The association between paramedic service system hospital offload time and response time.

OBJECTIVE: To address an important care issue in Canada, we tested the association between paramedic system hospital offload and response time, while considering the impact of other system-level factors. METHODS: Data from Calgary, Alberta (2014-2017), included median offload (exposure) and response (outcome) time aggregated by hour, with covariates paramedic system episodes of care-dispatch and arrival of a response unit-and hospital transport arrivals (collectively called volume), time of day, and season. Analyses used linear regression and modified Poisson models. RESULTS: 301,105 EMS episodes of care over 26,193 1-h periods were included. For any given 1-h period, the median (IQR) across all episodes of care for offload time, response time, episodes of care, and hospital transport arrivals were 55.3 (45.7, 66.3) min, 8.6 (7.6, 9.8) min, 12 (8, 16) episodes, and 8 (5, 10) hospital arrivals, respectively. Multivariable modelling revealed a complex association differing over levels of exposure and covariates, requiring description using "light stress" and "heavy stress" system scenarios. The light scenario was defined as median offload of 30 min and volume < 10th percentile (six episodes and four hospital arrivals), in the summer, and the heavy scenario as median offload of 90 min and volume > 90th percentile (17 episodes and 13 hospital arrivals), in the winter. An increase is reported in minutes:seconds for median hourly response time between scenarios by time of day: 1:04-4:16 (0000-0559 h.), 0:42-2:05 (0600-1159 h.), 0:57-3:01 (1200-1759 h.), and 0:18-2:21 (1800-2359 h.). CONCLUSIONS: Increasing offload is associated with increased response time; however the relationship is complex, with a greater impact on response time noted in select situations such as high volume in the winter. These observations illustrate the interdependence of paramedic, ED, and inpatient systems and provide high-yield targets for polices to mitigate the risk to community availability of paramedic resources at times of high offload delay/system stress.

ABSTRAIT: OBJECTIF: Afin de régler un problème important de soins au Canada, nous avons testé l'association entre le déchargement du système paramédical et le temps de réponse, tout en tenant compte de l'incidence d'autres facteurs au niveau du système. MéTHODES: Les données de Calgary, en Alberta (2014-2017) incluent le temps médian de déchargement (exposition) et de réponse (résultat) agrégé par heure, qui s'agit co-variables épisodes de soins du système paramédical - répartition et arrivée d'une unité d'intervention - et arrivées de transport hospitalier (collectivement appelé volume), l'heure et la saison. Les analyses ont utilisé la régression linéaire et des modèles de Poisson modifiés. RéSULTATS: 301105 épisodes de soins médicaux d'urgence sur 26193 périodes d'une heure ont été inclus. Pour une période d'une heure donnée, la médiane (QRI) pour tous les épisodes de soins pour le temps de déchargement, le temps de réponse, les épisodes de soins et les arrivées par transport à l'hôpital était de 55,3 (45,7, 66,3) minutes, 8,6 (7,6, 9,8) minutes, 12 (8, 16) épisodes et 8 (5, 10) arrivées à l'hôpital, respectivement. La modélisation multi-variable a révélé une association complexe qui varie selon les niveaux d'exposition et les co-variables, et qui nécessite une description à l'aide de scénarios de systèmes de « stress léger ¼ et de « stress lourd ¼. Le scénario léger a été défini comme un déchargement médian de 30 minutes, volume inférieur au 10e percentile (six épisodes et quatre arrivées à l'hôpital), pendant l'été. Le scénario lourd comme déchargement médian de 90 minutes, volume > 90e percentile (17 épisodes et 13 arrivées à l'hôpital), en hiver. Une augmentation est rapportée en minutes: secondes pour le temps de réponse horaire médian entre des scénarios par heure du jour : 1:04-4:16 (0000-0559 h.), 0:42-2:05 (0600-1159 h.), 0:57-3:01 (1200-1759 h.), et 0:18-2:21 (1800-2359 h.). CONCLUSIONS: L'augmentation du déchargement est associée à une augmentation du temps de réponse, mais la relation est complexe, avec un impact plus important sur le temps de réponse noté dans certaines situations, comme un volume élevé en hiver. Ces observations illustrent l'interdépendance des systèmes paramédicaux, des services d'urgence et des services aux patients hospitalisés et fournissent des cibles à haut rendement pour les politiques afin d'atténuer le risque pour la disponibilité des ressources paramédicales dans la collectivité en période de retard élevé ou de stress systémique.

