Introduction: Horseracing-related injuries have not been studied before in Korea in any detail, although horseracing takes place very regularly in the country. The injury rate is understandably high, owing to the weight of the horses and the speed they can achieve. The purpose of this study was to identify the incidence and the injury patterns of severe equestrian trauma, as well as the associated risk factors. Methods: All patients with equestrian injuries who visited the emergency department (ED) between June 2007 and May 2011 were reviewed retrospectively. Results: During the study period, 288 patients presented to ED with horse-related injury. Two hundred and eighty patients were enrolled in this study. The most common cause of the injury was a fall (168, 60.0%). The most common region of the injury was the face (123, 43.9%). The intermediate value of NISS was 3 (1-75). Thirty-two patients (11.4%) were diagnosed as having moderate to severe injury. Thoracic injuries occurred less often in cases of a fall. Facial and thoracic injuries occurred more often, however abdominal and pelvic injuries were not very common in cases of a clash. When thoracic injuries were accompanied by injuries to other parts of the body, the incidence of moderate to severe injury was very high. Conclusions: Horseracing is a much rougher sport than general horse-riding. Therefore, one recommendation from this study is that jockeys who participate in horseracing should wear additional protective equipment other than a helmet and boots. (Hong Kong j.emerg.med. 2014;21:387-