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Impact of helmet use in equestrian-related traumatic brain injury: a matched-pairs analysis
British Journal of Neurosurgery
Abstract
Purpose:
Traumatic brain injury is an important health concern in equestrian sports. Nevertheless, the use of safety helmets, especially in recreational riding, is reported to be rare. The purpose of this study was to perform the first matched-pairs analysis of traumatic brain injury with regard to the use of helmets.
Materials and methods:
In a multicenter retrospective database analysis 40 patients (mean age: 35 ± 17.13 years; 34 female & 6 male) were combined in 20 matched pairs based on age group, gender and trauma mechanism. Admission trauma computed tomography was qualitatively analyzed for the presence or absence of fractures or intracranial hemorrhage. Quantitatively, in patients with intracranial hemorrhage dedicated volumetry of the blood volume was performed. Odds ratio and relative risk were calculated for the endpoints fractures and intracranial hemorrhage. Crude risk ratio and lesion volume differences between helmeted and unhelmeted riders were compared.
Results:
Concerning skull fractures, in this cohort 6 patients (85.7% of all patients with fractures) did not wear a helmet and only one (14.3%) wore a helmet (p = .068).and fractures were considered more complex in the unhelmeted subgroup. Intracranial hemorrhage occurred significantly more often in the unhelmeted subgroup (10 vs. 2; p = .008). Moreover, the total lesion volume with 19.31 ± 23.93ml in the unhelmeted subgroup, presenting with intracranial hemorrhage, was significantly higher than in the control group (0.65 ± 0.35ml; p = .002). Odds ratios were 9 for intracranial hemorrhage (p = .014) and 8.14 for skull fractures without helmet (p = .09). Altogether, the relative risk for intracranial bleeding for unhelmeted riders was 5-fold higher and the relative risk reduction was 96% by wearing a safety helmet.
Conclusions:
Under consideration of comparable trauma mechanisms, horseback riders that do not wear a safety helmet are at risk to suffer significantly more severe brain injury than helmeted riders. Therefore, safety helmets are recommendable for all horseback riders.
... The majority of the literature regarding protective equipment focuses on the use of helmets. Most authors conclude that helmet use is protective [26,33,73,74,78,80,81]. Barone et al. [75], in a study of 136 patients ≤ 19 years of age, concluded that if effective safety gear had been utilized, many of the severe injuries could have been prevented. ...
... Moss et al. [80] noted that the majority of head-injured riders wearing approved helmets sustained only minor injuries. Bier et al. [81] noted that the odds ratio for a skull fracture was 8.14 times greater in the non-helmeted riders. Holland et al. [82] found that children wearing helmets when riding were less likely to suffer long-term neurological sequelae compared to those who did not. ...
Background: Fractures often occur due to equestrian activities with injury patterns varying by age. The purpose of this study was to investigate in detail fracture patterns and associated demographics in children due to equine activities. Materials: The US National Electronic Injury Surveillance System was queried for all injuries with the consumer product code 1239 (horseback riding) from 2000 to 2023. Those <16 years old with fractures were extracted. Statistical analyses were performed with SUDAAN 11.0.01™ software to obtain national estimates. Results: There were an estimated 101,677 patients with a fracture. Girls comprised 72.5% and the patient was discharged from the hospital in 81.5% of cases. Fractures involved the upper extremity in 80,973 (80.0%), the pelvis/lower extremity in 11,794 (11.7%), the spine in 3060 (3.0%), the skull/face in 4321 (4.4%), and the rib/sternum in 940 (0.9%). The humerus, elbow, radius/ulna, and wrist accounted for 62.4% of all the fractures. The youngest age group (0- to 5-year-olds) had more boys and was more likely to be admitted to the hospital. The child was injured due to a fall from the horse in 75.7%, bucked/thrown off/kicked off in 17.0%, with the remaining 7.3% from other mechanisms. Conclusions: This extensive description of fractures in children due to equestrian injuries can be used to determine the effectiveness of future prevention strategies, such as protective equipment and educational programs. It also gives pediatric trauma and orthopedic surgeons an overall view of the types of fractures which occur in children due to equestrian activities.
... 30 Despite the increased risk of TBIs without the use of helmets, rates of consistent helmet use in all forms of skating and horseback riding in children remain low. [29][30][31][32] Helmet Effectiveness ...
... Intracranial hemorrhage was reported to be more common in unhelmeted children (OR: 9.0; 95% CI: 1.64 to49.45). The authors concluded that the relative risk reduction of intracranial bleeding by wearing a safety helmet was 96%.32 ...
Bicycling, snow sports, and other recreational activities and sports are important activities to keep children and youth active as part of a healthy lifestyle. These activities can be associated with serious and fatal head and facial injuries. Helmets, when worn correctly, are effective in decreasing head injuries and fatalities related to these activities. Legislation for helmet use is effective in increasing helmet use in children and, ultimately, in decreasing deaths and head and facial injuries. A multipronged strategy employing legislation, enforcement of laws, and medical clinicians and community programs is important for increasing helmet use to decrease deaths and injuries from recreational sports.
... Helmets are believed to reduce head injury severity but have not been shown to reduce incidence of TBI, specifically concussions. Equestrians not wearing a helmet are more likely to sustain intracranial hemorrhage in an accident (34,35). Lack of helmet use also has been correlated with an increased injury severity overall, higher Injury Severity Scores and increased odds of loss of consciousness (25,35). ...
... Equestrians not wearing a helmet are more likely to sustain intracranial hemorrhage in an accident (34,35). Lack of helmet use also has been correlated with an increased injury severity overall, higher Injury Severity Scores and increased odds of loss of consciousness (25,35). ...
Equestrian sports represent a variety of activities involving a horse and rider. Due to the unpredictable nature of horses, their height, and potential high speeds involved, equestrian athletes are at risk of head and spinal injuries. This review describes the epidemiology, injury mechanisms, and risk factors for equestrian sports-related head and spinal injuries. Traumatic brain injuries, including concussions, are more common than spinal injuries. Both injury types are most commonly related to a rider fall from a horse. Spinal injuries are less common but are associated with potentially significant neurological morbidity when spinal cord injury occurs. An improved understanding of preventable injury mechanisms, increased certified helmet use, improved helmet technologies, and educational outreach may help to address the risk of head and spinal injuries in equestrian sports.
... These accidents most commonly result in head and brain injuries (Forero Rueda et al., 2010;Waller et al., 2000;Whitlock, 1999). The use of helmets has considerably reduced the amount of traumatic brain injuries (TBI) seen CONTACT Michael D. Gilchrist michael.gilchrist@ucd.ie in equestrian sports (Bier et al., 2018;Bond, Christoph, & Rodgers, 1995;Harrison, Mills, & Turner, 1996). However, concussions remain one of the most common injuries (Balendra, Turner, McCrory, & Halley, 2007;Forero Rueda et al., 2010;Meredith et al., 2018). ...
