Serious Winter Sport Injuries in Children and
Adolescents Requiring Hospitalization
ELISABETH GUENTHER SKOKAN, MD, MPH, EDWARD P. JUNKINS, J
R
,MD,
AND HOWARD KADISH, MD
To describe the epidemiology of serious winter sports-related injuries
resulting in hospitalization in children and adolescents, we prospectively
collected and analyzed records of all winter sports-related injuries re-
quiring hospitalization at our respective institutions from 1996 to 2000.
We identified 101 patients with a mean age of 10.7 years, of whom 68%
were male and 32% female. Skiers accounted for 71% and snowboarders
26% of injuries; 3% of injuries were snowmobile-or luge-related. Leading
mechanisms of injury were ground level falls (50%), crashes into trees,
(18%), and falls from ski lift (13%). Approximately 26% of the patients met
criteria for trauma-team activation. Leading diagnoses were head injury
(20%), femur fracture (18%), and concussion (11%). Five patients re-
quired admission to the intensive care unit. The median injury severity
score (ISS) was 7; 8% of patients had an ISS score > 15. Abbreviated
Injury Scale-1990 scores of > 3 were noted in 34% of the patients. We
conclude that Injuries sustained through participation in winter sports
may be severe, especially in the case of injuries involving the head.
Injury-prevention strategies should focus on head injuries. (Am J Emerg
Med 2003;21:95-99. Copyright 2003, Elsevier Science (USA). All rights
reserved.)
Injuries are the leading cause of death and life-years lost
for children and adolescents in the United States.
1
Annually,
6,000 deaths are related to unintentional injuries sustained
through sports and recreation.
2
Skiing is enjoyed by an
estimated 200-million people worldwide,
3
and snowboard-
ing is a winter sport that has increased considerably in
popularity during the past two decades.
4,5
Fortunately, most
injuries resulting from these popular winter activities are
relatively minor.
5,6
However, participation in such sports
may result in significant morbidity, as shown in the follow-
ing cases.
CASE PRESENTATIONS
Case 1
During a ski lesson, an 11-year-old male skier collided
with a tree at high speed. He suffered immediate loss of
consciousness. A nearby emergency medical technician re-
sponded, using basic life-support techniques while main-
taining cervical spine precautions. Bag–valve–mask (BVM)
ventilation was initiated. The patient’s Glasgow Coma
Scale (GCS) score was 3, his pupils were normally reactive,
and his vital signs were stable. Following rapid-sequence
intubation, the patient was transported by helicopter to the
area trauma center (Primary Children’s Medical Center
[PCMC], Salt Lake City, UT). Before arrival, his pupils
became nonreactive, his heart rate decreased to 70 beats per
minute (bpm), and his systolic blood pressure increased to
150 mm Hg. A subdural hematoma with cerebral edema was
noted on computed tomographic (CT) scanning of the pa-
tient’s brain. After a prolonged hospitalization, the patient
was discharged to a rehabilitation facility.
Case 2
An 8-year-old boy lost control of his skis during a ski
lesson and crashed into a tree. He immediately lost con-
sciousness. On arrival of the ski patrol, the patient’s GCS
score was 3 and his pupils were sluggishly reactive. His
trachea was suctioned, he was immobilized, and BVM
ventilation was initiated. The patient was transported by
helicopter to the PCMC emergency department, where his
GCS was 7. A CT of the head revealed a large epidural
hematoma, and the patient was taken emergently to the
operating room. After a prolonged course in the pediatric
intensive care unit (PICU), the patient was transferred to
another facility for rehabilitation.
The rates and patterns of injuries for both skiing and
snowboarding have been reported; however, most studies
have included few pediatric patients. An overall injury rate
of approximately 3.7 per 1,000 skier-days for adult skiers
was reported by Warme et al in 1995.
7
Machold et al.
surveyed 2,745 snowboarders and found 10.6 injuries re-
quiring medical care per 1,000 days of snowboarding.
6
The
risk of injury while snowboarding is thought to be about
twice that while skiing, although the injuries are less seri-
ous.
5
These injuries were mainly to the wrist, hand, and
head of the snowboarder. Other studies of snowboarders
have reported a similar pattern of injury, with subjects at
highest risk noted to be male, younger, and inexperienced.
8
Winter sports injuries of greatest concern are those seri-
ous injuries resulting in hospitalization and significant mor-
bidity or mortality. An estimated 135,000 skiing accidents
occur in the United States annually, of which 2.6% result in
potentially serious head injury, as an example of but one
type of serious injury.
9
Hagel et al specifically found a high
proportion of head injuries for male skiers and snowboard-
ers belonging to younger age groups.
10
For snowboarders,
the incidence of head injury was 6.5 per 100,000 hospital
From the Division of Pediatric Emergency Medicine, Department
of Pediatrics, University of Utah School of Medicine, and the Inter-
mountain Injury Control Research Center Salt Lake City, Utah.
Manuscript received February 20, 2002; accepted May 1, 2002.
This study was presented at American Academy of Pediatrics
annual fall meeting (Injury Prevention Section) in San Francisco, CA,
November, 2001.
Address reprints requests to: Elisabeth Guenther Skokan, MD,
MPH, Division of Pediatric Emergency Medicine, Primary Children’s
Medical Center, 100 No. Medical Drive, Salt Lake City, UT, 84113.
Email: eskokan@hsc.utah.edu
Key Words: Skiing, snowboarding, recreational injury, pediatric
trauma, helmets, injury prevention.
Copyright 2003, Elsevier Science (USA). All rights reserved.
0735-6757/03/2102-0002$30.00/0
doi:10.1053/ajem.2003.50032
95