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Journal ArticleDOI

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

01 Apr 2012-European Journal of Emergency Medicine (Eur J Emerg Med)-Vol. 19, Iss: 2, pp 73-76

TL;DR: Climbers with higher experience seem to be more prone to injuries, and larger studies on this subgroup are warranted, to identify typical risk profiles and to develop preventive strategies.

AbstractBACKGROUND: 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

Topics: Odds ratio (53%), Climbing (52%), Poison control (51%), Inherent risk (51%)

Summary (2 min read)

Introduction

  • What started as a traditional form of adventure has nowadays grown into a popular recreational and competitive activity, spreading rapidly across the globe.
  • The number of climbers, in general, is estimated to be much higher, given the size of the US country and opportunities for climbing there.
  • In Switzerland, approximately 100 000 people regularly climb as a recreational sport (unpublished data, Swiss Alpine Club, 2010).
  • Therefore, compared with other recreational activities, climbing sports have a lower injury incidence and severity score than many popular sports, including basketball, sailing, or soccer [3].

Setting

  • Three emergency departments (EDs), one level I trauma centre and two regional hospitals.
  • Unauthorized reproduction of this article is prohibited.

Case–control survey

  • All patients acutely injured from indoor or outdoor climbing and admitted to one of the three EDs between 1 June and 31 October 2008 were included.
  • Patients with chronic overuse syndromes, intracranial bleeding, skull fractures, Glasgow Coma Score (GCS) of greater than 14 or persistent retrograde amnesia were excluded.
  • Patients were interviewed after the injury at one of the three EDs, or, in cases that did not allow time for interview in the ED, during their hospital stay.
  • A questionnaire incorporating nine potential risk factors was used.
  • Noninjured climbers were prospectively interviewed during the same time period at different popular climbing spots, using the same questionnaire.

Ethical considerations

  • Participation in the study was voluntary and anonymous; confidentiality was granted.
  • Data were collected, stored, analyzed and shared according to the ethical committee standards of the three hospitals.

Statistical analysis

  • To identify study groups based on various predictors, univariate logistic regression analysis was performed.
  • Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were reported.
  • For ordinal or metric variables, ORs were expressed as the ratio of the odds increasing the predictor one unit.
  • All evaluations were calculated with R version 2.7.0 [5].

Study population

  • Fifty patients and 63 controls were interviewed.
  • Details are described in Fig. 2. Logistic regression analysis shown in Table 1 demonstrated that the following variables were significant for patients: more than 10 years of climbing experience (vs. < 1 year of climbing experience), and no previous experiences of the climbing route.
  • Crude numbers of risk factor variables are described in Table 2.

Discussion

  • Reports on risk factors in climbing are rare and to the best of their knowledge, there have been no case–control studies on risk factors in climbing injuries, other than Copyright © Lippincott Williams & Wilkins.
  • Unauthorized reproduction of this article is prohibited.
  • One explanation for this could be that dedicated climbers participate in different forms of climbing more often and therefore increase their cumulative injury risk [2].
  • After sustaining an accident, the reported readiness to take risk might be overestimated or underestimated.
  • Warm-up before climbing did not emerge as a protective factor in their analysis.

Limitations

  • To minimize sources of bias, patients with severe head or life-threatening injuries were excluded.
  • The results that emerged as statistically significant did so only when seen as isolated factors and not in the context of the distribution of all other factors in the patient and control groups.
  • The authors study is limited in numbers of participants and represents a pilot project for understanding risk factors in climbing.
  • Patients with moderate-to-severe brain injury were excluded, 18 patients suffered from mild head trauma or injury to the face.
  • The question on readiness for risk has been answered by self-estimation, which can cause recall and information bias.

Conclusion

  • Climbers with higher experience seem to be more prone to injuries and therefore larger studies on this subgroup are warranted to show typical risk profiles and to develop preventive strategies.
  • Not the level of difficulty of the route, but missing route experience seems to put climbers at risk.
  • Hence, advice about the increased injury risk when trying new climbing routes and specific information about the route should be given in advance.
  • In addition, physical, mental and technical preparations of climbers, as well as the role of the rope partner need further investigation.

