 24 years injured most frequently in both sports. Falls were the most common cause of injury in both skiing (68%) and snowboarding (78%). CONCLUSIONS Patterns of snow sports injury in Australia during 2003 to 2012 remain similar to findings of national studies conducted decades earlier. More importantly, however, Australian injury patterns are comparable to international statistics and thus may be generalizable internationally. Head injuries, although infrequent, are associated with great injury severity due to a high frequency of hospitalization. Furthermore, research into the use of personal protective equipment and other injury prevention measures among Australian participants, particularly by young, male snowboarders, is required. Given the similar injury patterns, injury prevention measures implemented internationally could reasonably translate to an Australian setting.
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Affiliation(s)
- Emma J Siesmaa
- School of Health Sciences and Psychology, Federation University Australia, Ballarat, Australia (Drs Siesmaa and Twomey).
| | - Angela J Clapperton
- Victorian Injury Surveillance Unit, Monash University, Melbourne, Australia (Ms Clapperton)
| | - Dara Twomey
- School of Health Sciences and Psychology, Federation University Australia, Ballarat, Australia (Drs Siesmaa and Twomey)
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Abstract
Skiing and snowboarding have increased in popularity since the 1960s. Both sports are responsible for a substantial number of musculoskeletal injuries treated annually by orthopaedic surgeons. Specific injury patterns and mechanisms associated with skiing and snowboarding have been identified. No anatomic location is exempt from injury, including the head, spine, pelvis, and upper and lower extremities. In these sports, characteristic injury mechanisms often are related to the position of the limbs during injury, the athlete's expertise level, and equipment design. Controversy exists about the effectiveness of knee bracing and wrist guards in reducing the incidence of these injuries. Understanding these injury patterns, proper training, and the use of injury prevention measures, such as protective equipment, may reduce the overall incidence of these potentially debilitating injuries.
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Karton C, Blaine Hoshizaki T. Concussive and subconcussive brain trauma: the complexity of impact biomechanics and injury risk in contact sport. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:39-49. [DOI: 10.1016/b978-0-444-63954-7.00005-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Epidemiology of Snow Skiing- Versus Snowboarding-Related Concussions Presenting to the Emergency Department in the United States from 2010 to 2014. Clin J Sport Med 2017; 27:499-502. [PMID: 27787350 DOI: 10.1097/jsm.0000000000000395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Vriend I, Hesselink A, Kemler E, Gouttebarge V, van Mechelen W, Verhagen E. Effectiveness of a nationwide intervention to increase helmet use in Dutch skiers and snowboarders: an observational cohort study. Inj Prev 2017; 24:205-212. [PMID: 28848058 DOI: 10.1136/injuryprev-2016-042179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 05/16/2017] [Accepted: 06/02/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS. METHODS The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season. RESULTS Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (β=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders. CONCLUSIONS Exposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.
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Affiliation(s)
- Ingrid Vriend
- Consumer Safety Institute (VeiligheidNL), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health and Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Ellen Kemler
- Consumer Safety Institute (VeiligheidNL), Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Consumer Safety Institute (VeiligheidNL), Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willem van Mechelen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health and Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health and Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
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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. Wilderness Environ Med 2017; 28:168-175. [PMID: 28684013 DOI: 10.1016/j.wem.2017.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/20/2017] [Accepted: 03/15/2017] [Indexed: 11/22/2022]
Abstract
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.
