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Mileva B, Goshev M, Dikov T, Georgieva M, Valcheva M, Tsranchev II, Alexandrov A, Ivanova V. Death Following a Skiing Incident: Severe Exsanguination Due to Rupture of the Left Renal Artery. Cureus 2024; 16:e57575. [PMID: 38707107 PMCID: PMC11069066 DOI: 10.7759/cureus.57575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
With the growing popularity of winter sports, it is necessary to pay more attention to the types of traumatic injuries that a person can sustain in various incidents related to their practice. We present a case in which an adult man died as a result of a collision with a tree while skiing. Although the deaths are associated with different types and severity of craniocerebral injuries in the majority of the cases, here we are dealing with an abdominal injury with rupture of the stomach, pancreas, and left renal artery. The exact localization of the resulting traumatic injuries and the mechanism of their occurrence were examined. Both macroscopic autopsy findings (gross pathology) and histologically proven ones are presented and described. Presenting this case, we want to raise awareness of the different types of injuries received while skiing, as well as to emphasize the possibility of death in the absence of visible external injuries over the victim's body.
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Affiliation(s)
- Biliana Mileva
- Department of Forensic Medicine and Deontology, Medical University of Sofia, Sofia, BGR
| | - Metodi Goshev
- Department of Forensic Medicine and Deontology, Medical University of Sofia, Sofia, BGR
| | - Tihomir Dikov
- Department of General and Clinical Pathology, University Hospital "Alexandrovska" Medical University of Sofia, Sofia, BGR
| | - Mihaela Georgieva
- Department of Forensic Medicine and Deontology, Medical University of Sofia, Sofia, BGR
| | - Martina Valcheva
- Department of Forensic Medicine and Deontology, Medical University of Sofia, Sofia, BGR
| | - Ivan I Tsranchev
- Department of Forensic Medicine and Deontology, Medical University of Plovdiv, Plovdiv, BGR
| | - Alexandar Alexandrov
- Department of Forensic Medicine and Deontology, Medical University of Sofia, Sofia, BGR
| | - Vesela Ivanova
- Department of General and Clinical Pathology, University Hospital "Alexandrovska" Medical University of Sofia, Sofia, BGR
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2
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Borchert W, Grady ST, Chen J, DeVille NV, Roscoe C, Chen F, Mita C, Holland I, Wilt GE, Hu CR, Mehta U, Nethery RC, Albert CM, Laden F, Hart JE. Air Pollution and Temperature: a Systematic Review of Ubiquitous Environmental Exposures and Sudden Cardiac Death. Curr Environ Health Rep 2023; 10:490-500. [PMID: 37845484 PMCID: PMC11016309 DOI: 10.1007/s40572-023-00414-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE OF REVIEW Environmental exposures have been associated with increased risk of cardiovascular mortality and acute coronary events, but their relationship with out-of-hospital cardiac arrest (OHCA) and sudden cardiac death (SCD) remains unclear. SCD is an important contributor to the global burden of cardiovascular disease worldwide. RECENT FINDINGS Current literature suggests a relationship between environmental exposures and cardiovascular disease, but their relationship with OHCA/SCD remains unclear. A literature search was conducted in PubMed, Embase, Web of Science, and Global Health. Of 5138 studies identified by our literature search, this review included 30 studies on air pollution, 42 studies on temperature, 6 studies on both air pollution and temperature, and 1 study on altitude exposure and OHCA/SCD. Particulate matter air pollution, ozone, and both hot and cold temperatures are associated with increased risk of OHCA/SCD. Pollution and other exposures related to climate change play an important role in OHCA/SCD incidence.
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Affiliation(s)
- William Borchert
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA.
