Helmets for sledding?

While 3 permanent injuries to child sledders over 8 years spotlights the need for parents to instruct their children in “safe sledding”, helmet use seems like overkill.

Here’s the study abstract as presented at today’s American Academy of Pediatrics National Conference and Exhibition in Boston:

Purpose: Injury control strategies are developed after epidemiological studies document morbidity and mortality associated with an activity. For example, ski helmet use has increased secondary to research and education that demonstrated marked injury reduction, especially traumatic brain injury for those using ski helmets. Sledding is another popular winter activity. In 2010 at a level 1 pediatric trauma center sledding injuries was the number one mechanism resulting in hospitalization for all winter activities. It is possible that sledding may benefit from a similar injury control strategy to downhill skiing. The purpose of this review is to describe our practice-based incidence of sledding injuries in children.
Methods: An 8-year (2003-2011) retrospective review of all hospitalized children from a level one pediatric trauma center (<18yrs) due to sledding injuries was performed. Demographic, standard injury data including; injury severity score (ISS) score, hospital stay, ICU stay, and discharge status were analyzed and compared to all other trauma hospitalizations.

Results: Fifty two children were hospitalized from sledding injuries. There were 34 males and 18 females with an average age of 10.1 ±3.7 years. Sled versus tree was the most common mechanism of injury in 33/52(63.5%). The average ISS, hospital and ICU stay data is shown in Table 1. Strikingly 20(37%) patients suffered a head injury with average ISS scores of 13.21 and 70% of them were admitted to the ICU. Head injuries included; epidural(6), subarachnoid(3), subdural(2) intraparenchymal (3) and positive LOC with skull fracture without CT finding of intracranial bleed(6). Three children had permanent disability including cognitive impairment and two others required long term hospitalization rehabilitation. Other injuries included fractures 17, solid organ injuries (10), chest trauma (1) vertebral fractures (3). Four of the 32 patients without a head injury required ICU admission. Nine orthopedic injuries required operative intervention while 8 were sent home with casting after closed reduction. Renal injuries (4) included two grade four one grade two, and one grade one. There were 6 splenic injuries: two grade three and four grade four.

Conclusions: In our series sledding was a significant component of hospitalized children during winter months. Thirty percent suffered significant head inquires and nearly 10% had a permanent disability. An injury control strategy ensuring a safe environment away from trees, and head protection should be publicized.

The study media release says,

Lead study author Richard Herman, MD, FAAP, said the study results support the need for public education campaigns that encourage helmet use while sledding, as well as awareness of potential dangers on a sled course.

But before we start scaring parents about child sledding, it would seem that scaring them about falls, the leading cause of unintentional injury for children, ought to be a higher priority.