Sledding injuries: is safety in this winter pastime overlooked? A three-year survey in South-Tyrol
© Corra and De Giorgi; licensee BioMed Central Ltd. 2007
Received: 15 November 2006
Accepted: 28 November 2007
Published: 28 November 2007
Sledding is a popular traditional pastime in northern countries. However it is only rarely thought as a potentially dangerous activity even though serious injuries and deaths do occur. The purpose of this study was to calculate the incidence, the severity and the pattern of sledding-related injuries in our area, in order to set up possible preventive measures.
In three consecutive winter seasons (Dec.–Apr.,2002–2005). 356 patients (182 males, 174 females, mean age 26.9 years, range 2 to 81) were referred directly to our ED after a sledding injury. One patient (male, age 21 years) was transferred from a community hospital and died on the following day. Two patients (males, age 47 and 28 years) were declared dead on the scene. In the majority of the cases the accident was due to a fall and collision with the ground or a standing object. The number of injuries showed a progressive increase during the observed seasons and all deadly accidents were observed in the last season. Injuries were divided into three severity classes: minor (ISS ≤ 3), intermediate (ISS ≥ 4 < 15), severe (ISS ≥ 15). Minor and intermediate injuries were equally distributed between males and females, whereas all severe and deadly accidents occurred to male patients. Time of accident and place of accident did not affect the injury severity. A total of 386 lesions were detected. The most common diagnosis was head trauma (14,5%), followed by knee sprain (13%), ankle sprain (11.5%), and ankle/leg fracture (9%). 41 patients required hospital admission. The mean hospital length of stay was 3.9 days and 16 patients required surgery. The most common diagnosis on admission was lower limb fracture (13 patients) and head trauma (13 patients). The percentage of pediatric injuries was much lower than that reported in other studies.
Sledding is rarely thought of as a potentially dangerous activity, but it can result in serious injury. Better public awareness of the risks of sledding injuries is required and preventive measures like the use of helmet, soft-side protections on the tracks, regular checks of the track conditions and good lightning for night sledding should be enforced.
Sledding is a popular traditional winter pastime in South Tyrol. Up to a decade ago it was practiced mainly by local residents, but recently it has been more and more advertised as tourist attraction and the participating population includes now tourists. In a recently published tourist guide book  over 130 sledding tracks are described in the region. These tracks are usually obtained by transforming mountain roads leading to cattle huts into well prepared sledding tracks. Some tracks are served by ski-lift facilities and few are lightened for "moonlight sledding": Few data are available worldwide about sledding injuries [2–7], and most of them are limited to pediatric accidents. To date no safety rules regulate the use of these tracks. The purpose of this study was to calculate the incidence, the severity and the pattern of sledding-related injuries in our area, in order to set up possible preventive measures.
For every patient referred to our Emergency Department (ED) after a sledding accident in three consecutive seasons (from December, 8th to April, 25th, 2002–2005) the following data were collected on admission: age, gender, date, time and place of the accident, previous sledding experience, type of accident (collision with other vehicles or sleds, or fall from sled), mean of transport to the ED. Data were collected independently from the hospital documentation system and used only for the purpose of this study, according to the Italian law on privacy. Ethical committee approval was not required for this study. Type of injury and Injury Severity Score (ISS), according to Baker et al. , were retrospectively assigned based upon ED and hospital charts. Data concerning mortality on the scene were obtained from the regional emergency call-centre. ISS was not calculated for patients dead on the scene. Injuries were divided into three severity classes: minor (ISS ≤ 3), intermediate (ISS ≥ 4 < 15), severe (ISS ≥ 15). Rescue and hospital costs were estimated from the provincial reimbursement table, based upon the ICD-9-CM classification.
During the study period 356 patients (182 males, 174 females, mean age 26,9, median age 26,5, SD 14,4, 95% CI = 3.5 – 79.5) were referred directly to our ED after a sledding injury. Two patients were declared dead on the scene and one patient (male, age 21 years) was transferred from a community hospital to our Intensive Care Unit (ICU) He sustained a devastating head trauma after collision with a snowmobile during a night ride. Cerebral death was declared on the following day and organs were donated. He was riding with a companion (male, age 28) who was declared dead on the scene. The third deadly case (male, age 47 years) happened during a night ride, too. The man lost by mistake the sledding track, ended on a steep ski slope and hit a ski lift pole at high speed. He was declared dead on the scene. All these patients were local residents with known good expertise in sledding. No one was wearing safety devices, and all accidents happened after dinner with probably intake of alcohol.
