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Helmet use and risk of head injuries in alpine skiers and snowboarders: changes after an interval of one decade
  1. Steinar Sulheim1,2,
  2. Arne Ekeland3,
  3. Ingar Holme2,
  4. Roald Bahr2
  1. 1Orthopaedic Department, Gjoevik hospital, SIHF, Gjøvik, Norway
  2. 2Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3Martina Hansens Hospital, Baerum, Norway
  1. Correspondence to Dr Steinar Sulheim, Orthopaedic Department, Gjoevik hospital, SIHF, Kyrre Grepps gate 11, Gjøvik 2819, Norway; steinar.sulheim{at}


Background In a previous study, we concluded that a safety helmet can reduce the risk for head injury by 60%. Other studies reported similar effects, resulting in a general recommendation to wear a helmet while skiing or snowboarding.

Aim To determine the effect of the expected increased helmet wear on the risk of head injury one decade after the recommendation.

Methods Ski patrols reported injury cases in major Norwegian alpine ski resorts. Injury type, helmet use and other risk factors were recorded. A multiple logistic regression analysis was used to assess the relation between individual risk factors and the risk of head injuries by comparing head injured skiers (cases) with skiers and snowboarders who reported other injuries (controls).

Results Helmet use was associated with improved odds for head injuries (OR: 0.45, 95% CI 0.34 to 0.60; p<0.001) in 2002; this effect was attenuated in 2010 (OR: 0.79, 95% CI 0.63 to 0.98; p=0.02), and not significant in 2011 (OR: 0.80, 95% CI 0.60 to 1.06; p=0.12). For potentially severe head injuries, the protective effect of using a helmet was better sustained over the observation period, from an OR of 0.44 (95% CI 0.28 to 0.68, p<0.001) in 2002 to an OR of 0.74 (95% CI 0.57 to 0.97, p=0.02) in 2010 and 0.67 (95% CI 0.47 to 0.96; p=0.03) in 2011.

Conclusions We observed an unexpected reduction in the protective effect of a skiing helmet. This may be due to new skiing trends in the alpine resorts.

  • Alpine skiing
  • Helmet

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  • Contributors SS and IH have performed the statistical analyses. SS have written the article, and RB and AE have contributed in preparing the manuscript for submission. The Norwegian Ski Patrols at the various resorts have recorded the injuries.

  • Funding The Oslo Sports Trauma Research Center has been established at the Norwegian School of Sport Sciences through grants from the Norwegian Eastern Health Corporatie, the Royal Norwegian Ministry of Culture, the Norwegian Olympic Committee and Confederation of Sport, the International Olympic Committee, and Norsk Tipping AS. Data collection was funded by the Norwegian Ski Lift Association. Helse Sør-Øst RHF.

  • Competing interests None declared.

  • Ethics approval The study was based on anonymised data from the Norwegian Ski Lift Association injury and marketing research databases, and the Regional Committee for Medical Research Ethics did not require ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.