... These conditions are associated with focal injuries such as subdural haematomas as it has been these injuries that are caused by relatively short duration acceleration loads at high magnitudes (Gennarelli, 1983). As a result, helmets have been effective at decreasing these types of loads and the occurrences of focal injuries has largely decreased across equestrian sports (Bier et al., 2018;Bond et al., 1995;Harrison et al., 1996). However, diffuse brain injuries such as DAI and concussion have been suggested to occur when rotational accelerations are applied to the head over a longer period of time (Gennarelli, 1983;Hoshizaki et al., 2017;Stemper et al., 2015). ...
Current equestrian standards employ a drop test to a rigid steel anvil. However, falls in equestrian sports often result in impacts with soft ground. The purpose of this study was to compare head kinematics and brain tissue response associated with surfaces impacted during equestrian accidents and corresponding helmet certification tests. A helmeted Hybrid III headform was dropped freely onto three different anvils (steel, turf and sand) at three impact locations. Peak linear acceleration, rotational acceleration and impact duration of the headform were measured. Resulting accelerations served as input into a three-dimensional finite element head model, which calculated Maximum principal strain (MPS) and von Mises stress (VMS) in the cerebrum. The results indicated that impacts to a steel anvil produced peak head kinematics and brain tissue responses that were two to three times greater than impacts against both turf and sand. Steel impacts were less than half the duration of turf and sand impacts. The observed response magnitudes obtained in this study suggest that equestrian helmet design should be improved, not only for impacts to rigid surfaces but also to compliant surfaces as response magnitudes for impacts to soft surfaces were still within the reported range for concussion in the literature.
... In general, correct use of protective riding helmets has been associated with positive outcomes, such as a 5-fold decrease in risk of traumatic cerebral hemorrhage, reduced length of stay in the hospital, and reduced severity of TBI. 12,57 However, some studies question helmet efficacy in protecting against concussion. [18][19][20] Most recently, the International Federation for Equestrian Sports (FEI) has dictated that all equestrians wear a properly fitted helmet that either meets or exceeds standards set by the American Society for Testing and Materials (ASTM) and Safety Equipment Institute (SEI). ...
Context
Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed.
Objective
To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation.
Data Sources
The PubMed Database was searched using the search terms “equestrian” and “horse” combined with “spinal cord injury,” “head injury,” “traumatic brain injury,” “experience levels,” and “demographics.”
Study Selection
A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review.
Study Design
Systematic review.
Level of Evidence
Level 4.
Data Extraction
None.
Results
Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury.
Conclusion
Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.
... [10][11][12][13][14] Despite the strong evidence for the effectiveness of helmets in decreasing head and facial injuries, their use is not consistent among sports participants. 10,[15][16][17][18][19][20] Helmet use is also cost-effective in the prevention of head injuries. 21,22 To increase helmet use, a multipronged approach including legislation, [23][24][25] enforcement of laws and rules, 26 public educational campaigns, 27 child education programs, 28,29 anticipatory guidance from clinicians, 30,31 and equitable access to helmets will be required. ...
Recreational activities and sports are a common and popular way for youth to enjoy physical activity; however, there are risks related to physical injury. Injuries can potentially result in death and long-term disability, especially from traumatic brain injury. Helmet use can significantly decrease the risk of fatal and nonfatal head injury, including severe traumatic brain injury and facial injuries when participating in recreational sports. The most robust evidence of helmet effectiveness has been demonstrated with bicycling and snow sports (eg, skiing, snowboarding). Despite this evidence, helmets are not worn consistently with all recreational sports. A multipronged approach is necessary to increase helmet use by children and youth participating in recreational sports. This approach includes legislation and enforcement, public educational campaigns, child education programs, and anticipatory guidance from clinicians. This policy statement guides clinicians, public health advocates, and policymakers on best practices for increasing helmet use in recreational sports, including bicycling and snow sports.
... A similar study to ours found that there was low awareness among equestrians of the inability of helmets to protect against concussion [12]. While helmets can greatly improve outcomes after falls [13], current safety inspections and helmet-testing occur through impact with hard, flat surfaces as opposed to 'real-world' injuries that often occur with a rotational component to the fall [14]. The recent advancements in helmet technology (such as the MIPS system) are promising in laboratory testing, which may help to protect riders more completely in such falls and could be better marketed to demonstrate the advancements in injury protection they may offer for riders [15]. ...
Background:
Equestrian athletes (horse riders) are at high risk for head injury, including concussions.
Materials & methods:
Adults riders were recruited via social media posting to complete a branching survey collecting data on demographics, riding experience, helmet use, injury history and concussion symptom knowledge. Results are reported as frequencies and percentages, with associations tested using chi-square with significance level p < 0.05.
Results:
Of the 2598 subjects, about 75% reported always wearing a helmet. Of those who did not, the most common reasons were that helmets are unnecessary (57.4%) or do not fit well (48.6%). Many indicated improper storage conditions and/or did not follow manufacturer's replacement recommendations. Most (75.4%) reported a high level of comfort with recognizing concussion signs, with half experiencing a prior head injury.
Conclusion:
This information suggests opportunities for intervention to improve helmet use through increased fit, while the responses indicate a need for further education on proper helmet use.
... The use of helmets has considerably reduced the instances of fatality and incidence rates for traumatic brain injury (TBI) seen in equestrian sports. [7][8][9][10][11][12][13][14][15] However, despite improvements in helmet technologies, concussion remains a common head injury. [3][4][5][6] Efforts to further reduce the incidences of concussion in equestrian sports require deeper insight in order to understand how equestrian helmets perform in real-world accidents. ...
There is significant difference between the loading conditions used to certify equestrian helmets and the environment in which they are commonly used: this may affect their ability to provide adequate protection against head injury during a riding accident. The efficacy of helmet performance under real-world riding conditions can be judged by examining physical damage to the helmet during an impact, along with details of any head injury that may have been sustained by the rider. The present study considered the influence of different impact events on helmet damage sustained during real-world equestrian racing and eventing accidents. Video analysis of the accidents and assessment of the corresponding helmets allowed helmet damage to be matched to impacts. From a total of 1119 accident videos and 218 inspected helmets, there was a total of 18 cases for which both the helmet and unobstructed video views of the accident sequence were available, along with details of any injuries sustained by the rider. All 18 cases involved the riders falling from their horses and impacting their heads against the turf. For 7 of the 18 cases, head impacts occurred in which a rider’s head was also either kicked, crushed or stomped on by a horse: those subsequent impacts led to significant helmet damage, suggesting that the helmets provided protection for the riders during those secondary and tertiary impacts. Surprisingly, 11 of the 18 cases involved only a fall for which none of the helmets had any evident damage, despite 6 of these cases involving diagnosed concussions and 1 hematoma. This indicates that traumatic brain injury can occur in equestrian sports even while the rider wears a helmet which suggests that there is scope to further improve the ability of equestrian helmets to protect against concussion when riders fall and impact their head against turf.
