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Yoon JH, Armstrong W, Philippopolous E, Dilworth N, Cheng I. Head Injuries in Rock Climbing: A Scoping Review. Wilderness Environ Med 2022; 33:479-487. [PMID: 36202720 DOI: 10.1016/j.wem.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
Abstract
Rock climbing was recognized as a sport at the 2020 Tokyo Olympics. Despite its increasing participation, there is no knowledge synthesis of head injuries (HIs), defined as any injury to the head, associated with climbing, making it challenging for clinicians to provide evidence-based care. Our aim was to synthesize HI literature within rock climbing and identify knowledge gaps. Six databases (Medline, Embase, Sports Medicine & Education Index, SPORTDiscus, CINAHL, and Cochrane) were searched. Two reviewers screened 345 studies and 31 studies were selected for data abstraction. We found the quality of individual studies mainly "fair" to "good." Both HI and traumatic brain injury (TBI) had inconsistent definitions and categorization. The HIs represented between 0 to 36% of reported climbing injuries. Between 11 to 100% of HIs were TBIs, defined as an HI with permanent or temporary neurological sequelae. The most common causes of HIs were outdoor falls and falling objects. Climbing-specific factors associated with the causes were infrequently examined in the literature. Data sources of safety practices were incomplete. Overall, there was a lack of literature examining HIs, mechanisms of injury, and safety practices associated with climbing. To improve the tracking of HIs in climbing, we suggest the use of consistent reporting standards and the creation of a climbing injury surveillance system.
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Affiliation(s)
- Joo Hyung Yoon
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
| | - Wes Armstrong
- Division of Emergency Medicine, University of Toronto, Toronto, Canada
| | | | - Neil Dilworth
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Cleveland Clinic Midtown, Toronto, Canada; Halton Healthcare, Georgetown, Canada
| | - Ivy Cheng
- Division of Emergency Medicine, University of Toronto, Toronto, Canada; Cleveland Clinic Midtown, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
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Into the wild and on to the table: A Western Trauma Association multicenter analysis and comparison of wilderness falls in rock climbers and nonclimbers. J Trauma Acute Care Surg 2021; 89:570-575. [PMID: 32265389 DOI: 10.1097/ta.0000000000002705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wilderness activities expose outdoor enthusiasts to austere environments with injury potential, including falls from height. The majority of published data on falls while climbing or hiking are from emergency departments. We sought to more accurately describe the injury pattern of wilderness falls that lead to serious injury requiring trauma center evaluation and to further distinguish climbing as a unique pattern of injury. METHODS Data were collected from 17 centers in 11 states on all wilderness falls (fall from cliff: International Classification of Diseases, Ninth Revision, e884.1; International Classification of Diseases, 10th Revision, w15.xx) from 2006 to 2018 as a Western Trauma Association multicenter investigation. Demographics, injury characteristics, and care delivery were analyzed. Comparative analyses were performed for climbing versus nonclimbing mechanisms. RESULTS Over the 13-year study period, 1,176 wilderness fall victims were analyzed (301 climbers, 875 nonclimbers). Fall victims were male (76%), young (33 years), and moderately injured (Injury Severity Score, 12.8). Average fall height was 48 ft, and average rescue/transport time was 4 hours. Nineteen percent were intoxicated. The most common injury regions were soft tissue (57%), lower extremity (47%), head (40%), and spine (36%). Nonclimbers had a higher incidence of severe head and facial injuries despite having equivalent overall Injury Severity Score. On multivariate analysis, climbing remained independently associated with increased need for surgery but lower odds of composite intensive care unit admission/death. Contrary to studies of urban falls, height of fall in wilderness falls was not independently associated with mortality or Injury Severity Score. CONCLUSION Wilderness falls represent a unique population with distinct patterns of predominantly soft tissue, head, and lower extremity injury. Climbers are younger, usually male, more often discharged home, and require more surgery but less critical care. LEVEL OF EVIDENCE Epidemiological, Level IV.
