Swedish study of horse-related accidents reveals surprisingly few serious mishaps

© Mike Bain
© Mike Bain

A Swedish study of injuries in horse-riding mishaps has left researchers wondering whether regulations and safety equipment may have reduced the number of serious injuries.

The researchers investigated the records of all patients attending the emergency department at Linköping University Hospital during a two-year period due to horse-related trauma.

Horse riding, with almost 200,000 participants, is the eighth most popular sport in Sweden.

In all, 147 children and 141 adults turned up at the department with horse-related injuries.

The researchers, Jakob Altgärde, Stefan Redéen, Niclas Hilding and Peder Drott, found that the most common mechanism of injury was falling from the horse.

Most commonly, minor sprains and soft tissue injuries were seen, but also minor head injuries and fractures, mainly in the upper limbs.

In total, 26 adults and 37 children were admitted. Of these 63 patients, 19 were considered to have a serious injury. In total, four patients needed treatment in intensive care units.

The authors, whose findings have been published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, said horse riding was a sport with well-known risks.

Their results largely corresponded with the literature, they said. “However, we have not observed the same incidence of serious injuries. In contrast, we find these to be fairly uncommon.

“The injuries are mainly minor, with a small risk of long term morbidity. Over time regulations and safety equipment seem to have decreased the number of serious accidents,” they wrote.

Altgärde and his colleagues launched the study to investigate if injuries associated with horse riding were common, which type of injuries occurred, what mechanisms were involved, and to estimate the costs to society.

Their research of admission records related to 2003-2004.

Results from previous studies showed that the most common horse-related injuries were head injuries and fractures of the long bones. Horse-related trauma is also more common among women, with a peak incidence at the age of 14.

They defined serious injuries as those requiring hospitalisation for three or more days, or requiring sick leave for one month or more.

The most common mechanism of injury was falling off the horse, involving 125 of the children and 92 of the adults. In some of these cases, the horse also fell, or stepped on the rider, or kicked them. In the cases of three children and three adults, they got their foot caught in a stirrup. One child and four adults were dragged as a consequence.

Eleven children turned up to hospital because they had been kicked, as did 23 adults. Six children were stepped on, as were 14 adults. One child suffered a bite requiring hospital treatment. Another child was injured when the horse suddenly stopped in front of an obstacle.

Two children and one adult were injured when squeezed between the horse and a wall.

Three adult riders got a finger caught in the reins and were pulled along by the horse. One adult hit an obstacle while riding.

Five adults were hit by the horse’s neck or head.

Most of the injuries were minor sprains and light soft tissue injuries, Altgärde and his colleagues reported.

In total, 37 children and 26 adults were admitted, with four children and nine adults staying for at least three days.

None of the patients died.

Medical authorities put the total cost of treating the children in the study at €210 000 and the adults at €200,000, which works out at about €400 per accident.

Sixteen percent of the adults required sick leave after their accident.

The researchers noted the dominance of females in the study population – 98 percent among the children and 91 percent among adults.

There was a higher rate of adults (31 percent) injured while dismounted than children (11 percent).

Comparing injury mechanisms between children and adults; 85 percent of the children had fall accidents and 7 percent were kicked, while 65 percent of the adults had fall accidents and 16 percent were kicked.

Minor sprains and soft tissue injuries were the most common type of injury in both groups. In both groups, fractures were mainly located in the upper extremity and usually followed falling injuries.

The most commonly injured sites were the extremities – the head and neck – especially so among the children.

They noted the admission rates and number of patients requiring sick leave were much lower than that recorded in a similar two-year study conducted at a different hospital 24 years earlier.

“The decreased need for sick leave and admission rate possibly reflects the changes in management of these patients over the years,” they said. “It might even reflect an increased use of safety equipment.”

Horse-related trauma in children and adults during a two year period.
Jakob Altgärde, Stefan Redéen, Niclas Hilding and Peder Drott.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22:40 doi:10.1186/s13049-014-0040-8

The full study can be read here.


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