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source: https://doi.org/10.7892/boris.13531 | downloaded: 9.8.2022
A pilot case–control study of behavioral aspects and risk
factors in Swiss climbers
Rebecca M. Hasler
a
, Priska Bach
a
, Monika Brodmann
a
, Dominik Heim
b
,
Jonathan Spycher
c
, Andreas Schotzau
d
, Dimitrios S. Evangelopoulos
a
,
Heinz Zimmermann
a
and Aristomenis K. Exadaktylos
a
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 1 000
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. European Journal of Emergency Medicine
19:73–76
c
2012 Wolters Kluwer Health | Lippincott
Williams & Wilkins.
European Journal of Emergency Medicine 2012, 19:73–76
Keywords: climbing, injury, risk factors
a
Department of Emergency Medicine, University of Bern, Inselspital, Bern,
b
Department of Surgery, Spital Frutigen, Frutigen,
c
Department of Orthopedic
Surgery, Spital Interlaken, Interlaken and
d
Scho
¨
tzau und Simmen, Statistical
Consulting, Basel, Switzerland
Correspondence to Dr Aristomenis K. Exadaktylos, MD, PD, FMH Anaesth DipTM
FCEM, Division of Anaest hesia, Department of Emergency Medicine, Director
Research and Clinical Development, Intensive Care and Emergency Medicine,
Inselspital Bern, University Hospital, Bern 3008, Switzerland
Tel: + 41796322900; fax: + 0041 31 632 4867;
e-mail: aristom enis@exadaktylos.ch
Received 29 November 2010 Accepted 11 May 2011
Introduction
What started as a traditional form of adventure has
nowadays grown into a popular recreational and compe-
titive activity, spreading rapidly across the globe. It has
been estimated that in the USA, more than 300 000
people have climbed a rock wall (http://www.hughston.com/
hha/a.climb.htm). The number of cli mbers, in general, is
estimated to be much higher, given the size of the US
country and opportunities for climbing there. In Switzer-
land, approximately 100 000 people regularly climb as a
recreational sport (unpublished data, Swiss Alpine
Club, 2010).
Climbing is a physically demanding sport, which allows
only slight errors, with a reported injury rate of 4.2
injuries per 1000 climbing hours [1]. As a result, there has
been a move to bring more awareness of the risks involved
to beginners, novices, and expert climbers, in the hope of
preventing injuries [2].
Climbing accounts only for one death in 320 000 climbs,
compared with scuba diving with one death in 200 000
dives or hang-gliding with one fatal injury in 116 000
flights (http://www.hse.gov.uk/education/statistics.htm). There-
fore, compared with other recreational activities, climbing
sports have a lower injury incidence and severity score
than many popular sports, including basketball, sail ing, or
soccer [3]. However, these numbers originate from the
UK and Germany, which have a different climbing
environment than Switzerland.
The increasing public interest in climbing injuries over
the last years prompted our institution to evaluate ways
of achieving more effective prevention by evaluating
potential risk factors. To the best of our knowledge, our
case–control survey of acute climbing injuries is the first
study of its kind in sports medicine literature.
Methods
Setting
Three emergency departments (EDs), one level I trauma
centre and two regional hospitals.
Original article 73
0969-9546
c
2012 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEJ.0b013e328348b460
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Case–control survey
All patients acutely injured from indoor or outdoor
climbing and admitted to one of the three EDs betwe en
1 June and 31 October 2008 were included. Patients with
chronic overuse syndromes, intracranial bleeding, skull
fractures, Glasgow Coma Score (GCS) of greater than 14
or persistent retrograde amnesia were excluded. Patients
with concussion were included as long as their GCS was
15 and they were able to fully and coherently understand
and answer the questions. No patients were interviewed
