The association between removing and reintroducing man-made jumps in terrain parks and severe alpine skiing and snowboarding injuries.

OBJECTIVES: To explore the effect of removing and reintroducing man-made jumps in terrain parks (TPs), on the proportion of severe injuries among alpine skiers and snowboarders in Québec, Canada. DESIGN: Quasi-experimental study. METHODS: Injuries were identified via injury report forms completed by ski patrollers during seasons 2000-2001 to 2016-2017 in Québec ski areas. Severe injuries were defined based on the type of injury or ambulance evacuation. Logistic regression analysis was used to provide adjusted odds ratios (AOR) for the comparison of the time periods before jump removal (PRE) and after jump reintroduction (POST) with the jump removal interval (INT). RESULTS: Compared with INT, the proportion of severe injuries in PRE was not significantly different (AOR: 1.05; 95% CI: 0.85-1.30), but was higher in POST (AOR: 1.76; 95% CI: 1.24-2.51) for ski areas with jump removal. In ski areas without jump removal, there was no change in PRE (AOR: 0.96; 95% CI: 0.87-1.07) and increased odds of severe injuries in POST (AOR: 1.20; 95% CI: 1.07-1.35). A supplementary analysis suggested that removing jumps from TPs has contributed significantly to a reduction in the proportion of severe injuries. This protective effect appears to decline over time. CONCLUSIONS: These results do not suggest that removing jumps from TPs as an effective long-term injury prevention strategy in skiing and snowboarding. Collecting data on exposure could improve our understanding of how removing, introducing or reintroducing man-made jumps in TPs is associated with the risk of minor and severe injuries in TPs and on regular trails.

Physical fitness is associated with better technical performance in adolescent alpine ski racers after controlling for practice time: A retrospective regression analysis.

In an effort to evaluate the mechanisms underpinning performance in alpine ski racing, researchers have focused on the predictive validity of measures derived from fitness assessments. However, a limitation of this literature is the absence of practice time, since prolonged training may naturally develop specific fitness capacities, making some tests of physical ability less predictive of performance. We examine the relationship between fitness tests, practice, and performance using linear regressions with fitness test data, practice history data, and performance results from adolescent alpine ski racers attending professional development academies in the United States (N = 82). Only aerobic capacity (i.e. 20 m shuttle run) was significantly associated with more practice time. After controlling for practice hours, 5.5-6.5% of variance in ski performance was significantly explained by assessments of lower body power (i.e. standing long jump, triple jump), anaerobic capacity (i.e. 60 s box jump), and upper body strength/endurance (i.e. push-ups). Findings highlight the important role of anaerobic power on alpine ski racing performance, which may be developed outside of regular practice, possibly through weight training or physical maturation. The small variance explained by physical/physiological measures suggests that superior ski performance is likely a product of various skills and characteristics (e.g. technical, tactical, perceptual-cognitive, psychosocial).

Training load characteristics and injury and illness risk identification in elite youth ski racing: A prospective study.

PURPOSE: The study aimed to investigate the role of training load characteristics and injury and illness risk in youth ski racing. METHODS: The training load characteristics as well as traumatic injuries, overuse injuries, and illnesses of 91 elite youth ski racers (age = 12.1 ± 1.3 years, mean ± SD) were prospectively recorded over a period of 1 season by using a sport-specific online database. Multiple linear regression analyses were performed to monitor the influence of training load on injuries and illnesses. Differences in mean training load characteristics between preseason, in-season, and post-season were calculated using multivariate analyses of variance. RESULTS: Differences were discovered in the number of weekly training sessions (p = 0.005) between pre-season (4.97 ± 1.57) and post-season (3.24 ± 0.71), in the mean training volume (p = 0.022) between in-season (865.8 ± 197.8 min) and post-season (497.0 ± 225.5 min) and in the mean weekly training intensity (Index) (p = 0.012) between in-season (11.7 ± 1.8) and post-season (8.9 ± 1.7). A total of 185 medical problems were reported (41 traumatic injuries, 12 overuse injuries, and 132 illnesses). The weekly training volume and training intensity was not a significant risk factor for injuries (p > 0.05). Training intensity was found to be a significant risk factor for illnesses in the same week (ß = 0.348; p = 0.044; R²â€¯= 0.121) and training volume represents a risk factor for illnesses in the following week (ß = 0.397; p = 0.027; R²â€¯= 0.157). CONCLUSION: A higher training intensity and volume were associated with increased illnesses, but not with a higher risk of injury. Monitoring training and ensuring appropriate progression of training load between weeks may decrease incidents of illness in-season.

Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study.

BACKGROUND: Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma. MATERIALS AND METHODS: Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15). RESULTS: We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury. CONCLUSIONS: At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.

The Incidence of Pediatric and Adolescent Concussion in Action Sports: A Systematic Review and Meta-Analysis.

BACKGROUND: This was a systematic review and meta-analysis of the incidence of concussion risk in youth athletes involved in action sports (AS). METHODS: A search of PubMed and Web of Science (from January 1980 to August 2020). Titles, abstracts, and full text were screened according to predefined inclusion criteria to find relevant studies. Moreover, the methodological quality of the studies selected was assessed. RESULTS: Nineteen of 1.619 studies were included in the systematic review and 14 in the meta-analysis. Motocross, sailing and snowboarding presented the highest incidence rates per 1000 athlete exposure at 39.22, 3.73 and 2.77 respectively, whereas alpine skiing had the lowest incidence rates resulting in 0.30. Overall risk of concussion was estimated at 0.33 (CI: 0.22, 0.45). Regarding the methodological quality, we have to report that 26.3% of the studies reported the definition of concussion while 36.8% presented age and gender-specific incidence rates. The mechanism of injury and follow up were reported only in one study. CONCLUSIONS: There are significant differences in the rates of incident youth concussion across AS. Despite some limitations, the data from this research can serve as the current sport-specific baseline risk of concussion among youth athletes who practice action sports.

Equipment Became Better in Backcountry Skiing-Did Severity of Injuries Decrease? An Analysis from the Swiss Alps.

Background: Large technical developments in avalanche transceivers as well as in ski-shoe-binding units should make backcountry skiing a safer sport and as a consequence, yield to a decrease in the number and severity of mountain emergency events. Methods: From 2009-2018, a total of 3044 mountain emergencies (953 females and 2091 males) were identified from the SAC (Swiss Alpine Club) central registry while backcountry skiing. These were classified descriptively by cause, whereby the severity of the mountain emergency was quantified with a NACA-Score (National Advisory Committee for Aeronautics Score). Results: A total of 1357 falls (44.6%), 558 emergencies caused by avalanches (18.3%), 408 cases of blocking (13.4%), 214 cases of illnesses (7.0%), 202 cases of losing way (6.6%), 138 cases of a crevasse accident (4.5%), and material failure in 30 cases (1%) were registered. For the remaining 137 cases (4.5%), no classification or rare forms were detected. No substantial sex differences were found in severity of injury, however looking at the two endpoints of the observed time frame, a significant increase in NACA-Score from 2009 to 2018 (2.1 ± 1.8 up to 2.6 ± 2.1, p < 0.01) was detected. Conclusions: The increase in the severity of mountain emergencies while backcountry skiing in the last decade might be due to the fact that too many inexperienced absolve backcountry tours. The tendency might be promoted by the improved material in the way that it seems easier to absolve a tour while underestimating potential hazards.

Leisure-time cross-country skiing is associated with lower incidence of type 2 diabetes: A prospective cohort study.