... The use of helmets in cycling is associated with a lower rate of intra-cranial injuries 11 and helmets in horse riding result in simpler skull fractures and smaller intra-cranial haematoma volumes after trauma. 12 The increasing awareness of the risks of head injuries in sports have led sporting authorities to change their rules in the interest of player safety. The American football 'crown of the helmet rule', which prevents players striking another person with the top of their head, is a successful example which has shown a reduction in the number of concussions. ...
Introduction: Accidents during sporting activities are a common cause of head injury, particularly in children and young adults. Whilst most sporting head injuries are minor, there remains a proportion which is associated with high morbidity and mortality. The epidemiology of sports associated head injuries is variable based on geographical region so the aim of this study was to review the management and outcomes of sporting head injuries managed by a single neurosurgical unit in the South of England.
Method: A retrospective review of the Trauma Audit and Research Network database was conducted for all patients admitted to a tertiary neurosurgical centre over a six-year period (January 2011–December 2016). Case notes were reviewed for demographics, mechanism of injury, injury severity score, intensive care admission, surgical interventions and Glasgow Outcome Score at discharge.
Results: Seventy-six patients (mean age: 37.6 ± 18.4 years, male gender n = 43; 56.6%) were eligible for inclusion in this series. Horse riding accidents were identified as the most common cause of head injury (n = 31; 40.8%). Fifteen patients (19.7%) in this series had a severe head injury (GCS 3–8 on admission). Twenty-eight (36.8%) patients required admission to an intensive care unit and 26 (34.2%) patients underwent neurosurgical intervention. At discharge, 68 (89.5%) patients had a Glasgow Outcome Score 4–5.
Conclusion: The majority of patients with head injuries admitted to a neurosurgical unit can expect a good functional outcome despite the need for intensive care or neurosurgical intervention. The range of sports resulting in head injury is likely influenced by geographic location; however, further national study is required for wider comparison.
Introduction: The study analyzed buccomaxillofacial trauma (TBF) in horseback riding, a sport that combines technical skill and inherent risk. TBFs, such as mandibular and maxillary fractures, avulsions, and dental luxations, were identified as the most common injuries due to falls, horse kicks, and collisions. These injuries not only impacted athletes physically, but also psychologically, affecting their self-esteem and confidence. The research highlighted the importance of mouthguards and helmets, although their use is not mandatory in all equestrian disciplines.Development: TBF was found to be frequent among riders and horsewomen, with a particularly high incidence in women and children. Of 20 patients evaluated, 70% had facial fractures, while the remainder suffered dental or soft tissue injuries. Most mandibular and maxillary fractures required surgical interventions such as reduction and osteosynthesis, in addition to dental rehabilitation and physiotherapy. It was also observed that dental injuries, such as dislocations and avulsions, were recurrent in falls and collisions. The use of customized mouthguards was shown to be effective in reducing the incidence of dental injuries, although it is not widely adopted.Conclusions: The study underlined the need for a comprehensive and preventive approach to horseback riding, including mandatory use of mouthguards and helmets. Multidisciplinary care, combining maxillofacial surgery, dentistry and psychological support, was highlighted as crucial for the full recovery of athletes. Finally, it was recommended to continue researching risk factors and preventive measures to improve safety in this high-impact sport
Sports practice is one of the main causes of oromaxillofacial injuries, with great variability depending on the sport practiced. Epidemiological studies don ́t refer to the incidence, management and complications of injuries caused by animals, taking into account that the kick of a horse has a lethal power capable of producing a ton of force, and generating more than 10,000 Newtons per day. human body, producing fractures of the skull, face and other bones of the human body.The prevalence of these injuries is related to cultural components, varying depending on the country, including from one region to another within the same country.A systematic review of scientific studies related to oral and maxillofacial trauma was carried out in athletes who perform horse riding both in our country and in different parts of the world.Proper understanding of horses' behavioral patterns can help improve safety when handling them, but working with animals will never be completely safe. The most common mechanism by which injuries occur is falling from a horse, however, being kicked was correlated with a more serious injury.In addition to the use of helmets, face protectors such as those used by polo players, and mouth guards, could be options to increase orofacial protection when interacting with these animals.In all the bibliography consulted and analyzed, it is determined that the use of a helmet does not seem to add any protection to the face; Likewise, to avoid further injuries, it is recommended to provide education and information to horse owners on the proper use of protective elements and supervise young riders
Equestrian sports are associated with high rates of major injury compared to collision and powered two-wheel sports. Advancements in rider and horse safety equipment and the implementation of comprehensive emergency action planning standards may help mitigate injuries, particularly in regard to the Olympic disciplines of dressage, show jumping, and three-day eventing covered in this review. Personal safety equipment to consider includes helmets, safety and air vests, and horse tack including safety stirrups, acoustic dampeners, and breakaway reins. Equestrian event medical coverage requires emergency action planning, partnership with local emergency medical services, and cooperation of interprofessional teams. Safety coordinators and medical providers may be tasked with providing first aid to spectators in addition to stabilizing and triaging crush trauma, traumatic brain injuries or spinal injuries, or fractures in competitors. Stationary and mobile medical units, proper medical equipment, acute spine stabilization protocols, and communication systems are critical components of equestrian medical coverage.
Introduction: Horseback riding can cause severe brain and spinal injuries. This study aimed to identify the spectrum of neurosurgical injuries related to recreational horseback riding.
Methods: A retrospective study was performed utilizing the University of Puerto Rico neurosurgery database to identify patients who were consulted to the neurosurgery service between 2018 and 2023 after a horse fall during recreational activities. The outcome upon discharge using the modified Rankin scale (mRS) was documented. Descriptive statistics were used to report frequency and median values.
Results: The neurosurgery service evaluated and managed 112 patients with a horseback riding fall-related injury during 6 years. Ninety-eight (87.5%) patients were male. The patients' median age was 31.5 (IQR 22-40). There were 89 head injuries (79.5%), 19 spinal injuries (17%), and 4 combined head/spine injuries (3.5%). Forty percent of the patients were admitted to inpatient care with a median length of stay of 7 days (IQR 3-17). Twenty-four patients (21%) required surgery. Upon discharge, 86.6% of the patients had an mRS grade of 0-2, 3.6% had a grade of 3, 1.8% had a grade of 4, and 1.8% had a grade of 5. Seven patients (6%) died (mRS grade 6).
Conclusions: Most neurologic injuries involve isolated trauma to the head. Fifteen percent of the riders' falls were caused after the horse was impacted by a motor vehicle. Forty percent of the patients require admission and 21% undergo surgery. Ten percent of the patients had a poor mRS grade of 4- to 6 when discharged.
Objective:
Little information exists about horse-related injury admissions to Level 1 trauma centres in the Western United States. This study describes injury patterns in this population, to reveal potential areas for injury prevention initiatives.
