• Mark W Greve, David J Young, Andrew L Goss, and Linda C Degutis.
• Department of Emergency Medicine, Injury Prevention Center, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA. mgreve@lifespan.org
• Wilderness Environ Med. 2009 Jan 1;20(3):234-8.

ObjectiveTo 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.MethodsThis 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.ResultsOf 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).ConclusionThere 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.

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