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Stephanie T Grady
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jie Chen
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicole V DeVille
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Charlotte Roscoe
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Futu Chen
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Isabel Holland
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Grete E Wilt
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Cindy R Hu
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Unnati Mehta
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel C Nethery
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
- Division of Preventative Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Francine Laden
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Jaime E Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Furian M, Latshang TD, Aeschbacher SS, Sheraliev U, Marazhapov NH, Mirrakhimov E, Ulrich S, Sooronbaev TM, Bloch KE. Markers of cardiovascular risk and their reversibility with acute oxygen therapy in Kyrgyz highlanders with high altitude pulmonary hypertension. Pulmonology 2021; 27:394-402. [PMID: 33674243 DOI: 10.1016/j.pulmoe.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND High altitude pulmonary hypertension (HAPH), a chronic altitude related illness, is associated with hypoxemia, dyspnea and reduced exercise performance. We evaluated ECG and pulse wave-derived markers of cardiovascular risk in highlanders with HAPH (HAPH+) in comparison to healthy highlanders (HH) and lowlanders (LL) and the effects of hyperoxia. METHODS We studied 34 HAPH+ and 54 HH at Aksay (3250m), and 34 LL at Bishkek (760m), Kyrgyzstan. Mean pulmonary artery pressure by echocardiography was mean±SD 34±3, 22±5, 16±4mmHg, respectively (p<0.05 all comparisons). During quiet rest, breathing room air or oxygen in randomized order, we measured heart-rate adjusted QT interval (QTc), an ECG-derived marker of increased cardiovascular mortality, and arterial stiffness index (SI), a marker of cardiovascular disease derived from pulse oximetry plethysmograms. RESULTS Pulse oximetry in HAPH+, HH and LL was, mean±SD, 88±4, 92±2 and 95±2%, respectively (p<0.05 vs HAPH+, both comparisons). QTc in HAPH+, HH and LL was 422±24, 405±27, 400±28ms (p<0.05 HAPH+ vs. others); corresponding SI was 10.5±1.9, 8.4±2.6, 8.5±2.0m/s, heart rate was 75±8, 68±8, 70±10 bpm (p<0.05, corresponding comparisons HAPH+ vs. others). In regression analysis, HAPH+ was an independent predictor of increased QTc and SI when controlled for several confounders. Oxygen breathing increased SI in HH but not in HAPH+, and reduced QTc in all groups. CONCLUSIONS Our data suggest that HAPH+ but not HH may be at increased risk of cardiovascular mortality and morbidity compared to LL. The lack of a further increase of the elevated SI during hyperoxia in HAPH+ may indicate dysfunctional control of vascular tone and/or remodelling.
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Affiliation(s)
- M Furian
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - T D Latshang
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - S S Aeschbacher
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - U Sheraliev
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - N H Marazhapov
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - E Mirrakhimov
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - S Ulrich
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - T M Sooronbaev
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - K E Bloch
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
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Procter E, Brugger H, Burtscher M. Accidental hypothermia in recreational activities in the mountains: A narrative review. Scand J Med Sci Sports 2018; 28:2464-2472. [PMID: 30203539 DOI: 10.1111/sms.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
The popularity of recreational activities in the mountains worldwide has led to an increase in the total number of persons exposed to cold and extreme environments through recreation. There is little conclusive evidence about the risk of hypothermia for specific activities or populations, nor is it clear which activities are represented in the literature. This is a non-systematic review of accidental hypothermia in different recreational activities in the mountains, with a specific focus on outdoor or winter activities that potentially involve cold exposure. Cases of hypothermia have been reported in the literature in mountaineering, trekking, hiking, skiing, activities performed in the backcountry, ultra-endurance events, and databases from search and rescue services that include various types of recreation. Of these activities, hypothermia as a primary illness occurs most commonly during mountaineering in the highest elevation areas in the world and during recreation practiced in more northern or remote areas. Hypothermia in skiers, snowboarders, and glacier-based activities is most often associated with accidents occurring off-piste or in the backcountry (crevasse, avalanche). Organizers of outdoor events also have a role in reducing the incidence of hypothermia through medical screening and other preparedness measures. More complete collection and reporting of data on mild hypothermia and temperature measurement would improve our understanding of the incidence of hypothermia in outdoor recreation in future.
