title: Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study.
abstract: OBJECTIVE
  To determine the effect of helmets on the risk of head and neck injuries in skiers and snowboarders.
  
  
  METHODS
  Matched case-control and case crossover study.
  
  
  METHODS
  19 ski areas in Quebec, Canada, November 2001 to April 2002.
  
  
  METHODS
  1082 skiers and snowboarders (cases) with head and neck injuries reported by the ski patrol and 3295 skiers and snowboarders (controls) with non-head or non-neck injuries matched to cases at each hill.
  
  
  METHODS
  Estimates of matched odds ratios for the effect of helmet use on the risk of any head or neck injury and for people requiring evacuation by ambulance.
  
  
  RESULTS
  The adjusted odds ratio for helmet use in participants with any head injury was 0.71 (95% confidence interval 0.55 to 0.92), indicating a 29% reduction in the risk of head injury. For participants who required evacuation by ambulance for head injuries, the adjusted odds ratio for helmet use was 0.44 (0.24 to 0.81). Similar results occurred with the case crossover design (odds ratio 0.43, 0.09 to 1.83). The adjusted odds ratio for helmet use for participants with any neck injury was 0.62 (0.33 to 1.19) and for participants who required evacuation by ambulance for neck injuries it was 1.29 (0.41 to 4.04).
  
  
  CONCLUSIONS
  Helmets protect skiers and snowboarders against head injuries. We cannot rule out the possibility of an increased risk of neck injury with helmet use, but the estimates on which this assumption is based are imprecise.
authors.affiliation: Alberta Centre for Injury Control and Research, Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 4075 RTF, 8308-114 Street, Edmonton, AB, Canada T6G 2E1. brent.hagel@ualberta.ca
authors.forename: Brent E
authors.initials: BE
authors.lastname: Hagel
authors.forename: I Barry
authors.initials: IB
authors.lastname: Pless
authors.forename: Claude
authors.initials: C
authors.lastname: Goulet
authors.forename: Robert W
authors.initials: RW
authors.lastname: Platt
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Robitaille
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012865:Skiing / Q000293:injuries* / Q000706:statistics & numerical data