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Rock Climbing Emergencies in the Austrian Alps: Injury Patterns, Risk Analysis and Preventive Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207596. [PMID: 33086551 PMCID: PMC7589766 DOI: 10.3390/ijerph17207596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022]
Abstract
To elucidate patterns of and risk factors for acute traumatic injuries in climbers in need of professional rescue, a retrospective evaluation was performed of the Austrian National Registry of Mountain Accidents regarding rock climbing incidents over a 13-year timeframe from 2005 to 2018. From 2992 recorded incidents, 1469 were uninjured but in need of recovery, mainly when alpine climbing. Acute traumatic injuries (n = 1217) were often classified as severe (UIAA ≥ 3; n = 709), and commonly involved fractures (n = 566). Main injury causes were falls (n = 894) frequently preceded by rockfall (n = 229), a stumble (n = 146), a grip or foothold break-out (n = 143), or a belaying error (n = 138). In fatal cases (n = 140), multiple trauma (n = 105) or head injuries (n = 56) were most common, whereas lower extremity injuries (n = 357) were most common in severely injured patients. The risk for severe or fatal injuries increased with age and fall height when ascending or bouldering, during the morning hours, and when climbing without a helmet or rope. The case fatality rate was 4.7%, and the estimated total mortality rate was 0.003–0.007 per 1000 h of rock climbing. Acute traumatic injuries requiring professional rescue when rock climbing are often severe or fatal. Consequent use of a helmet when sport climbing, consistent use of a rope (particularly when ascending), proper spotting when bouldering, and proper training, as well as high vigilance when belaying are likely to help prevent such injuries.
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Bernard M, Wright R, Anderson H, Bernard A. Wilderness Falls: An Analysis and Comparison of Rock Climbers and Nonclimbers. J Surg Res 2018; 234:149-154. [PMID: 30527467 DOI: 10.1016/j.jss.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/23/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Wilderness travel and rock climbing are increasingly popular. Urban falls from height have been reported from trauma centers; however, there have been no trauma center reports of rock climbing or wilderness falls (WFs) in the United States. We sought to describe the injury pattern of WF and to determine whether rock climbers represent a distinct pattern of injury. MATERIALS AND METHODS The trauma database from our level 1 trauma center was queried from 1/1/06 to 12/31/16 for the diagnosis of "fall from cliff" (ICD9: e884.1, ICD10: w15.xx). Demographics, injury characteristics, and trauma center care were analyzed. Data were analyzed using two sample unequal variance T-tests, two sample Z-tests for proportions, and Fisher's exact tests. RESULTS One hundred fifty-one falls were analyzed (40 climbers, 111 nonclimbers). WF victims were predominantly male (79%), moderately injured (mean injury severity score = 13.2), frequently intoxicated (34%), and fell from an average of 43 feet (7-200 ft). The most frequent injures were soft tissue (55%), spine (50%), head (43%), lower extremity (38%), and chest (39%). Climbers were younger, more often sustained upper extremity and soft tissue injuries, more often flown from the scene, injured during daytime, and were better insured. Helmet use was rare (one climber and one nonclimber). There were 3 (2%) deaths, including one climber. CONCLUSIONS WFs have a distinct injury pattern and demographic and occur from a height greater than twice those reported in urban falls. Rock climbing falls involve another distinct demographic and pattern of injury. Injury prevention strategies may include helmet use and avoiding nighttime wilderness travel and drug/alcohol use.
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Affiliation(s)
- Matthew Bernard
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky.
| | - Raymond Wright
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky
| | - Hannah Anderson
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky
| | - Andrew Bernard
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky
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Martin PS, StClair VJ, Willis C, Rickman AC, Hynd D. Safety performance testing of climbing helmet-mounted cameras. Inj Prev 2016; 22:261-7. [PMID: 26746231 DOI: 10.1136/injuryprev-2015-041857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/11/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND No research establishing the effects of climbing helmet-mounted cameras on head injury biomechanics. OBJECTIVE Establish the potential effects of climbing helmet-mounted cameras on the injury risks associated with falling object strikes and falls onto flat and angled surfaces. METHODS Three experimental studies were developed via the adaptation of European helmet testing standards and regulations. Study 1 performed falling striker tests to the helmet, Study 2 performed linear headform drop tests onto a flat anvil and Study 3 performed oblique headform drop tests onto an anvil angled 15° from vertical. Three helmet categories (hard-shell, foam and hybrid) were impacted at three locations (vertex, front and side), using five camera mounting combinations and three control helmets. Data was collected for the forces, linear accelerations, rotational velocities and rotational accelerations experienced by the headform. RESULTS All helmet and camera combinations investigated by this project complied with current legislative performance criteria, while no combination exceeded published injury thresholds. No increase in head injury risk was observed for the forces transferred to the head during falling object strikes or with the linear accelerations experienced during falls onto flat and angled surfaces. Finally, although greater rotational head velocities and accelerations were observed with falls onto flat and angled surfaces, no injury threshold was exceeded by any investigated helmet and camera combination. CONCLUSIONS All helmet and camera combinations investigated by this project complied with current legislative performance criteria, while no combination exceeded published injury thresholds. Further research may be required to establish the effects of additional impact mechanism, helmet or camera mounting configurations.