BACKGROUND: Cross-country skiing is associated with reduction in risk of adverse vascular outcomes, but its association with type 2 diabetes is uncertain. We aimed to assess the associations between leisure-time cross-country skiing habits and incident type 2 diabetes. METHODS: We analysed the data of 2483 middle-aged men with no history of diabetes at baseline in the Kuopio Ischemic Heart Disease prospective study. The frequency, average duration, and intensity of leisure cross-country skiing were assessed at baseline using a 12-month physical activity questionnaire. Hazard ratios (HRs) (95% CIs) for type 2 diabetes were estimated. RESULTS: During a median follow-up of 21.6 years, 539 men developed type 2 diabetes. Type 2 diabetes risk decreased with increasing total volume of cross-country skiing up to 1,215 metabolic equivalent task (MET) hours/year. In analyses adjusted for several established risk factors, when compared with men with no cross-country skiing activity, the HRs (95% CIs) for type 2 diabetes were 0.75 (0.62-0.92) and 0.59 (0.46-0.76) for men who did 1-200 and >200 MET hours/year of cross-country skiing, respectively. Compared with men with no cross-country skiing activity, the corresponding adjusted HRs (95% CIs) for type 2 diabetes were 0.73 (0.60-0.89) and 0.64 (0.50-0.82) for men who did 1-60 and >60 minutes/week of cross-country skiing, respectively. The associations remained consistent following further adjustment for prevalent comorbidities. CONCLUSION: Total volume and duration of leisure-time cross-country skiing are each inversely and independently associated with future type 2 diabetes risk in a male population. Cross-country skiing undertaken as a leisure activity has the potential to promote public health.

Delayed Clinical Manifestation of Parkinson's Disease Among Physically Active: Do Participants in a Long-Distance Ski Race Have a Motor Reserve?

BACKGROUND: Physical activity is associated with reduced risk of Parkinson's disease (PD). The explanations for this association are not completely elucidated. We use long-term PD-incidence data from long-distance skiers to study the relationship between exercise and PD. OBJECTIVE: We aimed to investigate if physical activity is associated with long-term lower risk of PD and if this association could be explained by physically active people being able to sustain more PD neuropathology before clinical symptoms, a motor reserve. METHODS: Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet (n = 197,685), exhibited reduced incidence of PD compared to matched individuals from the general population (n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5-15 years). RESULTS: Vasaloppet skiers (median age 36.0 years [IQR 29.0-46.0], 38% women) had lower incidence of PD (HR: 0.71; 95 % CI 0.56-0.90) compared to non-skiers. When reducing risk for reverse causation by excluding PD cases within the first five years from race participation, there was still a trend for lower risk of PD (HR: 0.80; 95 % CI 0.62-1.03). Further, the PD prevalence converged between skiers and non-skiers after 15 years of follow-up, which is more consistent with a motor reserve in the physically active rather than neuroprotection. CONCLUSIONS: A physical active lifestyle is associated with reduced risk for PD. This association weakens with time and might be explained by a motor reserve among the physically active.

Long distance ski racing is associated with lower long-term incidence of depression in a population based, large-scale study.

Physical activity has been proposed to be beneficial for prevention of depression, although the importance of exercise intensity, sex-specific mechanisms, and duration of the effects need to be clarified. Using an observational study design, following 395,369 individuals up to 21 years we studied whether participation in an ultralong-distance cross-country ski race was associated with lower risk of developing depression. Skiers (participants in the race) and matched non-skiers from the general population (non-participants in the race) were studied after participation (same year for non-participation) in the race using the Swedish population and patient registries. The risk of depression in skiers (n = 197,685, median age 36 years, 38% women) was significantly lower, to nearly half of that in non-skiers (adjusted hazard ratio, HR 0.53) over the follow-up period. Further, a higher fitness level (measured as the finishing time to complete the race, a proxy for higher exercise dose) was associated with lower incidence of depression in men (adjusted HR 0.65), but not in women. Our results support the recommendations of engaging in physical activity as a preventive strategy decreasing the risk for depression in both men and women. Furthermore, the exercise could reduce risk for depression in a dose-dependent matter, in particular in males.

Sudden Cardiac Arrest and Cardiopulmonary Resuscitation with Automated External Defibrillator in the Austrian Mountains: A Retrospective Study.

