Severity of Head Trauma in Skiing Accidents in the Past Decade

Aim: To describe the epidemiology of head injuries in alpine skiers and to analyze the association between helmet wearing and head injuries.

Method: Retrospective Cohort study with severe traumatic brain injury (TBI) as the main outcome. Classical methods to compare numbers of TBI by season (2000-2010). Logistic regression analysis to analyze the association between TBI and helmet wearing.

Results: 245 (18%) of 1,362 patients injured from alpine skiing sustained TBI and were included. 69% were male. Median age was 44 years, median Glasgow Coma Scale (GCS) score 15 and the median AIS head score 2. 3% of accidents were fatal. 76% sustained minor (GCS 13-15), 6% moderate and 14% severe TBI according to GCS category. The number and proportion of patients with TBI, regardless of the severity, differed from season to season with no significant trend. Pathological CT findings were present in 45% of patients, with 26% of these needing surgery. Data on helmet wearing was available for 62% of patients. Helmet wearing rates increased from 0% in 2000/2001 to 71% in 2010/2011 (p < 0.001). The main analysis comparing TBI in patients with and without a helmet resulted in an adjusted OR of 1.44 (p = 0.430) for suffering moderate to severe head injury in helmet wearers. The analyses comparing riders off-piste versus those on the slope showed a significantly increased OR of 7.62 (p = 0.004) for sustaining a head injury with need for surgical intervention.

Conclusion: Despite the tremendous increase in helmet wearing rates we found no decrease in TBI in alpine skiers. Logistic regression analysis showed no significant difference in TBI between those with and without a helmet, but an increased risk for skiers riding off-piste. The limited protection of helmets and the dangers riding off-piste should be targeted by future prevention programs.