Abstract：
BACKGROUND: Between 3 and 15% of winter sports-related injuries are related to head injuries, which are the primary cause of mortality and disability among skiers. Despite the widespread adoption of helmets in winter sports, which has reduced the incidence of direct head injury, there is a paradoxical trend of an increasing number of individuals wearing helmets sustaining diffuse axonal injuries (DAI), which can result in severe neurologic sequelae.
METHODS: We retrospectively reviewed 100 cases collected by the senior author of this work from 13 full winter seasons during the period from 1981 to 1993 and compared them with 17 patients admitted during the more shortened 2019 to 2020 ski season due to COVID-19. All data analyzed come from a single institution. Population characteristics, mechanism of injury, helmet use, need for surgical treatment, diagnosis, and outcome were collected. Descriptive statistics were used to compare the two databases.
RESULTS: From February 1981 to January 2020, most skiers with head injuries were men (76% for the 1981-1993 and 85% for 2020). The proportion of patients aged over 50 increased from <20% in 1981 to 65% in 2020 (p < 0.01), with a median age of 60 years (range: 22-83 years). Low- to medium-velocity injuries were identified in 76% (13) of cases during the 2019 to 2020 season against 38% (28/74) during the 1981 to 1993 seasons (p < 0.01). All injured patients during the 2020 season wore a helmet, whereas none of the patients between 1981 and 1993 wore one (p < 0.01). DAI was observed in six cases (35%) for the 2019 to 2020 season against nine cases (9%) for the 1981 to 1993 season (p < 0.01). Thirty-four percent (34) of patients during the 1981 to 1993 seasons and 18% (3) of patients during the 2019 to 2020 season suffered skeletal fractures (p = 0.02). Among the 100 patients of the 1981 to 1993 seasons, 13 (13%) died against 1 (6%) from the recent season during care at the hospital (p = 0.15). Neurosurgical intervention was performed in 30 (30%) and 2 (12%) patients for the 1981 to 1993 and 2019 to 2020 seasons, respectively (p = 0.003). Neuropsychological sequelae were reported in 17% (7/42) of patients from the 1981 to 1993 seasons and cognitive evaluation before discharge detected significant impairments in 24% (4/17) of the patients from the 2019 to 2020 season (p = 0.29).
CONCLUSIONS: Helmet use among skiers sustaining head trauma has increased from none in the period from 1981 to 1993 to 100% during the 2019 to 2020 season, resulting in a reduction in the number of skull fractures and deaths. However, our observations suggest a marked shift in the type of intracranial injuries sustained, including a rise in the number of skiers experiencing DAI, sometimes with severe neurologic outcomes. The reasons for this paradoxical trend can only be speculated upon, leading to the question of whether the perceived benefits of helmet use in winter sports are actually misinterpreted.
METHODS: We retrospectively reviewed 100 cases collected by the senior author of this work from 13 full winter seasons during the period from 1981 to 1993 and compared them with 17 patients admitted during the more shortened 2019 to 2020 ski season due to COVID-19. All data analyzed come from a single institution. Population characteristics, mechanism of injury, helmet use, need for surgical treatment, diagnosis, and outcome were collected. Descriptive statistics were used to compare the two databases.
RESULTS: From February 1981 to January 2020, most skiers with head injuries were men (76% for the 1981-1993 and 85% for 2020). The proportion of patients aged over 50 increased from <20% in 1981 to 65% in 2020 (p < 0.01), with a median age of 60 years (range: 22-83 years). Low- to medium-velocity injuries were identified in 76% (13) of cases during the 2019 to 2020 season against 38% (28/74) during the 1981 to 1993 seasons (p < 0.01). All injured patients during the 2020 season wore a helmet, whereas none of the patients between 1981 and 1993 wore one (p < 0.01). DAI was observed in six cases (35%) for the 2019 to 2020 season against nine cases (9%) for the 1981 to 1993 season (p < 0.01). Thirty-four percent (34) of patients during the 1981 to 1993 seasons and 18% (3) of patients during the 2019 to 2020 season suffered skeletal fractures (p = 0.02). Among the 100 patients of the 1981 to 1993 seasons, 13 (13%) died against 1 (6%) from the recent season during care at the hospital (p = 0.15). Neurosurgical intervention was performed in 30 (30%) and 2 (12%) patients for the 1981 to 1993 and 2019 to 2020 seasons, respectively (p = 0.003). Neuropsychological sequelae were reported in 17% (7/42) of patients from the 1981 to 1993 seasons and cognitive evaluation before discharge detected significant impairments in 24% (4/17) of the patients from the 2019 to 2020 season (p = 0.29).
CONCLUSIONS: Helmet use among skiers sustaining head trauma has increased from none in the period from 1981 to 1993 to 100% during the 2019 to 2020 season, resulting in a reduction in the number of skull fractures and deaths. However, our observations suggest a marked shift in the type of intracranial injuries sustained, including a rise in the number of skiers experiencing DAI, sometimes with severe neurologic outcomes. The reasons for this paradoxical trend can only be speculated upon, leading to the question of whether the perceived benefits of helmet use in winter sports are actually misinterpreted.