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Affiliation(s)
- Emily Procter
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen/Bolzano, Italy
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine and Mountain Medicine, Innsbruck, Austria
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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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6
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Viglino D, Maignan M, Michalon A, Turk J, Buse SK, Blancher M, Aufderheide TP, Belle L, Savary D, Ageron FX, Debaty G. Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network. Resuscitation 2017; 119:43-47. [PMID: 28827198 DOI: 10.1016/j.resuscitation.2017.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 11/27/2022]
Abstract
AIM Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. METHODS Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. RESULTS 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40-65] vs. 66 [52-79] years, p<0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p<0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p<0.001) and the time to the first electric shock was shorter (7.5min vs 14min, p<0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p<0.001, RR=3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42-4.81, p=0.002). CONCLUSION Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests.
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Affiliation(s)
- Damien Viglino
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - HP2 Laboratory INSERM U1042, Grenoble, France.
| | - Maxime Maignan
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - HP2 Laboratory INSERM U1042, Grenoble, France
| | - Arnaud Michalon
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - Julien Turk
- Chambery Metropole Savoie Hospital, Emergency Department and Mobile Intensive Care Unit, Chambery, France
| | - Sarah K Buse
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Marc Blancher
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Loïc Belle
- Annecy-Genevois Hospital, Cardiac Intensive Care Unit, Annecy, France
| | - Dominique Savary
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - François-Xavier Ageron
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - Guillaume Debaty
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - TIMC-IMAG laboratory Team PRETA CNRS UMR 5525, Grenoble, France
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Laver L, Pengas IP, Mei-Dan O. Injuries in extreme sports. J Orthop Surg Res 2017; 12:59. [PMID: 28420431 DOI: 10.1186/s13018-017-0560-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/15/2017] [Indexed: 12/27/2022] Open
Abstract
Extreme sports (ES) are usually pursued in remote locations with little or no access to medical care with the athlete competing against oneself or the forces of nature. They involve high speed, height, real or perceived danger, a high level of physical exertion, spectacular stunts, and heightened risk element or death.Popularity for such sports has increased exponentially over the past two decades with dedicated TV channels, Internet sites, high-rating competitions, and high-profile sponsors drawing more participants.Recent data suggest that the risk and severity of injury in some ES is unexpectedly high. Medical personnel treating the ES athlete need to be aware there are numerous differences which must be appreciated between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management following injury, treatment decisions, and rehabilitation.The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians. Appropriate safety gear is essential for protection from severe or fatal injuries as the margins for error in these sports are small.The purpose of this review is to provide an epidemiologic overview of common injuries affecting the extreme athletes through a focus on a few of the most popular and exciting extreme sports.
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Affiliation(s)
- Lior Laver
- Department of Trauma and Orthopaedics, University Hospital Coventry and Warwickshire, Coventry, UK.
