BACKGROUND: Approximately one-third of pediatric fractures occur during sport or recreational activity In this paper, we investigate the incidence and causes of pediatric fractures in our region and quantify the fracture rate per exposure time for the most common sport and recreational activities METHODS: We prospectively evaluated all children younger than sixteen years who presented to our institution with a new fracture within a twelve-month period Exposure time to the most common childhood activities was measured by means of interviewing random parents from the study population The main outcome measures were the annual fracture incidence in the population and fracture rates per 10,000 hours of exposure to various sports and recreational activities RESULTS: A total of 1403 fractures were included The overall annual incidence was 1801 fractures per 10,000 children younger than sixteen years The distal part of the radius was most often fractured (436 fractures, 311%) Snowboarding was associated with the highest activity-specific fracture rate, estimated to be 19 (95% confidence interval [CI], 116 to 260) fractures per 10,000 hours of exposure In comparison, the fracture rate per 10,000 hours of exposure was 079 (CI, 042 to 109) for handball, 044 (CI, 035 to 052) for soccer, and 035 (CI, 023 to 047) for trampolining CONCLUSIONS: The distal part of the radius is the most common fracture site in childhood Fracture rates differ between various physical activities The fracture rate for snowboarding was four times higher compared with that for other common childhood sport and recreational activities in our region CLINICAL RELEVANCE: This descriptive epidemiology study has identified high-risk activities for pediatric fractures Language: en

Fractures in children: epidemiology and activity-specific fracture rates

BACKGROUND: Approximately 600,000 ski- and snowboarding-related injuries occur in North America each year, with head injuries accounting for up to 20% of all injuries. Currently, there are no major institutional recommendations regarding helmet use for skiers and snowboaders in the United States, in part owing to previous conflicting evidence regarding their efficacy. The objective of this review was to evaluate existing evidence on the efficacy of safety helmets during skiing and snowboarding, particularly in regard to head injuries, neck and cervical spine injuries, and risk compensation behaviors. These data will then be used for potential recommendations regarding helmet use during alpine winter sports. METHODS: The PubMed, Cochrane Library, and EMBASE databases were searched using the search string helmet OR head protective devices AND (skiing OR snowboarding OR skier OR snowboarder) for articles on human participants of all ages published between January 1980 and April 2011. The search yielded 83, 0, and 96 results in PubMed, Cochrane Library, and EMBASE, respectively. Studies published in English describing the analysis of original data on helmet use in relation to outcomes of interest, including death, head injury, severity of head injury, neck or cervical spine injury, and risk compensation behavior, were selected. Sixteen published studies met a priori inclusion criteria and were reviewed in detail by authors. RESULTS: Level I recommendation is that all recreational skiers and snowboarders should wear safety helmets to reduce the incidence and severity of head injury during these sports. Level II recommendation/observation is that helmets do not seem to increase risk compensation behavior, neck injuries, or cervical spine injuries among skiers and snowboarders. Policies and interventions to increase helmet use should be promoted to reduce mortality and head injury among skiers and snowboarders. CONCLUSION: Safety helmets clearly decrease the risk and severity of head injuries in skiing and snowboarding and do not seem to increase the risk of neck injury, cervical spine injury, or risk compensation behavior. Helmets are strongly recommended during recreational skiing and snowboarding. Language: en

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An evidence-based review: efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders.

Background Rock climbing is an increasingly popular sport worldwide, as a recreational activity and a competitive sport. Several disciplines including sport climbing and bouldering have developed, each employing specific movements and techniques, leading to specific injuries. Objective To examine risk factors and prevention measures for injury in sport climbing and bouldering, and to assess the methodological quality of existing studies. Methods 12 electronic databases and several other sources were searched systematically using predetermined inclusion and exclusion criteria. Eligible articles were peer-reviewed, based on primary research using original data; outcome measures included injury, morbidity or mortality in rock climbing, and included one or more potential risk factor or injury prevention strategy. Two independent reviewers assessed the methodology of research in each study using the Downs and Black Quality Index. The data extracted is summarised, and appraisals of the articles are presented with respect to the quality of evidence presented. Results 19 studies met the inclusion criteria, and introduced 35 possible risk factors or injury prevention measures in climbing. Age, increasing years of climbing experience, highest climbing grade achieved (skill level), high climbing intensity score (CIS) and participating in lead climbing are potential risk factors. Results regarding injury prevention measures remain inconclusive. Discussion This field is relatively new and, as such, the data are not as robust as for more established sports with a larger research foundation. The key need is establishing modifiable risk factors using prospective studies and high quality methodology, such that injury prevention strategies can be developed. The CIS may be a useful measure in this field of research.

https://purehost.bath.ac.uk/ws/files/119065804/Accepted_version.pdf

Risk factors for injury in sport climbing and bouldering: a systematic review of the literature

