Horse-related Injuries Research Articles

The effects of pressure and release training on equine behavior and discipline

In America, there are over 100,000 horse-related injuries per year (Mendell, 2006). It is important that all horses are properly trained to avoid dangerous accidents resulting from poor training involving the horse, rider, or spectators. This study aims to understand how a person should approach properly training a horse. It determines what training methods are the most effective and why it is important that owners understand how horses process discipline. Previous research indicates the common need for pressure, but fails to explore it as a training method. As such, a definite answer that explains how Pressure and Release Training affects equine behavior and discipline has not been determined. A physical experiment collecting and analyzing quantitative data was conducted in order to obtain the most accurate and specific results. Horses of various breeds, ages, sexes, and training levels were subjected to five different Pressure and Release Training exercises and scored on their completion (attempt > accuracy). Each horse was tested twice on separate days to ensure replicability. All horses completed every exercise successfully without conflict behaviors or refusal (50/50). The experiment reveals that regardless of traits, Pressure and Release Training is an effective training method that horses understand even without previously consistent training. However, it is vital that trainers understand how horses process discipline so that they know if the training is effective and low stress for the horse.

Horse-related injury patterns: a single center report

BackgroundFor ages, humankind and horses have been closely related to occupational and recreational activities. The dangers of engaging with horses have been previously reported. Among sporting activities, horse riding is well-known for its risks. Despite multiple recommendations to wear protective gear, horse-related activities still comprise the risk of severe injuries. This study aimed to examine: (1) if specific mechanisms are correlated to particular injury patterns and (2) if injury types are related to patient demographics.MethodsFrom one level I trauma center, between July 2019 and July 2022 (3 years) all emergency reports and discharge letters were retrospectively reviewed by full-text search regarding horse-related injuries. Patient demographics, body mass index, trauma mechanism, injury types, and initiated treatment were extracted from medical records and analyzed.ResultsDuring the study period, 95 patients with 99 horse-related injuries were included. The overwhelming majority of the patients was female (93.7%). Age averaged 35.3 years (range 6 to 71). BMI was 23.6 kg/m2. Inpatient treatment was required in 60.6%. Length of hospital stay averaged 10 days. Surgical treatment was performed in 55 patients (55.6%). Open reduction and internal fixation was the most common procedure (74.5%). Trauma mechanism was fall from a horse followed by being hit by a horse (60.6% and 23.2%, respectively). Injured upper extremities counted up for 52.5% followed by spinal and pelvic injuries (23.2%). Spinal and pelvic injuries were related to fall from a horse (p < 0.001). Injuries to the lower extremities were predominantly caused by a kick of the horse when the rider was unmounted (p = 0.001) and negatively related to a fall from a horse (p = 0.002). Ten patients got their fingers tangled while holding the reins and suffered from injuries to the upper extremity (p < 0.001). Three of them required an amputation (30%).ConclusionDespite the fact that patients are young and healthy, horse related injuries must not be underestimated. In our study, almost two-thirds of the patients required inpatient treatment and 50% underwent surgery. We could show that patient age was related to injury severity according to the Abbreviated Injury Scale (AIS). Spinal and pelvic injuries were significantly related to a fall from a horse with a significantly greater trauma impact according to the AIS. Therefore, these severe entities need to be ruled out in such events. Accidents caused by holding the reins, may result in serious injuries to the hand with 30% requiring an amputation. Doctors need to be aware of possible horse-related injury patterns to reduce morbidity.

Unhandled horses classified with broken/unbroken test (BUT) exhibit longer avoidance, flight reactions, and displacement behaviors when approached by humans.

