Avalanche trauma and closed head injury: adding insult to injury

The incidence of fatal closed head injury (CHI) and nonfatal CHI causing an altered level of consciousness in avalanche victims is unknown. The purpose of this study was to assess the incidence and potential significance of CHI in avalanche-related deaths.

The records of the state medical examiner and hospital records of all victims killed in avalanches in the state of Utah from October 1, 1992 through April 30, 1999 were reviewed for a cause of death and for the presence of CHI. Closed head injury was described as "present" or "severe," depending on whether the degree of CHI was sufficient to have caused or directly contributed to death, as determined by the medical examiner.

In this review, 28 avalanche-related deaths were identified, of which 22 (79%) were due to asphyxia. Seventeen victims (61%) had evidence of some degree of CHI. Six victims (21%) had evidence of severe CHI. One of 7 snowmobile riders sustained a severe CHI, whereas 4 of 16 skiers or snowboarders sustained a severe CHI (P = not significant).

Although asphyxiation was the cause of death in most avalanche victims, evidence of CHI was present in 61% of the cases studied. While avalanche-associated CHI may not be sufficient to cause death in many cases, a depressed level of consciousness might render a victim incapable of self-rescue and predispose to asphyxia. Helmet use may help prevent avalanche-associated CHI and thus be a useful safety adjunct.