Increased injury risk among first-day skiers, snowboarders, and skiboarders

BACKGROUND: Inexperience predisposes skiers, snowboarders, and skiboarders to a higher risk of injury. HYPOTHESIS: Individuals on their very 1st day's experience of skiing, snowboarding, or skiboarding are at greater risk of injury. STUDY DESIGN: Case control study. METHODS: All individuals injured at the three largest ski areas in Scotland during the three winter seasons 1999-2000 through 2001-2002 were included. First-day participants were identified. Individual demographic details and snow sports-related parameters were recorded. Control data were collected from uninjured individuals. Factors associated with injury were explored in univariate and multivariate analyses. RESULTS: First-day participants were overrepresented in the injured population by a factor of 2.2. Participant age younger than 17 years or older than 26 years, snowboarding, taking professional instruction, and the use of rented or borrowed gear were all independently associated with increased injury risk among 1st-day participants. CONCLUSIONS: First-day participants are at increased risk of injury. Several independent risk factors for injury have been identified. CLINICAL RELEVANCE: First-day participants should be targeted in any future educational programs with emphasis on gear selection, use of protective gear, and the risks of exceeding the limits of their ability.     

Interaction of potential intrinsic and extrinsic risk factors in ACL injured recreational female skiers

The aim of this study was to investigate the interaction of potential intrinsic and extrinsic risk factors in ACL injured recreational female skiers. 93 female recreational skiers who had suffered a non-contact ACL injury and 93 age-matched controls completed a self-reported questionnaire relating to intrinsic risk factors (menstrual history, BMI, previous knee injuries, self reported weekly sports participation) and extrinsic risk factors (type of ski used, time of last binding adjustment, snow condition, weather and slope difficulty). A logistic regression model revealed the following independent ACL injury risk factors for female recreational skiers: icy snow conditions (odds ratio, 24.33; 95% confidence interval, 6.8-86.5, P<0.001), skiing during snowfall (odds ratio, 16.63; 95% confidence interval, 1.8-152.1, P=0.013), use of traditional skis (odds ratio, 10.49; 95% confidence interval, 2.0-54.5, P=0.005), and preovulatory phase of menstrual cycle (odds ratio, 2.59; 95% confidence interval, 1.2-5.5, P=0.013). In conclusion, ACL injuries in female recreational skiers are the result of a complex interaction of intrinsic and extrinsic risk factors.     

Injury rates and injury risk factors among U.S. Army wheel vehicle mechanics

This study describes injury rates, injury diagnoses, anatomical locations of injuries, limited duty days, and activities associated with injuries in a sample of Army mechanics. Medical records of 518 male and 43 female Army mechanics were screened for injuries during 1 year at a large U.S. Army installation. Weight, height, age, and ethnicity were also extracted from the medical records. Body mass index was calculated as weight/height2. Overall injury rates for men and women were 124 and 156 injuries/100 person-years, respectively, with a rate of 127 injuries/100 person-years for all soldiers combined. Women had higher overuse injury rates while men had higher traumatic injury rates. Limited duty days for men and women were 2,076 and 1,966 days/100 person-years, respectively. The lower back, knee, ankle, foot, and shoulder involved 61% of the injuries. Activities associated with injury included (in order of incidence) physical training, mechanical work, sports, airborne-related activities, road marching, garrison/home activities, and chronic conditions. Among the men, elevated injury risk was associated with higher body weight and higher body mass index. It may be possible to prevent many injuries by implementation of evidenced-based interventions currently available in the literature.     

