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    Kid care on the slopes

    Recognizing first that children have anatomic and physiologic differences from adults helps to provide optimal care for kids in winter sports emergencies.

    Skiing is an enormously popular winter sport for children, teenagers, and families both in the United States and internationally. Estimates put the number of skiers globally at more than 200 million, with children accounting for 13% to 27% of these skiers.1 According to the National Ski Areas Association, an estimated 10 million skiers and snowboarders made 53.6 million daily visits to US ski areas during the 2014-2015 US ski season.2,3 According to a national survey, there are 471 ski areas currently operating in the United States.2

    The authors are 2 pediatricians who have practiced over the last decade in Eagle County, Colorado, home of both Vail Mountain and Beaver Creek, 2 of the most visited ski areas in the United States. Approximately 20% of all the annual ski visits in the United States occur in Colorado, and Vail is the busiest ski area of the many in the state. Thus, the authors have considerable experience with pediatric skiing-related injuries and emergencies in their pediatric hospitalist and general pediatrics practices.

    Injury type and toll

    At the authors’ local Vail Valley Medical Center (VVMC), hospital billing data from the VVMC Emergency Department (ED) during the 2014-2015 ski season show there were nearly 4800 patient encounters with a diagnostic accident code E003.2 (activities involving snow; skiing, boarding, sledding). Twenty percent of these VVMC ED visits (nearly 1000) were for children and teenagers. Of the 4800 patients who visited the ED, approximately 500 were admitted to the hospital, and 15% of these admissions (about 75 total admissions) were for children and adolescents injured while skiing and snowboarding. Fifty percent of these admissions were orthopedic injuries (type unspecified) and 12% were for a traumatic brain injury.

    More: Why playground injuries are on the rise

    Clearly, skiing is a sport with a significant risk of injury and, rarely but tragically, death. During the 2012-2013 Colorado ski season, there were 25 skiing-related deaths. Twenty-three of the fatalities occurred while skiing and 2 while snowboarding. In general, there is a consistent 4:1, male-to-female ratio in skier deaths. According to the Colorado Department of Public Health and Environment, 88% of Colorado skier deaths occurred on the slopes, 11% in terrain parks, and 4% were chair-lift associated. Perhaps surprisingly, despite ski helmets’ critical role in injury prevention, about 60% of deaths were sustained by skiers who were wearing a ski helmet.

    Epidemiologists estimate that 600,000 people are injured annually in the United States as a result of skiing and snowboarding.4 Whereas some of these injuries are treated without pursuing medical care, many of the injured will seek care in an ED, acute care facility, or pediatrician’s or primary care provider’s office.

    Ski vs board trauma

    Skiers are prone to sustain lacerations, boot-top contusions, thumb injuries, and complex knee injuries. In contrast, snowboarders tend to experience distal radius fractures and foot and ankle injuries. Skiers are typically prone to severe injuries sustained from collisions on the slopes, while snowboarders tend to suffer injuries from falls and jumps, not uncommon in terrain parks. Snowboarders are 6 times more likely than skiers to sustain a splenic injury from abdominal trauma (so-called “boarder belly”), with males 21 times more likely to sustain this injury than females.5

    In a recent study published by colleagues at VVMC, snowfall and mechanism of injury were reviewed in 644 ski-related hospitalizations.6 The majority of these injuries occurred when there was less than 1 inch of new snowfall, and snowfall of less than 2 inches was associated with increased injury severity. This corroborates the long-held ski patroller observation that, with low snowfall, the slopes are icier and faster and skiers are at increased risk of all injuries under such conditions—particularly severe injuries. In the VVMC study, collisions were associated with the most severe injuries: renal injuries and severe thoracic injuries. Consequently, the authors recommend caution and a thorough evaluation of patients with any injury sustained in a collision.

    Kids are different

    When caring for pediatric and adolescent patients with skiing-related injuries, it is important to remember the mantra long articulated by pediatricians: “Kids are not little adults.” In regard to any cold weather injuries, keep in mind that children have a larger surface area and thinner skin for their weight. Therefore, they can have more difficulty maintaining body temperature compared with adults. They are also at increased risk of both dehydration and hypothermia when compared with adult skiers and snowboarders.

    The implications of these realities are clear: When caring for a child on the slopes, think warmth and hydration. Provide warmth by getting them inside as soon as possible, covering them with blankets and/or additional outdoor ski clothing, supplying hand warmers, and offering warm beverages. Water is the preferred first fluid to start with in caring for children. Avoid sports drinks because of their glucose and electrolyte content.7

    Regarding energy needs, kids have faster metabolisms than adults and consequently deplete their glucose stores more quickly. Therefore, it is a good idea to quickly get some simple sugars such as chocolates, energy bars, juices, and so on into a child suffering a winter sports-related injury.

    NEXT: More differences to consider


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