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Papers by Steinar Sulheim

Research paper thumbnail of Helmet Use and Risk of Head Injuries in Alpine Skiers and SnowboardersSulheim S, Holme I, Ekeland A, et al (Norwegian School of Sport Sciences, Oslo; Martina Hansens Hosp, Bærum, Norway) JAMA 295:919–924, 2006§

Jama the Journal of the American Medical Association, Feb 22, 2006

Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this eff... more Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders. To determine the effect of wearing a helmet on the risk of head injury among skiers and snowboarders while correcting for other potential risk factors. Case-control study at 8 major Norwegian alpine resorts during the 2002 winter season, involving 3277 injured skiers and snowboarders reported by the ski patrol and 2992 noninjured controls who were interviewed on Wednesdays and Saturdays. The controls comprised every 10th person entering the bottom main ski lift at each resort during peak hours. The number of participants interviewed corresponded with each resort's anticipated injury count based on earlier years. Injury type, helmet use, and other risk factors (age, sex, nationality, skill level, equipment used, ski school attendance, rented or own equipment) were recorded. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors (including helmet wear) and risk of head injury by comparing skiers with head injuries with uninjured controls, as well as to skiers with injuries other than head injuries. Head injuries accounted for 578 injuries (17.6%). Using a helmet was associated with a 60% reduction in the risk for head injury (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.55; adjusted for other risk factors) when comparing skiers with head injuries with uninjured controls. The effect was slightly reduced (OR, 0.45; 95% CI, 0.34-0.59) when skiers with other injuries were used as controls. For the 147 potentially severe head injuries, those who were referred to an emergency physician or for hospital treatment, the adjusted OR was 0.43 (95% CI, 0.25-0.77). The risk for head injury was higher among snowboarders than for alpine skiers (adjusted OR, 1.53; 95% CI, 1.22-1.91). Wearing a helmet is associated with reduced risk of head injury among snowboarders and alpine skiers.

Research paper thumbnail of Helmets Reduce the Risk of Head Injuries in Alpine Skiing Disciplines and Snowboarding

Medicine & Science in Sports & Exercise, 2004

Research paper thumbnail of Self-estimation of ability among skiers and snowboarders in alpine skiing resorts

Knee Surgery, Sports Traumatology, Arthroscopy, 2007

Skiing ability is thought to be an important risk factor for injuries, but the best method to cla... more Skiing ability is thought to be an important risk factor for injuries, but the best method to classify skiing ability is not known. The objective of this study was to validate five different questions designed to selfreport skiing ability for ski injury surveillance. To this end 512 alpine skiers, Telemark skiers, snowboarders and skiboarders were asked to selfestimate their skiing ability using five different questions based on skiing skill, piste difficulty, turning technique, skiing experience and falling frequency, each with four categories. The participants then made a test run to test their skiing ability. Observed and self-reported skiing ability were compared using kappa statistics. The correlation between observed and self-reported skiing ability was low to fair, with kappa values of 0.34 for skiing skill), 0.33 for piste difficulty, 0.38 for turning technique, 0.26 for experience and 0.16 for falling frequency. However, the sensitivity and specificity for each of the questionnaires in discriminating between individuals in the poorest skiing ability category on the test and the rest of the group was relatively good (skiing skill: sensitivity 75%, specificity 91%; piste difficulty 68, 96%; turning technique 75, 91%; experience 75, 90%; falling frequency 61, 97%). The results show that the capacity to self-assess skiing ability is limited, but estimation based upon turning technique or skiing skill seem to be best methods for epidemiological studies on injuries in snow sports.

Research paper thumbnail of Injury Rates and Injury Types in Alpine Skiing, Telemarking, and Snowboarding

Journal of ASTM International, 2005

Research paper thumbnail of Helmet Use and Risk of Head Injuries in Alpine Skiers and Snowboarders

JAMA, 2006

Context Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, ... more Context Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders.