Prevalence,age at onset,and risk factors of self‐reported asthma among Swedish adolescent elite cross‐country skiers

The objective of the study was to compare the prevalence of self‐reported physician‐diagnosed asthma and age at asthma onset between Swedish adolescent elite skiers and a reference group and to assess risk factors associated with asthma. Postal questionnaires were sent to 253 pupils at the Swedish National Elite Sport Schools for cross‐country skiing, biathlon, and ski‐orienteering (“skiers”) and a random sample of 500 adolescents aged 16‐20, matched for sport school municipalities (“reference”). The response rate was 96% among the skiers and 48% in the reference group. The proportion of participants with self‐reported physician‐diagnosed asthma was higher among skiers than in the reference group (27 vs 19%, P =.046). Female skiers reported a higher prevalence of physician‐diagnosed asthma compared to male skiers (34 vs 20%, P =.021). The median age at asthma onset was higher among skiers (12.0 vs 8.0 years; P <.001). Female sex, family history of asthma, nasal allergy, and being a skier were risk factors associated with self‐reported physician‐diagnosed asthma. Swedish adolescent elite cross‐country skiers have a higher asthma prevalence and later age at asthma onset compared to a reference population. Being an adolescent, elite skier is an independent risk factor associated with asthma.     

Injury profile of competitive alpine skiers: a five-year cohort study

Purpose

The aim of this study was to make a survey of injuries in young elite alpine skiers.

Methods

During 5 years, all students at the Swedish Ski High schools were prospectively followed regarding injuries, time of exposure, injury location, type of injury, injury severity and gender. Four hundred and thirty-one skiers, 215 males and 216 females completed the entire study.

Results

Of 431 skiers, 193 (91 males, 102 females) sustained 312 injuries during the 5-year study period. The injury incidence for males was 1.62 injuries/1,000 ski hours or 2.97 injuries/100 months at a Ski High school, and the corresponding values for females were 1.77 and 3.25, respectively. Forty-one percent of the injuries involved the knee, 69% were ligament injuries, and 49% were classified as severe injuries. Of 190 injured skiers, 120 injured their left leg (P = 0.0097). This was their first time injury. The risk of sustaining a re-injury or a new injury increased the sooner the first time injury occurred (P = 0.001).

Conclusion

There was a high risk for alpine ski students to sustain an injury during their education at the Swedish Ski High schools. Most injuries, especially ligament injuries, occurred in the knee joint in both males and females. Both genders were more likely to sustain injuries to the left than to the right leg. Nearly 50% of the injuries were classified as severe.

Level of evidence

II.     

Exercise-induced bronchospasm among healthy elite cross country skiers and non-athletic students

Regular exercise in cold, dry air is believed to be a predisposing factor for exercise-induced bronchospasm (EIB). The aim of this study was to compare the occurrence of EIB among previously healthy elite cross country skiers and their non-athletic control subjects. Twenty healthy elite cross country skiers and 18 non-asthmatic controls were challenged by a standardized free exercise test. Thereafter, subjects' respiratory function was followed by flow-volume spirometry up to 30 min. EIB was defined in the post-exercise spirometry as at least one of the following: a >or=10% decrease in forced expiratory volume in 1 s (FEV1), a >or=20% decrease in mean maximal expiratory flow (MMEF) or a >or=25% decrease in peak expiratory flow rate (PEF). EIB was found in two skiers and one control according to FEV1, for seven skiers and two controls according to MMEF. Two skiers and one control had exercise-induced asthma (EIA) according to both parameters. The largest decrease in PEF was 13%, that did not result in additional diagnoses. All nine of the subjects with a positive test result reported asthma-like symptoms (dyspnea, cough or increased mucus excretion) after the exercise challenge. Accordingly, seven previously healthy skiers (35%) and two controls (11%) were diagnosed as having EIB. In addition, three skiers of the original cohort were excluded because of an earlier asthma diagnosis, making the total asthma prevalence 10/23 (42%) among the elite skiers. It was concluded that EIB is more common in elite cross country skiers than in non-athletic controls. The bronchoconstriction induced by exercise is usually mild or moderate, and flow-volume spirometry with sensitive flow parameters is needed for it to be diagnosed. Even a mild asthma decreases minute ventilation and maximal performance of winter sport athletes. Therefore, skiers with long-term respiratory symptoms or decreased performance should be studied for EIA and treated adequately.     

