Children Should Wear Helmets While Ice-Skating: A Comparison of Skating-Related Injuries

Objective. This study compares injuries, especially head injuries, among ice-skaters with those among skateboarders, rollerskaters, and in-line skaters, to determine the need for helmet use during recreational ice-skating by children.Design. A comparative study of a consecutive series of patients.Setting. The emergency department of a large, urban, academic, children’s hospital.Participants. Children treated for injuries related to recreational ice-skating, skateboarding, rollerskating, and in-line skating.Results. During a 31-month period, 419 consecutive children were evaluated in the emergency department for skating-related injuries. Children were predominately male (53.9%), with a mean age of 10.0 years (SD: 3.0 years; median: 10.0 years; range: 1–18 years). The most frequent mechanism of injury was a fall. Overall, 76.5% of children (215 of 281 children) were reported to be wearing no protective equipment, such as a helmet or padding on the elbows or knees, at the time of injury. Ice-skaters were more likely to have adult supervision than were skateboarders (relative risk [RR]: 5.16; 95% confidence interval [CI]: 2.13–12.46), rollerskaters (RR: 1.21; 95% CI: 1.09–1.35), and in-line skaters (RR: 2.08; 95% CI: 1.72–2.51). Ice-skaters were at greater risk of injury to the head (20.0%) than were in-line skaters (4.9%) (RR: 4.09; 95% CI: 1.81–9.23); a weak difference was noted between ice-skaters and rollerskaters (9.9%) (RR: 2.18; 95% CI: 1.04–4.57), with no significant difference in head injuries between ice-skaters and skateboarders (15.9%) (RR: 1.60; 95% CI: 0.54–2.93). Ice-skaters demonstrated lacerations to the head in 68.8% of abnormal head examinations, compared with 37.0% for rollerskaters (RR: 1.86; 95% CI: 1.08–3.20) and 50.0% for in-line skaters (RR: 2.06; 95% CI: 1.35–3.16); however, there was no significant difference in lacerations to the head between ice-skaters and skateboarders (53.3%) (RR: 1.29; 95% CI: 0.76–2.19). Injuries to ice-skaters occurred more often in an indoor skating facility (92.9%, 52 of 56 cases), compared with injuries to skateboarders (3.6%, 1 of 28 cases) (RR: 13.96; 95% CI: 2.01–96.76), rollerskaters (63.4%, 59 of 93 cases) (RR: 1.46; 95% CI: 1.23–1.74), and in-line skaters (10.9%, 15 of 137 cases) (RR: 8.48; 95% CI: 5.23–13.75).Conclusions. The proportion of head injuries among ice-skaters in this study was greater than that observed for participants in other types of skating, for which helmet use is recommended and often required. Children should wear a helmet during recreational ice-skating. Mandatory helmet use by pediatric ice-skaters at indoor rinks should be implemented. Use of other types of protective equipment, such as wrist guards, knee pads, and elbow pads, should be considered for prevention of injuries to the extremities during ice-skating. Caution should be used when allowing young children to participate in recreational ice-skating. Additional research should be conducted in other populations, to corroborate these findings and to evaluate ice-skating safety recommendations for children.