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Severe injuries associated with skiing and snowboarding: A national trauma data bank study. J Trauma Acute Care Surg 2017; 82:781-786. [PMID: 28030491 DOI: 10.1097/ta.0000000000001358] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Injuries after skiing and snowboarding accidents lead to an estimated 7,000 hospital admissions annually and present a significant burden to the health care system. The epidemiology, injury patterns, hospital resource utilization, and outcomes associated with these severe injuries need further characterization. METHODS The National Trauma Data Bank was queried for the period 2007 to 2014 for admissions with Injury Severity Score > 15 and International Classification of Diseases Codes-9th Revision codes 885.3 (fall from skis, n = 1,353) and 885.4 (fall from snowboard, n = 1,216). Demographics, emergency department data, diagnosis and procedure codes, and outcomes were abstracted from the database. RESULTS Severe (Injury Severity Score > 15) ski-associated and snowboard-associated injuries differed with respect to age distribution (median age, 38; interquartile range, 19-59 for skiers and median age, 20; interquartile range, 16-25 for snowboarders; p < 0.001) and sex (78.9% and 86.4% males, respectively, p < 0.001). Traumatic brain injury was common for both sports (56.8% of skiers vs. 46.6% of snowboarders, p < 0.001). Injuries to the spine (28.9%), chest (37.6%), and abdomen (35.0%) were also common. Eighty percent of patients used emergency medical services (50% ambulance, 30% helicopter) with a median emergency medical services transport time of 84 minutes. 50.8% of patients required interhospital transport. 43.2% of injuries required surgical intervention (21.3% orthopedic, 12.5% neurosurgical, 10.5% thoracic, 7.8% abdominal). Median hospital length of stay was 5.0 days. 60.0% of patients required intensive care unit admission with median intensive care unit length of stay 3.0 days. Overall mortality was 4.0% for skiers and 1.9% for snowboarders. CONCLUSION Severe injuries after ski and snowboard accidents are associated with significant morbidity and mortality. Differences in injury patterns, risk factors for severe injury, and resource utilization require further study. Increased resource allocation to alpine trauma systems is warranted. LEVEL OF EVIDENCE Prognostic/epidemiologic, level III.
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Otten EJ, Dorlac WC. Managing Traumatic Brain Injury: Translating Military Guidelines to the Wilderness. Wilderness Environ Med 2017; 28:S117-S123. [DOI: 10.1016/j.wem.2017.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/26/2017] [Accepted: 02/28/2017] [Indexed: 11/25/2022]
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Sun H, Samra NS, Kalakoti P, Sharma K, Patra DP, Dossani RH, Thakur JD, Disbrow EA, Phan K, Veeranki SP, Pabaney A, Notarianni C, Owings JT, Nanda A. Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury. World Neurosurg 2017; 104:909-918.e8. [PMID: 28559075 DOI: 10.1016/j.wneu.2017.05.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). METHODS Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. RESULTS Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. CONCLUSIONS Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.
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Affiliation(s)
- Hai Sun
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
| | - Navdeep S Samra
- Department of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Piyush Kalakoti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Kanika Sharma
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Rimal H Dossani
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Jai Deep Thakur
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Elizabeth A Disbrow
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Barker St. Randwick, Prince of Wales Private Hospital, Sydney, Australia
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Galveston, Texas, USA
| | - Aqueel Pabaney
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - John T Owings
- Department of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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47
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Prahlow SP, Renner A, Grande AJ, deJong J, Prahlow JA. Recreational Sporting Activity Vehicle-Related Deaths. J Forensic Sci 2017; 63:460-468. [PMID: 28493344 DOI: 10.1111/1556-4029.13542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/27/2017] [Accepted: 04/12/2017] [Indexed: 01/22/2023]
Abstract
Deaths occurring in the setting of nonprofessional, vehicle-related, recreational sporting activities occurring on land or in water during warm or winter months represent a diverse group of cases. These deaths tend to involve scenarios where the participants are purposefully attempting to enjoy themselves prior to experiencing sudden, catastrophic accidents resulting in lethal outcomes. Ultimately, many of the deaths are related to the high speed at which these vehicle-related activities normally occur. Three broad categories of factors may play contributory roles in death: human factors, vehicle factors, and environmental factors. A series of selected cases are presented, representing examples of varying activity types, involving motorized and nonmotorized vehicles, land and water activities, and warm weather and cold weather environments. For each case, the various human, vehicle and environmental factors believed to be contributory to the accident are considered, and strategies for prevention of these and similar deaths involving recreational sporting vehicles are presented.
