Nicole T. R. Romanow

Characteristics of injuries sustained by snowboarders in a terrain park

Objective:To determine injured body regions and injury type resulting from snowboarding on aerial and nonaerial terrain park features and the accuracy of ski patrol assessments compared with physician diagnoses. Design:Case series study. Setting:An Alberta terrain park during the 2008-2009 and 2009-2010 seasons. Patients:There were 333 snowboarders injured on features (379 injuries). Assessment of Risk Factors:Aerial or nonaerial terrain park feature used at injury, injured body region, injury type, and additional risk factors were recorded from ski patrol Accident Report Forms, emergency department medical records, and telephone interviews. Measures:Odds of injury to body regions and injury types on aerial versus nonaerial features were calculated using multinomial logistic regression. Accuracy of ski patrol injury assessments was examined through sensitivity, specificity, and kappa (&kgr;) statistics. Results:The wrist was the most commonly injured body region (20%), and fracture was the most common injury type (36%). Compared with the upper extremity, the odds of head/neck [odds ratio (OR), 2.58; 95% confidence interval (CI), 1.37-4.85] and trunk (OR, 3.65; 95% CI, 1.68-7.95) injuries were significantly greater on aerial features. There was no significant association between aerial versus nonaerial feature and injury type. The accuracy of ski patrol injury assessment was higher for injured body region (&kgr; = 0.65; 95% CI, 0.54-0.75) than for injury type (&kgr; = 0.29; 95% CI, 0.22-0.37). Conclusions:Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features. Investigators should acknowledge potential misclassification when using ski patrol injury assessments.

Feature-specific terrain park-injury rates and risk factors in snowboarders: a case–control study

Background Snowboarding is a popular albeit risky sport and terrain park (TP) injuries are more severe than regular slope injuries. TPs contain man-made features that facilitate aerial manoeuvres. The objectives of this study were to determine overall and feature-specific injury rates and the potential risk factors for TP injuries. Methods Case–control study with exposure estimation, conducted in an Alberta TP during two ski seasons. Cases were snowboarders injured in the TP who presented to ski patrol and/or local emergency departments. Controls were uninjured snowboarders in the same TP. κ Statistics were used to measure the reliability of reported risk factor information. Injury rates were calculated and adjusted logistic regression was used to calculate the feature-specific odds of injury. Results Overall, 333 cases and 1261 controls were enrolled. Reliability of risk factor information was κ>0.60 for 21/24 variables. The overall injury rate was 0.75/1000 runs. Rates were highest for jumps and half-pipe (both 2.56/1000 runs) and lowest for rails (0.43/1000 runs) and quarter-pipes (0.24/1000 runs). Compared with rails, there were increased odds of injury for half-pipe (OR 9.63; 95% CI 4.80 to 19.32), jumps (OR 4.29; 95% CI 2.72 to 6.76), mushroom (OR 2.30; 95% CI 1.20 to 4.41) and kickers (OR 1.99; 95% CI 1.27 to 3.12). Conclusions Higher feature-specific injury rates and increased odds of injury were associated with features that promote aerial manoeuvres or a large drop to the ground. Further research is required to determine ways to increase snowboarder safety in the TP.

The relationship between visibility aid use and motor vehicle related injuries among bicyclists presenting to emergency departments.