Horses with a low level of tameness are at higher risk for transport-related disease and injury; hence, European regulations for the protection of animals during transport (EC 1/2005) are stricter for unhandled (unbroken) horses. However, the regulation does not provide adequate tools for unhandled horse identification. The Broken/Unbroken Test (BUT) was developed and validated to easily identify whether a horse is broken (handled) or not. As a further validation step, the aim of this study was to assess whether there is any correspondence between the BUT classification and the behavioral response of the horse. A total of 100 healthy Italian Heavy Draft horses were video recorded when assessed with the BUT. In total, 90 videos (48 handled and 42 unhandled horses) matched the inclusion criteria and were assessed. The behavior of each horse was evaluated by three observers blinded as to the horses' experience with a focal animal continuous recording method. Behaviors were classified in four categories: stress, avoidance, displacement, and aggression. A Mann–Whitney test was used to identify differences in behavioral patterns between horses classified as handled or unhandled with the BUT. Unhandled horses showed not only a significantly longer time to be approached by the handler but also more avoidance and flight reactions (p < 0.001). Unhandled horses showed significantly longer displacement behaviors, such as sniffing (p < 0.001). These findings further validate the BUT classification and confirm that horses classified as unhandled are more prone to show avoidance and flight reactions when approached by humans. For this reason, the adoption of the BUT could be helpful to minimize humans' horse-related injuries and, if applied regularly before loading, to contribute to safeguard the welfare of horses during transport.

Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns

IntroductionNineteen million people participate in horseback riding activities in the US, and the horse industry employs more than 460,000 full-time workers. Emergency department data suggest young female amateurs and male professionals are most at risk of death from horse-related injuries. However, there has been no investigation into factors that may increase severe injury and mortality risk in these populations. This study investigates demographics and injury pattern differences between occupational and non-occupational horse-related injuries in the US. MethodsThe 2017 American College of Surgeons National Trauma Databank (ACS NTDB) was analyzed for horse-related injury using ICD 10 codes. Demographics, injury data, protective device use, and hospital procedures were analyzed. Occupational versus non-occupational injuries based on incident location (farm, sports, recreational, residential) were compared using ANOVA or Pearson's Chi-squared test. ResultsOf 3911 incidents, the most common injury mechanism was falling from the horse, but occupational and non-occupational farm injuries showed higher incidence of being struck by a horse. One-third required surgery. Upper extremity injuries were most common. Occupational injuries more often affected upper extremities of working age, minority males with commercial insurance. Non-occupational injuries most often affected heads of women at the extremes of age. Helmet use was higher in occupational, non-occupational sports, and non-occupational recreation injuries, and severe head injury incidence was decreased in these groups. Complications and discharge dispositions were not different across groups. ConclusionsIn the largest trauma center study to date, we have shown equine-related trauma to be common and affect a predictable demographic that may permit injury prevention initiatives. Helmets may reduce severe head injury, but the efficacy of protective clothing remains to be validated.

Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre

Background Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ considerable weight and speed, serious injuries can occur. Riding style and equipment differ between North America and the United Kingdom with previous studies focusing on the former. Objective This study aims to assess the pattern of horse-related injury admissions to a major trauma centre in the United Kingdom. Methods A retrospective study of our hospital’s trauma registry between years 2012 and 2020 was performed. Cases included those admitted for severe horse-related injuries (irrespective of age/sex) with Injury Severity Score (ISS) of ≥ 4. Demographics, injury characteristics (ISS, Glasgow Coma Scale (GCS), injury region and operations), hospital stay and Glasgow Outcome Scale (GOS) on discharge were extracted. Four groups were formed based on mechanism of injury: fall from horse, fall and horse landing on top (FL group), kicked, and fall and kicked (FK group). Comparisons in injury and outcomes were analysed between these groups. Results 301 (2.8%) eligible cases were identified from 10,911 cases. 70.8% were female with mean (± SD) age of 42.7 (± 16.5) years. Most common mechanism of injury was fall (72.8%) then kicked (14.6%) with groups FL and FK forming &lt; 10% each. No significant difference was found between the groups initial GCS, ISS, total or ICU length of stay and GOS ( p &gt; 0.05). Most common regions of injury were orthopaedic (41.9%), spinal (26.2%), thoracic (20.1%) and head injuries (19.3%). 75% had good recovery on GOS though there were 3 fatalities relating to severe traumatic brain injury. Conclusion Orthopaedic limb injuries form the majority of horse-related injuries which contrasts the 1970s where head injury prevailed which is likely due to the widespread use of better head protection. Consideration should be given to enhanced limb safety equipment to prevent injury.