| | - Ioannis P Pengas
- Department of Trauma & Orthopaedics, Royal Cornwall Teaching Hospitals NHS Trust, Truro, UK
| | - Omer Mei-Dan
- CU Sports Medicine & Performance Center, Boulder, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
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Windsor JS, Rodway G, Mukherjee R, Firth P, Shattock M, Montgomery H. Prolongation of the Corrected QT Complex - A Cause of Sudden Cardiac Death in the Mountain Environment? J ROY ARMY MED CORPS 2011; 157:63-7. [DOI: 10.1136/jramc-157-01-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Windsor JS, Rodway GW, Montgomery HE. A Review of Electrocardiography in the High Altitude Environment. High Alt Med Biol 2010; 11:51-60. [DOI: 10.1089/ham.2009.1065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeremy S. Windsor
- UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, London, UK
| | - George W. Rodway
- UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, London, UK
- University of Utah, College of Nursing and School of Medicine, Salt Lake City, Utah, USA
| | - Hugh E. Montgomery
- UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, London, UK
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12
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Faulhaber M, Flatz M, Gatterer H, Schobersberger W, Burtscher M. Prevalence of cardiovascular diseases among alpine skiers and hikers in the Austrian Alps. High Alt Med Biol 2008; 8:245-52. [PMID: 17824825 DOI: 10.1089/ham.2007.1005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mountain sports, especially hiking and alpine skiing, are very popular. It is speculated that a high percentage of hikers and skiers are older and have cardiovascular diseases, but little is known about the real frequency of cardiovascular diseases in mountaineers and skiers. The goal of this study was to provide data on the prevalence of cardiovascular diseases (coronary artery disease with and without myocardial infarction, hypertension, and arrhythmias) of a representative sample of hikers and skiers in the Austrian Alps. Questionnaire results of 1431 hikers and 1043 skiers were included in the evaluation. Regarding the whole sample, 12.7% (11.0 to 14.4) of the hikers and 11.2% (9.3 to 13.1) of the skiers are afflicted with at least one type of cardiovascular disease. The frequency of cardiovascular diseases is age dependent and more pronounced in men, but only small differences were detected between hikers and skiers. It can be assumed that 4 to 5 million hikers and skiers with known cardiovascular diseases are active in the Alps annually. Scientific research should provide the basis of an optimal risk management for this large group of persons.
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Affiliation(s)
- Martin Faulhaber
- University of Innsbruck, Department of Sport Science, Innsbruck, Austria.
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13
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Xiang H, Kelleher K, Shields BJ, Brown KJ, Smith GA. Skiing- and Snowboarding-Related Injuries Treated in U.S. Emergency Departments, 2002. ACTA ACUST UNITED AC 2005; 58:112-8. [PMID: 15674160 DOI: 10.1097/01.ta.0000151270.26634.dd] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to describe the characteristics of skiing- and snowboarding-related injuries treated in U.S. emergency departments (EDs). METHODS Skiing- and snowboarding-related injuries collected by the National Electronic Injury Surveillance System in 2002 were analyzed. Data regarding skiing and snowboarding participation were used to calculate injury rates by age group and activity (skiing versus snowboarding). RESULTS An estimated 77,300 (95% CI = 11,600-143,000) skiing- and 62,000 (95% CI = 32,800-91,200) snowboarding-related injuries were treated in U.S. hospital EDs in 2002. Wrist injuries (17.9%) and arm injuries (16.6%) among snowboarders and knee injuries (22.7%) among skiers were the most common injuries. The age groups that have the highest skiing-related injury rates were the 55-64 years (29.0 per 1,000 participants), the 65+ years (21.7 per 1,000 participants), and the 45-54 years (15.5 per 1,000 participants). The age groups that have the highest snowboarding-related injuries were the 10-13 years (15.9 per 1,000 participants), the 14-17 years (15.0 per 1,000 participants), and the 18-24 years (13.5 per 1,000 participants). Traumatic brain injury (TBI) rates were higher among older skiers, 55-64 years (2.15 per 1,000 participants), and younger skiers, 10-13 years (1.69 per 1,000 participants). CONCLUSIONS Our study is the first to demonstrate that older skiers are at highest risk for injury. Adolescents are at highest risk for snowboarding-related injury. Prevention of TBI should be a top injury control priority among skiers and snowboarders.
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Affiliation(s)
- Huiyun Xiang
- Center for Injury Research and Policy, Children's Research Institute, Columbus Children's Hospital, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio 43205. USA.