twice or in the role as a control and patient.
Patients reporting climbing injuries or being admitted as
climbing injuries by Emergency Medical Services were
interviewed by final year medical students, working in
the ED as a part of their training. Patients were
interviewed after the injury at one of the three EDs, or,
in cases that did not allow time for interview in the ED,
during their hospital stay. A questionnaire incorporating
nine potential risk factors was used. Noninjured climbers
(controls) were prospectively interviewed during the
same time period at different popular climbing spots,
using the same questionnair e.
We defined nine primary outcome measures as possible
risk markers, as they have been used in previous risk
assessment studies [4]. The variables included patient/
control characteristics (age, sex, and experience in
climbing), behavioral aspects [readiness for risk (the
readiness to take risks, which might be beyond ones’
abilities to cope with), abstinence from alcohol or drugs
while climbin g, the duration of warm-up, knowledge of
climbing route] and external conditions (level of climbing
route; Fig. 1).
Ethical considerations
Participation in the study was voluntary and anonymous;
confidentiality was granted. Data were collected, stored,
analyzed and shared according to the ethical committee
standards of the three hospitals.
Statistical analysis
To identify study groups based on various predictors,
univariate logistic regression analysis was performed.
Odds ratios (OR) with corresponding 95% confidence
intervals (95% CI) were reported. For ordinal or metric
variables, ORs were expressed as the ratio of the odds
increasing the predictor one unit. A P value of less than
0.05 was considered as significant.
All evaluations were calculated with R version 2.7.0 [5].
Results
Study population
Fifty patients and 63 controls were interviewed. Seventy-six
percent (n = 38) of patients and 67% (n = 42) of controls
were male. The mean age was 34.2 years (range, 16–64
years) for patients and 31.3 years (range, 16–55 years) for
controls. The median injury severity score was 8 (range,
1–48). Thirty-eight patients (76.0%) and 26 controls
(41.2%) performed outdoor climbing and 12 patients
(24.0%) and 37 controls (58.8%) performed indoor climbing.
Most injuries affected the limbs, followed by head and face
injuries and spinal trauma. Details are described in Fig. 2.
Logistic regression analysis shown in Table 1 demon-
strated that the following variables were significant for
patients: more than 10 years of climbing experience
(vs. < 1 year of climbing experience), and no previous
experiences of the climbing route. No statistical sig-
nificance was detected for age, sex, level of difficulty of
the climbing route, duration of warm-up, readiness for
risk and abstinence from alcohol and drugs. Crude
numbers of risk factor variables are described in Table 2.
Discussion
Reports on risk factors in climbing are rare and to the best
of our knowledge, there have been no case–control
studies on risk factors in climbing injuries, other than
Fig. 1
Nine primary outcome measures:
Climber characteristics
(1) Age years
(a) 16 30
(b) 31 45
(c) 46 59
(d) > 59
(2) Sex: male/female
(3) Years of experience in climbing:
(a) <1
(b) 1–10
(c) >10
Behavioural aspects
(4) Readiness for risk: VAS 1–10 (1 implying minimal risk and 10 maximum of risk)
(a) 1 3
(b) 4 6
(c) 7 10
(5) Abstinence from alcohol while climbing: yes/no
(6) Abstinence from drugs while climbing: yes/no
(7) Duration of warm-up:
(a) none
(b) 110 min
(c) > 10 min
(8) Knowledge of climbing route:
(a) First ascent
(b) The route has already been taken two or more times in the past
External conditions
(9) Level of climbing route:
(a) 5b/VI-
(b) 5c – 6a/VI—VII
(d) 6b/VII
Possible risk factors. VAS, Visual Analogue Scale.
74 European Journal of Emergency Medicine 2012, Vol 19 No 2
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

overuse syndromes [1,6,7]. We showed that a higher level
of experience in climbing seems to be a risk factor for
being injured. We observed the highest injury rate for
climbers with more than 10 years of climbing experience.
One explanation for this could be that dedicated climbers
participate in different forms of climbing more often and
therefore increase their cumulative injury ris k [2]. A
further explanation could be that more experienced
climbers are used to manage dangerous situations easily
and therefore underestimate the still inherent risk. Last
but not least, more experienced climbers might suffer
from more chronic overuse injuries and therefore also be
more prone to acute injuries. It has also to be taken into
account that patients with severe and fatal injuries have
been excluded. We do not know whether these seriousl y
injured patients were predominantly novice or very
experienced climbers.
The lower interval of the variable ‘experience in climbing’
was intentionally as chosen as less than two times
climbing a route, as the investigators believe that
climbers climbing a route once only shoul d not be
classified as experienced.
We found no previous studies analysing the association of
experience with the climbing route and injuries. This
might be a risk factor, which has been previously
overlooked. Age and sex showed no statistical significance
between patients and controls and this finding is
supported by a study on climbers in the UK [7].
The term readiness for risk’ means the attit ude to take
risks, which might be beyond ones abilities to cope with.
Therefore, climbers with smaller or greater climbing
experience will rate their risk with respect to their
personal abilities. The Visual Analogue Scale (VAS) is a
widely used tool to rate emotions and feelings in clinical
medicine and provide a good basis for assessments in this
study. Readiness for risk seems not to correlate with
injuries. However, after sustaining an accident, the
reported readiness to take risk might be overestimated
or underestimated. In contrast to other researchers who
concluded that climbers under alcohol and drug influence
account for more injuries, we could not find an association
between reported alcohol and drug consumption and
accidents [8].
Table 1 Univariate logistic regression analysis
Variable OR 95% CI
P
value
Age 1.01 0.98–1.05 0.23
Sex 1.42 0.63–3.23 0.42
Readiness for risk 0.44 0.15–1.30 0.32
Abstinence from alcohol 0.42 0.04–4.13 0.63
Abstinence from drugs 0.85 0.14–5.30 1.00
Duration of warm-up (5–10 min vs. no warm-up) 1.06 0.44–2.33 0.902
Duration of warm-up ( > 10 min vs. no warm-up) 0.98 0.31–3.11 0.966
Level of climbing route (5c-6a/VI–VII vs. < 5b/VI-) 0.81 0.31–2.14 0.675
Level of climbing route ( > 6b/VII vs. < 5b/VI-) 0.94 0.38–2.31 0.893
Experience with climbing route (route taken for the
first time vs. route taken for > 2 times in the past)
2.72 1.15–6.39 0.022
Climbing experience (1–10 years vs. < 1 year
climbing experience)
2.23 0.71–6.97 0.167
Climbing experience ( > 10 years vs. < 1 year
climbing experience)
5.34 1.61–17.76 0.006
CI, confidence interval; OR, odds ratio.
Table 2 Crude numbers of risk factors in patients and controls
Variable
Number of
patients Missing
Number of
controls Missing
Age (16–30; 31–45; 46–59;
> 59 years)
24;20;4;2 0 35;19;9;0 0
Gender (ma le:female) 37;13 0 42;21 0
Readiness for risk (1–3; 4–6;
7–10 VAS)
13;19;9 9 14;27;22 0
Abstinence from alcohol 48 1 60 0
Abstinence from drugs 47 1 60 0
Duration of warm-up (none;
< 10 min; > 10 min)
30;13;6 1 39;16;8 0
Level of climbing route (r 5b/V-;
5c–6a/VI–VII; Z 6b/VII)
16;13;19 2 19;19;24 1
Experience with climbing route
(climbed route < 2 ; Z 2 )
29;18 3 29;34 0
Climbing experience
(1;1–10; Z 10 years)
5;21;22 2 17;32;14 0
VAS, Visual Analogue Scale.
Fig. 2
ChestHead/face Abdomen Pelvis
Injured body region
Injury pattern
Spine Upper
extremities
Lower
extremities
100
80
60
40
20
0
Percentage
Climbers’ injury pattern.
Risk factors in climbers Hasler et al. 75
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Warm-up before climbing did not emerge as a protective
factor in our analysis. Of course, this result does not imply
that the warm-up should be omitted, as this study did not
link the performance of warm-up with specific types of
injuries.