BACKGROUND Little is known about the effectiveness of visibility aids (VAs; e.g., reflectors, lights, fluorescent clothing) in reducing the risk of a bicyclist-motor-vehicle (MV) collision. PURPOSE To determine if VAs reduce the risk of a bicyclist-MV collision. METHODS Cases were bicyclists struck by a MV and assessed at Calgary and Edmonton, Alberta, Canada, emergency departments (EDs) from May 2008 to October 2010. Controls were bicyclists with non-MV injuries. Participants were interviewed about their personal and injury characteristics, including use of VAs. Injury information was collected from charts. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for VAs during daylight and dark conditions, and adjusted for confounders using logistic regression. Missing values were imputed using chained equations and adjusted OR estimates from the imputed data were calculated. RESULTS There were 2403 injured bicyclists including 278 cases. After adjusting for age, sex, type of bicycling (commuting vs. recreational) and bicyclist speed, white compared with black (OR 0.52; 95% CI 0.28, 0.95), and bicyclist self-reported light compared with dark coloured (OR 0.67; 95% CI 0.49, 0.92) upper body clothing reduced the odds of a MV collision during daylight. After imputing missing values, white compared with black (OR 0.57; 95% CI: 0.32, 0.99) and bicyclist self-reported light compared with dark coloured (OR 0.71; 95% CI 0.52, 0.97) upper body clothing remained protective against MV collision in daylight conditions. During dark conditions, crude estimates indicated that reflective clothing or other items, red/orange/yellow front upper body clothing compared with black, fluorescent clothing, headlights and tail lights were estimated to increase the odds of a MV collision. An imputed adjusted analysis revealed that red/orange/yellow front upper body clothing colour (OR 4.11; 95% CI 1.06, 15.99) and tail lights (OR 2.54; 95% CI: 1.06, 6.07) remained the only significant risk factors for MV collisions. One or more visibility aids reduced the odds of a bicyclist MV collision resulting in hospitalization. CONCLUSIONS Bicyclist clothing choice may be important in reducing the risk of MV collision. The protective effect of visibility aids varies based on light conditions, and non-bicyclist risk factors also need to be considered.

Mountain bike terrain park-related injuries: an emerging cause of morbidity

This case–control study describes the profile of bicyclists injured in mountain bike terrain parks (MBTPs) and examines risk factors for severe injury among MBTP riders. Cases were hospitalised bicyclists injured in MBTPs. Controls were bicyclists injured in MBTPs who were discharged from the emergency department. No significant differences were observed in the distribution of age and sex between cases and controls. A higher proportion of cases compared with controls suffered a head injury (22%), fracture (41%) or internal organ injury (32%). Controls suffered a higher proportion of superficial injuries (26%), sprains (10%) or wounds (16%). Upper extremity protective equipment (e.g. elbow or shoulder pads) was used more by cases than controls (23% vs. 11%, p = 0.03). Riders who self-reported cycling faster than usual had significantly higher risk of severe injury compared with others. The risk of severe injury may be reduced by encouraging bicyclists to control their speed or by modifying MBTP design to limit the opportunity to gain speed.

Comparing the characteristics of snowboarders injured in a terrain park who present to the ski patrol, the emergency department or both

Ski patrol report forms are a common data source in ski/snowboard research, but it is unclear if those who only present to the emergency department (ED) are systematically different from those who see the ski patrol. To determine the proportion and characteristics of injured snowboarders who bypass the ski patrol before presenting to the ED, three groups of injured snowboarders were compared: presented to the ED only, ski patrol only and ski patrol and ED. Data were collected from ski patrol Accident Report Forms (ARFs), ED medical records and telephone interviews. There were 333 injured snowboarders (ED only: 34, ski patrol only: 107, both: 192). Ability, time of day, snow conditions or drugs/alcohol predicted ED only presentation. Concussions (RRR: 4.66; 95% CI: 1.83, 11.90), sprains/strains (RRR: 4.22; 95% CI: 1.87, 9.49), head/neck (RRR: 2.90; 95% CI: 1.48, 5.78), trunk (RRR: 4.17; 95% CI: 1.92, 9.09) or lower extremity (RRR: 3.65; 95% CI: 1.32, 10.07) injuries were significantly more likely to present to ski patrol only versus ski patrol and ED. In conclusion, snowboarders who presented to the ED only had similar injuries as those who presented to both.

