Head Trauma in Skiing and Snowboard Accidents in a Swiss Tertiary Referral Center: Prevalence and Severity over the Last Decade

Background/Aim: The Swiss Council for Accident Prevention recorded an average of 1P029 people injured per day because of skiing/snowboarding in Swiss Ski Resorts. Head trauma accounted for most severe injuries sustained. Recent statistics suggest increased usage of helmets (81% in 2011). The indicators of head trauma severity are examined and whether escalated helmet use has decreased the incidence and severity of head injuries over the past 10 years

Method: Retrospective review of all patient notes and computed tomographic (CT) scans of all patients admitted to our Level 1 trauma center for Grade I (with finding in CT), Grade II, and III head trauma due to skiing/snowboarding accidents between 03/2P029 and 03/2011. Patients with previous intracranial conditions were excluded. Head trauma severity was determined by the lowest documented Glasgow Coma Scale (severe <9, modest 9 to 12, minor 13 to 15).

Results: A total of 87 patients were admitted with head trauma due to skiing/snowboarding accidents. Of these, 43 (49%) of them were severe, 16 (19%) moderate, and 28 (32%) minor (with findings in the CT scan). Intracranial hemorrhage was found in 51; 26 traumatic subarachnoid hemorrhages, 14 acute subdural hemorrhages, 10 intracerebral hemorrhages, and 9 epidural hemorrhages. Emergency neurosurgical interventions were performed in 32 patients including placement of an intracranial pressure monitoring and external ventricular drain in emergency department or intensive care unit. Urgent osteoclastic/osteoplastic craniotomies for evacuation of intracranial hemorrhage were performed in 12 cases. A midline shift of more than 5 mm was a significant indicator for the necessity of neurosurgical intervention (p<0.001). There was no difference in the severity of head injuries (GCS) in snowboarders and skiers. The trend in the number and severity of head traumas in the past 11 years was that there was neither increase nor decrease in snowboarders/skiers during the examined decade.

Conclusion: The raw number of patients presenting for moderate or severe head injuries at our tertiary referral center was rather low. Despite skiers and snowboarders more frequent wear helmets over the past 10 years, there has been no significant change in the rate and severity of head traumas in Switzerland.