Emergency department coding of bicycle and pedestrian injuries during the transition from ICD-9 to ICD-10.

BACKGROUND: The international classification of diseases version 10 (ICD-10) uses alphanumeric expanded codes and external cause of injury codes (E-codes). OBJECTIVE: To examine the reliability and validity of emergency department (ED) coders in applying E-codes in ICD-9 and -10. METHODS: Bicycle and pedestrian injuries were identified from the ED information system from one period before and two periods after transition from ICD-9 to -10 coding. Overall, 180 randomly selected bicycle and pedestrian injury charts were reviewed as the reference standard (RS). Original E-codes assigned by ED coders (ICD-9 in 2001 and ICD-10 in 2004 and 2007) were compared with charts (validity) and also to ICD-9 and -10 codes assigned from RS chart review, to each case by an independent (IND) coder (reliability). Sensitivity, specificity, simple, and chance-corrected agreements (κ statistics) were calculated. RESULTS: Sensitivity of E-coding bicycle injuries by the IND coder in comparison with the RS ranged from 95.1% (95% CI 86.3 to 99.0) to 100% (95% CI 94.0 to 100.0) for both ICD-9 and -10. Sensitivity of ED coders in E-coding bicycle injuries ranged from 90.2% (95% CI 79.8 to 96.3) to 96.7% (95% CI 88.5 to 99.6). The sensitivity estimates for the IND coder ranged from 25.0% (95% CI 14.7 to 37.9) to 45.0% (95% CI 32.1 to 58.4) for pedestrian injuries for both ICD-9 and -10. CONCLUSION: Bicycle injuries are coded in a reliable and valid manner; however, pedestrian injuries are often miscoded as falls. These results have important implications for injury surveillance research.

Head Games: A Systematic Review and Meta-analysis Examining Concussion and Head Impact Incidence Rates, Modifiable Risk Factors, and Prevention Strategies in Youth Tackle Football.

OBJECTIVES: The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level. METHODS: Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements. MAIN RESULTS: After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67-0.89] for high school football (ages 13-19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89-1.41) for minor football players (ages 5-15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2 days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75 min per week in the second week of the season and 60 min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003). CONCLUSIONS: This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775.

Factors associated with incorrect bicycle helmet use.

BACKGROUND: Incorrect bicycle helmet use increases head injury risk. OBJECTIVE: To evaluate the patterns of incorrect helmet use based on unobtrusive field observations. METHODS: Two observational surveys conducted in Alberta in 2000 and 2006 captured information on cyclist characteristics, including correct helmet use. Prevalence of correct helmet use was compared across multiple factors: age, gender, riding companionship, and environmental factors such as riding location, neighbourhood median family income, and region. Poisson regression analysis was used to relate predictor variables to the prevalence of incorrect helmet use, adjusting for clustering by site of observation. RESULTS: Among helmeted cyclists (n=5862), 15.3% were wearing their helmet incorrectly or were using a non-bicycle helmet. Children (53%) and adults (51%) tended to wear their helmet too far back, while adolescents tended not have their straps fastened (48%). Incorrect helmet use declined approximately 50% over the study period for children and adolescents, but 76% (95% CI 68% to 82%) in adults. Children were 1.8 times more likely to use their helmets incorrectly in 2000 compared with adults, but this effect increased to 3.9 (95% CI 2.9 to 5.4) in 2006. Adolescents were more likely to use their helmets incorrectly in 2006 compared with adults (prevalence ratio 2.76; 95% CI 1.9 to 4.02). Children and adolescents cycling alone, compared with adults cycling alone, cycling at non-school sites and cycling in Edmonton, was associated with incorrect helmet use. CONCLUSIONS: Important factors not previously identified were associated with incorrect bicycle helmet use. This information can be used to target interventions to increase correct use.

A systematic review of correct bicycle helmet use: how varying definitions and study quality influence the results.

