Characteristics of equestrian accidents and injuries leading to permanent medical impairment

BACKGROUND

Equestrian sports, also referred to as equestrianism, is practiced all over the world and a popular leisure activity in Sweden. Equestrianism is the country's second-largest youth sport, and previous studies indicate that accidents are common in equestrianism. However, few previous studies have examined acute equestrian injuries leading to permanent medical impairment (PMI).

METHODS

By using nationwide insurance data comprising all injured equestrians registered in the Swedish Equestrian Federation, the aim was to analyse characteristics of equestrian accidents and particularly injuries leading to PMI, both in general and by age, gender, incident type, injury type and injured body region. Injury incidence and injuries leading to PMI were examined. All equestrians injured during 2017-2021 were included (n = 6,876), however, only injuries occurring in 2017 and 2018 were used to analyse the risk and the injury distribution of injuries leading to PMI. Injury incidence was calculated separately for males and females, as well as for different age groups, by dividing the number of insurance claims by the number of members multiplied by 1,000. Risk Ratio (RR) was calculated between gender. Pearson's chi-squared test was used to analyse differences in distribution for categorical variables.

RESULTS

The majority of injuries affected females, correlating to approximately three times higher risk, compared to males. The age group 21-40 years were associated with the highest injury risk (14.26/1,000 registered riders). In total 12% of all injuries led to PMI. Injuries to the upper and lower extremities, along with fractures, had a higher risk of resulting in a PMI. The risk of injury leading to PMI was higher among riders over 20 years of age.

CONCLUSIONS

The fact that females face nearly three times the injury risk of males, and riders aged 21-40 had the highest injury risk while younger riders (Luke KL, McAdie T, Smith BP, Warren-Smith AK. New insights into ridden horse behaviour, horse welfare and horse-related safety. Appl Anim Behav Sci. 2022;246:105539.); (Havlik HS. Equestrian sport-related injuries: a review of current literature. Curr Sports Med Rep. 2010;9(5):299-302.); (Samuels K, Bettis A, Davenport DL, Bernard AC. Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns. Injury. 2022;53(1):171-5.); (Gharooni A-A, Anwar F, Ramdeep R, Mee H. Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre. Trauma. 2023;25(1):41-7.); (Hasler RM, Gyssler L, Benneker L, Martinolli L, Schotzau A, Zimmermann H, et al. Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey. J Trauma Manag Outcomes. 2011;5:4.); (Meredith L, Brolin K, Ekman R, Thomson R. Analyses of injuries to equestrians in a Swedish district over a 16-year period. Translational Sports Med. 2019;2:270-8.) had a lower risk, indicates that preventive efforts should target both older and female riders. Injuries predominantly resulting in PMI involve upper and lower extremities, however, to prevent the most serious injuries significantly affecting a rider's daily life, measures preventing head and spinal cord neck injuries, must be implemented. Head injures remain the most frequent, serious and most significant group of injuries to prevent and mitigate, within equestrian sports.

Patterns of horse and camel- related injuries: A descriptive analysis from a national trauma registry (2007-2021)

BACKGROUND

The large animal-related injuries are emerging major trauma but remain underestimated public health problem worldwide. We aimed to determine the incidence, clinical characteristics, mechanisms and patterns of horse and camel-related injuries (HCRIs) in a Middle Eastern country.

METHODS

A retrospective analysis of all patients who were hospitalized due to HCRIs was conducted. Data included patient's demographics, mechanism of injury, anatomical location and severity of injury, and hospital outcomes.

RESULTS

Between November 2007 and December 2021, there were 273 hospitalized patients with HCRIs representing1.3 % of the total trauma admissions. Of these, 145 (53.1 %) and 128 (46.9 %) were horse (HRI) and camel-related injuries (CRI) respectively. The most common presenting age group of the cohort was 20-29 years and 88 % were males. Patients with HRIs were younger (27.5 ± 11 years) than CRIs (34 ± 13.5 years). Injuries to the extremities were the most common (62 % vs. 40 %), followed by the head injury (25.5 % vs. 31 %) among the HRIs and CRIs, respectively. The most common mechanism of injury was falling off followed by getting kicked by the HCRIs. Major trauma (ISS ≥12) was found in 23 % of HRIs (47.5 %) and CRIs (52.5 %). Only 5 % of patients had shock index >0.90 on admission; two thirds were due to CRIs. There were four fatalities (1.5 %), all attributed to traumatic brain injury, of which three were due to HRIs and one due to CRIs.

CONCLUSION

This study reveals that HCRIs predominantly affect young adult males and may involve serious injuries, exhibit distinct injury patterns, however, it is associated with low mortality. Preventive measures need to be revisited.