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Affiliation(s)
- Philip S Martin
- Engineering & Assurance Division, Transport Research Laboratory (TRL), Wokingham, UK
| | - Vincent J StClair
- Engineering & Assurance Division, Transport Research Laboratory (TRL), Wokingham, UK
| | - Claire Willis
- Engineering & Assurance Division, Transport Research Laboratory (TRL), Wokingham, UK
| | | | - David Hynd
- Engineering & Assurance Division, Transport Research Laboratory (TRL), Wokingham, UK
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Schöffl V, Küpper T. Feet injuries in rock climbers. World J Orthop 2013; 4:218-28. [PMID: 24147257 PMCID: PMC3801241 DOI: 10.5312/wjo.v4.i4.218] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023] Open
Abstract
While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described.
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Abstract
OBJECTIVE The objective of this review is to summarize evidence on injuries occurring in individuals participating in mountain and wilderness sports. DATA SOURCES Scopus, ISI Web of Knowledge, SPORTDiscus, Ovid Safety and Health, Index to Theses, COPAC, and sportscotland e-library. The search terms were (mountain* or wilderness or adventure or climb* or (hill walk*)) and (accident* or injur* or rescue*) and (epidemiolog* or statistic* or pattern* or survey*). The search period was from 1987 to 2010. STUDY SELECTION A total of 2034 articles were identified. The full text of 137 articles was retrieved. Fifty articles met inclusion criteria-mountain and wilderness; nonmotorized, leisure time, outdoor activities; and nonfatal injury. Skiing and snowboarding articles were excluded. DATA EXTRACTION Study design was classified using the "STOX" hierarchy of evidence. Study quality was rated independently by 2 reviewers. DATA SYNTHESIS All studies were observational. Twenty-one (42%) were longitudinal, 20 (40%) were cross-sectional surveys, and 9 were cohort studies. A majority of casualties were aged 20 to 39 years. There was a clear male majority, 70% to 89% in most studies. The percentage of casualties who sustained severe injuries ranged from 5% to 10%--less than 10% were admitted to hospital. Casualties sustained an average of 1.2 to 2.8 injuries (most >1.6), which mainly affected the soft tissues; between 2% and 38% were fractures. Up to 90% of injuries were to the extremities. CONCLUSIONS The majority of mountain and wilderness sports injuries are minor to moderate. However, some casualties have life-threatening medical problems, which may have long-term implications for return to sport and general well-being.
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Rock climbing injuries treated in emergency departments in the U.S., 1990-2007. Am J Prev Med 2009; 37:195-200. [PMID: 19666157 DOI: 10.1016/j.amepre.2009.04.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/25/2009] [Accepted: 04/24/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND Rock climbing is an increasingly popular sport in the U.S., with approximately nine million participants annually. The sport holds an inherent risk of falls and stress-related injuries. As indoor climbing facilities become more common, more people are participating in the sport. PURPOSE The objective of this study is to describe the prevalence, characteristics, and trends of rock climbing-related injuries treated in U.S. emergency departments from 1990 through 2007. METHODS A retrospective analysis was conducted using data from the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission for all ages from 1990 through 2007. Sample weights provided by NEISS were used to calculate national estimates of rock climbing-related injuries. Trend significance of the number of rock climbing-related injuries over time was analyzed using linear regression. Analysis was conducted in 2008. RESULTS An estimated 40,282 patients were treated in emergency departments for rock climbing-related injuries in the U.S. over the 18-year period. Patients aged 20-39 years accounted for more than half of all injuries. Fractures, sprains, and strains accounted for the largest portion of injuries (29.0% and 28.6%, respectively). The lower extremities were the most frequently injured body part, accounting for 46.3% of all injuries; ankle injuries accounted for 19.2%. Men were more likely to sustain lacerations (OR=1.65; 95% CI=1.03, 2.67) and fractures (OR=1.54; 95% CI=1.10, 2.17), whereas women were more likely to sustain a sprain or strain (OR=1.68; 95% CI=1.13, 2.51). Overexertion injuries were more likely to occur to the upper extremities (OR=5.32; 95% CI=1.99, 14.23). Falls were responsible for three quarters of all injuries (77.5%). Overall, 11.3% of patients were hospitalized. CONCLUSIONS Our results indicate that the most common rock climbing-related injuries are to the lower extremities and are fractures, sprains, and strains. More research is needed to determine how rock-climbers' characteristics, climbing setting, style of climbing, and use of safety equipment and training may affect their risk for certain injury patterns.
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