BACKGROUND: Bicycle helmets effectively reduce the risk of bicycle-related head injuries and trauma; however, they must fit properly to be effective. Little is known about the prevalence of correctly worn helmets and factors associated with proper helmet use. OBJECTIVE: To examine proper bicycle helmet use through a systematic review. METHODS: Comprehensive searches of electronic medical databases were performed, and completed by grey literature and reference list checks to identify eligible studies. Studies eligible for inclusion had to involve cyclists and report on the prevalence of correct or incorrect helmet use. Two reviewers independently selected studies and data were extracted regarding the prevalence and factors influencing proper helmet wearing of cyclists. RESULTS: An inclusive search strategy led to 2285 prescreened citations; 11 of the studies were finally included in the review. Overall, correct helmet use varied from 46% to 100%, depending on the criteria used by researchers to define proper helmet use; stricter criteria reduced the proportion of properly worn helmets. Adulthood, female sex and educational interventions were associated with correct helmet use in some studies. Self-reported poor helmet fit (OR = 1.96; 95% CI 1.10 to 3.75), posterior positioning of helmet (OR = 1.52; 95% CI 1.02 to 2.26) and helmet loss in crash (OR = 3.25; 95% CI 1.82 to 5.75) increased the risk of head injury. In addition, educational programmes on helmet use in schools increased correct helmet use among schoolchildren. CONCLUSIONS: This systematic review outlines the current state of the literature including the variability in research methodology and definitions used to study proper helmet-wearing behaviour among cyclists.

The distribution of injuries in men's Canada West university football. A 5-year analysis.

We conducted a prospective cohort study from 1993 to 1997 to determine the frequency and severity of injury in men's Canada West university football. The Canadian Intercollegiate Sport Injury Registry was used to document baseline preseason data, daily athlete participation, and subsequent injury from five varsity football teams. An injury was defined as "any injury resulting in one or more complete or partial sessions of time loss" or "any concussion or transient neck neurologic injury." The annual proportion of injured athletes ranged from 53.5% to 60.4%, with a 5-year total of 1,811 injuries. Regression analysis indicated that the rate of nonconcussion, nonneck neurologic injuries increased. Concussion (N = 110), hamstring strain (N = 88), and brachial plexus (N = 84) injuries were the most common, specific injury diagnoses. Knee injuries resulted in the highest rate of severe (greater than or equal to 7 sessions of time loss) injury and resulted in the most time loss (3,350.5 sessions). Ligament sprains and muscle strains and spasms accounted for approximately half of all injury diagnoses. A total of 1,173 injuries (65%) were related to contact between players or between players and other obstacles. Future studies should be conducted to identify risk factors for the ultimate purpose of implementing injury prevention strategies.

Cyclist head and facial injury risk in relation to helmet fit: a case-control study.

INTRODUCTION: We examined the effect of bicycle helmet fit and position on head and facial injuries. METHODS: Cases were helmeted cyclists with a head (n=297) or facial (n=289) injury. Controls were helmeted cyclists with other injuries, excluding the neck. Participants were interviewed in seven Alberta emergency departments or by telephone; injury data were collected from charts. Missing values were imputed using chained equations and custom prediction imputation models. RESULTS: Compared with excellent helmet fit, those with poor fit had increased odds of head injury (odds ratio [OR] = 3.38, 95% confidence interval [CI]: 1.06-10.74). Compared with a helmet that stayed centred, those whose helmet tilted back (OR = 2.90, 95% CI: 1.54-5.47), shifted (OR = 1.91, 95% CI: 1.01-3.63) or came off (OR = 6.72, 95% CI: 2.86-15.82) had higher odds of head injury. A helmet that tilted back (OR = 4.81, 95% CI: 2.74-8.46), shifted (OR = 1.83, 95% CI: 1.04-3.19) or came off (OR = 3.31, 95% CI: 1.24-8.85) also increased the odds of facial injury. CONCLUSION: Our findings have implications for consumer and retail education programs.

