Do equestrian helmets prevent concussion? A retrospective analysis of head injuries and helmet damage from real-world equestrian accidents

Thomas A Connor,Rebecca Smith,Jayaratnam Jayamohan,Claire Williams,J Michio Clark,Michael D Gilchrist,Barry M Seemungal,Roy Burek,Adrian Mcgoldrick,Matt Stewart

doi:10.1186/s40798-019-0193-0

Abstract

ObjectivesTo collect and analyse helmets from real-world equestrian accidents. To record reported head injuries associated with those accidents. To compare damage to helmets certified to different standards and the injuries associated with them.MethodsTwo hundred sixteen equestrian helmets were collected in total. One hundred seventy-six helmets from amateur jockeys were collected via accident helmet return schemes in the UK and USA, while 40 helmets from professional jockeys were collected by The Irish Turf Club. All helmet damage was measured, and associated head injury was recorded.ResultsEighty-eight percent (189) of equestrian fall accidents returned an injury report of which 70% (139) reported a head injury. Fifty-four percent (75) of head injury cases had associated helmet damage while 46% had no helmet damage. Reported head injuries consisted of 91% (126) concussion, 4% (6) skull fractures, 1 (0.7%) subdural hematoma, 1 (0.7%) cerebral edema and 5 (3.6%) diffuse axonal injury (DAI). It is also shown that helmets certified to the most severe standard are overrepresented in this undamaged group (p <0.001).ConclusionsIt is clear that despite jockeys wearing a helmet, large proportions of concussion injuries still occur in the event of a jockey sustaining a fall. However, the data suggest it is likely that helmets reduce the severity of head injury as the occurrence of skull fracture is low. The proportion of undamaged helmets with an associated head injury suggests that many helmets may be too stiff relative to the surface they are impacting to reduce the risk of traumatic brain injury (TBI). It may be possible to improve helmet designs and certification tests to reduce the risk of head injury in low-severity impacts.

Highlights

The primary purpose of equestrian helmets is to reduce the risk of head injury to a rider during an impact by attenuating the impact energy
60% of the helmets analysed in this study showed evidence of impact damage, which shows that a significant proportion did not reach their threshold for permanent damage
Equestrian helmets may be effective at preventing skull fracture but the data presented in this study show high concussion incidence rates with current designs of helmets which may highlight an area where helmet standards and, in turn, helmet designs could be improved

Summary

Introduction

The primary purpose of equestrian helmets is to reduce the risk of head injury to a rider during an impact by attenuating the impact energy. Helmet designs are a product of standard tests by which they are certified, as well (2019) 5:19 as the styles that people are prepared to wear. They must perform in a range of environments (wet, cold and hot) and be comfortable to wear. The majority of professional jockey fatalities result from head injury where reported rates of concussion or mild traumatic brain injury (mTBI) are higher than those in boxing and American football [8]. Traumatic brain injury (TBI) is one of the main causes of death in adults under the age of 45, and survivors of such injuries can suffer long-term neurological disability, which has significant public health and societal implications [9,10,11]

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