kristi guyton, ellen peck, emily houchen -wise, john mayberry md

Equestrian Injury is Costly, Debilitating, and Frequently Preventable:

The Imperative for Improved Safety Awareness Kristi Guyton, Ellen Peck, Emily Houchen-Wise, John Mayberry MD

Equestrians in the Northwest

• Horses are integral to life in the Northwest

• 9.5 M horses in the US1

• 30 M people ride horses yearly in US2

• Symbol of life in the West

1. UN Food and Agriculture Organization 20092. Loder. J of Trauma 2008

Equestrian Activity

Horses: Size, Speed and Power

• Size: 5-15x larger– 800 to 2,000 lbs– 4ft 3in to 7ft at the shoulder– Rider’s head ~10 ft off the ground

• Speed: 2x faster• Strength: 20-40x stronger

– Kick: 1 ton of force

Horses: Action and Reaction

• Horses are unpredictable– Herd mentality

• Horses in uncomfortable situations– We ask challenging things

When Things Go Wrong

Horses cause Injury

• Few injured equestrians require treatment• 67,000 ER visits per year1

• ~300 people die per year in U.S.2

• Rate of serious injury per hours riding higher than motorcyclists1

• Fractures and traumatic brain injuries result in hospital admissions1

1. Loder. J of Trauma 20082. Ball. Am J of Surg 2007

Study Objectives

• Circumstances of Injury• Injury Patterns and Severity• Cost• Injury Prevention

Methods

• Retrospective analysis• Trauma patients with horse related injuries

treated at OHSU from 2001–2008 • Trauma registry and chart review• Survey

Injuries

• In 8 years 231 equestrians, 233 injury events

• Injuries ranged from mild to fatal– 35% have Injury Severity Scores >12– Three patients died

• 25% of patients (59) required 84 surgeries – Orthopedic 33 (39%)– Laparotomy 15 (18%) – Spinal 12 (14%) – Facial 12 (14%)– Craniotomy 7 (8%)

Age and Gender

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+0

5

10

15

20

25

30

35FemalesMales

Age

Median: 43yrsRange: 2-75yrsAverage: 38yrs

Body Regions Injured

• Head 96 (41%) – Intracranial Injury 79 (34%)

• Neck 20 (8%)• Chest 58 (25%) • Back 30 (13%) • Abdomen 30 (13%)• Pelvis 26 (11%)• Extremities 26 (11%)• Polytrauma 49 (21%)

Head Injuries

• 96 patients (41%) had LOC, skull fracture, or significant intra-cerebral injury

• 20% helmet use among mounted equestrians by EMS records

• 37% of serious head injuries were likely preventable with helmet use

• 2 deaths: neither wore a helmet, both likely preventable with helmet use

Survey Results: Experience

• Survey– 91 patients completed the survey – 66% of those successfully contacted

• Mode of Injury– 55% Fell or bucked off – 17% Kicked – 11% Stepped on

Survey Results

• Experienced Riders– 56% over 10 years riding experience– 73% formal instruction– 44% long-term training relationship

• Length of Horse Training– 59% had 2 or more years of training

• Location of accident– 89% familiar to the horse– 90% familiar to the rider

Results of Survey

Injury Severity Score

Equestrian Skill Level

% ofeachEquestrian SkillLevel

Beginner/Novice

Intermediate Advanced Professional0%

10%

20%

30%

40%

50%

60%

70%

80%

1-1011-2021-30>30

Survey: Preventive Measures Used

• 58% reported NOT wearing protective equipment

• 34% reported wearing a helmet at the time of injury

• 70% felt their protective gear helped prevent more serious injury

Results: Cost

• Average hospital charge: $29,800 – $3,000-$511,000– Does not include any subsequent care

• Total cost: $6.9 million

Private Public None

$4,393,000

$1,853,000

$652,000

Results of Survey

• 9% equipment failure • 30% poor horse and rider pairing • 40% environmental factors contributed• 59% long-term disabilities

Checklist

• Check protective equipment– helmet, boots, vest

• Check horse tack– saddle, bridle

• Check environment• Assess horses’ behavior• Assess your own attitudes• Consider steps to reduce risk

Limitations

• Retrospective• Low survey response rate• Survey response bias

– Recall bias – Persistently symptomatic– Employed in horse industry

Conclusions

• Lack of helmet use remains prevalent• Helmet use may prevent morbidity and mortality• Equestrian injuries have financial and disability

burdens• Riding environment and horse and rider pairings

contribute to injuries• Potential for increased safety awareness even among

experienced equestrians

Personal Experience

One Month Post Op

Why we continue to ride…

Acknowledgements

• Dr. John Mayberry• Ellen Peck and Emily Houchen-Wise• OHSU Trauma Team• My parents, Steve and Sigrid

• Anything can scare a horse: children, cows, dogs, rabbits, flower pots

• Be aware of your horse’s reactions and adjust your behavior• Practice everything at home: desensitize your horse• Check your equipment yourself every time• Be sure your position relative to the horse is safe• Wear a helmet ALWAYS

Survivor Wisdom