Snow sports (alpine skiing/snowboarding) would benefit from easily implemented and cost-effective injury prevention countermeasures that are effective in reducing injury rate and severity. For snow sports, to identify risk factors and to quantify evidence for effectiveness of injury prevention countermeasures. Searches of electronic literature databases to February 2014 identified 98 articles focused on snow sports that met the inclusion criteria and were subsequently reviewed. Pooled odds ratios (ORs) with 90 % confidence intervals (CIs) and inferences (percentage likelihood of benefit/harm) were calculated using data from 55 studies using a spreadsheet for combining independent groups with a weighting factor based on quality rating scores for effects. More experienced skiers and snowboarders are more likely to sustain an injury as a result of jumps, while beginners sustain injuries primarily as a result of falls. Key risk factors that countermeasure interventions should focus on include, beginner skiers (OR 2.72; 90 % CI 2.15–3.44, 99 % most likely harmful), beginner snowboarders (OR 2.66; 90 % CI 2.08–3.40, 99 % harmful), skiers/snowboarders who rent snow equipment (OR 2.58; 90 % CI 1.98–3.37, 99 % harmful) and poor visibility due to inclement weather (OR 2.69; 90 % CI 1.43–5.07, 97 % harmful). Effective countermeasures include helmets for skiers/snowboarders to prevent head injuries (OR 0.58; 90 % CI 0.51–0.66, 99 % most likely beneficial), and wrist guards for snowboarders to prevent wrist injuries (OR 0.33; 90 % CI 0.23–0.47, 99 % beneficial). The review identified key risk factors for snow-sport injuries and evaluated the evidence for the effectiveness of existing injury prevention countermeasures in recreational (general public use of slopes, not racing) snow sports using a Haddon’s matrix conceptual framework for injury causation (host/snow-sport participant, agent/mechanism and environment/community). Best evidence for the effectiveness of injury prevention countermeasures in recreational snow sports was for the use of helmets and wrist guards and to address low visibility issues via weather reports and signage.

/pdf/recreational-snow-sports-injury-risk-factors-and-4y2ila5xqn.pdf

Recreational Snow-Sports Injury Risk Factors and Countermeasures: A Meta-Analysis Review and Haddon Matrix Evaluation

Injuries are common in sports and can have significant physical, psychological and financial consequences. Machine learning (ML) methods could be used to improve injury prediction and allow proper approaches to injury prevention. The aim of our study was therefore to perform a systematic review of ML methods in sport injury prediction and prevention. A search of the PubMed database was performed on March 24th 2020. Eligible articles included original studies investigating the role of ML for sport injury prediction and prevention. Two independent reviewers screened articles, assessed eligibility, risk of bias and extracted data. Methodological quality and risk of bias were determined by the Newcastle–Ottawa Scale. Study quality was evaluated using the GRADE working group methodology. Eleven out of 249 studies met inclusion/exclusion criteria. Different ML methods were used (tree-based ensemble methods (n = 9), Support Vector Machines (n = 4), Artificial Neural Networks (n = 2)). The classification methods were facilitated by preprocessing steps (n = 5) and optimized using over- and undersampling methods (n = 6), hyperparameter tuning (n = 4), feature selection (n = 3) and dimensionality reduction (n = 1). Injury predictive performance ranged from poor (Accuracy = 52%, AUC = 0.52) to strong (AUC = 0.87, f1-score = 85%). Current ML methods can be used to identify athletes at high injury risk and be helpful to detect the most important injury risk factors. Methodological quality of the analyses was sufficient in general, but could be further improved. More effort should be put in the interpretation of the ML models.

https://biblio.ugent.be/publication/8708889/file/8708890.pdf

Machine learning methods in sport injury prediction and prevention: a systematic review

Objective To analyse risk factors leading to injuries during snowboarding. Design A case–control multicentre survey of injured and non-injured snowboarders. Setting One tertiary and two secondary trauma centres in Bern, Switzerland. Methods All snowboard injuries admitted to our tertiary and two affiliated secondary trauma centres from 1 November 2007 to 15 April 2008 were analysed on the basis of a completed questionnaire incorporating 15 variables. The same questionnaire was applied in non-injured controls at valley stations after a snowboarding day during the same period. A multiple logistic regression was performed (dichotomous variables). Patterns of combined risk factors were calculated by inference trees. Results 306 patients and 253 controls were interviewed. The following variables were statistically significant for the injured patients: low readiness for speed (OR 0.20, 95% CI 0.06 to 0.64, p=0.0037), bad weather/visibility (OR 19.06, 95% CI 2.70 to 134.73, p=0.0031) and old snow (OR 0.11, 95% CI 0.02 to 0.68, p=0.0323). Not wearing a helmet and riding on icy slopes emerged as a combination of risk factors associated with injury. Conclusions Several risk factors and combinations exist, and different risk profiles were identified. Future research should be aimed at more precise identification of groups at risk and developing specific recommendations for each group—for example, a snow-weather conditions index at valley stations.

https://bjsm.bmj.com/content/bjsports/44/11/816.full.pdf

Are there risk factors for snowboard injuries? A case-control multicentre study of 559 snowboarders