Severe bicycling injury risk factors in children and adolescents: A case–control study

BACKGROUND Bicycling is the most common cause of sports and recreation injury in children and adolescents; yet, there is limited evidence on the factors associated with severe bicycling injuries in youth. METHODS Case-control study of injured bicyclists less than 18 years old seen in seven emergency departments (EDs) from May 2008 to October 2010. Cases were bicyclists hospitalized after their ED visit (severe injury). Controls were bicyclists seen and discharged from the ED (non-severe injury). Personal, environmental, and crash characteristics were collected by interview. Injury data were collected from medical charts. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to estimate the odds of hospitalization associated with risk factors. Multiple imputation techniques were employed to address missing data. RESULTS There were 1470 participants including 119 cases. Those ages 13-17 had the highest proportion (23%) of severe injuries resulting from motor vehicle [MV] collision. In models including age, sex and MV collision, being male (OR: 2.02; 95% CI: 1.21-3.38), not wearing a helmet (OR: 2.18; 95% CI: 1.43-3.31) and MV collision (OR: 3.91; 95% CI: 2.26-6.78) were significant risk factors for severe injury. Riding on a paved surface (OR: 0.63; 95% CI: 0.41-0.97) and utilitarian (school, work) bicycling (OR: 0.44; 95% CI: 0.2-0.94) decreased injury risk. Results were similar, apart from utilitarian bicycling (OR: 0.49; 95% CI: 0.22-1.06), after imputation for missing data. CONCLUSION Bicycle-MV collisions increase severe injury risk in youth, and adolescents are often injured in these events. This suggests separating bicyclists from MVs or traffic calming strategies could improve safety.

Listening to a personal music player is associated with fewer but more serious injuries among snowboarders in a terrain park: a case-control study

Background Some snowboarders listen to music on a personal music player and the objective was to determine if listening to music was associated with injury in a terrain park. Methods A case–control study was conducted at a terrain park in Alberta, Canada during the 2008–2009 and 2009–2010 winter seasons. Cases were snowboarders who were injured in the terrain park and presented to either the ski patrol and/or a nearby emergency department (ED). Demographic, environmental and injury characteristics were collected from standardised ski patrol Accident Report Forms, ED medical records and telephone interviews. Controls were uninjured snowboarders using the same terrain park and were interviewed as they approached the lift-line on randomly selected days and times. Multivariable logistic regression determined if listening to music was associated with the odds of snowboard injury. Results Overall, 333 injured cases and 1261 non-injured controls were enrolled; 69 (21%) cases and 425 (34%) controls were listening to music. Snowboarders listening to music had significantly lower odds of injury compared with those not listening to music (adjusted odds ratio (OR) 0.68; 95% CI 0.48 to 0.98). Snowboarders listening to music had significantly higher odds of presenting to the ED versus ski patrol only compared with those not listening to music (adjusted OR 2.09; 95% CI 1.07 to 4.05). Conclusions While listening to music decreased the odds of any injury in the terrain park, it increased the odds of an injury resulting in ED presentation.

Risk Factors for Bicycling Injuries in Children and Adolescents: A Systematic Review

CONTEXT: Child and adolescent bicycling is beneficial, but injuries occur and can be severe and costly. OBJECTIVE: To systematically review the individual and environmental factors associated with bicycling injury risk in children and adolescents. DATA SOURCES: Fourteen electronic databases were searched. STUDY SELECTION: Two authors independently assessed potentially relevant articles for eligibility. The inclusion criteria were as follows: bicyclists younger than 20 years old; examined individual and environmental characteristics of bicycling crashes; compared injured and uninjured bicyclists or bicyclists with different types or severity of injury; study designs with a predetermined comparison group; and published in English from January 1990 to May 2015. The exclusion criteria were outcomes related to helmet use, helmet legislation, or mountain biking, and comparisons of census-based injury rates. DATA EXTRACTION: Data on study design, setting, population, injury definitions, injury risk factors, and results were extracted. Risk of bias was assessed by using the Newcastle-Ottawa Scales. RESULTS: Fourteen articles were included. Lower socioeconomic status, riding on the road, riding in rural compared with urban areas, and riding on the sidewalk were associated with bicycling injury. Bicycling safety education did not protect children against future injury. Injuries related to a motor vehicle collision were more severe than other bicycling injuries. LIMITATIONS: Study heterogeneity prevented meta-analyses. Study quality was affected by inadequate definitions of study groups and self-reported data. CONCLUSIONS: Lower socioeconomic status and riding location were associated with bicycling injury and severity increased with motor vehicle collisions. The bicycling environment is a promising avenue for prevention.

