The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis

Background

The prevention of head injuries in alpine activities has focused on helmets. However, no systematic review has examined the effect of helmets on head and neck injuries among skiers and snowboarders.

Methods

We searched electronic databases, conference proceedings and reference lists using a combination of the key words “head injury or head trauma,” “helmet” and “skiing or snowboarding.” We included studies that used a control group; compared skiers or snowboarders with and without helmets; and measured at least one objectively quantified outcome (e.g., head injury, and neck or cervical injury).

Results

We included 10 case–control, 1 case–control/case-crossover and 1 cohort study in our analysis. The pooled odds ratio (OR) indicated that skiers and snowboarders with a helmet were significantly less likely than those without a helmet to have a head injury (OR 0.65, 95% confidence interval CI] 0.55–0.79). The result was similar for studies that used controls without an injury (OR 0.61, 95% CI 0.36–0.92), those that used controls with an injury other than a head or neck injury (OR 0.63, 95% CI 0.52–0.80) and studies that included children under the age of 13 years (OR 0.41, 95% CI 0.27–0.59). Helmets were not associated with an increased risk of neck injury (OR 0.89, 95% CI 0.72–1.09).

Interpretation

Our findings show that helmets reduce the risk of head injury among skiers and snowboarders with no evidence of an increased risk of neck injury.Skiing and snowboarding are popular winter activities.¹ Estimates from numerous countries indicate that head injuries account for 9% to 19%, and neck injuries for 1% to 4%, of all injuries reported by ski patrols and emergency departments.^2–11 Rates of head and neck injuries have been reported between 0.09 and 0.46 per 1000 outings.¹² Head and neck injuries are disproportionately represented in cases of severe trauma, and traumatic brain injury is the leading cause of death and serious injury among skiers and snow-boarders.¹³ As far back as 1983, Oh and Schmid recommended mandatory helmet use for children while skiing.¹⁴Many studies of the relation between helmet use and head injuries among skiers and snowboarders have found a protective effect.^15–24 It has been suggested that the use of helmets may increase the risk of neck injury in a crash or fall.²⁵ This may be more evident among children because they have a greater head:body ratio than adults, and the additional size and weight of the helmet may increase the risk of neck injury in an otherwise routine fall.²⁶ We conducted a systematic review of the effect of helmets on head and neck injuries among skiers and snowboarders.