Self-estimation of ability among skiers and snowboarders in alpine skiing resorts

Skiing ability is thought to be an important risk factor for injuries, but the best method to classify skiing ability is not known. The objective of this study was to validate five different questions designed to self-report skiing ability for ski injury surveillance. To this end 512 alpine skiers, Telemark skiers, snowboarders and skiboarders were asked to selfestimate their skiing ability using five different questions based on skiing skill, piste difficulty, turning technique, skiing experience and falling frequency, each with four categories. The participants then made a test run to test their skiing ability. Observed and self-reported skiing ability were compared using kappa statistics. The correlation between observed and self-reported skiing ability was low to fair, with kappa values of 0.34 for skiing skill), 0.33 for piste difficulty, 0.38 for turning technique, 0.26 for experience and 0.16 for falling frequency. However, the sensitivity and specificity for each of the questionnaires in discriminating between individuals in the poorest skiing ability category on the test and the rest of the group was relatively good (skiing skill: sensitivity 75%, specificity 91%; piste difficulty 68, 96%; turning technique 75, 91%; experience 75, 90%; falling frequency 61, 97%). The results show that the capacity to self-assess skiing ability is limited, but estimation based upon turning technique or skiing skill seem to be best methods for epidemiological studies on injuries in snow sports.     

Injury occurrence and risk factors in construction engineers and combat artillery soldiers

OBJECTIVES: This 1-year prospective study compared 125 construction engineers and 188 combat artillery soldiers to determine whether there were differences in injury occurrences/ types because of their diverse occupational tasks and training requirements. Also, intrinsic factors were studied to establish any associations with a soldier's risk for injury. METHODS: Prestudy height, weight, and body mass index and fitness (3.2-km run, sit-ups, push-ups) data were collected prior to the injury medical records review. Approximately 30% of each battalion was studied. RESULTS: For engineers and artillery, 86.0% and 66.0% incurred at least one injury, respectively. Of total soldiers, 64.0% of engineers and 56.4% of artillerymen had injuries associated with limited duty profiles. Total injuries resulted in 743 days of limited duty time (5.9 days per soldier) in engineers and 1,078 days (5.7 days per soldier) in artillery. Odds ratios (OR) and 95% confidence intervals (CI) were also calculated. The odds of traumatic fractures were (OR = 6.5, 95% CI = 1.8-23.7) 6 times higher in engineers than artillery, but strains/sprains and abrasions/lacerations were (OR = 2.3, 95% CI = 1.5-3.7; OR = 2.5, 95% CI = 1.2-5.0) two times higher in artillery than engineers. The number of limited duty days associated with knee injuries was significantly higher in engineers than artillery (p < 0.0001), and number of days for low back injuries was significantly higher in the artillerymen (p < 0.0001). Greater body mass was a risk factor for lower back pain and the body mass index was > or = 25 for strains/sprains in both units. CONCLUSIONS: Significant differences in injuries were reported between the two units. It is plausible that the differences were related to the diverse training exposures of the units. However, it is beyond the scope of this study to make conclusions about the causes of the injury differences. The data also indicate that body mass and body mass index were identified as modifiable injury risk factors for both units, which suggests that these injuries are preventable.     

661例颅脑损伤患者伤情特点和结局危险因素分析

目的 分析住院颅脑损伤患者伤情特点,探讨结局相关危险因素,为医疗预防、干预和救治措施提供部分改进建议.方法 应用“创伤数据库系统”采集2009年所收治的661例颅脑损伤患者住院病历,分析颅脑损伤患者的一般情况、伤情及结局,并通过Logistic回归探讨影响颅脑损伤患者结局的危险因素.结果 颅脑损伤患者中男性占70.0％(463/661);45岁左右为高发年龄段;下半年患者数为上半年的1.65倍(412/249);交通伤是主要致伤原因(87.7％,580/661);多发伤达512例(77.5％).ISS评分、致伤原因、患者年龄、损伤发生的季度与救治结局密切有关.结论 颅脑损伤住院患者在性别、年龄、发生时间、致伤原因、多发伤等方面具有明显的特点,其最终治疗结局与损伤严重程度、致伤原因、年龄等因素密切相关.     