Patients distribution among the three ISS classes.
ISS 1–3 (N. of pts)
ISS 4–14 (N. of pts)
ISS ≥ 15 (N. of pts)
12 (p < 0.05)**
Comparison of the injuriy severity between day and night and in four different resorts.
N° of patients
Time of injury
Place of injury
Pattern of lesions observed
HEAD AND SPINE
Total number of lesions (%)
N. of lesions in adult population (%)
N. of lesions in pediatric population (%)
Minor head trauma (no neurological signs)
Brain concussion (nerological signs with negative CT)
Cervical sprain/vertebral contusion (without fracture)
2 (25), 3(9)
Knee sprain (with severe ligaments involvement)
Knee sprain (without or minor ligaments involvement)
Hemo- and/or pneumothorax
Internal abdominal injury
OPEN SKIN WOUND
Abdominal wall wound
N. of Pts
Length of stay (days), mean (SD, CI 95%, range)
Main admission diagnosis
N. of Pts requiring surgery
ED – Short term
1.29 (0.61, 0.35, 1–3)
Brain concussion (9)
Rib fracture (2)
Vertebral fracture (1)
Vertebral contusion (2)
5.63 (6.14, 2.96, 1–20)
Lower limb fracture (13)
Vertebral fracture (4)
Upper limb fracture (2)
3.5 (2.08, 3.31, 1–6)
Brain concussion (3)
Vertebral contusion (1)
Spleen-kidney lesion (1)
Spinal lesion (1)
Vertebral fracture (1)
Intracranial lesions (1)
Our findings are similar to those reported in other studies [2–7]. The pattern of lesion we observed resembles that reported by Skarbek-Boroswska et al.  in a large United States emergency services survey. The overall incidence of sledding injuries is in our region is higher than that reported in other studies [4, 6]. This is due to the high density of sledding tracks and to the size of the participating population, made up originally only by local residents and in the last years by a growing number of tourists. However, the most impressing data of our study, compared to other findings, is the greater incidence of sledding injuries in the adult population. Other studies showed that the vast majority of sledding-related injuries resulting in ED visits occurred in patients 19 years of age or younger, with a percentage of pediatric injuries ranging from 65 to 71 of all sledding accidents [6, 7]. In our study these data are reverse: only 25% of the patients are children (age 0–14, 36% considering age group 0–19). This means that development of prevention strategies, at least in our region, should not only target the pediatric population, as stated by Skarbek-Boroswska et al. . Sledding is rarely thought of as a potentially dangerous activity, but it can result in serious injury. Better public awareness of the risks of sledding injuries and preventive measures are required. At present, no safety rules regulate the use of sledding tracks in our region. Our findings could offer some suggestions to improve safety in this outdoor activity. All deadly accidents were observed during "moonlight sledding". In two cases the cause was a collision with a snowmobile and in the third case the unlucky patient lost by mistake the sledding track ending on a steep ski slope and hitting a ski lift pole at high speed. Sledding tracks should not be used by vehicles other than sleds, and "moonlight sledding" should be permitted only in tracks equipped with lightning powerful enough to prevent route mistakes with poor weather condition. In most cases injury was caused by a fall from sled and subsequent collision with a standing object. Since almost all the tracks run through woods, soft side protections in sharp turns or in steep stretches should be provided to avoid collision with trees. Snow condition should be checked daily at least in those popular tracks served by ski-lift facilities, and in dangerous conditions (ice or insufficient snow) the track should be closed. The high percentage of head injury found in this and in previous studies suggests that the use of helmets should be recommended to all participants. In the same way, the higher number of lower extremity trauma, as compared to skiers and snowboarders, would suggest the use of hard boots. In the adult population it would be also interesting to study the correlation between alcohol intake and sledding injuries.
We would like to thank the medical and nursing staff of the Emergency Department of the Hospital of Bolzano/Bozen for the precious help in collecting patients' data. This study did not receive any kind of funding.
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