Climbers attempting routes with increasing levels of
difficulty are said to be more prone to acute injuries and
overuse syndromes [7,9,10]. However, we found no
association between injuries and the level of difficulty
of the climbing route, which seems to be a key result of
our study.
Limitations
To minimize sources of bias, patients with severe head or
life-threatening injuries were excluded. Especially, as the
rehabilitation process of these patients and their ability to
answer a questionnaire varies widely, we decided to
exclude these patients. The generalization of the study
results is, therefore, limited by the examined patient
population. The results that emerged as statistically
significant did so only when seen as isolated factors and
not in the context of the distribution of all other factors in
the patient and control groups. Our study is limited in
numbers of participants and represents a pilot project for
understanding risk factors in cli mbing. Further investiga-
tions, including adjustm ent for suspected risk factors in
multiple regression analysis, are needed to substantiate
our results.
The numbers of outdoor and indoor climbers in the
patient and control group were not equal. However, only
risk factors affecting climbers in general and not
particularly due to specific types of climbing were asked
to minimize this source of bias. Although, patients with
moderate-to-severe brain injury were excluded, 18
patients suffered from mild head trauma or injury to
the face. Patients suffering from concussion were only
interviewed if their GCS was 15, and they were able to
answer the questions fully and coherently. Nevertheless,
this subpopulation might be more influenced from recall
bias than the rest of the study population. Questions on
alcohol and drug consumption were answered by self-
estimation and not on the observers own judgement and
therefore might lead to reporting bias. The question on
readiness for risk has been answered by self-estimation,
which can cause recall and information bias. After an
injury, patients may overestimate or underestimate their
readiness for risk. The VAS for the readiness for risk has
not been validated, and this may limit its value. In
general, VAS investigations have been validated for
emotions and ‘feelings’ in the past and the readiness to
take risk is certainly classified among feelings [11]. Falls
are regarded as ‘normal’ events during climbing, and
therefore climbing training often focuses on the techni-
que of falling and preventing injuries. What plays a major
role in these falls is the competence of the rope partner
to hold the falling climber. The questionnaire in this
study did not address these aspects, but focused on the
individual climber that suffered from an accident.
Conclusion
Climbers with higher experience seem to be more prone
to injuries and therefore larger studies on this subgroup
are warranted to show typical risk profiles and to develop
preventive strategies. Not the level of difficulty of the
route, but missing route experience seems to put
climbers at risk. Hence, advice about the increased inju ry
risk when trying new climbing routes and specific
information about the route should be given in advance.
In addition, physical, mental and technical preparat ions
of climbers, as well as the role of the rope par tner need
further investigation.
Acknowledgements
The authors thank Kathrin Dopke, MPH, study coordi-
nator, from the Department of Emergency Medicine,
Inselspital, University Hospital Bern, Switzerland, and
Mr Rodney Yeates, PhD, for English proofreading.
Conflicts of interest
The authors state that they have not received any
funding and they have no conflicts of interest, including
financial, consultant, institutional and other relationships
that might lead to bias or a conflict of the published work.
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Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Citations
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Journal ArticleDOI
TL;DR: Examination of risk factors and prevention measures for injury in sport climbing and bouldering and the methodological quality of existing studies found the CIS may be a useful measure in this field of research.
Abstract: 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.

