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

Injury. 2018 May;49(5):933-938. doi: 10.1016/j.injury.2017.12.003. Epub 2017 Dec 6.

Abstract

Introduction: Horse-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 methods: Trauma 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.

Results: More 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.

Conclusions: Horse-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.

Keywords: Accidental; Children; Falls; Horses; Injuries and wounds; Injury severity score; Protective devices.

MeSH terms

  • Abbreviated Injury Scale
  • Accident Prevention
  • Accidental Falls
  • Adolescent
  • Animals
  • Athletic Injuries / complications
  • Athletic Injuries / diagnosis*
  • Child
  • Child, Preschool
  • Craniocerebral Trauma / diagnosis*
  • Craniocerebral Trauma / etiology
  • Female
  • Fractures, Bone / diagnosis*
  • Fractures, Bone / etiology
  • Guideline Adherence
  • Horses
  • Hospitalization / statistics & numerical data*
  • Humans
  • Injury Severity Score
  • Male
  • Protective Devices / statistics & numerical data*
  • Retrospective Studies
  • Spinal Injuries / diagnosis*
  • Spinal Injuries / etiology
  • Wounds, Nonpenetrating / diagnosis*
  • Wounds, Nonpenetrating / etiology