Case Report of a Nipple Amputation After a Horse Bite

Horse related injuries include falling from a horse, being stepped on by a horse, kicks, or bites. Bites are rare and often associated with fatalities. We present a case of a 41-year-old healthy female who suffered a complete amputation of her right nipple and abrasion of the areola following a horse bite. We managed the nipple injury as a full-thickness skin graft, similar to that of a compromised nipple in a reduction mammaplasty or mastopexy case. Barring a lack of projection and minor hypopigmentation, the nipple had normal sensation with no scar contracture. Overall, the patient was happy with her final outcome. With a healthy, minimally contaminated wound bed, and lack of poor wound healing risk factors, we believe that treating a nipple amputation as a full thickness skin graft in the emergency setting results in aesthetic outcomes, sensation, and patient satisfaction comparable if not superior to other means of nipple reconstruction in adults.

Occupational vs Non-Occupational Equestrians: Differences in Demographics and Injury Patterns

ABSTRACT Introduction : Nineteen million people participate in horseback riding activities in the US, and the horse industry employs more than 460,000 full-time workers. Emergency department data suggest young female amateurs and male professionals are most at risk of death from horse-related injuries. However, there has been no investigation into factors that may increase severe injury and mortality risk in these populations. This study investigates demographics and injury pattern differences between occupational and non-occupational horse-related injuries in the US. Methods : The 2017 American College of Surgeons National Trauma Databank (ACS NTDB) was analyzed for horse-related injury using ICD 10 codes. Demographics, injury data, protective device use, and hospital procedures were analyzed. Occupational versus non-occupational injuries based on incident location (farm, sports, recreational, residential) were compared using ANOVA or Pearson's Chi-squared test. Results : Of 3,911 incidents, the most common injury mechanism was falling from the horse, but occupational and non-occupational farm injuries showed higher incidence of being struck by a horse. One-third required surgery. Upper extremity injuries were most common. Occupational injuries more often affected upper extremities of working age, minority males with commercial insurance. Non-occupational injuries most often affected heads of women at the extremes of age. Helmet use was higher in occupational sports, non-occupational sports, and non-occupational recreation injuries, and severe head injury incidence was decreased in these groups. Complications and discharge dispositions were not different across groups. Conclusions : In the largest trauma center study to date, we have shown equine-related trauma to be common and affect a predictable demographic that may permit injury prevention initiatives. Helmets may reduce severe head injury, but the efficacy of protective clothing remains to be validated.

Operative management of equine-related maxillofacial trauma presenting to a Melbourne level-one trauma centre over a six-year period.

The aim of this study was to examine the pattern of equine-related maxillofacial trauma that required operative treatment in patients who presented to a level-one trauma centre in Melbourne between 2011 and 2016. A total of 28 patients (16 female and 12 male, median (range) age 31 (16-76) years) were identified from a database of all operatively managed maxillofacial trauma cases, and data were collected on demographics, mechanisms and patterns of injury, and management. The most common mechanism was kicking (n=16), which was also the most likely to result in multiple injuries. Half the patients sustained an injury to the midface only, with naso-orbitoethmoidal (NOE) and orbital fractures being the most common fractures. Of the total fractures (those that did and did not require an operation), 44/54 were managed with internal fixation. Exactly half the patients were treated as inpatients and half as outpatients, and despite a longer total duration of hospital stay for inpatients, the postoperative period was the same in both. Many horse-related maxillofacial injuries were sustained by young women, and the midface was most commonly affected. More injuries overall were sustained while unmounted (particularly by kicks) than by falls.

Mapping equestrian injuries and injury incidence in Sweden using insurance registry data

A nationwide insurance database including all members of the Swedish Equestrian Federation and acute injuries reported to Folksam Insurance Group during 2017 was used to investigate horse-related injuries and calculate injury incidence nationally. Of the 152 069 insured members during 2017, 907 were injured, an average of 1.2 injuries per injured person. Females represented 96.9% of all those injured and had a higher risk of injury than males (RR = 3.18). The average age of injured equestrians was 30 years, and the highest injury incidence was for riders aged 21-40 years (RR = 8.83) and 41+- year-olds (RR = 7.33). The most common diagnoses included soft-tissue injuries (39%), fractures (36.7%), and concussions (17.3%). The most frequently injured body regions were the head and neck (36.4%) and the upper limbs (22.3%). Horse-related injuries occurred most frequently while riding a horse (86.2%), and the most frequent incident type was a fall (77.4%). The type of incident and activity was not independent from injury type. Injuries to equestrians represent a sizable public health concern. Injury prevention methods should be directed toward females, and protection against injury should be targeted for different incidents. Focus should be on preventing fall injuries, with appropriate matching of horse and rider and horsemanship skills.

