title: A 13-year analysis from Switzerland of non-fatal sledging (sledding or tobogganing) injuries.
abstract: BACKGROUND
  Winter sports have evolved from an upper class activity to a mass industry. Especially sledging regained popularity at the start of this century, with more and more winter sports resorts offering sledge runs. This study investigated the rates of sledging injuries over the last 13 years and analysed injury patterns specific for certain age groups, enabling us to make suggestions for preventive measures.
  
  
  METHODS
  We present a retrospective analysis of prospectively collected data. From 1996/1997 to 2008/2009, all patients involved in sledging injuries were recorded upon admission to a Level III trauma centre. Injuries were classified into body regions according to the Abbreviated Injury Scale (AIS). The Injury Severity Score (ISS) was calculated. Patients were stratified into 7 age groups. Associations between age and injured body region were tested using the chi-squared test. The slope of the linear regression with 95% confidence intervals was calculated for the proportion of patients with different injured body regions and winter season.
  
  
  RESULTS
  4956 winter sports patients were recorded. 263 patients (5%) sustained sledging injuries. Sledging injury patients had a median age of 22 years (interquartile range [IQR] 14-38 years) and a median ISS of 4 (IQR 1-4). 136 (51.7%) were male. Injuries (AIS ≥ 2) were most frequent to the lower extremities (n=91, 51.7% of all AIS ≥ 2 injuries), followed by the upper extremities (n=48, 27.3%), the head (n=17, 9.7%), the spine (n=7, 4.0%). AIS ≥ 2 injuries to different body regions varied from season to season, with no significant trends (p>0.19). However, the number of patients admitted with AIS ≥ 2 injuries increased significantly over the seasons analysed (p=0.031), as did the number of patients with any kind of sledging injury (p=0.004). Mild head injuries were most frequent in the youngest age group (1-10 years old). Injuries to the lower extremities were more often seen in the age groups from 21 to 60 years (p<0.001).
  
  
  CONCLUSIONS
  Mild head trauma was mainly found in very young sledgers, and injuries to the lower extremities were more frequent in adults. In accordance with the current literature, we suggest that sledging should be performed in designated, obstacle-free areas that are specially prepared, and that children should always be supervised by adults. The effect of routine use of helmets and other protective devices needs further evaluation, but it seems evident that these should be obligatory on official runs.
authors.affiliation: Department of Surgery, Regional Hospital Frutigen, Frutigen, Switzerland. Electronic address: dominik.heim@spitalfmi.ch.
authors.forename: Dominik
authors.initials: D
authors.lastname: Heim
authors.forename: Katrin
authors.initials: K
authors.lastname: Altgeld
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Hasler
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000145:classification; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification*; D012189:Retrospective Studies; D038161:Snow Sports / Q000293:injuries* / Q000706:statistics & numerical data; D013557:Switzerland / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data*; D055815:Young Adult