Injury risk factors in parachuting and acceptability of the parachute ankle brace

INTRODUCTION: This investigation examined risk factors for injuries during military parachute training and solicited attitudes and opinions regarding a parachute ankle brace (PAB) that has been shown to protect against ankle injuries. METHODS: Male Army airborne students (N = 1677) completed a questionnaire after they had successfully executed 4 of the 5 jumps necessary for qualification as a military paratrooper. The questionnaire asked about injuries during parachute descents, demographics, lifestyle characteristics, physical characteristics, physical fitness, airborne recycling (i.e., repeating airborne training because of failure to qualify on a previous attempt), PAB wear, problems with aircraft exits, and injuries in the year before airborne school. A final section of the questionnaire solicited open-ended comments about the PAB. RESULTS: Increased risk of a parachute-related injury occurred among students who had longer time in service, were older, taller, heavier, performed fewer push-ups, ran slower, were airborne recycles, did not wear the PAB, had an aircraft exit problem, and/or reported an injury in the year prior to jump school. Among students who wore the brace, most negative comments about the PAB had to do with design, comfort, and difficulties during parachute landing falls. CONCLUSIONS: This study supported some previously identified injury risk factors (older age, greater body weight, and not using a PAB) and identified a number of new risk factors. To address PAB design and comfort issues, a strap is being added over the dorsum of the foot to better hold the PAB in place.     

Recording injuries among World Cup skiers and snowboarders: a methodological study

No long‐term injury surveillance programs exist for competitive skiing or snowboarding. The objective of this study was, therefore, to compare different methods to record injuries among World Cup athletes in alpine, freestyle, and cross‐country skiing, snowboarding, ski jumping and Nordic combined. Information regarding injuries sustained during the 2006–2007 winter season was recorded through three separate and independent systems: prospective injury reports by technical delegates (TD) from the International Ski Federation, prospective medical team registration by selected teams, and retrospective athlete interviews at the end of the season. A total of 100 unique injuries to 602 World Cup athletes were identified from any of the three recording methods. Of these, 91% were registered through the athlete interviews, 47% by the medical team registration and 27% by the TD reports. Only 20 injuries (20%) were captured by all three methods. A total of 64 time‐loss injuries were registered. The interviews captured 60 (94%), the medical team registration 39 (61%), and the TD reports 23 (36%) time‐loss injuries, while 18 (28%) were registered by all three systems. Retrospective interviews with athletes/coaches regarding injuries during the last 6 months gave the most complete picture of injuries to World Cup skiers and snowboarders.     

Anterior cruciate ligament injury incidence among male and female professional alpine skiers

A retrospective review of anterior cruciate ligament injuries among professional alpine skiers was performed to compare sex-related differences in injury incidence. We screened 7155 ski patrollers or instructors (4537 men and 2618 women) for knee injuries before each ski season between 1991 and 1997. Screening involved a ski history questionnaire, a knee injury history questionnaire, and a knee physical examination. Any patient with an equivocal Lachman or pivot shift test was evaluated by KT-1000 arthrometry and excluded from the study if the manual maximum side-to-side difference was 3 mm or more. Thus, the study population was limited to subjects with intact anterior cruciate ligaments. Skiers injured during the study were identified through mandatory workers' compensation claims. Each injured skier was reevaluated using an injury questionnaire and physical examination. The men skied an average of 110 days per year (499,070 skier-days) and the women skied an average of 87 days per year (227,766 skier-days). Thirty-one skiing-related anterior cruciate ligament injuries were diagnosed, 21 in men and 10 in women. The incidence of ACL disruption was 4.2 injuries per 100,000 skier-days in men and 4.4 injuries per 100,000 skier-days in women. These data suggest that the incidences of anterior cruciate ligament injuries among male and female professional alpine skiers are similar.     

