Bailly Nicolas, Afquir Sanae, Laporte Jean-Dominique, Melot Anthony, Savary Dominique, Seigneuret Eric, Delay Jean-Baptiste, Donnadieu Thierry, Masson Catherine, Arnoux Pierre-Jean
1Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, F-13016 Marseille, FRANCE; 2Salomon S.A.S., Annecy, FRANCE; 3"Médecins de Montagne" Association, Chambéry, FRANCE; 4Department of Neurosurgery, Hôpital Nord, Marseille, FRANCE; 5Department of Mobile Emergency and Intensive Care Units, Annecy Hospital, Annecy, FRANCE; and 6Department of Neurosurgery, University Hospital of Grenoble, Grenoble, FRANCE.
Med Sci Sports Exerc. 2017 Jan;49(1):1-10. doi: 10.1249/MSS.0000000000001078.
Mechanisms of injury and description of head impacts leading to traumatic brain injury (TBI) in skiers and snowboarders have not been extensively documented. We investigate snow sport crashes leading to TBI 1) to identify typical mechanisms leading to TBI to better target prevention measures and 2) to identify the injury mechanisms and the head impact conditions.
The subjects were skiers and snowboarders diagnosed of TBI and admitted between 2013 and 2015 to one of the 15 medical offices and three hospital centers involved in the study. The survey includes the description of the patients (age, sex, practice, skill level, and helmet use), the crash (type, location, estimated speed, causes, and fall description), and the injuries sustained (symptoms, head trauma scores, and other injuries). Sketches were used to describe the crash and impact locations. Clustering methods were used to distinguish profiles of injured participants.
A total of 295 skiers and 71 snowboarders were interviewed. The most frequent type of mechanism was falls (54%), followed by collision between users (18%) and jumps (15%). Collision with obstacle (13%) caused the most serious TBI. Three categories of patients were identified. First, men age 16-25 yr are more involved in crash at high speed or in connection with a jump. Second, women, children (<16 yr), and beginners are particularly injured in collisions between users. Third, those older than 50 yr, usually nonhelmeted, are frequently involved in falls. Ten crash scenarios were identified. Falling head first is the most frequent of skiers' falls (28%).
Crash scenarios leading to TBI were identified and associated with profiles of injured participants. Those results should help to better target TBI prevention and protection campaigns.
滑雪者和单板滑雪者因头部撞击导致创伤性脑损伤（TBI）的损伤机制及描述尚未得到广泛记录。我们对导致TBI的雪上运动碰撞事故进行调查，一是为了确定导致TBI的典型机制，以便更好地针对性制定预防措施；二是为了确定损伤机制和头部撞击情况。
研究对象为2013年至2015年间被诊断为TBI并入住参与该研究的15个医务室和3个医院中心之一的滑雪者和单板滑雪者。调查内容包括患者描述（年龄、性别、运动项目、技能水平和头盔使用情况）、碰撞事故（类型、地点、估计速度、原因和摔倒描述）以及所受损伤（症状、头部创伤评分和其他损伤）。用草图描述碰撞事故和撞击位置。采用聚类方法区分受伤参与者的特征。
共访谈了295名滑雪者和71名单板滑雪者。最常见的机制类型是摔倒（54%），其次是使用者之间的碰撞（18%）和跳跃（15%）。与障碍物碰撞（13%）导致的TBI最严重。确定了三类患者。第一，16 - 25岁的男性更多地参与高速碰撞事故或与跳跃相关的碰撞事故。第二，女性、儿童（<16岁）和初学者在使用者之间的碰撞中特别容易受伤。第三，50岁以上的人，通常不戴头盔，经常摔倒。确定了10种碰撞场景。头部先着地摔倒是滑雪者摔倒中最常见的情况（28%）。
确定了导致TBI的碰撞场景，并将其与受伤参与者的特征相关联。这些结果应有助于更好地针对性开展TBI预防和保护活动。