Incidence of concussions and helmet use in equestrians

OBJECTIVES

Equestrians have a high risk of concussions per hospital records. However, most concussions occur in private settings where concussions are not tracked. We determined concussion incidence by self-report, expressed per 1000 h of exposure, and determined helmet usage and concussion knowledge.

DESIGN

Descriptive epidemiological study.

METHODS

Equestrians were recruited using a snowball method of sampling in which enrolled participants recruited more equestrians. Participants completed a survey of equestrian experience and history of concussion, symptoms and provided estimates of hours spent in various equestrian activities. From these data, incidences of concussions were calculated. In addition, they answered questions regarding helmet usage and willingness to take risks when concussed.

RESULTS

210 participants (203 women) reported 27 ± 14 years of equine experience and 728 concussions, 3.47 ± 5.34 per person (0-55). Incidence while riding was 0.19/1000 h which was greater than the incidence while driving (0.02/1000 h) or handling horses (0.03/1000 h). Riders were helmeted at the time of injury 85% of the time. While concussion knowledge was high, most reported willingness to risk permanent injury by continuing to work with horses while injured.

CONCLUSIONS

To our knowledge this is the first study to document incidence of concussions in equestrians: incidence is higher while riding than during football or rugby training. Helmets were far more commonly worn at the time of concussion than reported in hospital data, suggesting that helmets effectively reduce concussions severe enough to warrant urgent medical care.

Epidemiological Study of Equestrian Trauma in Geneva

BACKGROUND

Horse-related activities are increasingly popular among young people but are frequently associated with severe injuries requiring hospital treatment. There are few data on the incidence of equestrian injuries, especially in child populations, or on means of prevention. Thus, this study's purpose was to highlight the epidemiological data on specific injuries due to equestrianism and serve as the groundwork for future studies on the prevention of equestrian accidents.

METHODS

A retrospective study collected data on all children younger than 16 years old who attended our regional emergency department after involvement in an equestrian accident. The study covered the periods from 1990 to 2003 and 2011 to 2018. Twenty-two years of data on trauma circumstances, injury patterns (mechanism, anatomic site, and severity), treatment protocols, and hospital lengths of stay were analyzed.

RESULTS

This study confirmed that more young females participating in equestrian sports attended our emergency department than males. The leading cause of equestrian injury was falling from a horse (80.2%). Orthopaedic injuries represented around 60% of all reported lesions, far ahead of head injuries (30%). More than half of the injured children required hospitalization for inpatient medical care, and almost 50% of these underwent a surgical procedure, especially for upper extremity fractures (72% of all fractures). One patient died due to severe cerebral injury.

CONCLUSIONS

Horse riding injuries occur more frequently and are more serious than in many other sporting activities. There is an urgent need to reassess preventive measures to reduce the incidence and severity of equestrian injuries.

LEVEL OF EVIDENCE

Level IV.

Head and Spinal Injuries in Equestrian Sports: Update on Epidemiology, Clinical Outcomes, and Injury Prevention

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.

Retrospective analysis of equestrian-related injuries presenting to a level 1 trauma center

OBJECTIVE

Report the incidence, pattern, and severity of equestrian-related injuries presenting to a rural level 1 trauma center and detail the total radiation dose, imaging, and hospital charges related to those injuries.

METHODS

An IRB-approved retrospective review of patients presenting to our facility following equine-related trauma was conducted. Demographics, mechanism of injury, types and number of imaging exams, approximate radiation dose administered, imaging findings, Injury Severity Score (ISS), rate/length of hospitalization, and approximate cost of care were recorded.

RESULTS

A total of 222 patients (161 F:61 M; mean age 38.5 years (range 4-79)) presented to our emergency department following horse-related injury. Mechanisms of injury included the following: fall (n = 186), kick (n = 18), stepped on (n = 9), and other (n = 9). Body part injured included extremity (26.1%), torso (26.6%), spine (25.7%), and head/neck (18.5%). Longer hospital admission, higher expenditure, increased CT/MR imaging, higher ISS, and radiation dose were noted in older patients and those injured by a fall or kick. Head injuries were more frequent following a horse kick (p = 0.006). Spinal and torso injuries were more common in patients older than 54 years (p = < 0.001) and those with falls (p < 0.04). Extremity injuries were more common in older patients (p < 0.001).

CONCLUSION

Patient age greater than 54 years and mechanism of injury are strong predictors of the ISS, injury localization, healthcare expenditure, and mean hospital stay. With the exception of obvious minor wounds, full trauma work-ups (CT chest/abdomen/pelvis and cervical spine) are encouraged for equestrian-related injuries in older patients and those injured by a fall.