Methods:
A retrospective database review of 512 non-fatal equine-related injuries over a 15-year period was conducted, using a Level 1 hospital trauma registry. To determine patterns of injury, patients injured by riding or being near a horse were classified according to age, sex, helmet use, abbreviated injury score, anatomical region injured, and length of stay.
Results:
Equine-related injury was more frequent among females than males, the anatomical region most at risk among adults was the lower extremity (including pelvis), and among children and youth, the head. 75% of head-injured patients were not wearing a helmet at the time of injury and those with the most severe head injuries were least likely to be wearing a helmet.
Conclusion:
Preventable equine-related injuries occur across all ages, are more frequent among females, and affect all regions of the body. Despite head-injury risks associated with horse activities, helmet use was not common among most of the injured. Decreasing the risk of these injuries requires use of appropriate protective equipment and enhanced education campaigns aimed at those in the horse industry and the general public.
Introduction/Objecive
There are very few studies that have investigated equestrian-related maxillofacial injuries. A retrospective review was performed to investigate maxillofacial horse trauma at a Level 1 Trauma Centre at the Royal Stoke Hospital over the last 10 years between 2010 and 2020.
Study Design/Methods
Search of the hospital’s major trauma database as well as ED records showed 51 patients who sustained maxillofacial injuries related to horses. Statistical analysis was performed using Chi Squared tests.
Results
41 patients were female and the remaining 10 were male. 43% of patients were female and aged 30 and under. Kicks from horses accounted for 64.4% of equine-related maxillofacial injuries. A total of 90 injuries were recorded. Hard tissue injuries which include all fractures accounted for 66.3% of injuries sustained. 70.5% patients sustained isolated maxillofacial trauma. There was an association between patients sustaining non-isolated maxillofacial trauma and hard tissue maxillofacial injuries ( P = 0.04). 65.6% of injuries were managed operatively. Patients aged 30 and under were more likely to be managed operatively ( P = 0.03).
Conclusion
Equestrian related maxillofacial trauma represents a proportion of trauma workload. The safety aspect of horse riding should be considered and education in safe riding and the use of appropriate safety equipment is vital.
Introduction
: Large animal-related injuries (LARI) are relatively uncommon, but, nevertheless, a public hazard. The objective of this study was to better understand LARI injury patterns and outcomes.
Materials and Methods
We performed a retrospective review of the 2016 National Trauma Data Bank and used ICD-10 codes to identify patients injured by a large animal. The primary outcome was severe injury pattern, while secondary outcomes included mortality, hospital length of stay, ICU admission, and mechanical ventilation usage.
Results
: There were 6,662 LARI included in our analysis. Most LARI (66%) occurred while riding the animal, and the most common type of LARI was fall from horse (63%). The median ISS was 9 and the most severe injuries (AIS ≥ 3) were to the chest (19%), head (10%), and lower extremities (10%). The overall mortality was low at 0.8%. Compared to non-riders, riders sustained more severe injuries to the chest (21% vs. 16%, p<0.001) and spine (4% vs. 2%, p<0.001). Compared to motor vehicle collisions (MVC), riders sustained fewer severe injuries to the head (10% vs. 12%, p<0.001) and lower extremity (10% vs. 12%, p=0.01). Compared to auto-pedestrian accidents, non-riders sustained fewer severe injuries to the head (11% vs. 19%, p<0.001) and lower extremity (10% vs. 20%, p<0.001).
Conclusion
: Patients involved in a LARI are moderately injured with more complex injuries occurring in the chest, head, and lower extremities. Fall from horse was the most common LARI mechanism. Overall mortality was low. Compared to non-riders, riders were more likely to sustain severe injuries to the chest and spine. Severe injury patterns were similar when comparing riders to MVC and, given that most LARI are riding injuries, we recommend trauma teams approach LARI as they would an MVC.
Patients with equine-related injuries (ERI) have high rates of hospitalization and often require surgical treatment. This study aimed to clarify the injury profiles of patients sustaining ERI-related craniofacial fractures and their relationship with other severe head and neck injuries.
This retrospective study included all patients with craniofacial fractures admitted to a tertiary trauma center during 2013 to 2018. Out of 3256 patients, a total of 39 patients were included in the study (1.2%). Demographic and clinically relevant variables were reported and statistically evaluated.
Males represented only 7.7% of the study population. Isolated facial fractures were over-represented in this study population at 84.6% whereas only 7.7% of patients sustained isolated cranial fractures and 7.7% of patients sustained combined craniofacial fractures, respectively. Surgical intervention for craniofacial fractures was required in 48.7% of patients. In total, 17.9% of patients sustained severe head and neck injuries. Periods of unconsciousness and/or post-traumatic amnesia were seen in 41% of patients. Helmet use could only be confirmed in 17.9% of patients.
As trauma mechanisms behind ERI are often multifactorial and patients are at a high risk of sustaining associated injuries, attentive examination, and exclusion of serious life-threatening injuries through a multi-disciplinary approach is imperative for this specific patient population.
Zusammenfassung
Reiten ist eine hoch koordinative Sportart mit nur geringer kardio-pulmonaler Ausdauerkomponente. Dabei können Kinder schon frühzeitig mit dem Pferd in Kontakt gebracht werden und besonders Voltigieren stellt für sie eine gute Möglichkeit dar, unter kontrollierten Bedingungen den Zugang zum Pferd zu finden.
Voraussetzung ist die sichere Stabilisierung der Wirbelsäule und Kontrolle des Kopfes, wobei die dreidimensionale Übertragung des Schwingungsimpulses vom Pferderücken auf den Reiterrücken positive Effekte aufweist und Überlastungsschäden dabei nicht zu erwarten sind.
Der Pferdesport geht mit einem erhöhten Unfallrisiko einher, besonders auch in der Altersgruppe der unter 18-Jährigen. Die meisten Verletzungen ereignen sich beim Reiten selbst, aber auch beim Umgang mit dem Pferd. Neben Verletzungen der oberen und unteren Extremitäten machen Kopfverletzungen bereits im Kindes- und Jugendalter einen erheblichen Anteil aus.
Die beste Unfallprävention ist eine gute Ausbildung, die nicht nur das Reiten selbst, sondern auch den Umgang mit dem Pferd und eine korrekte Selbsteinschätzung der eigenen reiterlichen Fähigkeiten beinhaltet. Der wichtigste Ausrüstungsgegenstand ist ein gut passender Reithelm.
