title: Sledding-related injuries among children requiring emergency treatment.
abstract: OBJECTIVE
  The aims of the study were to describe sledding-related injuries among children requiring emergency treatment and assess the use of safety measures before and after these injuries.
  
  
  METHODS
  This is a study of a consecutive series of patients treated for sledding-related injuries in the emergency department of a large, urban, academic children's hospital during a 5-year period. Follow-up contact with patients' families was made by telephone or mail within 2 months after the injury.
  
  
  RESULTS
  One hundred sixty-eight children were treated for sledding-related injuries during the study period. Children ranged in age from 2 to 18 years (mean +/- SD, 9.1 +/- 3.8 years). The most common mechanism of injury was a collision with a stationary object (45.2%). The area of the body most commonly injured was the head/neck (53.6%). Soft tissue injuries were the most common type of injury (43.4%). Children 6 years or younger were more likely to sustain a head/neck injury (P < 0.001; relative risk [RR], 2.60; 95% confidence interval [CI], 1.46-4.64) and lacerations (P < 0.001; RR, 2.45; 95% CI, 1.58-3.82) than older children. Children 7 to 18 years were more likely to sustain an extremity injury (P < 0.005; RR, 1.39; 95% CI, 1.17-1.65), a fracture or dislocation (P < 0.05; RR, 1.31; 95% CI, 1.10-1.55), and a fall off a sled (P < 0.05, RR, 1.30; 95% CI, 1.08-1.55) than younger children. Children 7 to 18 years were also more likely to be admitted to the hospital (P < 0.05, RR, 1.39; 95% CI, 1.20-1.62) than younger children. Helmet use occurred in only 3.0% of the cases. No other safety equipment was used. Sixty-five percent of injuries occurred when adult supervision was present. After the injury, helmet use was reported to be 25.3%, representing a statistically significant increase (P < 0.001). Other safety measures implemented after the injury include change in behavior on the sled (59.5%) and change in location of sledding activity (19.2%). Only 1.0% of parents reported increased adult supervision after the injury event.
  
  
  CONCLUSIONS
  More than 50% of sledding-related injuries were to the head/neck region, but only 3% of patients were wearing a helmet at the time of injury. A program to increase helmet use while sledding could have a significant impact on reducing head injuries. Because most injuries occurred when sledders struck a stationary object in their path, checking the sledding location for the presence of obstacles is also an important preventive measure.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospitals and Clinics, St Paul, MN, USA.
authors.forename: Henry W
authors.initials: HW
authors.lastname: Ortega
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Shields
authors.forename: Gary A
authors.initials: GA
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001134:Arm Injuries / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D022125:Lacerations / Q000453:epidemiology; D007869:Leg Injuries / Q000453:epidemiology; D008297:Male; D009820:Ohio / Q000453:epidemiology; D011446:Prospective Studies; D038161:Snow Sports / Q000293:injuries*