Helmet Use and Risk of Neck Injury in Skiers and Snowboarders

In a case-control study, the authors examined the relation between helmet use and neck injury among Québec, Canada, skiers and snowboarders using 10 years of ski patrol data (1995-1996 to 2004-2005). Cases were defined as persons with any neck injury (n = 2,986), an isolated neck injury requiring ambulance evacuation (n = 522), or a cervical spine fracture or dislocation (n = 318). The control group included persons with non-head, non-neck injuries (n = 97,408) in an unmatched analysis. The authors also matched cases with controls injured at the same ski area, during the same activity (skiing vs. snowboarding), and during the same season. Helmet use was the primary exposure variable. For the unmatched analysis, the authors used unconditional logistic regression and adjusted for clustering by ski area and other covariates. They used conditional logistic regression for the matched analysis. Multiple imputation was used to address missing values. The adjusted odds ratio was 1.09 (95% confidence interval (CI): 0.95, 1.25) for any neck injury, 1.28 (95% CI: 0.96, 1.71) for isolated ambulance-evacuated neck injuries, and 1.02 (95% CI: 0.79, 1.31) for cervical spine fractures or dislocations. Similar results were found in the conditional logistic regression analysis and in analyses restricted to children under age 11 years. These results do not suggest that helmets increase the risk of neck injuries among skiers and snowboarders.