On and off the horse: Mechanisms and patterns of injury in mounted and unmounted equestrians
Introduction
Approximately 1 in 63 Americans is involved in some capacity with the horse industry and an estimated 30 million people ride horses each year in the United States, resulting in 78,279 visits to the Emergency Department in 2007 [1], [2], [3]. Several studies estimate the rate of injury to range from 1 per 350–1000 h of horseback riding or 18.7 injuries per 100,000 horse-related interactions [4], [5], [6]. By comparison to other sports, such as wrestling (10.7/1000 h) or football (6.1/1000 h), equestrian injury is less frequent, though the injury type and severity may differ. Hospital admission is common among equestrians by comparison to motorcyclists and snow skiers [4], [7]. Between 20% and 30% of adult equestrians and up to 50% of children (3–18 years) presenting to the Emergency Department are admitted to the hospital, and one in 10,000 riders dies in a given year [5], [7], [8], [9].
Kentucky represents a US national focal point of equitation with 1 in 22 residents actively involved in the horse industry and 50% of horses being utilized for recreation [3]. This environment facilitates a broad spectrum of participation from recreational riding to professional racing, training, diverse competition and the equine veterinary sciences. In comparison to a prior 5-year study at the same center, horse-related injuries have significantly increased at the University of Kentucky, a Level I trauma center in central Kentucky (0.75% vs. 2.2%, p < 0.01) [10]. This suggests an increase in equestrian interaction throughout the state. To identify opportunities for injury prevention, we re-evaluated equestrian injuries at our center by examining differences in patterns of injury among mounted and unmounted equestrians via our own trauma database. It is hypothesized that mounted and unmounted equestrians have distinctly different patterns of injury and that specific targets for injury prevention can be identified.
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Methods
Equestrian injury data were sampled from the University of Kentucky Trauma Registry between January 2003 and December 2007. Data points included age, gender, injury severity score (ISS), abbreviated injury score (AIS) by body region, Glasgow coma scale score (GCS), safety equipment usage, blood alcohol level, surgical procedures, length of hospital stay, length of stay in the ICU, discharge disposition, and whether the injury was occupational or recreational in nature. Age, gender, length of
Results
Between 2003 and 2007, 12,668 injuries were entered into the University of Kentucky Trauma Registry due to blunt force trauma. Of total blunt trauma, 284 (2.2%) cases were due to interaction with horses. Demographic data are summarized in Table 1.1. Mean age upon admission was 37.2 years (S.D. 17.2, 2–79). 51% were male. Three deaths occurred (3/284, 1%), all in the unmounted cohort, due to kick to the chest, kick to the head, or head injury after fall from a trailer while loading a horse. The
Discussion
The purpose of the present study is to determine whether discrepant patterns of horse-related trauma exist in mounted and unmounted equestrians at a single Level I trauma center in an area of dense equine–human interaction. Prior studies have indicated that both riders and handlers are at risk of significant injury and that safety equipment should be employed when in close proximity to the animal [11], [12]. In order to guide further injury prevention efforts, we describe the mechanisms and
Conclusion
In conclusion, this report reiterates and contributes several findings to the body of literature concerning equestrian injury:
- 1.
Reduction in head trauma coincides with reduction in mortality, as both were reduced in the present study by historical comparison (27% vs. 44%, p < 0.01; 1% vs. 6.7%, p = 0.01, respectively).
- 2.
Horses are dangerous to riders and handlers, as evidenced by equal rates of head injury. This finding reinforces the need for protective equipment usage at all times around horses.
- 3.
Conflict of interest statement
The authors have no conflicts of interest to report related to this manuscript.
Acknowledgements
The project described in this report was supported by the National Center for Advancing Translational Sciences, UL1TR000117. The content is solely the responsibility of the authors and does not necessarily reflect the views of the funding agency.
References (29)
- et al.
Equestrian injuries in children
J Pediatr Surg
(2009) - et al.
Accidents with horses: what has changed in 20 years?
Injury
(1996) - et al.
Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries
Am J Surg
(2007) - et al.
Equine-related injury: a retrospective analysis of outcomes over a 10-year period
Am J Surg
(2008) - et al.
Horse-related injuries in pediatric patients
J Pediatr Surg
(2000) Human injuries related to horses analyzed
Equine Dis Q
(2009)- et al.
Traumatic injuries associated with horseback riding
Scand J Surg
(2007) National Economic Impact of the U.S. Horse Industry American Horse Council
(2005)Paediatric and adolescent horse-related injuries: does the mechanism of injury justify a trauma response?
Emerg Med Australas
(2008)Spinal injuries resulting from horse riding accidents
Spinal Cord
(2002)
Current trends injuries associated with horseback riding – United States, 1987 and 1988
MMWR
Equestrian injury prevention efforts need more attention to novice riders
J Trauma
Pattern of equestrian injuries presenting to a Sydney teaching hospital
ANZ J Surg
Injury during contact with horses: recent experience with 75 patients at a level I trauma center
South Med J
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