The tragic death of actress Natasha Richardson this past March put a spotlight on the potential risks inherent to skiing, as well as the deadly consequences that can result from head trauma. Richardson died two days after suffering an epidural hematoma and slipping into a coma. What at first appeared to be a minor bump on the head from a fall on a beginner ski slope in Quebec proved fatal. "This tragedy likely could have been prevented by wearing a helmet and receiving timely treatment at a trauma center equipped to handle this type of injury. Hopefully this serves as a warning to all skiers to wear a helmet and to take appropriate precautions before hitting the slopes," stated AANS President Elect James T. Rutka, MD, PhD, a Toronto neurosurgeon.
And while skiing and snowboarding head injuries tend to me more severe, ice hockey contributes to more head injuries per year than skiing. Concussions related to ice hockey are commonly caused by collisions and hitting one's head against the boards and ice; of the nearly 5,300 ice hockey head injuries in 2008, 1,950 were concussions. "As a longtime hockey player, I can say that it is a highly enjoyable, but hard-hitting, collision sport. It is important to remember that serious neurological injuries associated with all winter sports can usually be avoided by wearing approved, well-fitting gear and following other safety precautions," remarked Dr. Rutka.
Injuries severe enough to cause head injury or other trauma often also cause neck fracture or spinal cord injury. Winter sports contribute to a greater number of head injuries than neck injuries, but both head and neck injuries can be devastating. While severe head injuries can result in a host of disabling cognitive and physical health problems, severe neck injuries or spinal cord injuries can result in partial or complete paralysis. The most severe of these injuries can tragically end in death.
Skiing/Snowboarding
According to the National Ski Areas Association, during the 2007/08 season there were 53 fatalities; 44 skiing deaths and nine snowboarding deaths. According to the US Consumer Product Safety Commission (CPSC), 4,562 people were treated at US hospital emergency rooms in 2008 for skiing-related head injuries and 6,841 for snowboarding-related head injuries. Of these totals, children age 14 and younger incurred an estimated 1,143 skiing and 2,258 snowboarding head injuries respectively. Further, in all age groups, there were 938 neck injuries from skiing and 1,390 neck injuries from snowboarding.
There are no state laws mandating helmets for skiing or any winter sports. Aspen ski resorts mandate that skiers under age 12 wear helmets. Other ski resorts are trying to institute such mandates, and in Michigan, statewide. Following the high-profile skiing-related deaths of Michael Kennedy in December 1997, and Sony Bono in January 1998, an increase in the number of skiers wearing helmets was noted in several studies.
Ice Hockey
According to the CPSC, 5,272 people were treated at US hospital emergency rooms in 2008 for ice hockey-related head injuries and 1,357 for neck injuries, respectively. Among children age 9-15, one study showed that body checking accounted for 86 percent of game-time injuries with 23 percent of these injuries affecting the head or neck.
Studies indicate that most hockey injuries occur during a game rather than at practice. It is estimated that direct trauma accounts for 80 percent of all injuries. Most of these injuries are caused by player contact (checking and collision), falls, and contact with the boards, a puck, high stick, and rarely, a skate blade. There is evidence from several studies to indicate that full facial protection reduces the number and risk of overall head and facial injuries in ice hockey compared to both partial facial protection and no facial protection.
The AANS offers these winter sports injury prevention tips:
•Buy and use helmets or protective head gear approved by the American Society for Testing and Materials (ASTM) for specific sports 100 percent of the time. These must fit correctly and be worn properly to be effective.
•For ice hockey, in addition to head gear, protective gear includes a face shield, mouth guard, shoulder and elbow pads, shin guards, cup/supporter, and gloves. Goalies require additional protective gear.
•Wear appropriate clothing for the sport.
•Do not participate in sports when you are ill, very tired, or have consumed alcohol.
•Do not participate in outdoor sports when weather conditions pose a serious hazard.
•Ice skate only in areas designated for skating, and be sure to check the ice for cracks and debris.
•Avoid overly aggressive behavior. Boarding, butt-ending, charging, clipping, contact to the head, cross-checking, elbowing, head-butting, high sticks, holding, kneeing, roughing, slashing, and spearing are all "illegal" moves that incur penalties in ice hockey.
•Use only sleds that can be steered, and never go down a slope head first.
•Follow all posted signs and warnings on ski slopes, sledding hills and ice skating rinks.
•Seek immediate treatment for head and neck injuries.
The AANS has more in-depth information on sports-related injuries on its public Web site at http://www.neurosurgerytoday.org/
what/patient_e/sports.asp and http://www.neurosurgerytoday.org/what/patient_e/sports
_neck_injury.asp.
Blood protein could be a potential biomarker for delayed concussion recovery in children