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Abstract
OBJECTIVE Young skiers are at increased risk for injury, however, epidemiological data on skiing related fatal injuries among child skiers are scarce. This study aimed to provide information needed to develop injury control and prevention programs. DESIGN AND SETTING Study subjects came from Colorado, USA and were identified using a death certificate based surveillance system. Fatal injuries were limited to events that occurred at established commercial ski resorts in Colorado, and subjects were classified as child skiers (0-17 years) or adult skiers (> or =18 years). MAIN OUTCOME MEASURE Type and external cause, time, and week day of injury, gender and residency of the decedents. RESULTS During the study period from 1980-2001, 149 fatal injuries associated with downhill skiing were identified; 21 (14.1%) occurred among child skiers aged < or =17 years. The age of the youngest decedent was 7 years. In females the proportion of fatal injuries among child skiers was nearly three times that of adults. Traumatic brain injuries were the leading cause of death (67% of all deaths) among children, while multiple internal injuries and traumatic brain injuries accounted for almost equal proportions of fatal injuries among adults. Collision was the leading external mechanism of fatal injuries, accounting for more than two thirds of fatal injuries in both child and adult skiers. CONCLUSIONS Traumatic brain injury was the leading cause and collision was the leading external injury mechanism of fatal injuries associated with downhill skiing among child skiers. This underscores the importance of brain injury prevention strategies, including the use of ski helmets and prevention of collisions on ski slopes.
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Affiliation(s)
- H Xiang
- Colorado Department of Public Health and Environment, USA
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Siu TLT, Chandran KN, Newcombe RL, Fuller JW, Pik JHT. Snow sports related head and spinal injuries: an eight-year survey from the neurotrauma centre for the Snowy Mountains, Australia. J Clin Neurosci 2004; 11:236-42. [PMID: 14975409 DOI: 10.1016/j.jocn.2003.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2003] [Accepted: 08/18/2003] [Indexed: 11/29/2022]
Abstract
Neurotrauma from snow-sports related injuries is infrequently documented in the literature. In Australia no collective data has ever been published. The aim of this study is to document the injury pattern of snow sports related neurotrauma admissions to The Canberra Hospital, the regional trauma centre for the Snowy Mountains. A computerised hospital record search conducted between January 1994 and July 2002 revealed 25 head and 66 spinal injury admissions. The incidence of severe injuries requiring referral to tertiary trauma hospital was estimated to be 7.4 per 100,000 skier-days and for head and spinal injury 1.8 per 1,000,000 skier-days and 5.6 per 1,000,000 skier-days, respectively. Collision with a stationary object was disproportionately associated with head injury ( [Formula: see text] ) and falling forward with spinal injury ( [Formula: see text] ). Snowboarders tended to sustain cervical fractures more often than skiers ( [Formula: see text] ). The importance of helmet usage in buffering the impact of head-on collision and the proposition of having both feet fastened to a snowboard in leading to cervical injury were highlighted.
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Affiliation(s)
- T L T Siu
- Department of Neurosurgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
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16
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Clingenpeel JM, Marshall SW. Helmet rental practices at United States ski areas: a national survey. Inj Prev 2004; 9:317-21. [PMID: 14693892 PMCID: PMC1731025 DOI: 10.1136/ip.9.4.317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Studies have shown that head injuries are the leading cause of death on ski slopes. Statistics on helmet rental practices at ski areas across the United States have never been reported. This study sought to determine the prevalence of United States ski areas offering helmet rental during the 2002-03 ski season. Secondarily it sought to analyze the relationships of geographic region and size of ski area with helmet rental availability and to gather information on ski helmet rental cost to the consumer. METHODS and setting: A stratified cross sectional telephone survey of a sample of 331 United States ski area onsite rental shops during February 2003. RESULTS Altogether 50% of ski areas offered helmet rental with significant variation in the prevalence of helmet rental among ski areas of differing regions and sizes (p<0.01). A majority of Northeastern (57%), Western (63%), and Rocky Mountain (71%) ski areas rented helmets, whereas a minority of Southern (37%) and Midwestern (23%) ski areas rented helmets. Twenty five percent of the smallest ski areas (< or =50 acres) rented helmets compared with 74% of the largest ski areas (> or =501 acres). CONCLUSIONS United States ski area helmet rental practices vary by region of the country and ski area size. Winter sports participants interested in wearing protective headgear should be aware of the helmet rental practices at the ski area in which they plan to visit and consider helmet purchase if they visit mainly smaller ski areas or areas within the South or Midwest.