Background: Few data exist on the likelihood of surviving sudden cardiac arrest in the mountains. The aim of this study was to analyze the epidemiology and outcomes of patients suffering sudden cardiac arrest and undergoing cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) in the Austrian mountains. Materials and Methods: We analyzed all cardiac arrest cases in the Austrian mountains reported in the nationwide Austrian Alpine Police database from October 26, 2005, to December 31, 2015. To obtain information on outcomes, these patient data were manually merged with patient data from the main Austrian referral center for mountain emergencies, Innsbruck Medical University Hospital. Results: Overall, 781 cases of sudden cardiac arrest in the Austrian mountains were recorded. In 136 cases (17%), CPR with AED was attempted. The most frequent activities at the time of sudden cardiac arrest were hiking (n = 63, 46%) and skiing or snowboarding (n = 44, 32%). In the nationwide Austrian Alpine Police database, only 4 (3%) patients survived, whereas in the Innsbruck Medical University Hospital database, there were seven survivors who received CPR and AED. All survivors had received immediate CPR with an AED. Five patients had good neurological outcome (cerebral performance category 1-2). Conclusions: In the Austrian mountains, CPR was attempted in less than 20% of sudden cardiac arrest cases. The few that survived had received immediate CPR with an AED. To better understand the circumstances and outcome of sudden cardiac arrest in the mountains, out-of hospital and in-hospital data should be linked.

Are Risk-Taking and Ski Helmet Use Associated with an ACL Injury in Recreational Alpine Skiing?

According to the risk compensation hypothesis, the use of a ski helmet might provide a false sense of security, resulting in a riskier behavior by skiing faster or more aggressively, which might lead to an increased injury risk. Injury of the anterior cruciate ligament (ACL) is a common diagnosis in downhill skiers. Thus, the aim of the study was to evaluate the potential impact of risk-taking and ski helmet use on ACL injury risk in recreational skiing. Eighty-two ACL injured and 446 uninjured skiers with a mean age of 37.3 ± 11.9 years (52% females) were surveyed during the winter season 2018/19 about age, sex, self-reported risk-taking behavior, self-reported skill level, perceived speed, and ski helmet use. Multiple regression analysis revealed that older age (OR: 1.3, 95% CI: 1.2-1.4), riskier behavior (OR: 5.4, 95% CI: 2.8-10.5), and lower skill level (OR: 6.7, 95% CI: 3.4-13.3) were found to be factors associated with ACL injury, while ski helmet use was not. In conclusion, no support for the risk compensation hypothesis was found with regard to ACL injuries. Therefore, we doubt that ski helmet use increases the risk for ACL injury and recommend wearing a ski helmet due to reported protective effects.

Risk of Death and Major Injury from Natural Winter Hazards in Helicopter and Snowcat Skiing in Canada.

INTRODUCTION: Guests and guides partaking in helicopter and snowcat skiing (collectively known as mechanized skiing) are exposed to numerous natural winter hazards that can result in injury or death, but detailed quantitative risk estimates are currently lacking. This lack represents a considerable barrier for evaluating existing risk management practices and implementing evidence-based improvements. METHODS: We collected historical incident and exposure information from mechanized skiing operations in Canada to perform a retrospective risk analysis. Our analysis dataset includes 713 incidents that resulted in injuries or fatalities among guests or guides during a total of 3,258,000 skier days from the 1970 to 2016 winter season. RESULTS: Overall risk of death from natural winter hazards in mechanized skiing was 18.6 fatalities per million skier days (1997-2016). Although the risk of death from avalanches decreased substantially over the entire study period, avalanches remain the largest contributor to the overall risk of death (77%), followed by tree wells and other non-avalanche-related snow immersions. The risk of death from avalanches in snowcat skiing is about half of that in helicopter skiing, but other snow immersion fatalities are more common. The risk of major injury to guests is primarily associated with other falls and collisions. The risk of major injury for guides is higher in snowcat skiing than in helicopter skiing. CONCLUSION: We recommend the design of an industry-wide incident and near-miss reporting system to support evidence-based improvements of safety practices.