Research paper thumbnail of Risk factors for injuries in alpine skiing, telemark skiing and snowboarding - case-control study

British Journal of Sports Medicine, 2011

Alpine skiing and snowboarding have a substantial risk of injuries, but precise risk factor estim... more Alpine skiing and snowboarding have a substantial risk of injuries, but precise risk factor estimates are limited. Objective To determine the risk factors among skiers and snowboarders. Case-control study. Ski patrols reported cases (N=3277) in eight major Norwegian alpine resorts. Injury type and risk factors (age, gender, nationality, skill level, equipment, helmet use, ski school attendance, rented or own equipment) were recorded. An uninjured control group (N=2992) was obtained at the same resorts. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors and risk of injury. The overall injury risk was increased among beginners (OR 2.72; 2.12 to 3.47), children (OR 1.72; 1.41 to 2.13), adolescents (OR 2.16; 1.72 to 2.66) and non-Nordic skiers (OR 1.80; 1.37 to 2.36). Snowboarders had a higher overall injury risk than skiers (OR 2.11; 1.81 to 2.46). Alpine skiers (OR 2.65; 1.47 to 4.80), beginners (OR 2.50; 1.61 to 3.85), children (OR 11.1; 6.7 to 20.0) and adolescents (OR 4.17; 2.44 to 7.14) were prone to lower leg fractures. Knee injuries occurred more frequently among alpine skiers (OR 1.82; 1.39 to 2.38), females (OR 1.67; 1.38 to 2.03) and beginners (OR 3.13; 2.50 to 3.85). Males (OR 1.85; 1.45 to 2.38), telemark skiers (OR 1.70; 1.30 to 2.23), children (OR 2.22; 1.37 to 3.57) and adults (OR 1.64; 1.11 to 2.37) had an increased risk for shoulder injuries. Snowboarders, beginners, children and adolescents had an increased injury risk.

Research paper thumbnail of Intraarticular location predicts cartilage filling and subchondral bone changes in a chondral defect

Acta Orthopaedica, 2010

Background and purpose The natural history of, and predictive factors for outcome of cartilage re... more Background and purpose The natural history of, and predictive factors for outcome of cartilage restoration in chondral defects are poorly understood. We investigated the natural history of cartilage filling subchondral bone changes, comparing defects at two locations in the rabbit knee.

Research paper thumbnail of Helmet Use and Risk of Head Injuries in Alpine Skiers and SnowboardersSulheim S, Holme I, Ekeland A, et al (Norwegian School of Sport Sciences, Oslo; Martina Hansens Hosp, Bærum, Norway) JAMA 295:919–924, 2006§

Jama the Journal of the American Medical Association, Feb 22, 2006

Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this eff... more Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders. To determine the effect of wearing a helmet on the risk of head injury among skiers and snowboarders while correcting for other potential risk factors. Case-control study at 8 major Norwegian alpine resorts during the 2002 winter season, involving 3277 injured skiers and snowboarders reported by the ski patrol and 2992 noninjured controls who were interviewed on Wednesdays and Saturdays. The controls comprised every 10th person entering the bottom main ski lift at each resort during peak hours. The number of participants interviewed corresponded with each resort's anticipated injury count based on earlier years. Injury type, helmet use, and other risk factors (age, sex, nationality, skill level, equipment used, ski school attendance, rented or own equipment) were recorded. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors (including helmet wear) and risk of head injury by comparing skiers with head injuries with uninjured controls, as well as to skiers with injuries other than head injuries. Head injuries accounted for 578 injuries (17.6%). Using a helmet was associated with a 60% reduction in the risk for head injury (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.55; adjusted for other risk factors) when comparing skiers with head injuries with uninjured controls. The effect was slightly reduced (OR, 0.45; 95% CI, 0.34-0.59) when skiers with other injuries were used as controls. For the 147 potentially severe head injuries, those who were referred to an emergency physician or for hospital treatment, the adjusted OR was 0.43 (95% CI, 0.25-0.77). The risk for head injury was higher among snowboarders than for alpine skiers (adjusted OR, 1.53; 95% CI, 1.22-1.91). Wearing a helmet is associated with reduced risk of head injury among snowboarders and alpine skiers.