Do riders who wear an air jacket in equestrian eventing have reduced injury risk in falls? A retrospective data analysis

OBJECTIVES

To investigate the association between air jacket usage and rider injury severity in equestrian eventing competition falls world-wide.

DESIGN

Retrospective data analysis.

METHODS

An analysis was conducted on Fédération Equestre Internationale data for 1819 riders who fell wearing an air jacket and 1486 riders who fell while not wearing an air jacket from 2015 to 2017. Injury data were categorised as either 'no/slight injury' or 'serious/fatal injury'. A chi-square test determined whether an association was present between injury severity category and air jacket usage and binary logistic regression determined the effect size of this association.

RESULTS

As a result of falls, 3203 riders sustained no/slight injuries and 102 sustained serious/fatal injuries. While 55.0% of riders who fell were wearing an air jacket, they represented 67.6% of the serious/fatal injury outcomes. Air jacket usage was significantly associated with serious/fatal injuries in falls (X² = 6.76; p = 0.009). Riders wearing an air jacket had 1.7 times (95%CI 1.14-2.64) increased odds of sustaining a serious or fatal injury in a fall compared to riders not wearing an air jacket.

CONCLUSIONS

Riders wearing an air jacket were over represented in the percentage of serious or fatal injuries in falls compared to riders who only wore a standard body protector. Further research is needed to understand the reason(s) for this finding. It is recommended that additional data on injury outcomes, rider characteristics and the biomechanics of falls be examined in future analyses, and that air jacket and body protector characteristics be further investigated.

On the protective capacity of a safety vest for the thoracic injury caused by falling down

Background

Aged people all over the world are prone to fall down accidentally and be injured with fracture, such as the rib fracture. To protect the elderly, the safety vest has been developed to protect them from being injured when falling down. To effectively protect the elderly, more analysis on the protective capacity of a safety vest under different situation are needed.

Results

Herein, a finite element model based on the computed tomography CT scanning data of a Chinese old female was built, and then used to simulate the process of falling down at different velocities. Analysis and comparison were done on the maximum shear stress, kinetic energy curves and internal energy curves with and without safety vest. The maximum shear stress indicated that the Abbreviated Injury Scale (AIS) 2+ injury risks of rib were 8%, 100% and 100% at the velocities of 1.5 m/s, 2.0 m/s and 2.5 m/s, respectively. The corresponding risks were lowered to 0%, 0% and 60% by the vest, respectively. Furthermore, the vest could absorb the internal energy resulted by the deformation of the thoracic osseous tissue by about 20%, thus decreasing the shear stress and the injury risk.

Conclusion

It is concluded that the safety vest decreases the injury risk when the elderly fall down, thus protects them from being injured.

Equestrian-related injuries, predictors of fatalities, and the impact on the public health system in Sweden

OBJECTIVES

Horse riding is a popular activity but has also been found to lead to many injuries and even fatalities. No reduction in the numbers of those being admitted to hospital for equestrian-related injuries have been seen in Sweden in recent years. The aim of this work was to examine injuries, fatalities, and predictors of fatalities in equestrian-related activities and to investigate the cost of these injuries to the public health system.

STUDY DESIGN

The study is a retrospective analysis of hospital data.

METHODS

National Swedish hospital and mortality registers were retrospectively examined, inclusive of the years 1997-2014. Logistic regression was used to examine the predictors of fatal injuries, and cost of hospital treatment was considered.

RESULTS

Over the study period, there were an observed 29,850 injured cases and 51 fatalities. Women comprized almost 90% of those injured and 70% of fatalities. The average age was 26.8 years (range 0-91, standard deviation [SD] = 16.1) for injured and 43 years (range 7-78 years, SD = 20.5) for fatal cases. Men dominated both injured and fatal samples in the older age ranges (Fatal: >50 years; Injured: >70 years), although overall numbers were small. Injuries to the head contributed more than any other body region for both injured and fatal cases, and fractures were the most frequently seen injury type. A chi-squared analysis confirmed that injury type and injured body region were not independent of age. Logistic regression examining the association between fatality and age, gender, home region, and year of injury, indicating trends over time, found that there was an increase of 5.1% in the odds of fatality for every year increase in age of the patient and men had 2.2 times higher odds to be in the fatal sample than women. The conservative estimated cost of injury was 1800 Euro per injury event, equating to over 3 million Euro per year.

CONCLUSION

Equestrian-related injury events present a major public health concern. Observed decreases in fatalities suggest improved health care, yet head injury and fatality rates are still high, indicating a need for further intervention. The type of injury changes with the age group, and a better understanding of injury patterns with age is needed to identify protective measures for the different user groups.