Distribution of injury mechanisms and related factors in ACL-injured female carving skiers

While ACL injury mechanisms in skiers using traditional skis are well studied, no study has yet investigated the distribution of injury mechanisms in carving skiers. In traditional skiers, the backward twisting fall seems to be the dominant injury mechanism, especially in female skiers. Female recreational skiers have a threefold higher risk to sustain an ACL injury than male skiers; therefore, it is important to determine if carving skis influence the distribution of injury mechanisms and the related frequencies of ACL injuries in female skiers. We investigated the frequencies of injury mechanisms and related factors in 65 ACL-injured female carving skiers by questionnaire. The forward twisting fall was the most reported ACL injury mechanism with about 51%, followed by the backward twisting fall within 29% of cases. Catching an edge of the ski (59 vs. 24%, P = 0.03) when executing turns (69 vs. 41%, P = 0.053) was a more frequent cause for forward twisting falls than for the other types of falling. While 29% of bindings released during a forward twisting fall, only 3.1% released during the remaining mechanisms. In contrast to traditional skiers, the forward twisting fall was the dominant injury mechanism in female carving skiers with ACL injury.     

Factors affecting injury severity among recreational skiers and snowboarders: an epidemiology study

Different results have been reported for skiing and snowboarding injuries worldwide. Few studies consider the injury severity score (ISS) for the evaluation of differences among injured skiers–snowboarders. The aim of this study is to identify possible risk factors that affect the severity of skiing and snowboarding injuries in three winter seasons (2002–2005) in South Tyrol. For every injured skier or snowboarder referred to our emergency department in three consecutive seasons, the following data were collected: date of birth, gender, self-declared technical skills level, place of residence (local/non-local), as well as the date, time, and place of the accident. Type of injury and ISS were retrospectively assigned. Data concerning the snowfall in the last 24 h, average snow level, and outdoor air temperature values were obtained from four weather stations that were located inside the ski resorts. A multiple linear regression model was used to evaluate the association between ISS and potential determinants. In the analyzed seasons, 2,511 injured skiers and 843 injured snowboarders were evaluated at our emergency department. There was a significant change in the ISS value for subjects with different self-reported skills levels (P < 0.001). Men and non-local residents experienced more severe injuries than women and local residents, respectively (P < 0.013, P < 0.001). The ISS was higher for people aged over 60 (P < 0.001). Snowfalls brought about a decrease in accident severity (P = 0.009). The severity of the injuries increases with age. Prevention and information programs should be targeted to people who are at high risk of severe injury. A 24-h fresh snowfall seems to reduce the severity of injuries. Very little is known about snow conditions and winter sports injury. Further studies are needed to explore this field.     

Prevalence of cardiovascular diseases among alpine skiers and hikers in the Austrian Alps

Mountain sports, especially hiking and alpine skiing, are very popular. It is speculated that a high percentage of hikers and skiers are older and have cardiovascular diseases, but little is known about the real frequency of cardiovascular diseases in mountaineers and skiers. The goal of this study was to provide data on the prevalence of cardiovascular diseases (coronary artery disease with and without myocardial infarction, hypertension, and arrhythmias) of a representative sample of hikers and skiers in the Austrian Alps. Questionnaire results of 1431 hikers and 1043 skiers were included in the evaluation. Regarding the whole sample, 12.7% (11.0 to 14.4) of the hikers and 11.2% (9.3 to 13.1) of the skiers are afflicted with at least one type of cardiovascular disease. The frequency of cardiovascular diseases is age dependent and more pronounced in men, but only small differences were detected between hikers and skiers. It can be assumed that 4 to 5 million hikers and skiers with known cardiovascular diseases are active in the Alps annually. Scientific research should provide the basis of an optimal risk management for this large group of persons.