A search was undertaken of the Forensic Science South Australia, Australia, autopsy database over a 25-year period from 1995-2019 with the aim of understanding more about the role that recreational horse use not involving racing may have in mortality. Eight cases were found with an age range of 8-73 years (mean 47 years) and a male:female ratio of 5:3. The major category was a fall while riding (N=7) with the remaining case (N=1) sustaining a lethal kicking. Blunt craniocerebral trauma was responsible for death in 4 cases with injuries following falls including acute subdural and subarachnoid haemorrhage, cerebral contusions and lacerations with associated significant cerebral edema. Skeletal injuries occurred in 2 cases with falls that had caused fractures of cervical vertebrae 2 and 4, with contusion of the underlying spinal cord (N = 1), and fracture of the pelvis with significant retroperitoneal hemorrhage from associated vascular injuries (N = 1). Lethal abdominal and chest injuries occurred in 2 cases, both with lacerated livers and multiple rib fractures. In the final case of an 8-year-old girl who was kicked by a horse there was a lacerated liver with a hematoperitoneum, and fractures of the ribs on the right side with contusion of the underlying lung. The size, strength and temperament of horses make them potentially dangerous during leisure time activities such as grooming and riding. Lethal head injuries often follow falls and kicks. Traumatic lesions identified at autopsy include fractures and blunt craniocerebral, thoracic and abdominal trauma.
Background:
Horse-related injuries can cause severe morbidity and mortality. The objective of this study is to investigate the epidemiological features of horse-related injuries treated in emergency departments (EDs) in the United States.
Methods:
A retrospective analysis of horse-related injuries from 1990 through 2017 was conducted utilizing the National Electronic Injury Surveillance System (NEISS). Cases were identified using the NEISS code 1239 (Horseback Riding: Activity, Apparel, or Equipment). Analyses performed included calculation of national injury estimates, relative risks (RRs) with 95% confidence intervals (CIs), and linear regression.
Results:
From 1990 through 2017, an estimated 1,836,536 (95% CI: 1,494,788-2,178,284) individuals presented to United States EDs with horse-related injuries. The annual injury rate decreased by 30.8% from 1990 to 1996, increased by 33.0% from 1996 to 2000, and then decreased by 46.0% from 2000 to 2017. Among older adults >60 years of age, the annual injury rate increased by 139.6% during the study period. The number of concussion and closed head injury diagnoses increased by 337.2% from 1990 to 2009. The most common mounted mechanism of injury was a fall or being thrown (73.9%), while the most common unmounted mechanism was being kicked (42.1%). Mounted injuries were more likely to lead to hospitalization than unmounted injuries (RR, 2.10, 95% CI: 1.59-2.77).
Conclusions:
Despite the recent decline in horse-related injuries, these injuries are still common. Clinicians should be aware of the spectrum of ED presentations of horse-related injuries. Prevention efforts focused on older adults and concussions and closed head injuries warrant special attention.
Simple
Equitation science describes an approach to horse training and riding that focuses on embracing the cognitive abilities of horses, their natural behaviour, and how human riders can use signalling and rewards to best effect. This approach is concerned with both horse welfare and rider safety, and this review discusses how equitation science can minimise risk to humans around horses and enhance horse welfare.
Equitation science is an evidence-based approach to horse training and riding that focuses on a thorough understanding of both equine ethology and learning theory. This combination leads to more effective horse training, but also plays a role in keeping horse riders and trainers safe around horses. Equitation science underpins ethical equitation, and recognises the limits of the horse’s cognitive and physical abilities. Equitation is an ancient practice that has benefited from a rich tradition that sees it flourishing in contemporary sporting pursuits. Despite its history, horse-riding is an activity for which neither horses nor humans evolved, and it brings with it significant risks to the safety of both species. This review outlines the reasons horses may behave in ways that endanger humans and how training choices can exacerbate this. It then discusses the recently introduced 10 Principles of Equitation Science and explains how following these principles can minimise horse-related risk to humans and enhance horse welfare.
Objectives
Equestrian sports can result in a variety of injuries to the nervous system due to many factors. We describe our series of 80 patients with injuries sustained during participation in equestrian sports.
Methods and Results
All patients seen at the regional trauma center with injuries associated with equestrian sports between 2003 and 2011 were reviewed; 80 patients were identified. Fifty-four per cent were female and the average age was 37 years (2·2–79·3). The mean injury severity score (ISS) was 9·9 ± 0·7. Only two patients had documented helmet use. Glasgow coma score (GCS) was 15 in 93% of patients. The most common neurosurgical injuries were to the cranial vault (28%), including concussions, intracranial hematomas and hemorrhages, and skull, facial, and spine fractures (10%), with the majority (63%) being transverse process fractures. The mechanisms of injury varied: 55% were kicked or stepped on, 28% were thrown or fell off, and 21% were injured by the horse falling on them. The causes ranged from carelessness and lack of attention to animal factors including inadequate training of horses and animal fear. Fourteen per cent required surgery. There were no mortalities and average length of stay was 3·7 ± 0·35 days. All patients were discharged home with 95% requiring no services.
Discussion
Equestrian sports convey special risks for its participants. With proper protection and precautions, a decrease in the incidence of central nervous system injuries may be achieved. Neurosurgeons can play key roles in advocating for neurologic safety in equestrian sports.
In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre.
To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk
We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland.Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees.
RETROSPECTIVE SURVEY: A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. CASE-CONTROL SURVEY: 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury.
Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index.
Jockey head injuries, especially concussions, are common in horse racing. Current helmets do help to reduce the severity and incidences of head injury, but the high concussion incidence rates suggest that there may be scope to improve the performance of equestrian helmets. Finite element simulations in ABAQUS/Explicit were used to model a realistic helmet model during standard helmeted rigid headform impacts and helmeted head model University College Dublin Brain Trauma Model (UCDBTM) impacts. Current helmet standards for impact determine helmet performance based solely on linear acceleration. Brain injury-related values (stress and strain) from the UCDBTM showed that a performance improvement based on linear acceleration does not imply the same improvement in head injury-related brain tissue loads. It is recommended that angular kinematics be considered in future equestrian helmet standards, as angular acceleration was seen to correlate with stress and strain in the brain.
A retrospective study of horse riding injuries in Berkshire was undertaken over a one year period from November 1983. The information was obtained from the Ambulance Service, the Jockey Club and the St. John Ambulance Brigade. There was a total of 103 injured persons with no deaths. Information from the Jockey Club was compared with the other two groups, the former sustaining more limb injuries and the latter more head injuries. A questionnaire was sent to all 42 ambulance patients. Thirty-eight had radiographs taken, 16 of which showed a fracture. Forty-one were wearing some form of hard hat, but if a safety strap was available it was attached in 24 cases. The dangers of riding are highlighted and the importance of adequate protective clothing emphasised.
The aim of this study was to describe the characteristics, nature, severity and outcome of injuries from horse-related trauma in pediatric patients, aged of 19 years or younger.
Retrospective analysis was conducted of 315 patients recorded in the National Pediatric Trauma Registry from February 1995 to August 1999.
A total of 62% of the 315 patients were girls. The median age of injury was 10 years. Sixty-five percent of the patients were injured while mounted on a horse, and the most common mechanism of injury was falling off the horse. The most frequent reason for hospital admission was skeletal fractures followed by head injuries. The head, neck, and face area was the most commonly injured anatomic site, followed by the upper extremity, the abdomen, and then the lower extremity. The median length of stay in the hospital was 2 days. Forty percent of the patients needed treatment in the intensive care unit with a median length of stay of 2 days. Thirty-nine percent of patients underwent surgical procedures. The Injury Severity Score ranged from moderate to critical in 31.5% of the children. There were 8 deaths, 2.5% of the injured children. The most common cause of mortality was head injuries. Of the 307 survivors, 3% were discharged to a rehabilitation center, and 2% of the children had 1 or more functional impairments lasting longer than 7 months after discharge.