Factors predicting surgery after horse related injuries, a rural hospital’s experience

Factors predicting surgery after horse related injuries, a rural hospital’s experience

Nonfatal horse-related injuries treated in emergency departments in the United States, 1990–2017

BackgroundHorse-related injuries can cause severe morbidity and mortality. The objective of this study is to investigate the epidemiological features of horse-related injuries treated in emergency departments (EDs) in the United States. MethodsA retrospective analysis of horse-related injuries from 1990 through 2017 was conducted utilizing the National Electronic Injury Surveillance System (NEISS). Cases were identified using the NEISS code 1239 (Horseback Riding: Activity, Apparel, or Equipment). Analyses performed included calculation of national injury estimates, relative risks (RRs) with 95% confidence intervals (CIs), and linear regression. ResultsFrom 1990 through 2017, an estimated 1,836,536 (95% CI: 1,494,788-2,178,284) individuals presented to United States EDs with horse-related injuries. The annual injury rate decreased by 30.8% from 1990 to 1996, increased by 33.0% from 1996 to 2000, and then decreased by 46.0% from 2000 to 2017. Among older adults >60 years of age, the annual injury rate increased by 139.6% during the study period. The number of concussion and closed head injury diagnoses increased by 337.2% from 1990 to 2009. The most common mounted mechanism of injury was a fall or being thrown (73.9%), while the most common unmounted mechanism was being kicked (42.1%). Mounted injuries were more likely to lead to hospitalization than unmounted injuries (RR, 2.10, 95% CI: 1.59–2.77). ConclusionsDespite the recent decline in horse-related injuries, these injuries are still common. Clinicians should be aware of the spectrum of ED presentations of horse-related injuries. Prevention efforts focused on older adults and concussions and closed head injuries warrant special attention.

Prevalence and impact of bumps, bruises, and other painful incidents among children while handling and riding horses

Horseback riding and related activities bring risks for serious injury. Extant literature focuses largely on moderate to severe horse-related injuries resulting in a need for medical care. Yet incidents deemed as less severe are also important, with potential to impact subsequent safety precautions and behaviors of parents and children. The study objectives were to gather preliminary information about: (1) the prevalence of a range of horse-related painful incidents experienced by children, (2) children's helmet use and supervision, and (3) the subsequent impact of horse-related painful incidents. The methodological approach was based on a questionnaire.One hundred and twenty four child (120 Female; Mage: 11.82 years; rangeage: 8–18; SDage: 2.26) and parent (103 mothers; 16 fathers; 5 other legal guardians) dyads completed a brief 5 minute researcher-generated questionnaire. The results show, that painful incidents are common for children when handling and riding horses, with the majority of children having experienced these incidents more than once. Helmet use and supervision (typically by parents and coaches) were reported to occur consistently during riding, but less commonly during handling (e.g., grooming). Despite the high prevalence of painful incidents, these incidents largely do not impact children's ability to participate in other activities, result in access to specialized medical attention, or alter children's perceptions or behavior around horses. Findings may have implications for safety and education initiatives. Management implicationsFindings from this work suggest several implications. First, in acknowledging the range and frequency of incidents that occur during horse-related activities, educational initiatives should target a broad range of incident types when teaching about horse safety and injury prevention. Second, in recognizing primary caregivers and riding coaches as the most common supervisors of horse-related activities, they should also be targeted in educational initiatives (e.g., horse and safety knowledge, first aid, supervision guidelines). Finally, in developing and implementing targeted safety and injury prevention initiatives, reported benefits of the sport (e.g., improved problem-solving skills) could be used and supported in safety programming.

Renal trauma: a 3-year audit from a Gold Coast trauma centre.