Effects of body protection vests and experience levels in prevention of equestrian injuries

Objectives

To investigate the risk reduction and benefit of wearing body protection/safety vests in equestrian sports.

Methods

A comparison of equestrians wearing body protective vests and those not wearing vests was performed using incident report data of 718 participants in the United States Pony Clubs during 2011-2017. Data obtained included age, gender, certification level of member, type of activity, description of incident, description of injuries, what protective equipment was worn and other possible contributing factors.

Results

While wearing body protective vests when riding on the flat or for show jumping was not correlated with a decrease in injuries, wearing vests for cross country was correlated with decrease in reported injuries (p=0.036) and showed a trend towards a lower incident severity level (p=0.062). Wearing body protection during cross country reduced the relative risk of injury by 56%. While the volume of incidents varied with a rider's experience level, the number of serious injuries did not appear to correlate with lesser equestrian experience.

Conclusions

While equestrian sports are considered to have a certain degree of risk associated with them, there are ways to make them safer. Wearing safety equipment, such as helmets and body protection, and obtaining education and experience can lessen the chance of incurring serious injuries.

Assessing the risk for major injuries in equestrian sports

Background/aim

Horse riding is a popular sport, which bears the risk of serious injuries. This study aims to assess whether individual factors influence the risk to sustain major injuries.

Methods

Retrospective data were collected from all equine-related accidents at a German Level I Trauma Centre between 2004 and 2014. Logistic regression was used to identify the risk factors for major injures.

Results

770 patients were included (87.9% females). Falling off the horse (67.7%) and being kicked by the horse (16.5%) were the two main injury mechanisms. Men and individuals of higher age showed higher odds for all tested parameters of serious injury. Patients falling off a horse had higher odds for being treated as inpatients, whereas patients who were kicked had higher odds for a surgical therapy (OR 1.7) and intensive care unit/intermediate care unit (ICU/IMC) treatment (OR 1.2). The head was the body region most often injured (32.6%) and operated (32.9%). Patients with head injuries had the highest odds for being hospitalised (OR 6.13). Head or trunk injuries lead to the highest odds for an ICU/IMC treatment (head: OR 4.37; trunk: OR 2.47). Upper and lower limb injuries showed the highest odds for a surgical therapy (upper limb: OR 2.61; lower limb: OR 1.7).

Conclusion

Risk prevention programmes should include older individuals and males as target groups. Thus a rethinking of the overall risk assessment is necessary. Not only horseback riding itself, but also handling a horse bears a relevant risk for major injuries. Serious head injures remain frequent, serious and an important issue to be handled in equestrians sports.

Blunt injuries related to equestrian sports: results from an international prospective trauma database analysis

INTRODUCTION

The objective of this study was to investigate the nature, management, and outcome of major injuries related to equestrian sports and to define the at-risk groups for serious and life-threatening injuries.

METHODS

We analyzed demographic, pre-hospital, clinical, and outcome data from an international population-based prospective trauma database (TraumaRegister DGU®). Patients with major injuries (Injury Severity Score [ISS] ≥9 points) related to equestrian sports activities were included (January 1, 1993, to December 31, 2012). Clinical and outcome parameters were stratified for four different types of injury mechanisms: fall from horse (FFH), horse-kick (HK), horse crush (HC), and carriage-related accidents (CRA). Participating countries included Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Statistical analyses were performed with SPSS (Version 22, IBM Inc., Armonk, NY).

RESULTS

The Database identified 122,000 documented patients, of whom 679 were equestrian incidents. Among these, the four major injury mechanisms were: FFH (n = 427), HK (n = 188), HC (n = 34), and the CRA (n = 30). Females were more likely to sustain FFH (75.5%, p < 0.001), leading to head injuries (n = 204, 47.8%) and spinal fractures (n = 109, 25.5%). HK injuries often resulted in facial fractures (29.3%, p < 0.001). Individuals sustaining HC injuries had a high risk for pelvic (32.4%, p < 0.001) and abdominal injuries (35.2%, p < 0.001). In contrast to the FFH cohort, the CRA cohort involved older males (57 ± 13 years), with chest (63.3% p = 0.001), and extremity injuries, resulting in significant injury severity (ISS 20.7 ± 10.6). In the CRA cohort, 16% were in haemorrhagic shock on scene, and also the highest in-hospital mortality (14.8%, p = 0.006) was observed.

CONCLUSIONS

Young female riders are at risk from falling, horse-kicks, and crush-injuries. Older males in carriage-related accidents sustained the highest injury severity and mortality rate, and must specifically be targeted by future prevention initiatives. Level of evidence Descriptive Epidemiologic Study, Level II.