Sledding-related injuries common among children

Howell CA. Pediatrics. 2010;125:517-524.

Sled-related injuries are common and can be very serious, particularly in younger children, and further research is needed into how to prevent these injuries, a study published online Monday concluded.

Investigators from the Research Institute at the Nationwide Children’s Hospital and the Ohio State University College of Medicine in Columbus evaluated the incidence and type of sledding-related injuries experienced by children presenting to EDs between 1997 and 2007. The researchers identified cases via the National Electronic Injury Surveillance System database and used weighted analyses to extract national estimates for sledding-related injuries.

During the study period, ED physicians treated 229,023 patients aged 19 years and younger for sledding-related injuries (95% CI, 165,805-292,241), the researchers said, with an average of 20,820 injuries occurring per year. These data equated to an annual average of 26 cases per 100,000 U.S. children in this age group.

Children aged 10 to 14 years, representing 42.4% of the study cohort, experienced the highest amount of sledding-related injuries. Children aged 5 to 9 years were the second most affected age group. The researchers also noted that 59.8% of cases involved boys.

Head injuries were the most common, accounting for 34.1% of all sledding-related injuries. Children aged 4 years and younger had the highest likelihood of sustaining a head injury compared with older children (OR=4.64; 95% CI, 3.52-6.1).

Fractures accounted for most injuries — about 26% — according to the researchers, although contusions and abrasions, which occurred in 25% of cases, followed close behind. Boys were more likely to sustain fractures (OR=1.23; 95% CI, 1.08-1.39) or lacerations (OR=1.55; 95% CI, 1.26-1.9) than other types of injuries. Girls, however, usually reported sprains or strains (OR=1.37; 95% CI, 1.22-1.76) or contusions (OR=1.34; 95% CI, 1.17-1.54).

Analysis of data by age group indicated that children aged 4 years and younger were more likely to experience lacerations (OR=2.59; 95% CI, 1.94-3.46), whereas children aged 10 to 14 years were at a higher risk for fractures (OR=1.5; 95% CI, 1.33-1.83). Those aged 15 to 19 years were most likely to sustain sprains or strains (OR=1.92; 95% CI, 1.47-2.5).

Collisions caused about half of the injuries, the researchers said, and were also more likely to result in traumatic brain injuries (OR=1.58; 95% CI, 1.24-2.02) and contusions (OR=1.25; 95% CI, 1.07-1.46). Falls were the most common cause of fractures (OR=1.82; 95% CI, 1.49-2.21) and sprains or strains (OR=1.6; 95% CI, 1.06-2.4).

Sled types played a role in incidence and the kinds of injuries sustained. Most sledding-related injuries involved traditional sleds, although children using snow tubes were more likely to sustain traumatic brain injury (OR=1.78; 95% CI, 1.35-2.33).

The researchers also noted that about half of fractures resulted in hospitalization, and traumatic brain injuries were responsible for approximately 25% of hospitalizations. Collisions also accounted for 65% of all hospitalizations.

The large amount of head injuries is a concern, the researchers said, adding that states have recently been campaigning for mandatory helmet laws for sledders. Yet, this is only one potential safety measure.

“Prevention of sledding-related injuries warrants more research, particularly regarding the impact of helmet use and the practice of pulling sleds behind vehicles,” the researchers wrote.

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