Non-fatal horse related injuries treated in emergency departments in the United States, 2001-2003.

OBJECTIVE: To characterise and provide nationally representative estimates of persons with non-fatal horse related injuries treated in American emergency departments. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Pediatric equestrian injuries.

Using data from four sources, horse-related injuries are summarized for persons younger than 25 years of age. Head injury caused 57% of deaths. The upper extremity was the most common area injured, with the next most frequent areas the lower extremity (National Park Service data) and the head (United States Pony Clubs [USPC] data). Injured females outnumbered injured males and had a greater percentage of participants injured (USPC data). Injuries occurred at home in 41% (National Electronic Injury Surveillance System data). USPC figures suggest that greater knowledge may reduce the severity of horse-related injuries. Previous horse-related injury had occurred in 1 of 4 of those injured (USPC data). One third of accidents occurred during lessons (USPC data). Riding instructors should be certified by a recognized organization, and parents should evaluate an instructor's personal riding and their safety records with students. The pediatrician's role should be in counseling parents with children who ride and in offering recommendations for safety to governing boards of youth horse activities.

Prevention of Neurologic Injuries in Equestrian Sports.

In brief: More than 42,000 injured horseback riders are treated each year in emergency departments. Although most of the injuries are relatively minor, as many as one third involve the CNS. Neurologic injuries are usually to the head-mostly concussions or cerebral contusions-and commonly occur when a rider falls from the horse. Certain medical conditions, eg, temporary paralysis and posttraumatic epilepsy, contraindicate equestrian activities. The risk of catastrophic injury may be lessened by identifying the persons who should not participate and enforcing the use of protective equipment-particularly adequate headgear.

Accidents in equestrian sports.

In a five-year study, 160 accidents occurred among 46,351 six-through 21-year-olds engaged in horse activities. Of these, 130 were riding accidents, 20 were horse-related and 10 did not involve horses. Bruises and abrasions were the most frequent injuries, and the area of the body most commonly injured was the head and face. The low accident rate may result from the requirement that riders wear approved protective headgear.

Youth Accidents With Horses.

In brief: In a two-year study of the estimated 13,428,000 hours of horse activities by 18,408 US Pony Clubs (USPC) members aged 6 to 21 in scheduled supervised programs, there were 64 accidents resulting in 88 injuries in 16 areas of the body. The head/face was the area most often injured (27.27%), and bruise/abrasion was the most common type of injury (28.26%). Cross-country riding was the most dangerous event (42.31%). Unexpected actions of the horse caused many accidents-25% occurred when the horse bucked and threw the rider, 23.08% when the horse refused a jump, and 17.31% when the horse fell or slipped. There were only two accidents to the most skilled riders, but riders with five or more years of experience had the highest percentage of accidents.

Head Injuries in the Equestrian Sports.

In brief: Head injuries are the most frequent and most severe of all injuries in equestrian sports. It has been estimated that head injuries make up approximately 20% of all horse-related injuries. They can be prevented or their severity can be reduced by wearing properly fitted and secured headgear. A good helmet must be secured from loss, protect the head from the impact or compression of a fall, and resist penetration. The author recommends that the medical community continue to work to make the most protective riding helmet acceptable to the equestrian community.