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Affiliation(s)
- J M Clingenpeel
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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17
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Abstract
OBJECTIVES To investigate the trend and injury patterns of deaths associated with snow skiing in Colorado between 1980 and 2001. METHODS Death certificates were searched electronically and reviewed manually. Total skier ticket sales were used to calculate death rates. Types of injuries and characteristics of those who died were investigated. RESULTS A total of 274 skier deaths occurred between 1980 and 2001 in Colorado. Death rates ranged from 0.53 to 1.88 per million skier visits. The majority of deaths were among males (>81%). Ages ranged from 7 to 77 years with an average of 32 years. The greatest number of deaths associated with downhill skiing (76 deaths) occurred between 10:00 a.m. and 2:00 p.m. while the greatest number of deaths associated with cross-country skiing happened between 2:00 and 6:00 p.m. About 65% of deaths associated with downhill skiing (133 cases) died of traumatic injuries resulting from collisions. CONCLUSIONS A slight increase in the rate of ski-related deaths was observed. The role of collisions in ski-related deaths warrants further investigation to reduce the risk of this activity for all skiers. Further work is needed to determine the efficacy of helmet use to reduce the risk of head injuries in the skiing population.
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Affiliation(s)
- Huiyun Xiang
- Health Statistics Section, Colorado Department of Public Health and Environment, Vital Statistics Unit, 4300 Cherry Creek Drive South, Denver, CO 80246-1530, USA.
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18
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Levy AS, Hawkes AP, Hemminger LM, Knight S. An analysis of head injuries among skiers and snowboarders. THE JOURNAL OF TRAUMA 2002; 53:695-704. [PMID: 12394869 DOI: 10.1097/00005373-200210000-00013] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Head injury is the leading cause of death and critical injury in skiing and snowboarding accidents. METHODS Data relating to head injuries occurring on the ski slopes were collected from the trauma registry of a Level I trauma center located near a number of ski resorts. RESULTS From 1982 to 1998, 350 skiers and snowboarders with head injuries were admitted to our Level I trauma center. Most of the injuries were mild, with Glasgow Coma Scale (GCS) scores of 13 to 15 in 81% and simple concussion in 69%. However, 14% of patients had severe brain injuries, with GCS scores of 3 to 8, and the overall mortality rate was 4%. Collision with a tree or other stationary object (skier-tree) was the mechanism of injury in 47% of patients; simple falls in 37%; collision with another skier (skier-skier) in 13%; and major falls in 3%. Skier-tree collision and major falls resulted in a higher percentage of severe injuries, with GCS scores of 3 to 8 in 24% and 20%, respectively, and mean Injury Severity Scores of 14 and 17, respectively. Mortality from skier-tree collision was 7.2%, compared with 1.6% in simple falls and no deaths from skier-skier collision or major falls. The risk of sustaining a head injury was 2.23 times greater for male subjects compared with female subjects, 2.81 times higher for skiers/boarders < or = 35 years of age compared with those > 35 years, and 3.04 times higher for snowboarders compared with skiers. CONCLUSION Skier-tree collision was the most common mechanism for head injuries in patients admitted to our Level I trauma center, and resulted in the most severe injuries and the highest mortality rate. Because most traumatic brain injuries treated at our facility resulted from a direct impact mechanism, we believe that the use of helmets can reduce the incidence and severity of head injuries occurring on the ski slopes.