Horse-related trauma is frequent in children and can cause severe injuries resulting in death and long-term disability. Awareness of the nature of injuries is important to avoid underestimation of their severity.
The association of helmet use with death in a motorcycle crash can be estimated using matched-pair cohort methods. By estimating effects among naturally matched pairs on the same motorcycle, one can account for potential confounding by motorcycle characteristics, crash characteristics, and other factors that may influence the outcome. The authors used Fatality Analysis Reporting System data, from 1980 through 1998, for motorcycles that crashed with two riders and either the driver or the passenger, or both, died. For their main analysis, the authors estimated the relative risk of death using conditional Poisson regression. The relative risk of death, accounting for the matching on motorcycle and adjusted for age, sex, and seat position, for a helmeted rider compared with an unhelmeted rider was 0.61 (95% confidence interval: 0.54, 0.70). The authors suggest that conditional Poisson regression is useful for the analysis of traffic crash data, where occupants are naturally matched in a vehicle and where crash-related confounders may be difficult or impossible to measure.
To characterise and provide nationally representative estimates of persons with non-fatal horse related injuries treated in American emergency departments.
The National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) is a stratified probability sample comprising 66 hospitals. Data on injuries treated in these emergency departments are collected and reported. NEISS-AIP data on all types (horseback riding and otherwise) of non-fatal horse related injuries from 2001 to 2003 were analysed.
An estimated 102,904 persons with non-fatal horse related injuries (35.7 per 100,000 population) were treated in American emergency departments each year from 2001 to 2003 inclusive. Non-fatal injury rates were higher for females (41.5 per 100,000) than for males (29.8 per 100,000). Most patients were injured while mounted on a horse (66.1%), commonly from falling or being thrown by the horse; while not mounted, injuries most often resulted from being kicked by the horse. The body parts most often injured were the head/neck region (23.2%), lower extremity (22.2%), and upper extremity (21.5%). The most common principal diagnoses were contusions/abrasions (31.4%) and fractures (25.2%). For each year that was studied, an estimated 11 502 people sustained traumatic brain injuries from horse related incidents. Overall, more than 11% of those injured were admitted to hospital.
Horse related injuries are a public health concern not just for riders but for anyone in close contact with horses. Prevention programmes should target horseback riders and horse caregivers to promote helmet use and educate participants about horse behaviour, proper handling of horses, and safe riding practices.
OBJECTIVE: Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates.
METHODS: Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis.
RESULTS: From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home.
CONCLUSIONS: Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use-particularly in equestrian and roller sports-are critical elements for decreasing sports-related TBI events in adults.
Sports-related concussions (SRC) and traumatic brain injury (TBI) represent a growing public health concern. We reviewed the literature regarding equestrian-related brain injury (ERBI), ranging from concussion to severe TBI.
A literature review was performed to address the epidemiology of SRC and TBI in equestrian-related sports. MEDLINE and PUBMED databases were searched to identify all studies pertaining to brain injury in equestrian-related sports. We included two broad types of brain injury using a distinction established in the literature: 1) TBI with functional impairment, including concussion, or mild TBI, with negative imaging findings; 2) TBI with structural impairment, with positive imaging and at least one of the following pathologies identified: subdural hemorrhage (SDH), epidural hemorrhage (EDH), subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), cerebral contusions, and skull fractures.
Our literature search yielded 199 results. We found 26 studies describing functional TBI and 25 mentioning structural TBI, and 8 including both. Of all modern sporting activities, equestrian sports were found to cause some of the highest rates of total bodily injury, severe brain injury, and mortality. Concussions comprise approximately 9.7-15% of all equestrian-related injuries brought to hospitals for evaluation. Structural TBI was rare, and documentation of these injuries was poor. While demographic risk factors like age and sex are minimally discussed in the literature, two studies identified a protective effect of increasing rider experience on all forms of bodily injury. However it remains unclear if increasing rider experience protects specifically against head injury. Finally, rates of helmet use in horseback riding remain dismally low - ranging from 9-25%, depending on the activity. These low rates have persisted over time, despite evidence in this literature that helmets lead to an absolute risk reduction for head injury of 40-50% in equestrian sports.
Equestrian-related functional and structural TBI, represents a significant public health burden. Rider and horse characteristics make the sport uniquely dangerous, as the athlete has limited control over an animal weighing over a thousand pounds. Helmet use rates remain very low despite clear evidence of risk reduction. Healthcare providers are strongly urged to lobby professional and governmental organizations for mandatory helmet use in all equestrian sports.
Copyright © 2014 Elsevier Inc. All rights reserved.
Patients with equestrian injuries were identified in the trauma registry from 2004 to 2007. We a priori divided patients into three groups: 0 to 18 years, 19 to 49 years, and 50 years old or older. There were 284 patients identified with equestrian-related trauma. Injury Severity Score for the three major age categories 0 to 18 years, 19 to 49 years, and 50 years or older, were 3.47, 5.09, and 6.27, respectively. The most common body region injured among all patients was the head (26.1%). The most common injuries by age group were: 0 to 18 years, upper extremity fractures; 19 to 49 year olds, concussions; and 50 years or older, rib fractures. Significant differences were observed among the three age groups in terms of percent of patients with rib fractures: percent of patients with rib fractures was 2, 8, and 22 per cent in age groups 0 to 18, 19 to 49, and 50 years or older, respectively. We found different patterns of injuries associated with equestrian accidents by age. Head injuries were commonly seen among participants in equestrian activities and helmet use should be promoted to minimize the severity of closed head injuries. Injury patterns also seem to vary among the various age groups that ride horses. This information could be used to better target injury prevention efforts among these patients.
Using a cross-sectional survey design, this study sought to determine usage rates and barriers to the use of protective equipment in roughstock athletes. Between 2004 and 2006, amateur, collegiate, and professional roughstock athletes were surveyed using national organizational mailing lists. Findings revealed that during competition, 69% never wore a helmet. Barriers were a negative effect on performance and sport persona. Conversely, 88% always wore a vest. The perception that vest usage was required encouraged roughstock athletes to wear them. Mouthpiece use results were mixed; 58% always used and 21% never used a mouthpiece. Barriers were discomfort and frequent forgetfulness. Reported injury rate was high, with users noting fewer injuries to head and ribs than nonusers, and riders agreed that protective equipment prevented injury to the head, ribs, and mouth. However, equipment usage rates varied widely by type and seemed to be underutilized because the equipment affected performance, was uncomfortable, and "not cowboy."