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Affiliation(s)
- Samuel P Prahlow
- College of Social Sciences and Health Policy, Florida State University, Tallahassee, FL
| | - Andrew Renner
- Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, IN
| | - Abigail J Grande
- Department of Pathology and Office of the Medical Examiner, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Joyce deJong
- Department of Pathology and Office of the Medical Examiner, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Joseph A Prahlow
- Department of Pathology and Office of the Medical Examiner, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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48
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Emery CA, Black AM, Kolstad A, Martinez G, Nettel-Aguirre A, Engebretsen L, Johnston K, Kissick J, Maddocks D, Tator C, Aubry M, Dvořák J, Nagahiro S, Schneider K. What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. Br J Sports Med 2017; 51:978-984. [PMID: 28254746 DOI: 10.1136/bjsports-2016-097452] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/03/2022]
Abstract
AIM OR OBJECTIVE To examine the effectiveness of concussion prevention strategies in reducing concussion risk in sport. DESIGN Systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. DATA SOURCES Eleven electronic databases searched and hand-search of references from selected studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES The following were the study inclusion criteria: (1) contained original human research data; (2) investigated an outcome of concussion or head impact; (3) evaluated a concussion prevention intervention; (4) included sport participants; (5) analytical study designand (6) peer-reviewed. The following were the exclusion criteria: (1) review articles, case series or case studies and (2) not in English. RESULTS The studies selected (n=48) provided evidence related to protective gear (helmets, headgear, mouthguards) (n=25), policy and rule changes (n=13) and other interventions (training, education, facilities) (n=10). Meta-analyses demonstrate a combined effect of a 70% reduction (incidence rate ratio (IRR)=0.3 (95% CI: 0.22 to 0.41)) in concussion risk in youth ice hockey leagues where policy disallows body checking, and the point estimate (IRR=0.8 (95% CI: 0.6 to 1.1)) suggests a protective effect of mouthguards in contact and collision sport (basketball, ice hockey, rugby). SUMMARY/CONCLUSIONS Highlights include a protective effect of helmets in skiing/snowboarding and the effectiveness of policy eliminating body checking in youth ice hockey. Future research should examine mouthguards in contact sport, football helmet padding, helmet fit in collision sport, policy limiting contact practice in youth football, rule enforcement to reduce head contact in ice hockey and soccer, ice surface size and board/glass flexibility in ice hockey and training strategies targeting intrinsic risk factors (eg, visual training). SYSTEMATIC REVIEW REGISTRATION PROSPERO 2016:CRD42016039162.
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Affiliation(s)
- Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Amanda M Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Ash Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - German Martinez
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Medical and Scientific Department, International Olympic Committee (IOC), Lausanne, Switzerland
| | - Karen Johnston
- Division of Neurosurgery, University of Toronto, Ontario, Canada.,Concussion Management Program Athletic Edge Sports Medicine, Ontario, Canada
| | - James Kissick
- Carleton University Sport Medicine Centre, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,International Paralympic Committee Medical Committee
| | | | - Charles Tator
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Mark Aubry
- Ottawa Sport Medicine Centre, Ontario, Canada.,International Ice Hockey Federation.,IOC Medical Commission Games Group
| | - Jiří Dvořák
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Schulthess Clinic Zurich
| | - Shinji Nagahiro
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
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49
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Van Tilburg C, Grissom CK, Zafren K, McIntosh S, Radwin MI, Paal P, Haegeli P, Smith WWR, Wheeler AR, Weber D, Tremper B, Brugger H. Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents. Wilderness Environ Med 2017; 28:23-42. [PMID: 28257714 DOI: 10.1016/j.wem.2016.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/14/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
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Affiliation(s)
- Christopher Van Tilburg
- Occupational, Travel, and Emergency Medicine Departments, Providence Hood River Memorial Hospital, Hood River, OR (Dr Van Tilburg); Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler).
