Table 1.
Description of studies included in a systematic review of the effect of helmets on the risk of head and neck injuries among skiers and snowboarders
| Study (country) | Study design | Study population | Sex and age | Snowboarders | Ability | Definition used for head or neck injury | Verification of head or neck injury |
|---|---|---|---|---|---|---|---|
| Mueller et al.17 (United States) | Case–control | 21 375 injured skiers and snowboarders reported by ski patrol; 4779 with helmet, 16 855 without helmet | Cases (head/neck/face injury): male 69% (2904/3701) Controls (no injury): male 57% (10 057/17 626) Age: NR |
Cases: 62% Controls: 59% | Cases: Expert: 1394 Intermediate: 1660 Beginner: 935 Controls: Expert: 4608 Intermediate: 7085 Beginner: 4608 |
Head injury: injury to scalp or skull above the hairline; includes ear and brain injury Facial injury: injury between lower jaw and hairline Neck injury: NR |
NR; ski patrol data |
| Russell et al.30 (Canada) | Case–control | 47 200 injured skiers and snowboarders reported by ski patrol; helmet use 24.3% among cases, 20.2% among controls | Sex: NR Age: 1–18 yr |
55.2% | NR | Neck injury: neck or cervical spine | NR; ski patrol data |
| Fukuda et al.24 (Japan) | Case–control | 1190 injured snowboarders who sought medical treatment for head injury at nearby medical facility; 92 with helmet, 1098 without helmet | Helmet: male 76% (70/92) Mean age 24.6 (SD 4.04) yr No helmet: male 64% (704/1098) Mean age 22.7 (SD 4.8) yr |
100% | Helmet: “Upper” technique level: 31 Other: 61 No helmet: “Upper” technique level: 129 Other: 969 |
Serious head injury: traumatic amnesia, loss of consciousness, craniofacial fracture or intracranial lesion | Physician data; cases and injured controls recruited from neurosurgery institute |
| Shealy et al.23 (United States) | Case–control | 4637 injured skiers at a ski resort in Vermont; 1113 with helmet, 3524 without helmet | NR | None | NR | Potentially serious head injury: diagnosed concussion, more severe closed head injury, skull fracture and/or death Less serious head injury: scalp lacerations and abrasions |
Physician data; cases diagnosed by hospital personnel or clinic staff |
| Sulheim et al.15 (Norway) | Case–control | 3562 injured skiers and snowboarders reported by ski patrol; 752 with helmet, 2810 without helmet | Cases (head injury): male 67% (388/576) Age < 13 yr: 78 13–20 yr: 251 > 20 yr: 237 Controls (non-head injury): male 60% (1801/2986) Age < 13 yr: 295 13–20 yr: 766 > 20 yr: 1919 |
Cases: 44% Controls: 26% | Cases: Expert:108 Good: 186 Intermediate: 147 Beginner: 123 Controls: Expert: 570 Good: 1055 Intermediate: 1005 Beginner: 348 |
Potentially severe head injury: head injury referred to physician or hospital by ski patrol | NR; ski patrol data |
| Ekeland et al.18 (Norway) | Case–control | Skiers and snowboarders with injuries recorded in a central registration of injuries over four major Norwegian ski hills | NR | 45% | NR | NR | NR |
| Hagel et al.16 (Canada) | Case–control/case-crossover | 3988 injured skiers and snowboarders reported by ski patrol; 1104 with helmet, 2884 without helmet | Cases (head/neck injury): male 58% (476/824) Age < 15 yr: 322 15–25 yr: 336 > 26 yr: 166 Controls (non-head/neck injury): male 44% (1457/3294) Age < 15 yr: 1277 15–25 yr: 1185 > 26 yr: 832 |
47% | Days per season Cases: 1 d: 191 2–10 d: 382 > 11 d: 209 Controls: 1 d: 929 2–10 d: 1690 > 11 d: 591 |
Potentially severe cases: isolated head or neck injury requiring evacuation by ambulance | NR; ski patrol data |
| Johnson et al.20 (Canada) | Case–control | 745 snowboarders who reported to hospital emergency department; 410 with helmet, 335 without helmet | Male 67% (501/745) Age ≤ 16 yr |
100% | NR | NR | NR |
| Macnab et al.21 (Canada) | Case–control | 307 injured snowboarders; 131 with helmet, 176 without helmet | Sex NR Age < 13 yr |
Helmet: 24% No helmet: 50% | NR | Inconsequential: no treatment or investigation Minor: investigation and local treatment Major: investigation and referral to hospital for further treatment |
Physician data; injury examined by physician |
| Ekeland et al.19 (Norway) | Case–control | 3605 skiers and snowboarders with injuries recorded in a central registration of injuries over four major Norwegian ski slopes; 397 with helmet, 3208 without helmet | NR | 34% | Helmet: Beginner: 23% Expert: 16% Cases: Beginner: 13% Expert: 17% |
NR | NR; ski patrol data |
| Machold et al.2 (Austria) | Cohort | 2562 students from 86 schools in Austria during 131 winter sport-weeks; 196 with helmet, 2366 without helmet | NR | NR | 100% | NR | Physician data (attending trauma surgeon or local hospital) |
| Sandegard et al.22 (Sweden) | Case–control | Injured skiers and snowboarders (n = NR) who were part of the Swedish Ski Lift and Ski Areas’ Organization injury registration | NR | NR | NR | NR | NR; physician data |
Note: NR = not reported, SD = standard deviation.