Equestrian sports continue to grow in popularity in the Unites States and abroad, with an estimated 30 million people riding horses annually in the United States alone. Approximately one in five of these riders will suffer a serious injury during their riding career, requiring medical care and potentially hospitalization. Riding carries with it an implicit risk of injury associated with the unpredictability of the animals, the rider's head being positioned approximately 9 feet off the ground, and traveling unrestrained at speeds up to 40 mph. This article reviews common equestrian injuries, epidemiology, mechanism of injury, risk factors, and prevention strategies, with an emphasis on the more dangerous aspects of the sport.
It was the purpose of this study to review equestrian-related injuries using a large nation wide database and analyze predictors of significant injury.
The National Electronic Surveillance System database was queried for equestrian injuries from 2002 to 2004. The presence of a fracture, dislocation, traumatic brain injury, musculoskeletal injury, orthopedic injury, and spinal injury, as well as injury mechanism, geographical location, and emergency room disposition were noted. Bivariate, cosinor seasonal, and multiple logistic regression analyses were performed. p < 0.01 was considered significant.
Emergency room visits because of equestrian-related injuries from 2002 to 2004 from the NEISS database were reviewed; there were 5,033 visits during this time span. The average age was 30.0 +/- 17.0 years; 66% were women. The injuries occurred at home (36%), recreation/sporting facility (30%), on a farm (19%), and other public property (12%). The injury was due to a fall (59%), thrown/bucked from the horse (22.0%), and while riding the horse (9%). The most common injuries were contusion/abrasions (31%), fractures (28%), sprain/strains (18%), traumatic brain injuries (12%), and lacerations (6%). The body area injured was the head and neck (24%), trunk (29%), upper extremity (30%), lower extremity (16%), and multiple locations (1%). Most injuries occurred in the summer. Predictors of hospital admission were age >18 years, traumatic brain injury, fracture, or occurrence on other public property (odds ratios 1.4, 6.25, 7.7, and 1.5, respectively).
The largest number of equestrian injuries occur in white females in the 2nd, 4th, and 5th decades of life. Serious injuries are due to falling or being bucked off a horse and most commonly occur at home or at a recreational/sporting facility. Prevention strategies (educational and passive protection equipment) should be especially targeted to this high risk group.
A retrospective survey has been carried out of 59 patients who suffered head injury related to horse riding out of 7172 cases of head and spinal injury admitted to a regional head injury unit in the 5-year period 1980-85. Most (85%) were female, against the usual 80% male predominance of head injury, 56 were minor injuries and 3 severe, of whom 2 died. Skull fracture was present in 10 patients (17%) of whom at least 5 had been wearing headgear at impact, and scalp trauma was noted in 22 (37%) with a predominance of occipital injuries. All the severely injured cases had an occipital skull fracture. One fifth of the patients suffered additional significant injuries. While most patients (90%) made a good recovery, 2 remained moderately and one severely disabled. Horse riding posed a significant risk of head injury to the population of riders, mainly young women. This survey suggests that the wearing of amateur riding headgear does not adequately protect the rider from scalp and skull injury, particularly in the occipital region.
To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries.
A prospective observational study of all children less than 15 years of age who were brought to the University of Virginia children's Emergency Department with horse-related injuries.
During the two-year period of the study, 32 children were evaluated. Two children were injured when a horse stepped on them. Thirty children fell from or were thrown from a horse. Of these, 20 were wearing a helmet. Head injuries were more frequent in those patients not wearing helmets. The mean Modified Injury Severity Scale (MISS) score for riders without a helmet (12.9) was significantly higher (more severe) than that for helmeted riders (2.8). All three patients with a Glascow Coma Score < 15 on arrival were not wearing a helmet at the time of injury. The frequency of hospitalization was significantly higher for those not wearing a helmet. Compared with other common mechanisms of childhood injury the mean Modified Injury Severity Scale score of injured riders was exceeded only by that of pedestrians struck by a car.
Equestrian injuries are more severe than those suffered from other common pediatric mechanisms. Helmet use is associated with decreased frequency and severity of central nervous system injury.
The medical and sports literature databases were searched for equestrian sports-related injury published in English since 1980, together with conference abstracts and discussions with equestrian sporting bodies. This literature was critically reviewed, with emphasis on measures to prevent or control injury i.e. countermeasures. While there is considerable literature available on the epidemiology of injury incurred in most equestrian sports, there is little on the prevention of these injuries. Case-control or other studies evaluating the effectiveness of the countermeasures suggested by authors do not seem to exist. There is a good body of epidemiology that supports the proper use of approved helmets as a means of preventing injury in these sports. However, protective helmets do not always prevent injury as expected, and many riders do not choose to wear them because of perceived poor design. The search for the ideal equestrian helmet should continue. Ideally the effectiveness of helmets should be assessed scientifically. Among the other countermeasures discussed are the use of rules and regulations for conduct of events, knowledge of horse behaviour, well-conducted lessons, contraindicated medical conditions, public education, rider education, appropriate equipment and clothing, the riding environment, rider experience, safety stirrups, body protectors, falling techniques, and first aid measures. Even though the injury rate for equestrians is relatively low when compared with other sports, the injuries that are incurred are usually severe. prevention is often difficult because the behaviour of the horse is unpredictable. Countermeasures used for prevention should be evaluated for the effectiveness to reduce the frequency and severity of injuries to equestrians.
To determine the demographics of hospital admissions and mortality associated with equestrian activities in the 33,000 riders in British Columbia (BC).
Analysis of admission data from the Ministry of Health for the years 1991-96, review of information obtained from the Office of the Chief Coroner, and comparison of data from Canadian Hospitals Injury Reporting and Prevention Program.
The mean number of admissions per year was 390. Head injury was the most common cause of admission to hospital (20%) in BC. Females most often required admission (62%). Teenagers and children have a higher incidence of head injuries than the general population. The injury rate was 0.49/1000 hours of riding. There were three deaths per year, 1/10,000 riders; 60% were caused by head injury and females predominated.
Head injuries and other serious injuries occur with equestrian activities and it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including helmets, especially for children.
The aim of this study was to highlight the neuro-ophthalmological dangers associated with horse riding, and working around horses, and the importance of wearing adequate headgear to protect the rider from neuro-ophthalmic injuries. It raises the questions of whether the current laws regarding helmet use are satisfactory, and whether helmets currently used are of an adequate standard.
The records over a 20-year period of one neuro-ophthalmologist in Adelaide were reviewed producing 22 patients with neuro-ophthalmological sequelae of head injuries as a result of horse-related accidents.
There were 22 patients (16 female, six male), one of whom was involved in three separate accidents, Of these, seven were professional riders and 15 amateur. In 20 of the 24 accidents, patients were either thrown or fell from the horse. Helmets were worn in 15 of the accidents. All the patients had closed head injuries of varying severity. The most common neuro-ophthalmological complication found was a fourth-nerve palsy in 11 patients. Five patients had a significant loss of vision and two of these were severe enough to warrant a blind pension.
