title: Major trauma in winter sports: an international trauma database analysis.
abstract: OBJECTIVE
  The aim of this study was to compare the demographics, injury patterns, and outcomes following major trauma between Alpine skiing, snowboarding, and sledding winter sports.
  
  
  METHODS
  An international population-based prospective trauma database (TraumaRegister DGU®) was analyzed for demographic data, types and severity of injuries [body regions, Injury Severity Score (ISS)], early physiology [Glasgow Coma Scale (GCS), blood pressure, body temperature], rescue modality, surgical care, length of stay, and major complications (shock, multiple organ failure mortality). Participating countries included Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands.
  
  
  RESULTS
  A total of 243 winter sport athletes with major trauma were identified (1993-2012), and subjects were divided into Alpine skiers (n = 174), snowboarders (n = 29), and sledders (n = 40). Athletes were predominantly male and presented hypothermic at emergency room arrival, despite a large proportion of air rescue (77 %). Alpine skiing was associated with higher injury severity (ISS 20.8 ± 14.0, p = 0.010) when compared with snowboarding (ISS 18.7 ± 14.0) and sledding (ISS 13.8 ± 9.5). Snowboarding was associated with the highest pre-hospital intubation rate (40.9 %, p = 0.007), despite comparable GCS values and prevalence of loss of consciousness at scene. The injury patterns were different between the three groups. Skiing was associated with head (47.1 %), chest (40.2 %, p = 0.047), and spinal injuries (40.9 %, p = 0.022). Snowboarding was associated with the highest percentage of upper extremity trauma. Sledders had the highest prevalence of facial and lower extremity trauma.
  
  
  CONCLUSIONS
  Alpine skiing, snowboarding, and sledding result in different injury patterns and affect various age groups. Our data suggest an increased risk for chest and spinal injuries in Alpine skiers. Due to high-energy injury mechanisms, all three winter sports involve a risk of severe multiple trauma. While all athlete groups required a high rate of emergency surgery procedures, the observed in-hospital mortality from winter sports remains low.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Pauwels Street 30, 52074, Aachen, Germany. chrweber@ukaachen.de.|Olympic Center Rhineland, Aachen, Germany. chrweber@ukaachen.de.
authors.forename: C D
authors.initials: CD
authors.lastname: Weber
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Pauwels Street 30, 52074, Aachen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Horst
authors.affiliation: Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Pauwels Street 30, 52074, Aachen, Germany.|Olympic Center Rhineland, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hofman
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Pauwels Street 30, 52074, Aachen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Dienstknecht
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Pauwels Street 30, 52074, Aachen, Germany.
authors.forename: H-C
authors.initials: HC
authors.lastname: Pape
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000453:epidemiology*; D003080:Cold Temperature; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D012621:Seasons
keywords: Alpine skiing; Major trauma; Morbidity; Mortality; Sledding; Snowboarding; Trauma registry; Winter sports