Head injuries on rise despite helmets

A new study shows 2004-10 saw a rise in skiing- and snowboarding-related head injuries in the U.S., despite the fact that more people started riding with helmets during same period. Michelson

A new study presented last week in Denver at the American College of Emergency Physicians (ACEP) annual Scientific Assembly conference revealed some counterintuitive and eyebrow-raising findings: 2004-2010 saw a rise in skiing- and snowboarding-related head injuries in the United States, despite the fact that more people started riding with helmets during same period.

"Our initial hypothesis was that we would see a decrease in head injuries correlating with the increase in helmet use, and we found the opposite," said Dr. Mark Christensen, the author of the study and a resident physician in the Emergency Medicine department at Western Michigan University. "Anybody who skis has noticed that there are a lot more people wearing helmets out there -- but we didn't really have a lot of real hard evidence to show that it helps a lot. This study challenged, rather than supported, our assumptions."

Christensen cautions that he's considering his study to be preliminary at best, and concedes that a number of potentially correlating factors -- like the increase in use of terrain parks and the overall increase of skier/rider visits to U.S. ski areas -- were not taken into account. He also said that the six-year sample is too small to be statistically significant in the bigger picture: He's ultimately hoping to extend the study for a 15- or 20-year perspective.

Nonetheless, since reports of all other injuries on the slopes have remained steady while reports of head injuries have increased dramatically, the initial trends are worth taking a closer look at.

The study relies on data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS), which estimates that there were 68,761 reports of head injuries sustained while skiing or snowboarding presented to U.S. emergency departments from 2004-2010, with males (68.8 percent of total reported head injuries), snowboarders (57.9 percent), and young riders between the ages of 11-17 (47.7 percent) most likely to be injured.

According to Christensen's abstract, "The percentage of helmeted riders that sustained head injuries increased from 36.7 percent to 57.99 percent over the six-year period, which correlates with National Ski Areas Association (NSSA) data on increases in helmet use in the general population."

So what's behind that counterintuitive correlation?

"My assumptions are that those increases parallel the increase in terrain park use and the level of difficulty and risk in these sports over the last decade,"Christensen said, "and also that we're simply seeing more people reporting head injuries because there's been more education and awareness around them.

"Ten years ago when someone had a significant impact to the head ... they'd just kind of walk it off. ... Now just about anybody who hits their head -- I'm an ER physician and I see it all the time -- will go in and get it checked out, because there's been a tremendous increase in awareness about traumatic brain injury thanks to all the high-profile stories about NFL athletes with concussions."

It's not just NFL athletes, either: concussions and traumatic brain injuries have plagued action sports in recent years, with high-profile injury stories like snowboarder Kevin Pearce, skateboarder Adam Taylor, and BMX riders Kevin Robinson, Jay Eggleston and (most recently) Brett Banasiewicz helping to spread awareness. Each of those athletes were wearing helmets at the time of their injury; each of those injuries also might have been much, much worse without them.

Christensen said his study has prompted a surprising number of questions from the press about the base-level effectiveness of helmets for skiers and snowboarders, and whether they're even worth wearing, but that those questions are missing the point.

One aspect of his analysis fully confirms the effectiveness of helmets: Children under 10 years old -- the most likely to be wearing helmets -- were the only age group in the study to buck the trend, showing a significant decrease (from 11.7 percent of all reported head injuries to a mere 4.6 percent) over the period of the study.

"That was interesting because the biggest increase in helmet use has also been in the youngest population," Christensen said. "And that's the only age group where we saw any real improvement that went against the overall trend."

When evaluating the study, the important thing to bear in mind is that "we're not trying to say helmets are bad," Christensen emphasized. "Helmets are important and probably prevent a lot of serious injuries. But I've seen other studies showing that helmet wearers are more likely to take more risks, so there's a need there for more education and recognizing that skiing or snowboarding safely and wearing a helmet is what's going to prevent injuries, not just wearing helmets alone.

"Helmet use clearly isn't a solve-all solution, especially since most consumer-level helmets are only designed to prevent injury at impact in the 12-15 mile per hour range. We should approach helmet use like we approach wearing seatbelts in a car: Just because we're wearing a seatbelt doesn't mean we can drive recklessly."