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom)
| | - Ken Zafren
- Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler); Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Dr Zafren); International Commission for Mountain Emergency Medicine (Drs Brugger, Paal, and Zafren)
| | - Scott McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh and Wheeler)
| | - Martin I Radwin
- Iasis Healthcare Physician Group of Utah, Salt Lake City, UT (Dr Radwin)
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (Drs Brugger, Paal, and Zafren); Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, United Kingdom (Dr Paal); Department of Anesthesiology and Critical Care Medicine, University Hospital, Innsbruck, Austria (Dr Paal)
| | - Pascal Haegeli
- School of Resource and Environmental Management, Simon Fraser University, Burnaby, BC (Dr Haegeli)
| | - William Will R Smith
- Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler); Department of Emergency Medicine, St. Johns Medical Center, Jackson, WY (Drs Smith and Wheeler); Clinical WWAMI Faculty, University of Washington School of Medicine, Seattle, WA (Dr Smith)
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler); Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh and Wheeler); Department of Emergency Medicine, St. Johns Medical Center, Jackson, WY (Drs Smith and Wheeler)
| | - David Weber
- Denali National Park & Preserve, Talkeetna, AK (Mr Weber); Intermountain Life Flight, Salt Lake City, UT (Mr Weber)
| | - Bruce Tremper
- Utah Avalanche Center, Salt Lake City, UT (Mr Tremper)
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (Drs Brugger, Paal, and Zafren); EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy (Dr Brugger)
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50
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Helmet use and injury severity among pediatric skiers and snowboarders in Colorado. J Pediatr Surg 2017; 52:349-353. [PMID: 27876383 DOI: 10.1016/j.jpedsurg.2016.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Skiing and snowboarding are popular winter recreational activities that are commonly associated with orthopedic type injuries. Unbeknownst to most parents, however, are the significant but poorly described risks for head, cervical spine and solid organ injuries. Although helmet use is not mandated for skiers and snowboarders outside of resort sponsored activities, we hypothesized that helmet use is associated with a lower risk of severe head injury, shorter ICU stay and shorter hospital length of stay. METHODS The trauma registry at a level I pediatric trauma center in the state of Colorado was queried for children ages 3-17years, who sustained an injury while skiing or snowboarding from 1/1/1999 to 12/31/2014. Injury severity was assessed by Abbreviated Injury Severity (AIS) score, injury severity score (ISS) and admission location. Head injury was broadly defined as any trauma to the body above the lower border of the mandible. Regression analysis was used to test associations of variables with injury severity. RESULTS 549 children sustained snow sport related injuries during the 16year study period. The mean patient age was11±3years, most were male (74%) and the majority were Colorado residents (54%). The overall median ISS was 9 (IQR 4-9) and 78 children (14%) were admitted to the ICU. Colorado residents were nearly twice as likely to be wearing a helmet at the time of injury, compared to visitors from out-of-state (adjusted OR 1.86, 95% CI 1.24-2.76, p=0.002). In a multivariate analysis injury severity was significantly associated with injury while skiing (p=0.026), helmet use (p=0.0416), and sustaining a head injury (p<0.0001). In a separate multivariate analysis ICU admission was associated with head injury (p<0.0001) and wearing a helmet (p=0.0257); however, those wearing a helmet and admitted to the ICU had significantly lower ISS (p=0.007) and head AIS (p=0.011) scores than those who were not wearing a helmet at the time of injury. CONCLUSION Visitors from out of state were less likely to be wearing a helmet when injured and more likely to be severely injured, suggesting Colorado residents have a better understanding of the benefits of helmet usage. Helmeted skiers and snowboarders who were admitted to the ICU had significantly lower ISS and head AIS scores than those who were not helmeted. Pediatric skiers, snowboarders and their parents should be educated on the significant risks associated with these activities and the benefits of helmet usage. LEVEL OF EVIDENCE III.
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