Helmet use is associated with higher Injury Severity Scores in alpine skiers and snowboarders evaluated at a Level I trauma center.

BACKGROUND: There is uncertainty regarding the efficacy of ski helmets in preventing traumatic injury. We investigated the relationship between helmet use, injury types, and injury severity among skiers and snowboarders. METHODS: The trauma registry at a Northeast American College of Surgeons Level I trauma center was queried by International Classification of Diseases Codes-9th or 10th Revision for skiing and snowboarding injury between 2010 and 2018. The primary exposure was helmet use and primary outcome was severe injury (Injury Severity Score >15). We performed univariate and multivariable logistic regression to assess for injury types and severity associated with helmet use. RESULTS: Seven hundred twenty-one patients (65% helmeted, 35% unhelmeted) met inclusion criteria. Helmet use doubled during the study period (43% to 81%, p < 0.001), but the rate of any head injury did not significantly change (49% to 43%, p = 0.499). On multivariable regression, helmeted patients were significantly more likely to suffer severe injury (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.30-3.11), intracranial hemorrhage (OR, 1.81; 95% CI, 1.10-2.96), chest injury (OR, 1.66; 95% CI, 1.05-2.61), and/or lumbosacral spine injury (OR, 1.84; 95% CI, 1.04-3.25) than unhelmeted patients. Helmeted patients were half as likely to suffer cervical spine injury (OR, 0.51; 95% CI, 0.30-0.89) and a third as likely to sustain skull fracture and/or scalp laceration (OR, 0.30; 95% CI, 0.14-0.64). More patients who hit a stationary object were helmeted compared with those who fell from standing height onto snow (70% vs. 56% respectively, p < 0.001). After adjustment, hitting a stationary object was the injury mechanism most significantly associated with severe injury (OR, 2.80; 95% CI, 1.79-4.38). CONCLUSION: Helmeted skiers and snowboarders evaluated at a Level I trauma center were more likely to suffer severe injury, including intracranial hemorrhage, as compared with unhelmeted participants. However, they were less likely to sustain skull fractures or cervical spine injuries. Helmeted patients were also more likely to hit a stationary object. Our findings reinforce the importance of safe skiing practices and trauma evaluation after high-impact injury, regardless of helmet use. LEVEL OF EVIDENCE: Prognostic and epidemiological, level IV.

Leisure-time cross-country skiing is associated with lower incidence of hypertension: a prospective cohort study.

OBJECTIVE: The prospective relationship between cross-country skiing and hypertension is uncertain. We aimed to assess the associations of leisure time cross-country skiing habits with incident hypertension in a general population. METHODS: The frequency, average duration, and intensity of leisure cross-country skiing were assessed at baseline using a 12-month physical activity questionnaire in the Kuopio Ischemic Heart Disease prospective study of 1809 middle-aged men without hypertension. Hazard ratios [95% confidence intervals (CIs)] were calculated. RESULTS: New onset diagnosis of hypertension was observed in 279 participants during a median (interquartile range) follow-up of 24.7 (18.1-26.8) years. Total volume and duration of cross-country skiing were continuously associated with hypertension risk. In analyses adjusted for hypertension risk factors, when compared with men with no cross-country skiing activity, the hazard ratios (95% CIs) of incident hypertension were 0.75 (0.57-0.99) and 0.57 (0.41-0.79) for men who did 1-200 and more than 200 MET hours/year of cross-country skiing, respectively. Compared with men with no cross-country skiing activity, the corresponding adjusted hazard ratios (95% CIs) for incident hypertension were 0.72 (0.55-0.94) and 0.62 (0.44-0.86) for men who did 1-60 min/week and more than 60 min/week of cross-country skiing, respectively. In subsidiary analyses, there were age-adjusted associations of cross-country skiing habits with risk of stroke and acute coronary events, but these were attenuated on further adjustment for several confounders. Cross-country skiing habits were associated with reduced risk of type 2 diabetes. CONCLUSION: Total volume as well as duration of leisure time cross-country skiing are each continuously, inversely, and independently associated with future risk of hypertension in a white male population.

