Greve Mark W, Young David J, Goss Andrew L, Degutis Linda C
Department of Emergency Medicine, Injury Prevention Center, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA.
Wilderness Environ Med. 2009 Fall;20(3):234-8. doi: 10.1580/08-WEME-OR-244R1.1.
To explore the use of helmets in skiers and snowboarders injured at ski runs and terrain parks in Colorado and the northeast United States and to examine differences in head injury severity in terrain parks as compared to ski runs.
This was a retrospective cohort study. We reviewed emergency department medical records of injured skiers at 9 medical facilities in Colorado, New York, and Vermont to examine the frequency of helmet use, type of terrain on which injuries occurred, and effect of injury event type and helmet use on change in mental status. Injuries that occurred from July 2002 to July 2004 were included. Eligible patients were skiers and snowboarders who sustained a head injury as defined by International Classification of Diseases-9 codes for acute head injuries. Data elements included event location, mechanism of injury, helmet use, loss of consciousness, neurologic findings, Glasgow Coma Scale score, and initial outcome. Data were entered into SPSS for analysis.
Of 1013 patients, 52.6% were skiing, 46.7% were snowboarding, and the remainder engaged in other activities such as sledding or using a sit ski. Most (78.7%) were using a ski run, whereas 19.1% were at a terrain park when their injuries occurred, and 37.1% were wearing helmets. Most injuries (74.1%) occurred when the victim hit his/her head on the snow; 10.0% and 13.1% occurred in collisions with other skiers and fixed objects, respectively. There were significantly fewer instances of loss of consciousness in fall events in the Colorado group (chi(2): 4.127; P < .05), a significantly lower incidence of loss of consciousness in helmet users who struck a fixed object (chi(2): 5.800; P < .05), and a significantly higher incidence of skiers colliding with fixed objects in the Northeast (chi(2): 14.05; P < .005). There were significantly more documented head injuries in terrain parks, even when controlling for helmet use (chi(2): 5.800; P < .05).
There is an increased risk of head injury, regardless of helmet use, at terrain parks as compared to ski runs, and helmets were notably protective in collisions with fixed objects. Regional differences in injury events were noted in that there were more fall-related head injuries and a higher incidence of collisions with fixed objects in the Northeast compared to Colorado.
探讨科罗拉多州以及美国东北部滑雪场和地形公园中受伤的滑雪者和单板滑雪者使用头盔的情况，并研究与滑雪场相比，地形公园中头部损伤严重程度的差异。
这是一项回顾性队列研究。我们查阅了科罗拉多州、纽约州和佛蒙特州9家医疗机构中受伤滑雪者的急诊科医疗记录，以检查头盔使用频率、受伤发生的地形类型，以及损伤事件类型和头盔使用对精神状态变化的影响。纳入2002年7月至2004年7月期间发生的损伤。符合条件的患者为根据国际疾病分类第9版急性头部损伤编码定义的头部受伤的滑雪者和单板滑雪者。数据元素包括事件地点、损伤机制、头盔使用情况、意识丧失、神经系统检查结果、格拉斯哥昏迷量表评分和初始结局。数据录入SPSS进行分析。
在1013名患者中，52.6%为滑雪者，46.7%为单板滑雪者，其余从事其他活动，如雪橇运动或使用坐式雪橇。大多数（78.7%）在滑雪场受伤，而19.1%在地形公园受伤，37.1%佩戴头盔。大多数损伤（74.1%）发生在受害者头部撞到雪地时；分别有10.0%和13.1%发生在与其他滑雪者和固定物体碰撞时。科罗拉多组跌倒事件中意识丧失的情况明显较少（卡方值：4.127；P < .05），撞到固定物体的头盔使用者意识丧失的发生率明显较低（卡方值：5.800；P < .05）, 东北部滑雪者与固定物体碰撞的发生率明显较高（卡方值：14.05；P < .005）。即使在控制头盔使用情况后，地形公园中记录的头部损伤仍明显更多（卡方值：5.800；P < .05）。
与滑雪场相比，地形公园中头部受伤的风险增加，无论是否使用头盔，并且头盔在与固定物体碰撞时具有显著的保护作用。注意到损伤事件存在地区差异，与科罗拉多州相比，东北部与跌倒相关的头部损伤更多，与固定物体碰撞的发生率更高。
