The effectiveness of helmet wear in skiers and snowboarders: a systematic review.
OBJECTIVE
To summarise the best available evidence to determine the impact of helmet use on head injuries, neck injuries and cervical spine injuries in skiers and snowboarders.


METHODS
Relevant publications were identified through electronic searches of MEDLINE, PubMed, EMBASE, CINAHL and the Cochrane Library databases (1966-2009) in addition to manual reference checks of all included articles.


METHODS
45 articles were identified through our systematic literature search. Of these, 10 studies met the inclusion criteria after two levels of screening. Two independent reviewers critically appraised the studies. Data were extracted on the primary outcomes of interest: head injury, neck injury and cervical spine injury. Studies were assessed for quality by the criteria of Downs and Black.


RESULTS
Studies reviewed indicate that helmet wear reduces the risk of head injuries in skiing and snowboarding. Four case-control studies reported a reduction in the risk of head injury with helmet use ranging from 15% to 60%. Another cohort study found a significantly lower incidence of head injuries involving loss of consciousness in helmet users (p<0.05). The five remaining studies suggested a major protective effect of helmets by indicating that none or few of the head-injured and deceased participants wore a helmet.


CONCLUSIONS
There is strong evidence to support the protective value of helmets in reducing the risk of head injuries in skiing and snowboarding. There is no good evidence to support the claim that the use of helmets leads to an increase risk of cervical spine injuries or neck injuries.
Division of Neurosurgery, St Michael's Hospital, 30 Bond Street, Toronto, ON M5W 1W8, Canada. injuryprevention@smh.ca
Michael D
MD
Cusimano
Judith
J
Kwok
D002574:Cervical Vertebrae / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000517:prevention & control*; D004812:Epidemiologic Methods; D006260:Head Protective Devices; D006801:Humans; D019838:Neck Injuries / Q000209:etiology*; D040242:Risk Reduction Behavior; D012865:Skiing / Q000293:injuries*