Prospective analysis of 1619 alpine skiing and snowboarding injuries: Spatial clustering and prevention implications

Alpine skiing and snowboarding are among the leading causes of sport-related trauma in mountain regions and place a substantial burden on emergency medical services. While injury patterns by sport, age and sex are well described, little is known about system-level risk factors such as spatial clustering and terrain characteristics. This study prospectively examined risk factors by integrating patient-level data with precise accident geolocation and snow/weather measurements to guide targeted prevention and slope management.

In this single-centre prospective observational study, 1619 injured participants (1190 skiers, 429 snowboarders) presenting to the emergency department of a tertiary hospital in a major Swiss ski resort with skiing- or snowboarding-related injuries during two winter seasons (2022-2024) were included. Participants completed a structured questionnaire capturing accident circumstances and location. Injury diagnoses were extracted from medical records and imaging. Accident sites were georeferenced and analysed using a 150 m spatial resolution. Snow and weather data from two automated research stations were linked to each accident. Multivariable logistic regression was performed to assess associations between injury types and individual, environmental and terrain-related factors.

Accidents clustered strongly: 33% occurred on just 3% of total slope length, mainly steep, narrow, high-traffic runs; most collisions occurred on a single hotspot. Sex- and age-specific differences emerged during adolescence and peaked in young adults. Female skiers frequently sustained knee injuries, while snowboarding children sustained mainly wrist fractures; men had more shoulder injuries than women in both sports. Off-piste skiing (ungroomed terrain outside marked slopes) was independently associated with an increased risk of knee trauma. In contrast, objective snow and weather parameters were not significantly associated with injury types.

Injury risk in alpine winter sports depends on sport type, sex, age, and terrain rather than day-to-day weather. Prevention should target redesign of identified slope hotspot, sex-adjusted ski-binding settings, routine wrist-protector use in snowboarding kids, and improved ski-pole release systems.