Limited data Exists ? on the Australian epidemiology of renal trauma, with very few studies published in the literature. The authors aim to detail the trends of renal trauma in the coastal city of the Gold Coast. Retrospective data collection yielded 81 patients who sustained renal trauma from our 3-year period. Data included information on demographics, mechanism, American Association for the Surgery of Trauma (AAST) grade, presence of haematuria, associated injuries, management, and complications. Male patients accounted for 83% (n = 67) of cases, and the average age of all injuries was 36 years. Low-grade AAST Grade I-III injuries comprised of 76% (n = 62) of injuries, AAST Grade IV contributed to 20% (n = 16) and 4% (n = 3) of injuries were AAST Grade V. The most common mechanism of injury was road accidents accounting for 35% (n = 28) followed by fall-related injuries (26%, n = 21). Other mechanisms included sport-related (13.5%, n = 11), non-motorized bicycle injuries (8.5%, n = 7), alleged assault (8.5%, n = 7), pedestrian injuries (5%, n = 4) and horse-related injuries (2%, n = 2). Ninety-six percent (n = 78) of kidney injuries were managed conservatively. Of the patients requiring intervention, all were AAST Grade V kidney injuries. Males accounted for the majority of renal trauma cases, similar to the 3:1 ratio of male-to-female injuries found in other studies. In line with other studies, renal trauma reviewed on the Gold Coast also revealed road trauma as the leading cause, closely followed by falls. The majority of high-grade renal trauma was managed conservatively.

Epidemiology of Equestrian Accidents: a Literature Review

Purpose: This manuscript aimed to present a review of the literature pertaining to horse riding and other horse-related injuries. Method: A review of the literature was performed, searching for appropriate terms with regards to horse accidents, horse riding injuries and protective clothing for the horse riding context. The literature review search returned 151 relevant full-text articles, with 71 of these detailing the overall injury epidemiology of horse-related accidents. Most of these studies were conducted in the USA and used a retrospective review of hospital data methodology. Results: Of the 71 articles investigated, 60 suggested that those most frequently involved in horse-related accidents are young females and 97% of papers investigating injury mechanisms found the most commonly involved was a fall from horseback. It was suggested in multiple studies that these injury events mostly occurred in warm weather conditions, when the horse behaved in an unexpected manner. Injury type and location varied by the primary mechanism of injury; but frequently involved body regions were the head and upper extremities, and the most common injuries observed were fractures and soft tissue injuries. Neurological trauma was reported by all relevant studies to be the most frequent cause of fatality. Conclusion: Some improvements in horse-related accident numbers and outcomes have been observed with the development and introduction of protective devices such as helmets and vests. Yet despite the benefits of helmet and vest usage, there is evidence to suggest helmets do not perform as well as they could. Further work could investigate improvements in safety measures and risk factors associated with fatalities.

Horse-related incidents and factors for predicting injuries to the head

ObjectivesHead injuries are the leading cause of death in horse-related injury events and, even since the introduction of helmets, represent a sizeable proportion of all horse-related injuries. Falls from horseback...

Horse-related injuries: Causes, preventability, and where educational efforts should be focused

A high percentage of equestrians will experience accidents, with different degrees of severity, throughout their riding careers. Horse-related injuries have the highest likelihood of requiring hosp...

Patterns of mandibular fractures related to interaction with horses

Background: The risks of facial injuries with horse-related activities are much higher than in other sports. There are just a few studies about horse-related maxillofacial injuries, and there are even less data in particular about mandibular fractures. However, the aim of this study was to determine the patterns for mandibular fractures caused by horse contact or horseback riding. Materials and Methods: Data from patient records were collected over 15 years from January 2000 to March 2015. All patients who suffer a mandibular fracture caused by horse contact or horseback riding were included in this study. The analysis contained demographical data, trauma mechanism, type of mandible fracture, and type of protective clothing. Results: Overall, 23 patients within 37 fractures were included in the study. Of those, 87% were females and 13% males. More than the half (52.2%) were aged between 16 and 30 years. The most common trauma mechanism was a horse kick (78.3%). The most common site of fractures was the parasymphysis (32.4%) and the condylar region (32.4%), followed by the angle (21.7%). In addition, 52.2% of the patients had a single and 47.8% a combined fracture of the mandible. Nearly all patients (95.7%) underwent surgery. Open reduction and internal fixation was the treatment of choice. Only 17.4% of the patients wore a helmet. Conclusion: Mandibular fractures are not the leading trauma in horse relating accidents; however, they are often associated with functional loss. The most frequent cause is a kick from the horse while unmounted. Hence, there is a need for protective equipment usage at all times around horses especially wearing a helmet with a face guard.

