title: An evidence-based review: efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders.
abstract: BACKGROUND
  Approximately 600,000 ski- and snowboarding-related injuries occur in North America each year, with head injuries accounting for up to 20% of all injuries. Currently, there are no major institutional recommendations regarding helmet use for skiers and snowboaders in the United States, in part owing to previous conflicting evidence regarding their efficacy. The objective of this review was to evaluate existing evidence on the efficacy of safety helmets during skiing and snowboarding, particularly in regard to head injuries, neck and cervical spine injuries, and risk compensation behaviors. These data will then be used for potential recommendations regarding helmet use during alpine winter sports.
  
  
  METHODS
  The PubMed, Cochrane Library, and EMBASE databases were searched using the search string helmet OR head protective devices AND (skiing OR snowboarding OR skier OR snowboarder) for articles on human participants of all ages published between January 1980 and April 2011. The search yielded 83, 0, and 96 results in PubMed, Cochrane Library, and EMBASE, respectively. Studies published in English describing the analysis of original data on helmet use in relation to outcomes of interest, including death, head injury, severity of head injury, neck or cervical spine injury, and risk compensation behavior, were selected. Sixteen published studies met a priori inclusion criteria and were reviewed in detail by authors.
  
  
  RESULTS
  Level I recommendation is that all recreational skiers and snowboarders should wear safety helmets to reduce the incidence and severity of head injury during these sports. Level II recommendation/observation is that helmets do not seem to increase risk compensation behavior, neck injuries, or cervical spine injuries among skiers and snowboarders. Policies and interventions to increase helmet use should be promoted to reduce mortality and head injury among skiers and snowboarders.
  
  
  CONCLUSIONS
  Safety helmets clearly decrease the risk and severity of head injuries in skiing and snowboarding and do not seem to increase the risk of neck injury, cervical spine injury, or risk compensation behavior. Helmets are strongly recommended during recreational skiing and snowboarding.
authors.affiliation: Center for Surgery Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. ahaider1@jhmi.edu
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Taimur
authors.initials: T
authors.lastname: Saleem
authors.forename: Jaroslaw W
authors.initials: JW
authors.lastname: Bilaniuk
authors.forename: Robert D
authors.initials: RD
authors.lastname: Barraco
mesh_terms: D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000517:prevention & control*; D006260:Head Protective Devices; D006801:Humans; D019838:Neck Injuries / Q000453:epidemiology* / Q000517:prevention & control*; D012309:Risk-Taking; D012865:Skiing / Q000293:injuries*