Horse riding and working around horses constitute an occupation or recreation with inherent dangers. Previous studies have shown that wearing of protective headgear reduces the risk and severity of head injuries, and helmet use should be vigorously promoted. The current laws and practices regarding helmet use are not uniform and seem to be inadequate. The current standard for equestrian safety helmets (AS/NZS 3838:1998) embodies improvements on earlier helmet standards and certainly increases the rider's chances of surviving a severe impact. Nevertheless, serious brain injuries have occurred in wearers of approved helmets, and further research is desirable to ensure the optimum degree of protection compatible with rider acceptance.
The objective of this study was to examine equine-related trauma at a trauma center servicing a region in which there is significant contact between horses and humans.
Data were collected on all patients admitted to the University of Kentucky Medical Center from January 1994 to December 1998 for treatment of horse-related injuries.
Seventy-five patients were admitted to our center after injuries due to contact with horses (0.75% of all trauma admissions). There were 42 men (55%). The mean age was 37 years (range, 3 to 81 years). The majority of patients (67/75) were injured during recreational activities, and most fell or were thrown (40/75). Only 14% of patients were wearing helmets. The most common injuries were extremity fractures and head injuries, but thoracic and abdominal injuries were not rare. Of the 75 patients, 34 required surgery. Five patients (6.7%) died, all of head injury. During the study period, 11 people died in Kentucky due to contact with horses.
Injury due to contact with horses is uncommon even at a center servicing a region with a large equine population. However, injuries are often serious and lead to significant morbidity and occasional mortality. Prevention of death from horse-related trauma is synonymous with prevention of head injury.
Professional horse racing is an exciting and demanding sport with high injury rates. Surprisingly few epidemiological studies have been published and no prospective studies have been reported. This paper reviews the literature and provides a detailed breakdown of injuries in Great Britain and the Republic of Ireland for 1992-2000. The introduction of protective equipment is discussed and evidence for its effectiveness put forward.
Using US data for 1986-1998 fatal crashes, we employed matched-pair analysis methods to estimate that the relative risk of death among belted compared with unbelted occupants was 0.39 (95% confidence interval (CI) 0.37-0.41). This differs from relative risk estimates of about 0.55 in studies that used crash data collected prior to 1986. Using 1975-1998 data, we examined and rejected three theories that might explain the difference between our estimate and older estimates: (1) differences in the analysis methods; (2) changes related to car model year; (3) changes in crash characteristics over time. A fourth theory, that the introduction of seat belt laws would induce some survivors to claim belt use when they were not restrained, could explain part of the difference in our estimate and older estimates; but even in states without seat belt laws, from 1986 through 1998, the relative risk estimate was 0.45 (95% CI 0.39-0.52). All of the difference between our estimate and older estimates could be explained by some misclassification of seat belt use. Relative risk estimates would move away from 1, toward their true value, if misclassification of both the belted and unbelted decreased over time, or if the degree of misclassification remained constant, as the prevalence of belt use increased. We conclude that estimates of seat belt effects based upon data prior to 1986 may be biased toward 1 by misclassification.
Standard analysis of matched-pair cohort data requires information only from pairs in which at least one had the study outcome. This can be useful in traffic fatality studies of characteristics that can vary among vehicle occupants, such as seat belt use, as crash databases often lack information about vehicles in which all survived. However, matching crash victims who were in the same vehicle does not necessarily eliminate confounding by vehicle or crash related factors, because the matched occupants must be in different seat positions. This paper reviews three methods for estimating relative risks in matched-pair crash data. The first, Mantel-Haenszel stratified methods, may produce biased estimates if seat position is associated with the outcome. The second, the double-pair comparison method, was designed to deal with confounding by seat position. If the effects of seat position vary according to some vehicle or crash characteristic which is associated with the study exposure, adjustment for this characteristic may be needed to produce unbiased estimates. Third, conditional Poisson regression and Cox proportional hazards regression can produce unbiased estimates, but may require model interaction terms between seat position and vehicle or crash characteristics. This paper reviews some of the strengths and limitations of each of these methods, and illustrates their use in simulated and real crash data.
Horse riding and handling are uniquely dangerous. Knowledge of the risk factors of horse-related injuries is essential to prevent them. We aimed to define the factors that affect the severity of horse-related injuries and the length of hospital stay. A number of 231 patients (136 females and 95 males) with horse-related injuries were studied. A generalized linear model was used to test the effect of age, sex, cause of injury, complexity of the mechanism of injury, year, place of injury and profession of the injured, on the injury severity score (ISS) and the hospital stay. Fall from a horse was the most common cause of injury (67%). Most of the patients were non-professional (153, 66%). Females were significantly younger than males (P<0.001, t-test). Statistical analysis showed that the primary mechanism of injury (F=2.73, P=0.014) and the complexity of this mechanism (F=4.47, P=0.013) significantly affected the duration of hospital stay. None of the studied variables affected the injury severity score. The mechanism of the horse-related injuries and their complexity significantly affected the duration of hospital stay but not the injury severity score.
This study aims to estimate the burden and describe the profile of equestrian injuries in Greece, where horses, donkeys, and mules are still used in agriculture and where horse riding is a popular leisure activity.
Prospectively collected information on 140,823 injuries reported in the national Emergency Department Injury Surveillance System was examined and 244 equestrian-related injuries that occurred during farming, equestrian sports, or horse racing were analyzed.
The estimated countrywide injury incidence for farming and equestrian sports combined was 21 per 100,000 person-years, but it was 160 times higher for horse-racing personnel. Men had higher rates of racing injuries and women had higher rates of equestrian sport injuries. Fractures accounted for 39.0% of injuries in horse racing and 30.5% in farming; head injuries accounted for approximately 50% of injuries among farmers. Farming injuries were more serious, with 25% requiring hospitalization. Analysis through the Barell matrix pointed to the role of spurs in the causation of ankle fractures and dislocations and the likely contribution of helmets in preventing traumatic brain injuries.
Equestrian-related injuries are a serious but underappreciated health problem and merit targeted prevention efforts for each category affected.
Horseback riding is more dangerous than motorcycle riding, skiing, football, and rugby. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with severe equestrian trauma.
All patients with major equestrian injuries (injury severity score > or = 12) admitted between 1995 and 2005 were reviewed. A 46-question survey outlining potential rider, animal, and environmental risk factors was administered.
Among 7941 trauma patients, 151 (2%) were injured on horseback (mean injury severity score, 20; mortality rate, 7%). Injuries included the chest (54%), head (48%), abdomen (22%), and extremities (17%). Forty-five percent required surgery. Survey results (55%) indicated that riders and horses were well trained, with a 47% recidivism rate. Only 9% of patients wore helmets, however, 64% believed the accident was preventable.
Chest trauma previously has been underappreciated. This injury pattern may be a result of significant rider experience. Helmet and vest use will be targeted in future injury prevention strategies.