Horse riders’ brain injury risk “5-fold higher” without a helmet

© Steph Freeman

It’s no surprise that using a safety helmet when riding can reduce the risk of serious injury, but a new study by German scientists has put some numbers to the facts on traumatic brain injuries.

They found that the relative risk for intracranial bleeding for unhelmeted riders was 5-fold higher and the relative risk reduction was 96% by wearing a safety helmet.

In their retrospective study published in the British Journal of Neurosurgery, the researchers combined 40 patients into 20 matched pairs based on age group, gender and trauma mechanism, and looked at the presence or absence of fractures or intracranial hemorrhage.

Odds ratio and relative risk were calculated for the endpoints fractures and intracranial hemorrhage. Crude risk ratio and lesion volume differences between helmeted and unhelmeted riders were compared.

Of the horse riders who sustained skull fractures, six were not wearing helmets and their fractures were considered more complex than the one who was wearing a helmet.

“Intracranial hemorrhage occurred significantly more often in the unhelmeted subgroup. Moreover, the total lesion volume in the unhelmeted subgroup, presenting with intracranial hemorrhage, was significantly higher than in the control group,” said the researchers, variously affiliated with Eberhard Karls University Tuebingen, the University of Münster, and Ibbenbueren Hospital.

“Odds ratios were 9 for intracranial hemorrhage (p = .014) and 8.14 for skull fractures without a helmet (p = .09).”

In conclusion, they said that, under consideration of comparable trauma mechanisms, “horseback riders that do not wear a safety helmet are at risk to suffer a significantly more severe brain injury than helmeted riders. Therefore, safety helmets are recommended for all horseback riders”.

Impact of helmet use in equestrian-related traumatic brain injury: a matched-pairs analysis. G Bier, MN Bongers, A Othman, JM Hempel, V Vieth, W Heindel, U Ernemann, and MC Burg. British Journal of Neurosurgery. doi: 10.1080/02688697.2017.1409874.

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