title: Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital.
abstract: OBJECTIVE
  Helmet use has been associated with fewer hospital visits among injured skiers and snowboarders, but there remains no evidence that helmets alter the intracranial injury patterns. The authors hypothesized that helmet use among skiers and snowboarders reduces the incidence of head injury as defined by findings on head CT scans.
  
  
  METHODS
  The authors performed a retrospective review of head-injured skiers and snowboarders at 2 Level I trauma centers in New England over a 6-year period. The primary outcome of interest was intracranial injury evident on CT scans. Secondary outcomes included the following: need for a neurosurgical procedure, presence of spine injury, need for ICU admission, length of stay, discharge location, and death.
  
  
  RESULTS
  Of the 57 children identified who sustained a head injury while skiing or snowboarding, 33.3% were wearing a helmet at the time of injury. Of the helmeted patients, 5.3% sustained a calvarial fracture compared with 36.8% of the unhelmeted patients (p = 0.009). Although there was a favorable trend, there was no significant difference in the incidence of epidural hematoma, subdural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, or contusion in helmeted and unhelmeted patients. With regard to secondary outcomes, there were no significant differences between the 2 groups in percentage of patients requiring neurosurgical intervention, percentage requiring admission to an ICU, total length of stay, or percentage discharged home. There was no difference in the incidence of cervical spine injury. There was 1 death in an unhelmeted patient, and there were no deaths among helmeted patients.
  
  
  CONCLUSIONS
  Among hospitalized children who sustained a head injury while skiing or snowboarding, a significantly lower number of patients suffered a skull fracture if they were wearing helmets at the time of the injury.
authors.affiliation: Division of Neurosurgery, University of Vermont, Burlington, Vermont 05401, USA. anand.rughani@mail.mcgill.ca
authors.forename: Anand I
authors.initials: AI
authors.lastname: Rughani
authors.forename: Chih-Ta
authors.initials: CT
authors.lastname: Lin
authors.forename: Wiliam J
authors.initials: WJ
authors.lastname: Ares
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Cushing
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horgan
authors.forename: Bruce I
authors.initials: BI
authors.lastname: Tranmer
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Jewell
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Florman
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012865:Skiing / Q000293:injuries*; D012886:Skull / Q000293:injuries; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D013124:Spinal Injuries / Q000209:etiology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult