在一级创伤中心评估的高山滑雪者和单板滑雪者中，头盔的使用与更高的损伤严重程度评分相关。

Helmet use is associated with higher Injury Severity Scores in alpine skiers and snowboarders evaluated at a Level I trauma center.

机构信息

From the Division of Trauma and Acute Care Surgery (E.D.P., S.W.T., J.C.C., A.B.W., A.B., K.K.R., A.O.C.), Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon; and Geisel School of Medicine (M.G.H., J.C.C., A.B.W., A.B., K.K.R., A.O.C.), Hanover, New Hampshire.

出版信息

J Trauma Acute Care Surg. 2019 Nov;87(5):1205-1213. doi: 10.1097/TA.0000000000002447.

DOI:10.1097/TA.0000000000002447

PMID:31335753

Abstract

BACKGROUND

There is uncertainty regarding the efficacy of ski helmets in preventing traumatic injury. We investigated the relationship between helmet use, injury types, and injury severity among skiers and snowboarders.

METHODS

The trauma registry at a Northeast American College of Surgeons Level I trauma center was queried by International Classification of Diseases Codes-9th or 10th Revision for skiing and snowboarding injury between 2010 and 2018. The primary exposure was helmet use and primary outcome was severe injury (Injury Severity Score >15). We performed univariate and multivariable logistic regression to assess for injury types and severity associated with helmet use.

RESULTS

Seven hundred twenty-one patients (65% helmeted, 35% unhelmeted) met inclusion criteria. Helmet use doubled during the study period (43% to 81%, p < 0.001), but the rate of any head injury did not significantly change (49% to 43%, p = 0.499). On multivariable regression, helmeted patients were significantly more likely to suffer severe injury (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.30-3.11), intracranial hemorrhage (OR, 1.81; 95% CI, 1.10-2.96), chest injury (OR, 1.66; 95% CI, 1.05-2.61), and/or lumbosacral spine injury (OR, 1.84; 95% CI, 1.04-3.25) than unhelmeted patients. Helmeted patients were half as likely to suffer cervical spine injury (OR, 0.51; 95% CI, 0.30-0.89) and a third as likely to sustain skull fracture and/or scalp laceration (OR, 0.30; 95% CI, 0.14-0.64). More patients who hit a stationary object were helmeted compared with those who fell from standing height onto snow (70% vs. 56% respectively, p < 0.001). After adjustment, hitting a stationary object was the injury mechanism most significantly associated with severe injury (OR, 2.80; 95% CI, 1.79-4.38).

CONCLUSION

Helmeted skiers and snowboarders evaluated at a Level I trauma center were more likely to suffer severe injury, including intracranial hemorrhage, as compared with unhelmeted participants. However, they were less likely to sustain skull fractures or cervical spine injuries. Helmeted patients were also more likely to hit a stationary object. Our findings reinforce the importance of safe skiing practices and trauma evaluation after high-impact injury, regardless of helmet use.

LEVEL OF EVIDENCE

Prognostic and epidemiological, level IV.

摘要

背景

滑雪头盔在预防创伤性损伤方面的效果存在不确定性。我们调查了滑雪和单板滑雪者中头盔使用、损伤类型和损伤严重程度之间的关系。

方法

通过国际疾病分类第 9 或 10 版代码，对东北美国外科医师学会一级创伤中心的创伤登记处进行了 2010 年至 2018 年期间的滑雪和单板滑雪损伤查询。主要暴露因素为头盔使用，主要结局为严重损伤（损伤严重程度评分>15）。我们进行了单变量和多变量逻辑回归分析，以评估与头盔使用相关的损伤类型和严重程度。

结果

721 名患者（65%戴头盔，35%不戴头盔）符合纳入标准。研究期间头盔使用率翻了一番（从 43%增加到 81%，p<0.001），但头部任何损伤的发生率并未显著变化（从 49%降至 43%，p=0.499）。在多变量回归中，戴头盔的患者发生严重损伤（优势比[OR]，2.01；95%置信区间[CI]，1.30-3.11）、颅内出血（OR，1.81；95%CI，1.10-2.96）、胸部损伤（OR，1.66；95%CI，1.05-2.61）和/或腰骶部脊柱损伤（OR，1.84；95%CI，1.04-3.25）的可能性明显高于未戴头盔的患者。戴头盔的患者发生颈椎损伤的可能性降低一半（OR，0.51；95%CI，0.30-0.89），发生颅骨骨折和/或头皮裂伤的可能性降低三分之一（OR，0.30；95%CI，0.14-0.64）。与从站立高度摔倒在雪地上的患者相比，撞击固定物体的患者戴头盔的比例更高（分别为 70%和 56%，p<0.001）。调整后，撞击固定物体是与严重损伤最显著相关的损伤机制（OR，2.80；95%CI，1.79-4.38）。