Objective: To analyse risk factors in alpine skiing. Design: A controlled multicentre survey of injured and non-injured alpine skiers. Setting: One tertiary and two secondary trauma centres in Bern, Switzerland. Patients and methods: All injured skiers admitted from November 2007 to April 2008 were analysed using a completed questionnaire incorporating 15 parameters. The same questionnaire was distributed to non-injured controls. Multiple logistic regression was performed. Patterns of combined risk factors were calculated by inference trees. A total of 782 patients and 496 controls were interviewed. Results: Parameters that were significant for the patients were: high readiness for risk (p = 0.0365, OR 1.84, 95% CI 1.04 to 3.27); low readiness for speed (p = 0.0008, OR 0.29, 95% CI 0.14 to 0.60); no aggressive behaviour on slopes (p speed >4 and bad weather/visibility; (2) VAS speed 4–7, icy slopes and not wearing a helmet; (3) warm-up >12 min and new skiing equipment. Conclusions: Low speed, high readiness for risk, new skiing equipment, old and powder snow, and drug consumption are significant risk factors when skiing. Future work should aim to identify more precisely specific groups at risk and develop recommendations—for example, a snow weather index at valley stations.

https://bjsm.bmj.com/content/bjsports/43/13/1020.full.pdf

Are there risk factors in alpine skiing? A controlled multicentre survey of 1278 skiers

Introduction Winter sports have evolved from an upper class activity to a mass industry. Especially sledging regained popularity at the start of this century, with more and more winter sports resorts offering sledge runs. This study investigated the rates of sledging injuries over the last 13 years and analysed injury patterns specific for certain age groups, enabling us to make suggestions for preventive measures. Methods We present a retrospective analysis of prospectively collected data. From 1996/1997 to 2008/2009, all patients involved in sledging injuries were recorded upon admission to a Level III trauma centre. Injuries were classified into body regions according to the Abbreviated Injury Scale (AIS). The Injury Severity Score (ISS) was calculated. Patients were stratified into 7 age groups. Associations between age and injured body region were tested using the chi-squared test. The slope of the linear regression with 95% confidence intervals was calculated for the proportion of patients with different injured body regions and winter season. Results 4956 winter sports patients were recorded. 263 patients (5%) sustained sledging injuries. Sledging injury patients had a median age of 22 years (interquartile range [IQR] 14–38 years) and a median ISS of 4 (IQR 1–4). 136 (51.7%) were male. Injuries (AIS ≥ 2) were most frequent to the lower extremities (n = 91, 51.7% of all AIS ≥ 2 injuries), followed by the upper extremities (n = 48, 27.3%), the head (n = 17, 9.7%), the spine (n = 7, 4.0%). AIS ≥ 2 injuries to different body regions varied from season to season, with no significant trends (p > 0.19). However, the number of patients admitted with AIS ≥ 2 injuries increased significantly over the seasons analysed (p = 0.031), as did the number of patients with any kind of sledging injury (p = 0.004). Mild head injuries were most frequent in the youngest age group (1–10 years old). Injuries to the lower extremities were more often seen in the age groups from 21 to 60 years (p  Conclusion Mild head trauma was mainly found in very young sledgers, and injuries to the lower extremities were more frequent in adults. In accordance with the current literature, we suggest that sledging should be performed in designated, obstacle-free areas that are specially prepared, and that children should always be supervised by adults. The effect of routine use of helmets and other protective devices needs further evaluation, but it seems evident that these should be obligatory on official runs.

A 13-year analysis from Switzerland of non-fatal sledging (sledding or tobogganing) injuries.

BACKGROUND: Climbing is a popular sport in Switzerland, with approximately 100 000 active participants. There is an inherent risk of falls, overuse and stress-related trauma, with a reported injury rate of 4.2 injuries per 1000 climbing hours. OBJECTIVE: Comparison of possible risk factors in patients and noninjured controls. METHODS: A case-control survey was conducted. Climbers admitted to three trauma units between June and October 2008 were surveyed using a questionnaire evaluating nine potential risk factors. The same questionnaire was distributed to noninjured climbers during the same time period. Logistic regression was performed. RESULTS: Fifty patients and 63 controls were included in this survey. Variables significant for patients were: more than 10 years versus less than 1 year of climbing experience (odds ratio: 5.34; confidence interval: 1.16-17.76; P=0.006) and no previous experiences of the climbing route (odds ratio: 2.72; confidence interval: 1.15-6.39; P=0.022). No statistical significance was detected for age, sex, difficulty level of the climbing route, warm-up, readiness for risk and abstinence from alcohol and drugs. CONCLUSION: Climbers with higher experience seem to be more prone to injuries. Larger studies on this subgroup are warranted, to identify typical risk profiles and to develop preventive strategies. Furthermore, climbers should be advised about the increased injury risk when trying new climbing routes and specific information should be given. Language: en

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Dominik Heim

Papers

Are there risk factors for snowboard injuries? A case-control multicentre study of 559 snowboarders

Are there risk factors in alpine skiing? A controlled multicentre survey of 1278 skiers

A 13-year analysis from Switzerland of non-fatal sledging (sledding or tobogganing) injuries.

A pilot case-control study of behavioral aspects and risk factors in Swiss climbers