Horse injuries are often overlooked public health problem, US researchers say

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Image by Ped Briggs

The risks of horseback riding are laid bare in a new study that analyzed 10 years of horseback riding injuries in the United States.

The authors painted a disturbing picture of sports and recreation, finding that the risk of injury requiring hospitalization is higher for horseback riding than for other potentially risky hobbies such as football, motor racing. or skiing.

While the most common injury site was the chest, head and neck injuries were the most fatal, according to the results.

Data from the United States Centers for Disease Control and Prevention shows that more than 30 million people participate in equestrian sports and recreation in the United States each year.

However, relatively little is known about the prevalence and consequences of injuries sustained while riding.

The study team, led by trauma surgeon Dr Jeffrey Skubic, a trauma surgeon from DHR Health in Texas, relied on data provided by Level 1 and 2 trauma centers to the US National Trauma Data Bank. on injuries sustained by adults while riding between 2007 and 2016.

Details of 45,671 patients with equestrian injuries were retrieved for this period. However, information was incomplete for 20,880 of the injuries, leaving 24,791 for inclusion in the study analysis.

The average age of the injured was 47, with almost equal proportions of men and women.

The most common site of injury was the chest, in 9,189 accidents, accounting for 37% of all injuries. Arm and leg injuries occurred in 6,560 cases (26.5%), while 5,689 (23%) patients sustained head injuries. Abdominal injuries were the least frequent, being involved in 3353 cases, or 13.5%.

Severe neurological lesions, ranked by a Glasgow Scale (GCS) score of 3 to 8, were observed in 888 patients, representing 3.5% of injuries analyzed in the study. The clinical scale is used to reliably measure a person’s level of consciousness after brain injury. It varies from 3 to 15.

In this group, head and neck injuries were the most likely cause, occurring in 706 patients. Moderate impairment (a score of 9 to 12) occurred in only 258 injury cases (1%).

Some 21,917 (88.5%) patients had a GCS between 13 and 15. But 4,508 (20.5%) of these patients nonetheless had head and neck trauma. While the injuries were primarily classified as mild (33%) to moderate (43.5%) in severity, most (88%) of these patients required hospitalization, and more than a quarter (28%) had been sent to intensive care. About 1 in 10 required surgery.

Protective gear could save lives, the researchers said, but it was often not worn.
Protective gear could save lives, the researchers said, but it was often not worn. photo by ufopilot

The average length of hospital stay was 4.5 days, with an average of 4 days spent in intensive care and 6 days on a ventilator.

People aged 50 to 59 were the most likely to present to trauma centers, accounting for more than 1 in 4 of all those injured. People aged 60 and over accounted for 22% of those injured. People aged 30 to 39 were the least likely to be among the injured, accounting for only 13% of patients.

Some 14,096 patients, or 57%, returned home without the need for additional health services, while 7% were transferred to rehab or a skilled nursing facility.

Some 320 people died of their injuries during the study period, with head and neck injuries being the leading cause of death in three out of four cases. Only 2% of those who died had suffered injuries to the arms or legs.

Bikers with head and neck injuries were 44 times more likely to die than those with arm / leg injuries, while those with chest and abdomen injuries were about six times more likely to die. to do.

If patients arrived at the emergency room with systolic blood pressure below 90 mm Hg, they were 23 times more likely to die than patients with a higher reading.

The researchers, reporting in the journal Trauma surgery and acute care Open, concluded that equestrian sports injuries are an often overlooked public health problem. The results, taken together, suggest that the dangers of equestrian activities have been severely underestimated.

“When controlled for hours of activity, horseback riding resulted in a higher proportion of hospitalizations than other higher risk activities such as skiing. “

"Studies have shown that a large proportion of riders involved in equestrian injuries were not wearing helmets at the time of their accident," the researchers said.
“Studies have shown that a large proportion of riders involved in equestrian injuries were not wearing helmets at the time of their accident,” the researchers said. photo by BLM Oregon and Washington

Protective gear can save lives, but is not always worn, they noted.

“Studies have shown that a large proportion of riders involved in equestrian injuries were not wearing helmets at the time of their accident. It stands to reason that raising awareness of possible injuries and increasing preventive measures to protect against head injuries would significantly reduce mortality. “

They add: “It is interesting that the risk of admission to hospital from horseback riding is higher than football, car and motorcycle racing, and skiing.

“Recently,” they continued, “equestrian sports agencies have paid some attention to the use of protective equipment to prevent injuries, especially with regard to concussions and brain injuries; however, very few public health campaigns have focused on preventing injury to riders using horses for recreation and work.

“This contrasts sharply with the popularity of riding these animals,” they said.

Horseback riding is immensely popular among Americans, they noted, “We suggest that preventative measures and campaigns be instituted to highlight safety practices. Implementing the consistent use of personal protective equipment, such as helmets and vests, will provide additional protection for all riders (work or leisure) on horseback.

The researchers said it is also imperative that medical professionals examine patients injured during horseback riding for head and neck injuries, as they contribute to the highest mortality.

The authors noted that little work has been done to quantify the true costs of equestrian injuries. “Although the overall death toll is low, previous work has shown that the costs of long-term rehabilitation to treat these injuries can be high. Further investigation into the true financial burden of these injuries is warranted, they said.

Discussing their findings, they noted that the demographics of the study revealed that men and women were injured at the same rate.

“This flies in the face of several studies which have claimed that women injure themselves more often in equestrian sports-related injuries. This finding would suggest that both sexes are susceptible to injury and that current prevention efforts should focus on both sexes. “

Skubic was joined in the study by Kevin Mutore, Jiyun Lim, and Demba Fofana, all of the University of Texas Rio Grande Valley; and Annelyn Torres-Reveron, Center of Excellence for Trauma Research in the Border Region, part of the DHR Health Institute for Research and Development.

Mutore K, Lim J, Fofana D, et al. Think Head and Neck Trauma: A 10-Year BNDT Analysis of Horseback Riding Trauma at the USATrauma Surgery & Acute Care Open 2021; 6: e000728. doi: 10.1136 / tsaco-2021-000728

The study, published under a Creative Commons License, can be read here.


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