41 citations


Journal ArticleDOI
TL;DR: High-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur), which implied longer and more complex interventions.
Abstract: Introduction Extreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations. Aim Our aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs. Methods This is a retrospective study, reviewing all rescue missions dedicated to ESs provided by HEMS REGA Lausanne, from 1 January 1998 to 31 December 2008. ES were classified into three categories of practice, according to the type of risk at the time of the fall. Results Among the 616 cases meeting inclusion criteria, 219 (36%) were clearly high-risk ES accidents; 69 (11%) and 328 (53%) were related to potential ES, but with respectively low or indeterminate risk at the time of the fall. In the high-risk ES group, the median age was 32 years and 80% were male. Mortality at 48 h was 11%, almost ten times higher than in the other two groups. The proportion of potentially life-threatening injuries (the National Advisory Committee for Aeronautics (NACA) score ≥ 4) was 39% in the high-risk ES group and 13% in the other two groups. Thirty per cent of the cases in the high-risk ES group presented an Injury Severity Score (ISS) >15, compared with 7% in the other groups. Thoracolumbar vertebral fractures were the most common injuries with 32% of all cases having at least one, involving the T12–L2 junction in 56% of cases. The other most frequent injuries were traumatic brain injuries (16%), rib fractures (9%), pneumothorax (8%) and femoral (7%), cervical (7%), ankle (5%) and pelvic (5%) fractures. Median time on site for rescue teams was higher in the confirmed high-risk ES group, with 50% of prehospital missions including at least one environmental difficulty. Conclusions High-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur). We identified a considerable percentage of thoracolumbar vertebral fractures, mainly in the T12–L2 junction. HEMSs dedicated to high-risk ESs implied longer and more complex interventions.

14 citations


Journal ArticleDOI
TL;DR: Both high level and elevated BMI may increase the demands to the hands and fingers leading to CRIH, and it is difficult to address as the climbers cannot recommend the climbers to climb easier routes and decrease their BMI below 20 kg/m2.
Abstract: This study aimed to investigate the protective mechanisms or risk factors that can be related to the occurrence of hand climbing-related injuries (CRIH ) CRIH (tendon, pulley, muscle, and joint injuries) were retrospectively screened in 528 adult climbers The questionnaire contained anthropometric items (eg, body mass index - BMI), as well as items regarding climbing and basic training activities (warm-up, cool-down and session durations, number of session per week, hydration, practice level, climbing surface, and duration of the cardiovascular training) Higher skilled climbers and climbers with BMI above 21 kg/m(2) were more likely to have experienced CRIH (P Language: en

7 citations


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  • ...…as they do not address the described risk factors of CRI (e.g., overweight, climbing level, climbing experience, climbing frequency, and the climbing type; Josephsen et al., 2007; Jones et al., 2008; Backe et al., 2009; van Middelkoop et al., 2011; Hasler et al., 2012; Woollings et al., 2015)....

    [...]

  • ...However, our results confirm previous observations showing that these traditional preventive measures are not associated with, or are not effective enough to prevent climbing injuries (Josephsen et al., 2007; van Middelkoop et al., 2011; Hasler et al., 2012; Woollings et al., 2015)....

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Journal ArticleDOI
TL;DR: It is found that climbing accidents are a rare event, since approximately 10% of all mountain accidents are climbing related, and Appropriate training, preparation and adherence to safety standards are key in reducing the incidence and severity of climbing accidents.
Abstract: Climbing has become an increasingly popular sport, and the number of accidents is increasing in parallel. We aim at describing the characteristics of climbing accidents leading to severe (multisystem) trauma using data from the International Alpine Trauma Registry (IATR) and at reporting the results of a systematic review of the literature on the epidemiology, injury pattern, severity and prevention of climbing accidents. We found that climbing accidents are a rare event, since approximately 10% of all mountain accidents are climbing related. Climbing accidents mainly affect young men and mostly lead to minor injuries. Fall is the most common mechanism of injury. Extremities are the most frequently injured body part. However, in multisystem climbing-related trauma, the predominant portion of injuries are to head/neck, chest and abdomen. The fatality rate of climbing accidents reported in the literature varies widely. Data on climbing accidents in general are very heterogeneous as they include different subspecialties of this sport and report accidents from different regions. A number of risk factors are accounted for in the literature. Appropriate training, preparation and adherence to safety standards are key in reducing the incidence and severity of climbing accidents.

