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In their meta-analysis on the effects of helmets on the risk of head and neck injuries among skiers and snowboarders,1 Russell and colleagues found a 35% reduced risk of head injury when a ski helmet was used. Recently, we showed a similar reduction in the number of head injuries in skiers and snowboarders involved in falls and collisions in the winter season 2008–09.2 We strongly assume that the beneficial effects of helmet use are even underestimated when using controls with injuries below the head. This assumption is based on the fact that higher rates of helmet use have been observed in uninjured compared with injured skiers and snowboarders. In the 2009–10 winter season, helmets were mandatory for children under the age of 15 years in most Austrian provinces. Future investigations are needed to evaluate the impact of mandatory rules on increasing helmet use and reduced risk of head injury, especially in children.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/4/333#333045