title: Cohort Study on the Association Between Helmet Use and Traumatic Brain Injury in Snowboarders From a Swiss Tertiary Trauma Center.
abstract: BACKGROUND
  Since the introduction of helmets in winter sports there is on-going debate on whether they decrease traumatic brain injuries (TBI).
  
  
  METHODS
  This cohort study included 117 adult (≥ 16 years) snowboarders with TBI admitted to a level I alpine trauma center in Switzerland between 2000/2001 and 2010/2011. The primary objective was to examine the association between helmet use and moderate-to-severe TBI. Secondary objectives were to describe the epidemiology of TBI during the past decade in relation to increased helmet use.
  
  
  RESULTS
  Of 691 injured snowboarders evaluated, 117 (17%) suffered TBI. Sixty-six percent were men (median age, 23 years). Two percent of accidents were fatal. Ninety-two percent of patients sustained minor, 1% moderate, and 7% severe TBI according to the Glasgow coma scale. Pathologic computed tomography findings were present in 16% of patients, 26% of which required surgery. Eighty-three percent of TBIs occurred while riding on-slope. There was no trend in the TBI rate during the studied period, although helmet use increased from 10% to 69%. Comparing patients with and without a helmet showed no significant difference in odds ratios for the severity of TBI. However, of the 5 patients requiring surgery only 1 was wearing a helmet. Off-piste compared with on-slope snowboarders showed an odds ratio of 26.5 (P = 0.003) for sustaining a moderate-to-severe TBI.
  
  
  CONCLUSIONS
  Despite increased helmet use we found no decrease in TBI among snowboarders. The possibility of TBI despite helmet use and the dangers of riding off-piste should be a focus of future prevention programs.
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland. Electronic address: rebecca.hasler@gmail.com.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Hasler
authors.affiliation: Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Baschera
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Taugwalder
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
authors.affiliation: Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
mesh_terms: D000293:Adolescent; D000328:Adult; D020201:Brain Hemorrhage, Traumatic / Q000453:epidemiology* / Q000601:surgery; D015331:Cohort Studies; D003128:Coma / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D012865:Skiing / Q000293:injuries*; D013557:Switzerland / Q000453:epidemiology; D014193:Trauma Centers; D055815:Young Adult
keywords: Helmet; Snowboarding; TBI; Traumatic brain injury