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Snow Sport Injuries Journal Scan

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Prepared by Annie Bacevice, MD, FAAP J Pediatr Surg. 2018 May;53(5):1024-1027. doi: 10.1016/j.jpedsurg.2018.02.044. Epub 2018 Feb 10.

Safety on the slopes: ski versus snowboard injuries in children treated at United States trauma centers.
Polites SF1, Mao SA2, Glasgow AE3, Moir CR2, Habermann EB3.

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.

PTS Summary: This was a National Trauma Data Bank review looking at children < 15 years of age over a 5-year period. The injuries were split evenly between skiing and snowboarding with children < 10 being twice as likely to be injured skiing than snowboarding. Nearly all injuries were blunt with the lower extremities being the most common. One quarter sustained head injuries. Overall, helmet use was reported on 40% of children. Head injuries were more common in snowboarding and helmet use was greater in skiers. Severe head injury was even between the two sports. Nearly 20% of injuries were to the trunk. One should have suspicion for abdominal injuries when evaluating snowboarders and thoracic injuries when evaluation skiers.

Am J Emerg Med. 2018 Jun 2. pii: S0735-6757(18)30468-6. doi: 10.1016/j.ajem.2018.06.006. [Epub ahead of print]

The risk of snow sport injury in pediatric patients.
McLoughlin RJ1, Green J2, Nazarey PP3, Hirsh MP4, Cleary M5, Aidlen JT6.

PURPOSE: In 2015, approximately 13,436 snowboarding or skiing injuries occurred in children younger than 15. We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment.

METHODS: A retrospective analysis was performed of 10-17 year old patients with snow-sport related injuries at a Level-1 trauma center from 2005 to 2015. Participants were divided into groups, 10-13 (middle-school, MS) and 14-17 years (high-school, HS) and compared using chi-square, Student's t-tests, and multivariable logistic regression.

RESULTS: We identified 235 patients. The HS group had a higher proportion of females than MS (17.5% vs. 7.4%, p = 0.03) but groups were otherwise similar. Helmet use was significantly lower in the HS group (51.6% vs. 76.5%, p < 0.01). MS students were more likely to suffer any head injury (aOR 4.66, 95% CI: 1.70-12.8), closed head injury (aOR 3.69 95% CI: 1.37-9.99), or loss of consciousness (aOR 5.56 95% CI 1.76-17.6) after 4 pm. HS students engaging in jumps or tricks had 2.79 times the risk of any head injury (aOR 2.79 95% CI: 1.18-6.57) compared to peers that did not. HS students had increased risk of solid organ injury when helmeted (aOR 4.86 95% CI: 1.30-18.2).

CONCLUSIONS: Injured high-school snow sports participants were less likely to wear helmets and more likely to have solid organ injuries when helmeted than middle-schoolers. Additionally, high-schoolers with head injuries were more like to sustain these injures while engaging in jumps or tricks. Injury prevention in this vulnerable population deserves further study.

PTS Summary: This was a retrospective study looking at children ages 10-17 who presented to a Level 1 trauma center in Massachusetts from 2005-2017. This study broke the ages in to middle school (ages 10-13) and high school (ages 14-17). The majority of the patients were male (86%) and snowboarders (94.5%). Helmet use was statically significantly lower in the high schoolers than the middle schoolers. There was no difference in injury patterns between the two groups. In the HS group, attempting trick or jump was associated with an increased risk of head injury. In the HS group, those wearing helmets had an increased risk of abdominal injuries. Middle schoolers were more likely to have any head injury after 4pm compared to the high schoolers making the researchers wonder if fatigue played a part in the younger age group.

Pediatr Emerg Care. 2018 Feb;34(2):106-108. doi: 10.1097/PEC.0000000000001398.

Chair Lift Falls and Injuries in Children.
Glissmeyer EW, Metzger RR, Bolte R.

OBJECTIVE: The objective of this study was to compare demographic injury and treatment characteristics of hospitalized pediatric cases of falls from chair lifts to cases of other ski and snowboarding injuries and identify potential interventions for preventing falls from chair lifts.

METHODS: Retrospective query of the trauma registry of Utah's only pediatric trauma center for children younger than 18 years requiring hospitalization for a ski or snowboarding injury from November 2004 to February 2014.

RESULTS: There were 443 cases of hospitalized ski and snowboarding injuries during the study period. Twenty-nine cases (7%) fell from height while riding a chair lift. Children falling from chair lifts were more likely to be younger (6.9 years vs 12.1, P < 0.0001), female (41% vs 20%, P < 0.01), and elicit trauma team activation (72% vs 34%, P = <0.0001) but were less frequently treated in the operating room (14 vs 24%, P = 0.02) than children with other ski and snowboarding injuries. There were no differences in mortality, injury severity score, length of hospital stay, or airway intubation outside the operating room. When stated (11/29 cases), mean estimated height of fall from lift was 26 feet. The most common body region in chair lift falls with a significant injury (abbreviated injury scale, ≥3) was lower extremity (4/29, all femur fractures). Patient age discriminated chair lift falls well (area under the receiver operating characteristic curve, 0.87) with age of 7 years and below predicting chair lift fall with a sensitivity of 76% and a specificity of 91%.

CONCLUSIONS: Injuries requiring hospitalization after falls from chair lifts occur at regulated facilities and are more common in younger female children when compared with other ski and snowboarding injuries. Interventions for reducing falls from chair lifts may be most effective applied to children 7 years and younger.

PTS Summary: This was a retrospective study at a level 1 pediatric trauma center in Utah looking at children 17 years and below who fell from a chair lift from 2004-2014. This study excluded injuries sustained entering or exiting the chair lift. 29 children were identified during this time period as falling from a height from a ski lift. These children were more likely to be younger and female. The most common injury was femur fractures followed by abdominal trauma. These children were more likely to utilize the resources of a trauma team activation. The study determined that an optimal cut off age value for an increased susceptibility for chair lift falls to be 7 years. Using this information, interventions could be made towards that age group to decrease the risk of falls from chair lifts.

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