Fall, Crush, Kick: Mechanisms and Outcomes in a Cohort of Equine-Related Injuries

Abstract

Introduction The potential for significant traumatic injury to individuals who interact with horses remains high due to animal size, forces applied, and unpredictability. Despite an estimated 30 million riders in the United States annually, few recent publications have addressed this patient population. Objectives This study describes characteristics of patients injured in interactions with horses, focusing on mechanism of injury and use of protective equipment. Methods We queried our institution’s trauma registry for all patients admitted for equine-related injuries (ERI) between January 1, 2013 and December 31, 2017. We categorized by specific mechanism of injury (fall, crush, kick, fall + crush, and fall + kick) and presence or absence of protective devices. Results We discovered 143 patients admitted for injuries in equine-related accidents. Patients averaged 49.2 years old, and 62.2% were female. Crush injuries resulted in a high rate of rib fractures. Riders who were kicked had an increased chance of solid organ and facial injuries and falls most commonly led to rib fractures and extremity trauma. Despite lack of documentation on most subjects, protective devices were associated with less severe injuries in those with data (n = 36). Conclusions In this relatively large series of patients with ERI, we found mechanism differences within injury groups. Providers should more carefully document specific circumstances of ERIs. All individuals working with or around horses should exercise prudence and consider using protective equipment.

Epidemiology of horse trauma: a literature review

“…Regarding length of stay (LOS) in hospital, most studies placed in the 3- to 4-day band (range 0–15) [ 14 , 16 , 17 , 31 , 35 , 39 , 40 ] with more severe injuries (ISS equal/greater than 4) requiring 8.56 (± 10.84, range 1–64) days [ 30 ]. Older patients had longer LOS although not recording any worse injuries, the explanation being perhaps the case of more cautious monitoring [ 33 , 42 ].…”

“…Reports regarding Injury Severity Score (ISS) [ 46 ] have shown varying results and are most likely due to such factors as different mechanisms, cohorts, and types of riding. For example, the mean ISS ranges from 5 [ 7 ] to 11 (SD 6.4) [ 31 ], median 4 (IQR = 1) [ 7 ] to 12 (range 4–45) [ 30 ] with similar fluctuations for the pediatric studies [ 35 , 39 , 45 ]. Both Van Balen, Barten [ 28 ] and Gross, Hadar [ 39 ] reported on cases with an ISS greater than 15.…”

“…As some of the mishaps occur because of the unpredictable nature of this large animal, it does not matter if the environment is recreational or a workplace [14,44]; it is recommended that protective equipment, such as helmets and protective vests, be used across the board to control the incidence and severity of injury [8,10]. It has been established that the incidence of severe head injury is lower in groups that wear helmets [14,31,33].…”

“…GCS In studies that reported on the Glasgow Coma Scale (GCS) [52], around 88% of individuals presented with scores between 13 and 15 [16,18,30,31,44]. Furthermore, Mutore et al [16] found severe neurological impairment classified as a GCS score of 3-8 on presentation was observed in 3.58% patients.…”