Purpose: The purpose of this study is to identify the number, type, severity and cause of horse related injuries and deaths that presented to the emergency departments of 16 hospitals iri western Montana from 2002-2004. The information and knowledge gained is to be incorporated into. an equestrian injury prevention program with the ultimate goal of decreasing the incidence and severity of horse-related injuries and deaths in western Montana.
Methods: Sixteen hospitals voluntarily participated in this multi-center retrospective descriptive study of horse-related injuries in Western Montana. Included were 15 hospitals represented in the Western Regional Trauma Advisory Committee (WRTAC) and one hospital located in Salmon, ID. Each medical facility was given a copy of the description of the study and data gathering worksheets. The data gathering worksheet was to be completed by the primary emergency health care provider caring for all patients presenting with a horse-related injury. Data points collected included: initial treating facility, date of injury, patient age, mode of arrival, gender, safety equipment used, disposition from medical facility, injuries identified, cause of injury, and a section for narrative of circumstances surrounding the event. The data were compiled in a spreadsheet format and analyzed for basic statistical descriptors including mean age of patients, percentages of injury types, etc as well as for statistically significant· differences between groups. An injury severity score (ISS) was calculated when sufficient data concerning an injury was provided.
Results: A total of 596 patients were included in the study. The mean age of patients was 39 years, with 44.1 % male and 55.2% female. Most subjects arrived to the ED via private vehicle( 78.9%). Very few (7.7%) of patients· wore any safety equipment such as a helmet or vest. The majority of patients (71.0%) were discharged to home, but more than 20% were either admitted or transferred to another facility. Almost half of those with injuries serious enough to warrant admission presented to the ED via private vehicle. Two deaths occurred in the study, one from chest trauma and another from pelvic trauma. Any deaths that occurred after 24 hours were not included in the study. The most common injury was extremity injury (37.1 %), but chest (13.3%), head/face (12.6%), pelvic (9.3%), and skull/brain (9.2%) injuries were not uncommon. Almost 30% of patients injured multiple body systems. The ISS of patients ranged from 1-25 with an average of 3.8. The most common mechanism of injury was being bucked off (40.8%) or falling off (26.7%) the horse, but approximately 10% of patients received multiple insults, such as being bucked off then kicked. Several statistically significant.differences in mechanism of injury and injuries sustained were found for younger patients. Children aged 0-12 were 25 times more likely to sustain a head/face injury (p=0.010) and 16 times more likely to be stepped on (p=0.043) than adults.
Conclusions: Horse-related accidents are a source of significant injuries in western Montana. Riders often have multiple injuries that can be potentially serious. Very few riders use protective equipment or access EMS. Injury prevention programs should focus on the use and development of appropriate safety equipment, increased pediatric risk for head trauma, and the mobilization of EMS for severe injuries.
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