Velocity distribution of women's 30-km cross-country skiing during Olympic Games from 2002-2014.

BACKGROUND: Within several investigated endurance sport disciplines the distribution of load of the best competitors has a manner of evenly or slightly rising velocity values. Unfortunately many other competitors have usually diminishing values or when they are very poor they have evenly values. The aim of this study was to investigate distribution of velocity within 30-km cross-country female skiers. METHODS: Cross-country skiing runs were investigated of Olympic Games 2002-2014 (Salt Lake City, Turin, Vancouver, Sochi). At every race two 15 km or three 10 km loops of the same vertical profile were taken into account. The competitors were divided onto: A) winners; B) medalists; C) competitors who obtained places 4 to 10 at the finish line (medium runners); and D) competitors who obtained places 11 to 30 at the finish line (poor runners). Velocity data presented on the web pages of several institutions were utilized. RESULTS: The competitors had their velocity distributed in a manner with usually diminishing values. While comparing velocity of sequential loops with the mean velocity the difference for the poor runners reached the value of almost 6%, which was too high. There was significant (usually negative) correlation coefficient between values of velocity deviation for the first and second loops and the mean value of velocity for the entire distance for the better runners and mixed, i.e. positive and negative values for the poorer runners. CONCLUSIONS: It was postulated investigations of velocity distribution should be introduced in coaching in order to inform competitors about their running. This advises is especially important for the poorer runners. Up to now cross-country skiers run for themselves. It should be discussed whether the tactics used by road and track runners, i.e. running with pace makers, can be introduced in cross country skiing. Also the use of a drone during training can be used in order to maintain proper pace.

Avalanche Safety Practices Among Backcountry Skiers and Snowboarders in Jackson Hole in 2016.

INTRODUCTION: Carrying standard safety gear (beacon, probe, and shovel), planning a route of descent, and recreating with companions can help to mitigate the risk of injury or death resulting from avalanches in the backcountry. The goal of this study was to identify factors associated with performance of these safety practices. METHODS: A convenience sample of backcountry skiers and snowboarders was surveyed in 2016 at the backcountry gates of Jackson Hole Mountain Resort. Each participant was surveyed on characteristics including skill level, sex, age, prior avalanche education, and residency in the Jackson Hole area. Safety practices were also measured against avalanche hazard forecasts. Correlations were assessed using Fisher's exact testing. RESULTS: A total of 334 participants were surveyed. Factors associated with carrying avalanche safety gear included higher expertise, being a resident of the Jackson Hole area, and prior avalanche education. Factors associated with having a planned route of descent included higher expertise and being a resident of the Jackson Hole area. Factors associated with recreating with companions included younger age and lower expertise. Sex had no association with any of the surveyed safety practices. Participants were less likely to carry avalanche safety gear on low avalanche hazard days. CONCLUSIONS: Certain individual characteristics of backcountry skiers and snowboarders are associated with increased frequency of adherence to recommended safety practices. These findings suggest that particular categories of backcountry recreationists may benefit from further avalanche safety education. The results of this study could help direct future educational efforts among backcountry recreationists.

Chair Lift Falls and Injuries in Children.

OBJECTIVE: The objective of this study was to compare demographic injury and treatment characteristics of hospitalized pediatric cases of falls from chair lifts to cases of other ski and snowboarding injuries and identify potential interventions for preventing falls from chair lifts. METHODS: Retrospective query of the trauma registry of Utah's only pediatric trauma center for children younger than 18 years requiring hospitalization for a ski or snowboarding injury from November 2004 to February 2014. RESULTS: There were 443 cases of hospitalized ski and snowboarding injuries during the study period. Twenty-nine cases (7%) fell from height while riding a chair lift. Children falling from chair lifts were more likely to be younger (6.9 years vs 12.1, P < 0.0001), female (41% vs 20%, P < 0.01), and elicit trauma team activation (72% vs 34%, P = <0.0001) but were less frequently treated in the operating room (14 vs 24%, P = 0.02) than children with other ski and snowboarding injuries. There were no differences in mortality, injury severity score, length of hospital stay, or airway intubation outside the operating room. When stated (11/29 cases), mean estimated height of fall from lift was 26 feet. The most common body region in chair lift falls with a significant injury (abbreviated injury scale, ≥3) was lower extremity (4/29, all femur fractures). Patient age discriminated chair lift falls well (area under the receiver operating characteristic curve, 0.87) with age of 7 years and below predicting chair lift fall with a sensitivity of 76% and a specificity of 91%. CONCLUSIONS: Injuries requiring hospitalization after falls from chair lifts occur at regulated facilities and are more common in younger female children when compared with other ski and snowboarding injuries. Interventions for reducing falls from chair lifts may be most effective applied to children 7 years and younger.

