Helmet use and injury severity among pediatric skiers and snowboarders in Colorado

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 snow-boarders outside of resort sponsored activities, we hypothesized that helmet use is as sociated 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 3-17 years, 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 16 year study period. The mean patient age was 11 +/- 3 years, 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. (C) 2017 Elsevier Inc. All rights reserved.