• Rebecca M Hasler, Dominik Baschera, David Taugwalder, Aristomenis K Exadaktylos, and Andreas Raabe.
• Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland. Electronic address: rebecca.hasler@gmail.com.
• World Neurosurg. 2015 Sep 1;84(3):805-12.

BackgroundSince the introduction of helmets in winter sports there is on-going debate on whether they decrease traumatic brain injuries (TBI).MethodsThis cohort study included 117 adult (≥ 16 years) snowboarders with TBI admitted to a level I alpine trauma center in Switzerland between 2000/2001 and 2010/2011. The primary objective was to examine the association between helmet use and moderate-to-severe TBI. Secondary objectives were to describe the epidemiology of TBI during the past decade in relation to increased helmet use.ResultsOf 691 injured snowboarders evaluated, 117 (17%) suffered TBI. Sixty-six percent were men (median age, 23 years). Two percent of accidents were fatal. Ninety-two percent of patients sustained minor, 1% moderate, and 7% severe TBI according to the Glasgow coma scale. Pathologic computed tomography findings were present in 16% of patients, 26% of which required surgery. Eighty-three percent of TBIs occurred while riding on-slope. There was no trend in the TBI rate during the studied period, although helmet use increased from 10% to 69%. Comparing patients with and without a helmet showed no significant difference in odds ratios for the severity of TBI. However, of the 5 patients requiring surgery only 1 was wearing a helmet. Off-piste compared with on-slope snowboarders showed an odds ratio of 26.5 (P = 0.003) for sustaining a moderate-to-severe TBI.ConclusionsDespite increased helmet use we found no decrease in TBI among snowboarders. The possibility of TBI despite helmet use and the dangers of riding off-piste should be a focus of future prevention programs.Copyright © 2015 Elsevier Inc. All rights reserved.

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