TITRE: Risque de blessures à la tête et au visage chez les cyclistes en relation avec l'ajustement du casque : une étude cas-témoins. INTRODUCTION: Nous avons examiné l'effet de l'ajustement et de la position du casque de vélo sur les blessures à la tête et au visage. MÉTHODOLOGIE: Les cas étaient ceux de cyclistes portant un casque qui avaient subi des blessures à la tête (n = 297) ou au visage (n = 289). Les témoins étaient des cyclistes portant un casque qui avaient subi d'autres blessures, à l'exception des blessures au cou. Les participants ont été interrogés dans sept services d'urgence de l'Alberta ou par téléphone. Les données sur les blessures ont été recueillies au moyen des dossiers médicaux. Les valeurs manquantes ont été déduites à l'aide d'équations enchaînées et de modèles personnalisés d'imputation par prédiction. RÉSULTATS: Comparativement aux sujets dont l'ajustement du casque était excellent, ceux dont l'ajustement était mauvais affichaient un plus grand risque de blessures à la tête (rapport de cotes [RC] = 3,38, intervalle de confiance [IC] à 95 % : 1,06 à 10,74). Comparativement aux sujets dont le casque était demeuré bien centré, ceux dont le casque s'était incliné vers l'arrière (RC= 2,90, IC à 95% : 1,54 à 5,47) ou s'était déplacé (RC = 1,91, IC à 95 % : 1,01 à 3,63) et ceux qui avaient perdu leur casque (RC = 6,72, IC à 95 % : 2,86 à 15,82) présentaient un plus grand risque de blessures à la tête. Un casque qui s'était incliné vers l'arrière (RC = 4,81, IC à 95 % : 2,74 à 8,46), s'était déplacé (RC = 1,83, IC à 95 % : 1,04 à 3,19) ou avait été perdu (RC = 3,31, IC à 95% : 1,24 à 8,85) augmentait aussi le risque de blessures au visage. CONCLUSION: Nos observations ont des retombées sur les consommateurs et les programmes d'éducation des détaillants.

The relationship between visibility aid use and motor vehicle related injuries among bicyclists presenting to emergency departments.

BACKGROUND: Little is known about the effectiveness of visibility aids (VAs; e.g., reflectors, lights, fluorescent clothing) in reducing the risk of a bicyclist-motor-vehicle (MV) collision. PURPOSE: To determine if VAs reduce the risk of a bicyclist-MV collision. METHODS: Cases were bicyclists struck by a MV and assessed at Calgary and Edmonton, Alberta, Canada, emergency departments (EDs) from May 2008 to October 2010. Controls were bicyclists with non-MV injuries. Participants were interviewed about their personal and injury characteristics, including use of VAs. Injury information was collected from charts. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for VAs during daylight and dark conditions, and adjusted for confounders using logistic regression. Missing values were imputed using chained equations and adjusted OR estimates from the imputed data were calculated. RESULTS: There were 2403 injured bicyclists including 278 cases. After adjusting for age, sex, type of bicycling (commuting vs. recreational) and bicyclist speed, white compared with black (OR 0.52; 95% CI 0.28, 0.95), and bicyclist self-reported light compared with dark coloured (OR 0.67; 95% CI 0.49, 0.92) upper body clothing reduced the odds of a MV collision during daylight. After imputing missing values, white compared with black (OR 0.57; 95% CI: 0.32, 0.99) and bicyclist self-reported light compared with dark coloured (OR 0.71; 95% CI 0.52, 0.97) upper body clothing remained protective against MV collision in daylight conditions. During dark conditions, crude estimates indicated that reflective clothing or other items, red/orange/yellow front upper body clothing compared with black, fluorescent clothing, headlights and tail lights were estimated to increase the odds of a MV collision. An imputed adjusted analysis revealed that red/orange/yellow front upper body clothing colour (OR 4.11; 95% CI 1.06, 15.99) and tail lights (OR 2.54; 95% CI: 1.06, 6.07) remained the only significant risk factors for MV collisions. One or more visibility aids reduced the odds of a bicyclist MV collision resulting in hospitalization. CONCLUSIONS: Bicyclist clothing choice may be important in reducing the risk of MV collision. The protective effect of visibility aids varies based on light conditions, and non-bicyclist risk factors also need to be considered.

Bicycle helmet use four years after the introduction of helmet legislation in Alberta, Canada.