Horse-related injuries in children – unmounted injuries are more severe: A retrospective review

IntroductionHorse-related injuries account for one quarter of all paediatric sports fatalities. It is not known whether the pattern of injury spectrum and severity differ between children injured whilst mounted, compared with those injured unmounted around horses. We aimed to identify any distinctions between the demographic features, spectrum and severity of injuries for mounted versus unmounted patients. Patients and methodsTrauma registry data were reviewed for 505 consecutive paediatric patients (aged<16years) admitted to a large paediatric trauma centre with horse-related injuries over a 16-year period. Patients were classified into mounted and unmounted groups, and demographics, injury spectrum, injury severity, and helmet usage compared using odds ratios and Wilcoxon rank-sum tests. ResultsMore patients (56%) were injured in a private setting than in a sporting or supervised context (23%). Overall, head injuries were the most common horse-related injury. Mounted patients comprised 77% of the cohort. Mounted patients were more likely to sustain upper limb fractures or spinal injuries, and more likely to wear helmets. Unmounted were more likely to be younger males, and more likely to sustain facial or abdominal injuries. Strikingly, unmounted children had significantly more severe and critical Injury Severity Scores (OR 2.6; 95% CI 1.5, 4.6) and longer hospital stay (2.0days vs 1.1days; p<0.001). Unmounted patients were twice as likely to require intensive care or surgery, and eight times more likely to sustain a severe head injury. ConclusionsHorse-related injuries in children are serious. Unmounted patients are distinct from mounted patients in terms of gender, age, likelihood of personal protective equipment use, severity of injuries, and requirement for intensive or invasive care. This study highlights the importance of vigilance and other safety behaviours when unmounted and around horses, and proposes specific targets for future injury prevention campaigns, both in setting of organised and private equestrian activity.

Preventing horse-related injuries by watching out for other humans

The more one rides or handles horses, the more likely one is to have a horse-related injury. These injuries are caused by many factors, including those generated by other riders, handlers or spectators. An analysis of 266 cases of injured equestrians showed that 16% of those injuries were caused by other humans. A panel of horse riding safety experts felt 63% were preventable, and the injured individuals themselves felt 51% were preventable. The study findings suggest that increased awareness of the role others play in causing horse-related injuries and increased education about common people-caused injuries could reduce the number of horse-riding and handling injuries, and medical visits to physicians, emergency rooms, and hospitalizations. Management implicationsHorse riding organizations and businesses such as guest ranches, horse parks, and training centers, which bring many individuals together with various levels of equine experience, should include an orientation to horse safety, especially noting the role of other humans in causing injuries, that explains how to avoid some of the most common accidents.

Paediatric horse-related trauma.

This retrospective cohort study reported on the epidemiology of horse-related injuries for patients presenting to the only tertiary paediatric trauma hospital in Queensland. The secondary outcome was to examine the use of helmets and adult supervision. Traumatic brain injury (TBI) was examined in relation to helmet use. Morbidity and mortality were also recorded. Included were all patients presenting with any horse-related trauma to the Royal Children's Hospital in Brisbane from January 2008 to August 2014. Data were retrospectively collected on patient demographics, hospital length of stay (LOS), mechanism of injury (MOI), safety precautions taken, diagnoses and surgical procedures performed. Included in the analysis were 187 incidents involving 171 patients. Most patients were aged 12-14 years (36.9%) and female (84.5%). The most common MOI were falls while riding horses (97.1%). Mild TBI (24.6%) and upper limb fractures (20.9%) were common injuries sustained. Patients who wore helmets had significantly reduced hospital LOS and severity of TBI when compared with those who did not wear helmets (P < 0.001 and P = 0.028, respectively). Morbidity was reported in 7.5% of patients. There were three deaths in Queensland. Helmet use is recommended for non-riders when handling horses, in addition to being a compulsory requirement whilst horse riding. Prompts in documentation may assist doctors to record the use of safety attire and adult supervision. This will allow future studies to further investigate these factors in relation to clinical outcomes.