摘要：
背景：3-15％的冬季运动相关伤害归因于头部受伤，这是滑雪者死亡和残疾的主要原因。尽管在冬季运动中广泛采用头盔，这已经被证明可以减少头部直接损伤的发生率，有一个矛盾的趋势，即越来越多的戴头盔的人遭受弥漫性轴索损伤（DAI），会导致严重的神经后遗症.
方法：我们回顾性回顾了这项工作的资深作者在1981-1993年期间从13个冬季收集的100例病例，并将其与2019-2020年因COVID-19而缩短的滑雪季节期间收治的17例患者进行了比较。所有分析的数据都来自一个机构(Sion州医院，瑞士)。人口特征,损伤机制,头盔的使用,需要手术治疗，收集诊断和结果。使用描述性统计来比较两个数据库。
结果：从1981年2月到2020年1月，大多数头部受伤的滑雪者是男性（分别为76％和85％）。50岁以上患者的比例从不到20%上升到2020年的65%(p<0.0001),年龄中位数为60岁（范围为22-83岁）。在2019-2020赛季中，76％（13）的病例中发现了中低速伤害，而在1981-1993赛季中发现了38％（28/74）（p<0.0001）。在2020赛季期间，所有受伤的患者都戴着头盔，而在1981-1993年期间，没有患者穿着一件（p<0.0001）。在2019-2020年和1981-1993年季节，分别观察到6例（35％）和9例（9％）的弥漫性轴索损伤（p<0.0001）。在1981-1993赛季中，有34％（34）的患者和2019-2020赛季中18％（3）的患者患有骨骼骨折（p=0.02）。在1981-1993赛季的100名患者中，有13名（13％）在医院护理期间死于最近一个赛季的1名（6％）（p=0.15）。在1981-1993和2019-2020季节，分别对30例患者（30％）和2例患者（12％）进行了神经外科干预（p=0.003）。在1981-1993年的季节中，有17％（7/42）的患者报告了神经心理学后遗症，在2019-2020年的季节中，出院前的认知评估发现24％（4/17）的患者存在显着损害（p=0.29）。
结论：虽然遭受头部创伤的滑雪者的头盔使用率从1981-1993年的零增加到2019-2020赛季的100％，导致颅骨骨折和死亡人数减少，我们的观察表明，持续的颅内损伤类型发生了明显的变化，包括经历弥漫性轴索损伤（DAI）的滑雪者数量增加，有时会出现严重的神经系统结局。这种矛盾趋势的原因只能推测，导致质疑在冬季运动中使用头盔的感知好处是否实际上被误解了。
方法：我们回顾性回顾了这项工作的资深作者在1981-1993年期间从13个冬季收集的100例病例，并将其与2019-2020年因COVID-19而缩短的滑雪季节期间收治的17例患者进行了比较。所有分析的数据都来自一个机构(Sion州医院，瑞士)。人口特征,损伤机制,头盔的使用,需要手术治疗，收集诊断和结果。使用描述性统计来比较两个数据库。
结果：从1981年2月到2020年1月，大多数头部受伤的滑雪者是男性（分别为76％和85％）。50岁以上患者的比例从不到20%上升到2020年的65%(p<0.0001),年龄中位数为60岁（范围为22-83岁）。在2019-2020赛季中，76％（13）的病例中发现了中低速伤害，而在1981-1993赛季中发现了38％（28/74）（p<0.0001）。在2020赛季期间，所有受伤的患者都戴着头盔，而在1981-1993年期间，没有患者穿着一件（p<0.0001）。在2019-2020年和1981-1993年季节，分别观察到6例（35％）和9例（9％）的弥漫性轴索损伤（p<0.0001）。在1981-1993赛季中，有34％（34）的患者和2019-2020赛季中18％（3）的患者患有骨骼骨折（p=0.02）。在1981-1993赛季的100名患者中，有13名（13％）在医院护理期间死于最近一个赛季的1名（6％）（p=0.15）。在1981-1993和2019-2020季节，分别对30例患者（30％）和2例患者（12％）进行了神经外科干预（p=0.003）。在1981-1993年的季节中，有17％（7/42）的患者报告了神经心理学后遗症，在2019-2020年的季节中，出院前的认知评估发现24％（4/17）的患者存在显着损害（p=0.29）。
结论：虽然遭受头部创伤的滑雪者的头盔使用率从1981-1993年的零增加到2019-2020赛季的100％，导致颅骨骨折和死亡人数减少，我们的观察表明，持续的颅内损伤类型发生了明显的变化，包括经历弥漫性轴索损伤（DAI）的滑雪者数量增加，有时会出现严重的神经系统结局。这种矛盾趋势的原因只能推测，导致质疑在冬季运动中使用头盔的感知好处是否实际上被误解了。