BACKGROUND: Bicycle helmets reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation targeted at those less than 18 years old on helmet use for all ages in Alberta. METHODS: Two comparable studies were conducted two years before and four years after the introduction of helmet legislation in Alberta in 2002. Bicyclists were observed in randomly selected sites in Calgary and Edmonton and eight smaller communities from June to October. Helmet wearing and rider characteristics were recorded by trained observers. Poisson regression adjusting for clustering by site was used to obtain helmet prevalence (HP) and prevalence ratio (PR) (2006 vs. 2000) estimates. RESULTS: There were 4002 bicyclists observed in 2000 and 5365 in 2006. Overall, HP changed from 75% to 92% among children, 30% to 63% among adolescents and 52% to 55% among adults. Controlling for city, location, companionship, neighborhood age proportion <18, socioeconomic status, and weather conditions, helmet use increased 29% among children (PR = 1.29; 95% CI: 1.20-1.39), over 2-fold among adolescents (PR 2.12; 95% CI: 1.75-2.56), and 14% among adults: (PR = 1.14; CI: 1.02-1.27). CONCLUSIONS: Bicycle helmet legislation was associated with a greater increase in helmet use among the target age group (<18). Though HP increased over 2-fold among adolescents to an estimated 63% in 2006, this percentage was approximately 30% lower than among children <13.

An international review of head and spinal cord injuries in alpine skiing and snowboarding.

BACKGROUND: Alpine skiing and snowboarding are popular winter activities worldwide, enjoyed by participants of all ages and skill levels. There is some evidence that the incidence of traumatic brain injury (TBI) and spinal cord injury (SCI) in these activities may be increasing. These injuries can cause death or severe debilitation, both physically and emotionally, and also result in enormous financial burden to society. Indeed, TBI is the leading cause of death and catastrophic injury in the skiing and snowboarding population. Furthermore, there are severe limitations to therapeutic interventions to restore neurological function after TBI and SCI, and thus the emphasis must be on prevention. OBJECTIVES: (1) To examine the worldwide epidemiology of TBI and SCI in skiing and snowboarding; (2) to describe and examine the effectiveness of prevention strategies to reduce the incidence of TBI and SCI in skiing and snowboarding. SEARCH STRATEGY: Searches were performed on a variety of databases to identify articles relevant to catastrophic central nervous system injury in skiing and snowboarding. The databases included PubMed, Medline, EMBASE, CDSR, ACP Journal Club, DARE, CCTR, SportDiscus, CINAHL, and Advanced Google searches. SELECTION CRITERIA AND DATA COLLECTION: 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. RESULTS: 24 relevant articles, from 10 different countries, were identified. They indicate that the incidence of TBI and SCI in skiing and snowboarding is increasing. The increases coincide with the development and acceptance of acrobatic and high-speed activities on the mountains. There is evidence that helmets reduce the risk of head injury by 22-60%. Head injuries are the most common cause of death among skiers and snowboarders, and young male snowboarders are especially at risk of death from head injury. 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.

Effectiveness of bicycle helmet legislation to increase helmet use: a systematic review.

BACKGROUND: Head injuries related to bicycle use are common and can be serious. They can be prevented or reduced in severity with helmet use; however, education has resulted in modest helmet use in most developed countries. Helmet legislation has been proposed as a method to increase helmet wearing; while this social intervention is thought to be effective, no systematic review has been performed. OBJECTIVES: This review evaluates the scientific evidence for helmet use following legislation to identify the effectiveness of legislative interventions to increase bicycle helmet use among all age groups. SEARCH STRATEGY: Comprehensive searches of CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, British Education Index, LILACS Database, TRIS (Transport Research Information Service), the grey literature, reference lists, and communication with authors was performed to identify eligible studies. SELECTION CRITERIA: Eligible studies for this review were community based investigations including cohort studies, controlled before-after studies, interrupted time series studies, non-equivalent control group studies Data collection and analysis: Two reviewers extracted the data regarding the percentage of helmet use before and after legislation from each study. Individual and pooled odds ratios were calculated along with 95% confidence intervals. MAIN RESULTS: Out of 86 prescreened articles, 25 were potentially relevant to the topic and 11 were finally included in the review. Of 11 studies, eight were published articles, two were published reports, and one was an unpublished article. One additional survey was incorporated following personal communication with the author. While the baseline rate of helmet use among these studies varied between 4% and 59%, after legislation this range changed to 37% and 91%. Helmet wearing proportions increased less than 10% in one study, 10-30% in four studies, and more than 30% in seven studies. While the effectiveness of bicycle helmet legislation varied (n = 11 studies; OR range: 1.2-22), all studies demonstrated higher proportions of helmet use following legislation, particularly when the law was targeted to a specific age group. CONCLUSIONS: Legislation increased helmet use among cyclists, particularly younger age groups and those with low pre-intervention helmet wearing proportions. These results support legislative interventions in populations without helmet legislation.