Research paper thumbnail of Helmets Reduce the Risk of Head Injuries in Alpine Skiing Disciplines and Snowboarding

Medicine & Science in Sports & Exercise, 2004

Research paper thumbnail of Self-estimation of ability among skiers and snowboarders in alpine skiing resorts

Knee Surgery, Sports Traumatology, Arthroscopy, 2007

Skiing ability is thought to be an important risk factor for injuries, but the best method to cla... more Skiing ability is thought to be an important risk factor for injuries, but the best method to classify skiing ability is not known. The objective of this study was to validate five different questions designed to selfreport skiing ability for ski injury surveillance. To this end 512 alpine skiers, Telemark skiers, snowboarders and skiboarders were asked to selfestimate their skiing ability using five different questions based on skiing skill, piste difficulty, turning technique, skiing experience and falling frequency, each with four categories. The participants then made a test run to test their skiing ability. Observed and self-reported skiing ability were compared using kappa statistics. The correlation between observed and self-reported skiing ability was low to fair, with kappa values of 0.34 for skiing skill), 0.33 for piste difficulty, 0.38 for turning technique, 0.26 for experience and 0.16 for falling frequency. However, the sensitivity and specificity for each of the questionnaires in discriminating between individuals in the poorest skiing ability category on the test and the rest of the group was relatively good (skiing skill: sensitivity 75%, specificity 91%; piste difficulty 68, 96%; turning technique 75, 91%; experience 75, 90%; falling frequency 61, 97%). The results show that the capacity to self-assess skiing ability is limited, but estimation based upon turning technique or skiing skill seem to be best methods for epidemiological studies on injuries in snow sports.

Research paper thumbnail of Injury Rates and Injury Types in Alpine Skiing, Telemarking, and Snowboarding

Journal of ASTM International, 2005

Research paper thumbnail of Helmet Use and Risk of Head Injuries in Alpine Skiers and Snowboarders

JAMA, 2006

Context Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, ... more Context Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders.

Research paper thumbnail of Risk factors for injuries in alpine skiing, telemark skiing and snowboarding - case-control study

British Journal of Sports Medicine, 2011

Alpine skiing and snowboarding have a substantial risk of injuries, but precise risk factor estim... more Alpine skiing and snowboarding have a substantial risk of injuries, but precise risk factor estimates are limited. Objective To determine the risk factors among skiers and snowboarders. Case-control study. Ski patrols reported cases (N=3277) in eight major Norwegian alpine resorts. Injury type and risk factors (age, gender, nationality, skill level, equipment, helmet use, ski school attendance, rented or own equipment) were recorded. An uninjured control group (N=2992) was obtained at the same resorts. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors and risk of injury. The overall injury risk was increased among beginners (OR 2.72; 2.12 to 3.47), children (OR 1.72; 1.41 to 2.13), adolescents (OR 2.16; 1.72 to 2.66) and non-Nordic skiers (OR 1.80; 1.37 to 2.36). Snowboarders had a higher overall injury risk than skiers (OR 2.11; 1.81 to 2.46). Alpine skiers (OR 2.65; 1.47 to 4.80), beginners (OR 2.50; 1.61 to 3.85), children (OR 11.1; 6.7 to 20.0) and adolescents (OR 4.17; 2.44 to 7.14) were prone to lower leg fractures. Knee injuries occurred more frequently among alpine skiers (OR 1.82; 1.39 to 2.38), females (OR 1.67; 1.38 to 2.03) and beginners (OR 3.13; 2.50 to 3.85). Males (OR 1.85; 1.45 to 2.38), telemark skiers (OR 1.70; 1.30 to 2.23), children (OR 2.22; 1.37 to 3.57) and adults (OR 1.64; 1.11 to 2.37) had an increased risk for shoulder injuries. Snowboarders, beginners, children and adolescents had an increased injury risk.

Research paper thumbnail of Intraarticular location predicts cartilage filling and subchondral bone changes in a chondral defect

Acta Orthopaedica, 2010

Background and purpose The natural history of, and predictive factors for outcome of cartilage re... more Background and purpose The natural history of, and predictive factors for outcome of cartilage restoration in chondral defects are poorly understood. We investigated the natural history of cartilage filling subchondral bone changes, comparing defects at two locations in the rabbit knee.