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Affiliation(s)
- A Stewart Levy
- Intermountain Neurosurgery and Neuroscience, Saint Anthony Central Hospital, Denver, Colorado 80204, USA
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Langran M, Jachacy GB, MacNeill A. Ski injuries in Scotland. A review of statistics from Cairngorm ski area winter 1993/94. Scott Med J 1996; 41:169-72. [PMID: 9122664 DOI: 10.1177/003693309604100605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Scottish skiing is a growth industry-nearly all acute ski injuries in Aviemore are managed initially by local general practitioners. This study set out to examine the nature and incidence of ski injuries in one Scottish ski resort, and to calculate the additional workload generated for the health centre, ambulance service and local hospital. During the study period, the winter ski season of 1993-94, a prospective study was made of the 486 acute ski injuries presenting to Aviemore Health Centre. Despite frequently poor weather conditions, the season's injury rate for Cairngorm was 2.43 per 1000 skier days which compares favourably with statistics from other ski centres world-wide. The anatomical pattern of injuries for both downhill skiing and snowboarding was similar to that of other countries. Knee injuries constituted nearly one third of all cases. 8% of injuries involved the ski lift machinery. 31% of casualties underwent radiographic examination, 17% needed hospital referral and 7% required admission to hospital. The management of acute ski injuries can be performed effectively in the primary care setting. It has significant benefits in rural areas by rationalising the use of ambulance and hospital services.
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Affiliation(s)
- M Langran
- Aviemore Health Centre, Muirton, Aviemore, Inverness-shire
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20
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Abstract
Thirty-seven consecutive patients with severe snowboard-related injuries (defined by referral to a Level I trauma centre) were reviewed. The type and mechanism of each injury were examined and found to be similar to those reported for skiers. Mild closed head injuries were common (54 per cent). Head and abdominal injuries were more common among snowboarders than skiers, but chest and skeletal injuries were rare. There were no deaths. Serious snowboarding injury rates were similar to those for serious skiing injuries. The incidence of snowboarding injuries sufficiently severe to require tertiary referral was estimated at 0.03 injuries/1000 snowboarder days. Similar to reports of minor snowboarding injury, these data indicate that injury patterns in more serious snowboarding accidents are quite different from those of serious downhill skiing accidents. Injured snowboarders suffer splenic injuries more often and chest and spinal injuries less often than do skiers, and should be evaluated for blunt injuries with these statistical differences in mind.
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Affiliation(s)
- J A Prall
- Department of Surgery, University of Colorado Health Sciences Center, Denver, USA
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21
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Abstract
This study, through retrospective review, examines the injury rate of selected disable skiing populations in general and as compared to able-bodied skiers in areas where comparison was possible. Data on disabled skiers gathered from instructional programs at multiple sites indicate that the disabled skier had a very low rate of injury occurrence. Where comparison could be make, it was found that there was no significant difference in overall injury rates between able-bodied and physically disabled skiers. Disabled skiers appear to sustain less severe injuries, and they do not show the trend in increasing injury rates that able-bodied skiers in this study show. In addition, the uphill transport of skiers with a disability who use sit- or mono-skis was examined in one large program and found to be efficient and exceedingly safe, with no injuries reported. A major limitation of this study is the inconsistency in methods of data collection and reporting. There is a need for further prospective studies in the general able-bodied and disabled skiing populations with direct comparisons of rate, location and severity of injury, type of disability, and experience level of the skier. We hope that this study will stimulate more ski areas to allow disabled skiers on their slopes, even it limited to participation in supervised, instructional programs.
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Affiliation(s)
- E R Laskowski
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905
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22
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Sherry E, Fenelon L. Trends in skiing injury type and rates in Australia: A review of 22 261 injuries over 27 years in the Snowy Mountains. Med J Aust 1991. [DOI: 10.5694/j.1326-5377.1991.tb93885.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eugene Sherry
- St Vincent's General Hospital Victoria Street Darlinghurst NSW 2010
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Giddings P. Survival after burial by avalanche. Med J Aust 1990; 153:172. [PMID: 2377123 DOI: 10.5694/j.1326-5377.1990.tb136842.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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