The risks of horse-riding are laid bare in a fresh study that analyzed 10 years of equestrian-related injuries in the United States.
The authors painted a worrying picture of the sporting and leisure pursuit, finding that the risk of an injury requiring hospital admission is higher for horse riding than for other potentially risky pastimes such as football, motor racing, or skiing.
While the most common site of injury was the chest, head and neck injuries were the most lethal, the findings show.
Data from the US Centers for Disease Control and Prevention show that more than 30 million people participate in equestrian leisure and sporting activities every year in the United States.
However, relatively little is known about the prevalence and consequences of injuries sustained while horse riding.
The study team, led by trauma surgeon Dr Jeffrey Skubic, a trauma surgeon with DHR Health in Texas, drew on data supplied from level 1 and 2 trauma centers to the US National Trauma Data Bank on injuries sustained by adults while horse riding between 2007 and 2016.
Details of 45,671 patients with equestrian injuries were retrieved for this period. However, the information was incomplete for 20,880 of the injuries, leaving 24,791 for inclusion in the study analysis.
The average age of those injured was 47, with almost equal proportions of men and women.
The most common injury site was the chest, in 9189 of the mishaps, representing 37% of all injuries. Injuries to arms and legs occurred in 6560 of cases (26.5%), while 5689 (23%) patients sustained head injuries. Abdominal injuries were the least common, being involved in 3353 cases, or 13.5%.
Severe neurological damage, classified as a Glasgow Coma Scale (GCS) score of 3 to 8, was observed in 888 patients, representing 3.5% of the injuries analyzed in the study. The clinical scale is used to reliably measure a person’s level of consciousness after a brain injury. It ranges from 3 to 15.
Within 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 on injuries (1%).
Some 21,917 (88.5%) patients had a GCS between 13 and 15. But 4508 (20.5%) of these patients nevertheless had a head and neck injury. While injuries were mainly categorised as mild (33%) to moderate (43.5%) in severity, most (88%) of these patients required admission to hospital, with more than a quarter (28%) sent to intensive care. Around 1 in 10 required surgery.
The average length of stay in hospital was 4.5 days, with an average of 4 days spent in intensive care and 6 days on a ventilator.
Those aged 50 to 59 were most likely to present to trauma centres, accounting for more than 1 in 4 of all those injured. Those aged 60 or more accounted for 22% of the injured. Those aged 30 to 39 were least likely to feature among the injured, accounting for just 13% of patients.
Some 14,096 patients, or 57%, were discharged home without requiring additional healthcare 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 the leading cause of death in three out of four. Just 2% of those who died had sustained injuries to their arms or legs.
Riders with head and neck injuries were 44 times as likely to die as those with arm/leg injuries, while those with chest and abdominal injuries were around six times as likely to do so.
If patients arrived at the emergency care department with a systolic blood pressure of less than 90 mm Hg, they were 23 times more likely to die than were patients with a higher reading.
The researchers, reporting in the journal Trauma Surgery and Acute Care Open, concluded that equestrian-related injuries are a frequently ignored public health issue. The findings, when taken together, suggest that the dangers of equestrian activities have been severely underappreciated.
“When controlled for hours of activity, horseback riding resulted in a higher proportion of hospital admission than other higher-risk activities like skiing.”
Protective gear can save lives, but is not always worn, they noted.
“Studies have shown that a large fraction of riders involved in equestrian injuries were not wearing helmets at the time of their accident. It stands to reason that raising awareness of the possible injuries and increasing preventive measures to protect against head injuries would significantly reduce mortality.”
They add: “Interestingly, hospital admission risk from horseback riding is higher than football, auto and motorcycle racing, and skiing.
“Recently,” they continued, “some attention has been paid by equestrian sporting agencies to the use of protective equipment to prevent injuries, especially as it relates to concussion and brain injuries; however, very few public health campaigns have focused on preventing injuries in riders using horses for leisure and work.
“This is in stark contrast to the popularity of riding these animals,” they said.
Horseback riding is immensely popular among Americans, they noted: “We suggest that preventive measures and campaigns should be instituted to highlight safety practices. Implementing the consistent use of personal protective equipment, such as helmets and vests, will provide added protection to all riders (working or leisure) while on horseback.”
The researchers said it is also imperative that medical professionals examine patients injured during horseback riding for head and neck injuries as these contribute to the highest mortality.
The authors noted that little work has been done to quantify the real costs of equestrian injuries. “Although overall death numbers are low, previous work has shown that the long-term rehabilitation costs to treat these injuries may be high.” Further investigation into the true financial burden of these injuries is warranted, they said.
Discussing their findings, they noted that the demographic data in the study revealed men and women were injured at the same rate.
“This goes against several studies that have claimed that women are injured more often in equestrian-related injuries. This finding would suggest that both sexes are susceptible to injuries and that the current prevention efforts should be focused on both sexes.”
Skubic was joined in the study by Kevin Mutore, Jiyun Lim and Demba Fofana, all with the University of Texas Rio Grande Valley; and Annelyn Torres-Reveron, with the 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 alHearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USATrauma Surgery & Acute Care Open 2021;6:e000728. doi: 10.1136/tsaco-2021-000728