BMJ  2005;330:281 (5 February), doi:10.1136/bmj.38314.480035.7C (published 4 January 2005)

Paper

Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study

¹ Alberta Centre for Injury Control and Research, Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 4075 RTF, 8308-114 Street, Edmonton, AB, Canada T6G 2E1, ² Departments of Pediatrics and Epidemiology and Biostatistics, 1020 Pine Avenue West, McGill University, Montreal, QC, Canada H3A 1A2, ³ Direction de la promotion de la sécurité, Ministère des Affaires municipales, du Sport et du Loisir, 100 rue Laviolette, suite 306, Québec Gouvernement, Trois-Rivières, QC, Canada G9A 5S9, ⁴ Institut national de santé publique du Québec, 4835, Christophe-Colomb, Montreal, QC, Canada H2J 3G8

Objective To determine the effect of helmets on the risk of head and neck injuries in skiers and snowboarders.

Design Matched case-control and case crossover study.

Setting 19 ski areas in Quebec, Canada, November 2001 to April 2002.

Participants 1082 skiers and snowboarders (cases) with head and neck injuries reported by the ski patrol and 3295 skiers and snowboarders (controls) with non-head or non-neck injuries matched to cases at each hill.

Main outcome measures Estimates of matched odds ratios for the effect of helmet use on the risk of any head or neck injury and for people requiring evacuation by ambulance.

Results The adjusted odds ratio for helmet use in participants with any head injury was 0.71 (95% confidence interval 0.55 to 0.92), indicating a 29% reduction in the risk of head injury. For participants who required evacuation by ambulance for head injuries, the adjusted odds ratio for helmet use was 0.44 (0.24 to 0.81). Similar results occurred with the case crossover design (odds ratio 0.43, 0.09 to 1.83). The adjusted odds ratio for helmet use for participants with any neck injury was 0.62 (0.33 to 1.19) and for participants who required evacuation by ambulance for neck injuries it was 1.29 (0.41 to 4.04).

Conclusions Helmets protect skiers and snowboarders against head injuries. We cannot rule out the possibility of an increased risk of neck injury with helmet use, but the estimates on which this assumption is based are imprecise.

Related Articles

Helmets protect skiers and snowboarders, but may also cause harm
BMJ 2005 330: 0. [Full Text]

Questions and answers

Kamran Abbasi
BMJ 2005 330: 0. [Extract] [Full Text] [PDF]

Related external webpages:

Paper plus

This article has been cited by other articles:

• Sakamoto, Y., Sakuraba, K. (2008). Snowboarding and Ski Boarding Injuries in Niigata, Japan. Am J Sports Med 36: 943-948 [Abstract] [Full text]  
• Ackery, A, Hagel, B E, Provvidenza, C, Tator, C H (2007). An international review of head and spinal cord injuries in alpine skiing and snowboarding. Inj. Prev. 13: 368-375 [Abstract] [Full text]  
• Scott, M. D, Buller, D. B, Andersen, P. A, Walkosz, B. J, Voeks, J. H, Dignan, M. B, Cutter, G. R (2007). Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding. Inj. Prev. 13: 173-177 [Abstract] [Full text]  
• Bandara, I. (2007). THE WAY I SEE IT: Snow joking matter. BMJ CAREER FOCUS 334: gp172-gp172 [Full text]  
• Lu, Y., Zeger, S. L. (2007). On the equivalence of case-crossover and time series methods in environmental epidemiology. Biostatistics 8: 337-344 [Abstract] [Full text]  
• Pless, B (2006). Are Editors free from bias? The special case of Letters to the Editor. Inj. Prev. 12: 353-354 [Full text]  
• Sulheim, S., Holme, I., Ekeland, A., Bahr, R. (2006). Helmet Use and Risk of Head Injuries in Alpine Skiers and Snowboarders. JAMA 295: 919-924 [Abstract] [Full text]  
• Hagel, B., Pless, I. B., Goulet, C. (2005). The Effect of Wrist Guard Use on Upper-Extremity Injuries in Snowboarders. Am J Epidemiol 162: 149-156 [Abstract] [Full text]  
• (2005). Splinters & Fragments. Inj. Prev. 11: 128-128 [Full text]  
• (2005). Should Skiers and Snowboarders Wear Helmets?. JWatch General 2005: 4-4 [Full text]  

Rapid Responses:

Read all Rapid Responses

Absolute risk reduction is the figure that counts

Edwin P Kirk
bmj.com, 4 Feb 2005 [Full text]

At risk of confusion or confusion of risk

Matthew P Doogue
bmj.com, 7 Feb 2005 [Full text]

...and water is wet and blood is red.

Peter w Ward
bmj.com, 8 Feb 2005 [Full text]

Re: Absolute risk reduction is the figure that counts

Brent E. Hagel
bmj.com, 10 Feb 2005 [Full text]

Re: At risk of confusion or confusion of risk

Brent E. Hagel
bmj.com, 10 Feb 2005 [Full text]

do helmets prevent head injuries or people's behaviour?

dan keown
bmj.com, 10 Feb 2005 [Full text]

Cochrane review of bicycle helmets: an unsound guide

William J. CURNOW
bmj.com, 23 Feb 2005 [Full text]

Ski helmets do not protect faces

Toby KA Baring
bmj.com, 16 Mar 2005 [Full text]

Re: Ski helmets do not protect faces

Brent E. Hagel
bmj.com, 22 Mar 2005 [Full text]

Effectivness of helmets

Matthew Robert Gammons
bmj.com, 19 Jan 2006 [Full text]