6 citations


Cites background from "A pilot case-control study of behav..."

  • ...Most of the articles are retrospective or describe the prevalence of climbers who received medical treatment [2,32]....

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References
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Journal Article
TL;DR: Copyright (©) 1999–2012 R Foundation for Statistical Computing; permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and permission notice are preserved on all copies.
Abstract: Copyright (©) 1999–2012 R Foundation for Statistical Computing. Permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and this permission notice are preserved on all copies. Permission is granted to copy and distribute modified versions of this manual under the conditions for verbatim copying, provided that the entire resulting derived work is distributed under the terms of a permission notice identical to this one. Permission is granted to copy and distribute translations of this manual into another language, under the above conditions for modified versions, except that this permission notice may be stated in a translation approved by the R Core Team.

229,202 citations



Journal ArticleDOI
TL;DR: Climbing frequency and technical difficulty are associated with climbing injuries occurring at both indoor and outdoor venues, particularly cumulative trauma to the upper extremities.
Abstract: Objectives: To determine the prevalence and nature of rock-climbing injuries, and the factors associated with these injuries. Design: A retrospective cross-sectional study. Setting: Rock climbers were recruited at five outdoor and six indoor climbing venues in the UK. Participants: 201 active rock climbers (163 male, 38 female climbers) aged 16–62 years. Assessment of risk factors: Rock climbing behaviours and key demographics. Main outcome measures: Injuries requiring medical attention or withdrawal from participation for ⩾1 day. Results: Around 50% of climbers had sustained ⩾1 injury in the past 12 months, causing a total of 275 distinct anatomical injuries. 21 climbers (10%) had sustained acute climbing injuries as a result of a fall, 67 (33%) had chronic overuse injuries, and 57 (28%) had acute injuries caused by strenuous climbing moves. Dedicated climbers participating in different forms of rock climbing more often and at a higher level of technical difficulty may be more prone to injury, particularly overuse injuries of the finger and shoulder. The principal sources of treatment or advice sought by climbers were physiotherapists (18%), other climbers (14%) and doctors (11%). Conclusions: Climbing frequency and technical difficulty are associated with climbing injuries occurring at both indoor and outdoor venues, particularly cumulative trauma to the upper extremities.

107 citations


Journal ArticleDOI
TL;DR: The multivariate analysis showed that overweight and practicing bouldering generally implied an increased primary injury risk, while there was a higher re‐injury risk among male climbers and a lower risk among the older climbers.
Abstract: The objective was to examine injury rates and associated risk factors in a representative sample of climbers. A random sample (n=606) of the Swedish Climbing Association members was sent a postal survey, with an effective response rate of 63%. Self-reported data regarding climbing history, safety practices and retrospective accounts of injury events (recall period 1.5 years) were obtained. Descriptive statistical methods were used to calculate injury incidences, and a two-step method including zero-inflated Poisson's regression analysis of re-injuries was used to determine the combination of risk factors that best explained individual injury rates. Overall, 4.2 injuries per 1000 climbing hours were reported, overuse injuries accounting for 93% of all injuries. Inflammatory tissue damages to fingers and wrists were the most common injury types. The multivariate analysis showed that overweight and practicing bouldering generally implied an increased primary injury risk, while there was a higher re-injury risk among male climbers and a lower risk among the older climbers. The high percentage of overuse injuries implies that climbing hours and loads should be gradually and systematically increased, and climbers regularly controlled for signs and symptoms of overuse. Further study of the association between body mass index and climbing injury is warranted.

95 citations


Journal ArticleDOI
TL;DR: To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.
Abstract: Rock and ice climbing are widely considered to be ‘high-risk’ sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a ‘high-risk’ sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.

93 citations