Ski and snowboard school programs: Injury surveillance and risk factors for grade-specific injury

The objective of our study was to evaluate incidence rates and profile of school program ski and snowboard‐related injuries by school grade group using a historical cohort design. Injuries were identified via Accident Report Forms completed by ski patrollers. Severe injury was defined as those with ambulance evacuation or recommending patient transport to hospital. Poisson regression analysis was used to examine the school grade group‐specific injury rates adjusting for risk factors (sex, activity, ability, and socioeconomic status) and accounting for the effect of clustering by school. Forty of 107 (37%) injuries reported were severe. Adolescents (grades 7‐12) had higher crude injury rates (91 of 10 000 student‐days) than children (grades 1‐3: 25 of 10 000 student‐days; grades 4‐6: 65 of 10 000 student‐days). Those in grades 1‐3 had no severe injuries. Although the rate of injury was lower in grades 1‐3, there were no statistically significant grade group differences in adjusted analyses. Snowboarders had a higher rate of injury compared with skiers, while higher ability level was protective. Participants in grades 1‐3 had the lowest crude and adjusted injury rates. Students in grades 7‐12 had the highest rate of overall and severe injuries. These results will inform evidence‐based guidelines for school ski/snowboard program participation by school‐aged children.

750 The effect of body checking policy change on contact mechanisms in 11–12 year old ice hockey players

Background Hockey Canada’s evidence-based body checking (BC) policy change (2013) was informed by evidence that policy allowing BC in Pee Wee (11–12 year old) ice hockey players resulted in a >3-fold increased risk of injury and concussion compared with leagues where BC was not allowed. Objective To compare the frequency of type and intensity of physical contacts (PC) and head contact in elite (upper 30%) Pee Wee ice hockey games in leagues not allowing BC (2013–2014) compared with leagues allowing BC (2007–2008) using video analysis. Methods Ten elite games pre-policy change (2007–2008) and 11 elite games post-policy change (2013–2014) were video recorded and analysed using a validated methodology to compare the frequency of type (trunk and other types of PC with limb/head/stick) and intensity (trunk contacts – level 1–5 intensity) of PC and head contact. Incidence rate ratios (IRR) were estimated using Poisson regression controlling for clustering by game) to compare PC before and after the BC policy change. Results A total of 4409 trunk PCs and 2623 other PCs were observed. The total number of trunk PCs (IRR = 0.97, 95% CI: 0.83–1.14) and other contacts (IRR = 0.87, 95% CI: 0.59–1.29) did not change post-policy change. High intensity contacts (levels 4 and 5) were less frequent post-policy change (IRR4 = 0.13, 95% CI: 0.09–0.19 and IRR5 = 0.13, 95% CI: 0.07–0.26) and low intensity contacts (level 2) increased (IRR2 = 1.47, 95% CI: 1.21–1.79). Limb PCs decreased in 2013–14 (IRR = 0.48, 95% CI; 0.33–0.71) and there was no difference for head contacts (IRR = 0.81, 95% CI; 0.51–1.30). Conclusions There were no significant differences in total number of PC by study year. However, the incidence of high intensity (level 4–5) PCs decreased post -policy change. There was no significant difference in direct head contact or total number of other contacts. This will inform the development and evaluation of injury prevention and skill training strategies in youth ice hockey.