Evaluación postural y análisis del equilibrio en principiantes de esquí nórdico / Postural evaluation and balance analysis in nordic skiing beginners

Se trata de un estudio de diseño transversal con evaluación del control postural antes-después de un curso de iniciación al esquí nórdico (5 jornadas, 6h/día), a un grupo experimental de 25 sujetos, participantes de la formación, y un grupo control de 8 sujetos. Se pretende evaluar el efecto de un entrenamiento inicial de esquí nórdico sobre el control postural en jóvenes deportistas. La estabilidad corporal se evaluó por medio de un test estabilométrico, calculando el área de desviación del centro de presiones por medio de una plataforma de fuerzas con sensores electrónicos. No se aprecian diferencias significativas en el grado de mejora del equilibrio entre el grupo experimental y el grupo control. Nuevos estudios con una mayor exigencia en la formación en esquí nórdico y un mayor número de sujetos en el grupo control son requeridos (AU)

Cross-sectional study with evaluation of postural control before and after a course of initiation to Nordic skiing (5 days, 6 hours per day). The sample consisted of an experimental group of 25 subjects participated in the training and a control group of 8 subjects. It is intended to evaluate the effect of initial training of Nordic skiing on postural control in young athletes. The physical stability was evaluated by a stabilometric test, calculating the deviation of the area of the center of pressures by the use of a force platform with electronic sensors. No significant differences were observed in the degree of improvement of the balance between the experimental group and the control group. New studies with a greater emphasis on training in Nordic skiing and a greater number of subjects in the control group are required (AU)

The spectrum of pediatric injuries sustained in snow sports.

BACKGROUND: Snow sports are popular among children but carry the potential for significant injury. Head injuries are less common than fractures and sprains but may be fatal. Helmets are recommended for all snow sports, and yet their effectiveness remains unknown. We aimed to evaluate the spectrum of injuries sustained at three large alpine resorts and to assess the effect of helmet usage on injury severity. METHODS: We performed a retrospective analysis of prospectively collected pediatric trauma data (2005-2015) from the three largest alpine resorts in our state. Data were analyzed using Spearman's correlation, chi-square, and odds ratio. RESULTS: A total of 6299 incidents were reviewed. Skiers accounted for 3821 (60.7%) patients, while snowboarders accounted for 2422 (38.5%) patients. More than half (53.5%) of the injuries were related to falls, predominantly affecting knees in skiers and wrists in snowboarders. Overall, helmet usage decreased with age (p<0.001), though helmet uptake was positively associated with higher level of ability in both skiers and snowboarders (p<0.001). Concussions in both skiers and snowboarders were inversely correlated with the rates of helmet usage (p<0.05). CONCLUSION: Helmet usage was associated with reduced rates of concussion. However, helmet usage decreased with age. We advocate for promotion of helmet usage, using mandatory guidelines, across all pediatric age groups. LEVEL OF EVIDENCE: Level II - Retrospective study.

Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network.

AIM: Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. METHODS: Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. RESULTS: 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40-65] vs. 66 [52-79] years, p<0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p<0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p<0.001) and the time to the first electric shock was shorter (7.5min vs 14min, p<0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p<0.001, RR=3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42-4.81, p=0.002). CONCLUSION: Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests.