 Poster: A snowHead
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 Serious head and spinal injuries are on the rise worldwide in skiers and snowboarders, according to research published this week. Canadian researchers have pooled together the results of 24 medical articles from 10 different countries covering the period from January 1990 to December 2004. The results of the systematic review, published in ‘Injury Prevention’ (BMJ Group), suggest that the rising popularity of acrobatics and high speed on the slopes could be responsible for the increase in injuries.
...Head injuries are the most common cause of death among skiers and snowboarders. The researchers stated that encouraging or requiring skiers and snowboarders to wear helmets would help reverse the trend; there is evidence that helmets reduce the risk of head injury by 22–60%.
The review found that, among countries that have reported data, the number of serious injuries has been rising steadily over the last decade and-a-half. Head injuries now make up 15% of injuries sustained by skiers, compared to 12% in 1993. It also showed that the number of serious injuries sustained by snowboarders has quintupled during the same period and that, overall, snowboarders were substantially more likely than skiers to suffer serious injuries. Also, males and skiers or snowboarders under age 35 were more likely to be injured.
It sounds all doom and gloom but, in reality, the numbers of such injuries are low. One study in the review estimated that for every one million visits to a ski hill, between 0.5 and 1.96 people would die.
Citation: Ackery A et a. An international review of head and spinal cord injuries in alpine skiing and snowboarding. Injury Prevention 2007;13:368-375.
To view abstract: http://injuryprevention.bmj.com/cgi/content/abstract/13/6/368
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Does anyone have statistics on the accident rate for snowsports. The figures seem hard to come by.
The only ones I have seen are some unreferenced insurance claim rates which suggested that 4% of policies are claimed on, half of which were for injuries requiring a hospital visit. But they could very well be the made up on the spot type of statistics.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| It also showed that the number of serious injuries sustained by snowboarders has quintupled during the same period |
Not clear here whether they are talking absolute numbers. If so, well obviously serious injuries of snowboarders will have shot up, during a period when the number of snowboarders has shot up. The most useful and interesting numbers are the ones which measure risk - e.g. how many days the average skier has to do, before getting a serious injury. Even more useful if split up by age group; the average 50 year old skier, the average 18 year old snowboarder, etc. That would help put things in perspective - and enable us to bear in mind the relative risks of other hazardous activities such as driving, cycling, sprawling on a sofa with bags of crisps and cans of lager, or standing on step ladders putting up Christmas decs (remembering that a high proportion of serious injuries are related to ladders in the home). We're installing skirting boards today; much safer!
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pam w, as you suggest, it is sensible not to be alarmist. It is also sensible not to be an ostrich.
However you play with the figures, the report from a respected journal shows that over the period of 1990 to 2004 the incidence of traumatic brain injury (TBI) and spinal cord injury (SCI) increased.
This confirms the impression many of us have of how things are developing in the slopes.
It pays to be careful.
Many of those injuries are caused by collisions between skiers. As the slopes get more crowded this event becomes more likely.
Hence the importance of wearing a helmet, and getting off piste as quick as you can. 
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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The headline & brief news report I saw on this suggested that there is a massive increase in the no of skiers sustaining head/spinal injury. The article itself suggests that the increase is mostly in younger male snowboarders & free style skiers (and no doubt those into whom some of them crash). Well, no prizes for working out that these are the more dangerous activities, or for working out that insurance for ALL of us will rise on the back of it. The recommendation at the end of the abstract is entirely sensible -
"Conclusions: There should be enhanced promotion of injury prevention that includes the use of helmets and emphasizes the skier’s and snowboarder’s responsibility code"
However, shouldn't it go further than enhanced promotion? Isn't it time for the wearing of helmets to be made compulsory, thus getting rid of issues such as the young novice group who tease the solitary helmet wearer in their crowd? Incidentally, has anyone witnessed an irresponsible/reckless skier or boarder being taken to task for their lack of respect for the code?
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You'll need to Register first of course.
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| the incidence of traumatic brain injury (TBI) and spinal cord injury (SCI) increased. |
Jonpim, your link suggests that "incidence" is either an absolute number, or a percentage. But there's a big difference; a single number can't become a percentage without knowing the size of the population. Just the numbers of cases, on its own, tells us nothing very useful. The incidence could be increasing whilst the risk goes down. Or vice versa. Personally, I started wearing a helmet for snowboarding and now wear it just about all the time, as it's comfortable and plays music. I am also a hyper cautious worse than middle aged skier who comes home to the UK during the weeks of crowded high-season pistes. Certainly not an ostrich; but it would be quite helpful to know the statistics. I should read the original research, I suppose!
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| NewSkier wrote: |
| Isn't it time for the wearing of helmets to be made compulsory, thus getting rid of issues such as the young novice group who tease the solitary helmet wearer in their crowd? |
Well, I've heard a lot of reasons for helmets being compulsory, but I've never met the suggestion that they should be compulsory to stop teasing! 
(I am a helmet wearer, but would not support any movement to make helmets compulsory.)
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No, I wouldn't either. There are lots of legal things more dangerous than skiing without a helmet.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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pam w, The paper looks like a poor one to me anyway, they don't actually tell you much about any change in incidence of head injury. The papers that are cited as demonstrating an increase in head injury appear to come from America. As the increase in head injury appears to have coincided with a large rise in the wearing of helmets it is far from clear to a simple soul like myself that advocating an increase in helmet useage is the most important factor in preventing head injury. I will continue to wear a hat.
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Interesting how much speculation come off from an ABSTRACT. Anyone read the full text of the article and can answer the following question?
1) What's the trend in injuries in skier, without getting mixed up with snowboarders?
2) What's the trend of injuries for non-helmeted skiers? And trend of helmeted skiers?
3) What's the percentage of injuries due to collision, acrobat and just-cruising?
I would expect a "published" scientific journal have those data analyzed and shown.
BTW, how does helmet prevent spinal injuries?
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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T Bar, it does say that "There is evidence that helmets reduce the risk of head injury by 22–60%.". I see no reason to disbelieve that. Presumably, had the huge increase in "snowpark" style activities NOT coincided with a large rise in the wearing of helmets, the incidence of injury would have been higher. But, on its own, the data in this paper do not tell us anything, as far as I can see, about how risks are changing, or for that matter, what the risks are. I suspect that many 18 - 25 year old males are at greater risk of serious injury in car accidents than on skis or snowboards. They'd be safer in cars if they wore helmets too, I dare say, as would the rest of us. We can only make rational decisions about risk if we know the numbers.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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The paper looks like a poor one to me anyway,
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T Bar, are you talking about the abstract or the full article?
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The paper looks like a poor one to me anyway,
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T Bar, are you talking about the abstract or the full article (I'm too cheap to pay for the subscription needed to access the full text of the article)?
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You know it makes sense.
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If the full article/research did provide significant stats on changing incidence/risks then the abstract is a very poor one!
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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abc,
The answer to all your questions is that it doesn't tell you.
I looked at the full article.
pam w,
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"There is evidence that helmets reduce the risk of head injury by 22–60%.". I see no reason to disbelieve that.
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I have wittered on about the previous papers before and don't really want to bore everyone again. But the reduction in head injury rate is not necessarily what it seems. Head injury and severity were not defined in either paper AFAIR and the main end point in severity was whether or not the injured party was transferred to hospital from the pistes which is not a very robust end point.
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Presumably, had the huge increase in "snowpark" style activities NOT coincided with a large rise in the wearing of helmets, the incidence of injury would have been higher.
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Can't tell from the data
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I suspect that many 18 - 25 year old males are at greater risk of serious injury in car accidents than on skis or snowboards. They'd be safer in cars if they wore helmets too, I dare say, as would the rest of us. We can only make rational decisions about risk if we know the numbers.
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I agree when I did the sums myself I seemed to have a ten fold greater chance of being killed driving than skiing, I don't wear a helmet for either activity.
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Poster: A snowHead
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abc,
The answer to all your questions is that it doesn't tell you.
I looked at the full article.
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If the "researcher" doesn't bother to analyze the data, it's meaningless. You're right, it's a poor "research".
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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I immediately thought to myself 'and they needed an expensive survey to come to those conclusions'?:
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The results of the systematic review, published in ‘Injury Prevention’ (BMJ Group), suggest that the rising popularity of acrobatics and high speed on the slopes could be responsible for the increase in injuries.
...Head injuries are the most common cause of death among skiers and snowboarders. The researchers stated that encouraging or requiring skiers and snowboarders to wear helmets would help reverse the trend; there is evidence that helmets reduce the risk of head injury by 22–60%.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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abc,
I don't think they would have to necessarily answer the questions you pose as they are reviewing other peoples work which probably have not looked at that . However to me a lot of the commentary is sloppy. In most ofthe studies they have not identified the time period studied. They have not stated the aims of a lot of the studies.They have stated that some studies have found changes in incidence of injuries without commetnig on whether this is what they were looking for or whether the changes were significant or what the changes were. They have not commented on whether the incidence is unchanged in other studies or not etc. etc. etc. All in all a really sloppy bit of work from which it is very difficult to draw any conclusions at all. 
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You need to Login to know who's really who.
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So what have they actually "studied", besides throwing out some iffy statements?
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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abc,
IMHO not very much. I think the most valid conclusion is that you can get injured skiing and snowboarding but serious injuries aren't that common, though even this is unclear.
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You'll need to Register first of course.
You'll need to Register first of course.
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Fascinating discussion so far. I can't get access to Injury Prevention full text, so don't have all the information that T Bar has.
But it is interesting how we deal with research data. Few things in science are certain. Few data are conclusive: we make the best of what we have.
Frequently review papers come along that suggest a change in practice - in medicine we have had articles on epidurals, albumin solution (http://www.jficm.anzca.edu.au/pdfdocs/Journal/Journal1999/J1999%20(a)%20March/Resuscitation.pdf), and Swann-ganz catheters (among many others) - and the response is usually to divide into two camps.
1. I agree. Well done: just what I knew all along
2. I disagree. Patients will be put in danger. The data is rubbish.
But in each case the reviews have been of all the available data. It may be flawed, but it is the only data.
So, how are those who disagree making their decision? On no data at all? On prejudice?
In the article being discussed here, according to the abstract, they searched PubMed, Medline, EMBASE, CDSR, ACP Journal Club, DARE, CCTR, SportDiscus, CINAHL, and Advanced Google. "After initial prescreening, articles included in the review required epidemiological data on SCI, TBI, or both. Articles had to be directly associated with the topic of skiing and/or snowboarding and published between January 1990 and December 2004"
So, they looked at all the data they could find. We may like to re-interpret the data, but we can't criticise the data. It is all there is.
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Few things in science are certain. Few data are conclusive: we make the best of what we have.
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I'm afraidn I totally disagree with you there.
Science IS certain, within its limits of validity. You're perhaps confusing mere assumption/hypothesis that still needs validation with science?
Raw data without any sort of analysis is just that, a bunch of data. There's nothing "conclusive" about them.
Ants face with the raw data of sugar will simply respond by eating it. We human are (supposed to be) intelligent so we can "conslude" the sugar contains poison!
Yes, we "make the best" of raw data by doing careful analysis to see if there exist any correlation between any cause and consequence. At times, we must conclude there's not enough data, instead of stretching the incomplete data to reach iffy conclusions.
Sorry, raw data do not "speak". Only well conducted research based on sound data do.
Based on what T bar's report of the "paper" itself, it seems stretching the "data" to reach iffy conclusions.
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| We may like to re-interpret the data, but we can't criticise the data. It is all there is. |
Nobody is criticizing the "data". We're criticising the interpretation of the authors of that article.
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abc, interesting. I fear we are doomed to disagree. So be it. 
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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abc, much of biological science isn't certain, merely indicative or even just intuitive
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| slikedges wrote: |
| abc, much of biological science isn't certain, merely indicative or even just intuitive |
Indicative is fine, as long as it's accepted as so.
However, intuitive should not be accepted as "science" until proven by abundunt data. At which point it's not JUST intuitive any more.
What many forget is the simply fact that our level of knowledge in biology is comparitively primitive, say, not at the same level of chemistry. Much of the time we're groping in the dark. So in strict terms, many of the "knowledge" in biology isn't really science but rather just emperical experience.
We have to live with what we know and do the best we can. But not acknowledging we don't know (by pretending we do) is surely going to slow down the process of discovery and understanding.
Disclaimer: I'm not saying that about you or Jonpim but about the article (or ANY "article") that mistaken indicative evidence as "fact" (of sceience).
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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abc, I don't disagree, but lots of biological science will never be more than intuitive or empirical experience though, due to insurmountable problems in design, control, standardisation, stratification, sample size etc etc of any conceivable attempt at systematic analysis
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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slikedges, I see your point. Perhaps that's also due to our different perspective.
I (used to) work in particle physics research. There, we were also dealing with huge sample size of millions and billions whilst trying to seek evidence in the amounts of 10's or 100's. Large scale computer and computation technology has steadily made many of such "impissible" search possible. Many earlier "indicative" evidence had since been either disproved or accepted as a result of better experiement design that lent it self to better data analysis. As such, I developed a healthy dose of skepticism (as well as respect) to indicative evidence.
So, coming from that background and perspective, I would expect the same path of advance in biological and medical science. Hence perhaps a particularly low tolerance to "research" that doesn't take full advantage of 21th century technology and methodology.
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abc, I don't think that without a truly inconceivable leap in our understanding of seemingly random biological variations, diversity and sheer unpredictability (and I can imaginate with the best of them), coupled then with a comparable leap in our ability to model said accurately(!), we'll be doing as you've been able to do in physics. My impression is that physics even of the particle flavour can often be nailed down with numbers (albeit very big, very small or quite unnatural ones) in a way that makes it a very different sort of science indeed from biology.
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You know it makes sense.
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slikedges, I'm ventureing a little beyond my "area of expertie" here. But my understanding is biological science is large of the statistical in nature. Whilst most people think of Newtonian physics as "number" (deterministic) science.
But much of modern (e.g. particle) physics is also largely statistical ("wave/distribution" instead of individual solid "particle" in the traditional sense). The difference between that and biological science isn't as distinct as with the "old" physics.
Having done a lot of statistical data analysis, I'm often perturbed by the lack of statistical methodology in many so called "scientific papers" in life science we heard about. Either they're not really "scientific" research, or I'd be really disappointed by the standard of publication in those journals.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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abc, except that in particle physics the substance of concepts can often be couched in formulaic or equation terms, can't they? This makes them much easier to define and experiments easier to frame, doesn't it? I think you'd laugh if you saw what passes as evidence in the life sciences - very little is strictly scientifically robust or rigorous... 
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Poster: A snowHead
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Jonpim,
I agree with much of what you say. but:
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So, they looked at all the data they could find. We may like to re-interpret the data, but we can't criticise the data. It is all there is.
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The problem with the data is not that they have not identified the papers but having identified the papers they have not presented the data from these papers on a manner in which one can satisfactorily agree or disagree with much of the authors commentary.
The authors have identified 24 papers with epidemiological studies of head injuries in skiing/snowboarding. In only four of them have they stated that the rate of head injury is increasing. In one they have not identified what the increase is. In the other three papers the increase is given as a % of injuries. In only one of them is the injury rate said to be constant. The other twenty papers it is not stated whether there was a constant rate of head injury or not and for none of the papers is the size of the study given and for the majority of the papers the study period is not stated. For none of the studies is the purpose of the study stated.
If these were the only four studies that were done from which a change in head injury rate could have been detected. The observation from these studies is likely to have a more general appplication. If however a change in rate could have been detected from the other studies but was not, the generalisation is likely to be innapropriate. The data is presented in a manner that this is impossible to tell which is why I am criticising their use of data.
PS
I was wrong about the rise in head injuries being largely in America. The writing referred to this but the other (few Papers) were European
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FAQ