Bicycle helmet prevalence two years after the introduction of mandatory use legislation for under 18 year olds in Alberta, Canada.

OBJECTIVE: To determine changes in helmet use in cyclists following the introduction of a bicycle helmet law for children under age 18. METHODS: Cyclists were observed by two independent observers from July to August 2004 (post-legislation) in Edmonton, Alberta. The data were compared with a similar survey completed at the same locations and days in July to August 2000 (pre-legislation). Data were collected for 271 cyclists in 2004 and 699 cyclists in 2000. RESULTS: The overall prevalence of helmet use increased from 43% (95% CI 39 to 47%) in 2000 to 53% (95% CI 47 to 59%) in 2004. Helmet use increased in those under 18, but did not change in those 18 and older. In the cluster adjusted multivariate Poisson regression model, the prevalence of helmet use significantly increased for those under age 18 (adjusted prevalence ratio (APR) 3.69, 95% CI 2.65 to 5.14), but not for those 18 years and older (APR 1.17, 95% CI 0.95 to 1.43). CONCLUSION: Extension of legislation to all age groups should be considered.

Quality of information on risk factors reported by ski patrols.

OBJECTIVE: To determine the reliability of reporting of information on risk factors from a standard accident report form used by ski patrols and a follow up mail questionnaire or telephone interview among injured skiers and snowboarders. SETTING: 19 ski areas in the Canadian province of Quebec between November 2001 and April 2002. PARTICIPANTS: 4377 injured skiers and snowboarders seen by the ski patrol, who completed a follow up mail questionnaire or telephone interview. MAIN OUTCOME MEASURES: Kappa and weighted kappa statistics were used to measure the chance corrected agreement for self reported ability, age, skiing time on day of injury, lessons, type of practice, use of helmet at time of injury, and hill difficulty. RESULTS: The kappa value for helmet use at the time of injury was 0.88 (95% confidence interval 0.87 to 0.90) and for other risk factors ranged from 0.45 (skiing time on day of injury) to 0.98 (age). Few differences were seen in reporting by body region of injury. Reporting consistency was lower for respondents who completed telephone interviews compared with those who completed mail questionnaires and those who responded more than four months after the injury. CONCLUSIONS: Moderate to almost perfect agreement, depending on the risk factor, exists between ski patrols' accident report forms and follow up information. Ski patrol reports can be a reliable and readily available source of information on risk factors for skiing and snowboarding.

Skiing and snowboarding injuries in the children and adolescents of Southern Alberta.

OBJECTIVE: To identify injuries and profile the characteristics of injured skiers and snowboarders younger than 18 years of age in Southern Alberta, Canada. DESIGN: Case-series over one year. PARTICIPANTS: Injured skiers and snowboarders younger than 18 years of age presenting to the ski patrol members at each of seven ski areas in Southern Alberta. MAIN OUTCOME MEASURES: Information on injured individuals reporting to the ski patrol at the involved areas was documented on a standardized injury reporting form. Anonymous information was then copied and sent to the University of Calgary Sport Medicine Centre, where the data were analyzed. Proportions of injured skiers and snowboarders with specific characteristics or participating in specific environmental conditions are presented. RESULTS: There were a total of 832 (60.0%) injury reports filed for skiers and 557 (40.1%) for snowboarders, reflecting 1,635 separate injuries. Head injuries were the most frequently reported (19.1% of all regional injuries). The most commonly injured region was the knee among skiers (n = 213; 22.8%) and the wrist among snowboarders (n = 173; 27.8%). Lower extremity injuries in skiers and upper extremity injuries in snowboarders were most common. Younger male skiers and snowboarders reported high proportions of head, neck, and back injuries. CONCLUSION: The lower extremity in skiers and the upper extremity in snowboarders were most susceptible to injury. A cause for concern is the high proportion of head injuries reported for both male skiers and snowboarders of younger age groups. Further study into protective equipment design and function is required.