Objective To summarise the best available evidence to determine the impact of helmet use on head injuries, neck injuries and cervical spine injuries in skiers and snowboarders.

Data sources Relevant publications were identified through electronic searches of MEDLINE, PubMed, EMBASE, CINAHL and the Cochrane Library databases (1966–2009) in addition to manual reference checks of all included articles.

Review methods 45 articles were identified through our systematic literature search. Of these, 10 studies met the inclusion criteria after two levels of screening. Two independent reviewers critically appraised the studies. Data were extracted on the primary outcomes of interest: head injury, neck injury and cervical spine injury. Studies were assessed for quality by the criteria of Downs and Black.

Results Studies reviewed indicate that helmet wear reduces the risk of head injuries in skiing and snowboarding. Four case-control studies reported a reduction in the risk of head injury with helmet use ranging from 15% to 60%. Another cohort study found a significantly lower incidence of head injuries involving loss of consciousness in helmet users (p<0.05). The five remaining studies suggested a major protective effect of helmets by indicating that none or few of the head-injured and deceased participants wore a helmet.

Conclusions There is strong evidence to support the protective value of helmets in reducing the risk of head injuries in skiing and snowboarding. There is no good evidence to support the claim that the use of helmets leads to an increase risk of cervical spine injuries or neck injuries.