University of Vermont AAHS

National Injury Data Reveal Details About Accidents


By
Doris Bixby Hammett, MD
Founder and Member of Board of Directors of
American Medical Equestrian Association

[reproduced from Spring 2001 Caution:Horses, Vol. 6, No. 1]

Introduction

The American Medical Equestrian Association believes that records of horse-related accidents provide means to learn about these accidents, how they can be prevented and/or their severity reduced.

Accident records present many problems.

1. Most activities do not keep records of injuries, reporting that their activities do not have accidents or injuries.

2. Most accidents are in recreational leisure riding, not shows, events, clinics, or classes.

a. This means by which these can be tabulated is through the emergency room records. The medical personnel may not know or be interested in the events involved in the injury, only the medical~spectss of the injury.

b. Another means of tabulation is through surveys, but the replies do not give an unbiased

response.

3. Each study seeks different information with no agreement of what should be reported. Reports are difficult to be compared.

The National Electronic Injury Surveillance System (NEISS) provides the only national figures available. The NEISS is a division of the US Consumer Products Safety Commission. Through the National Injury Information Clearinghouse, NEISS provides figures on horse-related injuries that go to hospital emergency rooms over the nation.

NEISS changes the base figure as indicated by opening of new hospital emergency rooms, closing of some hospital emergency rooms and changes in the caseload in other hospital emergency rooms. This base figure was changed in 1990 and again in 1997 to reflect the most current figures from hospital emergency rooms in the United States. The 1997 sample update took into account changes between the 1985 and 1995 sampling frames. From these reports, NEISS projects national figures. These figures omit injuries not treated, treated on site, by private physicians, in free standing clinics or resulting in death without emergency room admission.

NEISS statistics for horse related injuries (product 1239) became available to the American Medical Equestrian Association (AMEA) in 1979 and continued until 1982. At this time, NEISS discontinued keeping figures on product 1239 as this was the time of federal budget cutting. With requests from the AMEA and the American Society for Testing and Materials (ASTM), the figures for horse related injuries was reinstated in 1987. The first report to the AMEA was in the was in the AMEA News Vol. 1, #2 May 1991.

The article in the AMEA NEWS 1991 compared the figures for the four years 1979-1982 with the years 1987-1990 as no figures were available for the years 1983-1986. These years, 1979 to 1986, were the years in which protective headgear was being introduced to the horse activities. The head had a decreasing percent of injuries during this period and there was an increase in the percent of injuries to the trunk. During these years we saw the beginning of the increase of injuries to the older riders, but the "older riders" were those in the age bracket of 25-44 years of age.

Females began to increase in the percent of those injured. Accidents at home increased, with those in supervised sports decreased. The editorial note stated the marked increase in injuries at home would seem to indicate that riders may use helmets and safety procedures at organized events, but at other times do not, which would explain the increase in injuries at leisure.

The figures beginning in 1991, according to Vicky Leonard, Technical Information Specialist, Consumer Products Safety Commission, National Injury Information Clearinghouse (NEISS), can be compared. The total figures for these years are:

 

Table One
Total Injuries Reported
1991-1999

Year Reported Injuries
1991 74363
1992 73685
1993 68527
1994 70948
1995 65700
1996 60316
1997 48710
1998 64693
1999 72790
TOTAL 599,732

 

During the years 1995 to 1996, we felt that the horse community was making progress in safety and that the total number of injuries were decreasing. However, the years of 1997 - 1999 have increases which should alert those in the horse community.

WHY? NEISS figures do not tell us the cause of any change. NEISS figures are simply observational statistics. The horse community can deny that NEISS figures are correct. The other alternative is to assume these figures are correct and attempt to see possible causes.

A possible reason for the increase in horse-related injuries is that persons are going to the emergency rooms with less severe injuries which increase the number of visits. Another reason is that greater numbers are participating in horse activities. The American Horse Council and the Horse Industry Alliance believe this is so. Conflicting information comes from horse tack, equipment and apparel manufacturers who report decreased sales.

Two influences can be seen that might cause a trend for an increase in the number of persons in horse activities. The first is that Americans have more time and money to spend on recreational activities, including equestrian sports. The second is that the baby boomer generation is continuing its active life style as the members grow older, while previous generations reduced their riding as they matured. This may be increasing the number of persons riding horses.

 

Table Two
Body Part Injured

Body Part 1991 1992 1993 1994 1995 1996 1997 1998 1999 Total
L. Trunk 9904 9592 10282 9928 9773 11228 9638 10201 12290 92836
Head 6504 8280 7436 8408 8341 7030 6425 8941 8867 70131
U. Trunk 6567 8089 6853 6580 6979 6410 5441 5787 8126 60832
Shoulder 5563 5077 5176 5082 5298 5628 3814 5887 5602 47097
Wrist 5389 6242 5532 5136 4869 2736 4057 4641 4704 43305
L. Arm 3715 4357 2801 3941 2982 3722 3849 3856 3811 33034
Face 5364 4209 3522 3548 3291 3084 2283 3209 4208 32718
Ankle 4597 4212 3679 4169 3388 2556 3714 2815 2951 32080
L. Leg 3477 3522 3319 3093 2054 2614 2947 2717 3174 26917
Knee 3681 2784 2567 2327 2919 1818 2724 2807 3319 24945
Finger 3083 3110 2750 3363 2623 1937 2157 1686 3217 24927
Foot 3685 2582 2984 2917 1915 2243 1717 1274 2541 21859
Elbow 2516 2009 1472 2097 2317 1706 1550 1514 2159 17340
Hand 1486 2109 1681 2100 1750 1409 2068 1193 1272 15068
Neck 1384 1637 1459 2025 1761 1382 1554 1848 1346 14395
U. Leg 1828 1615 1585 1662 1604 1426 875 1504 1487 13584
U. Arm 1614 1226 1211 1284 951 729 1046 1445 1043 10549
25-50% 1386 712 894 909 816 950 632 810 735 7844
Toe 798 424 922 447 502 376 372 356 603 4800
Mouth 535 350 481 442 318 274 547 623 227 3797
Pubic 328 467 429 475 500 275 372 341 240 3427
All Parts 284 552 336 397 326 242 329 550 209 3223
Eyeball 408 308 17 310 293 280 267 537 506 2926
Ear 198 155 122 107 34 22 111 66 135 950
Known 74294 73519 68510 70717 65604 60075 48489 64608 72772 598588
Unknown 69 166 17 231 96 241 221 85 18 1144
TOTAL 73363 73685 68527 70948 65700 60316 48710 64693 72790 599732

 

The most frequent area injured is the lower trunk, followed by the head and the upper trunk. [Table Two] Injuries to the lower trunk have had a gradual increase over the years 1991 to 1999, with no sudden increases or decreases. [Table Two]

Unlike injuries to the lower trunk, the number of head injuries has varied. In 1997 we felt that we were making advances in reducing head injuries, but the horse related head injuries have increased during the last two years. We can take comfort in the fact that although the total number of injuries has increased during the past two years, in 1999 head injuries were fewer than the previous years of 1992, 1994 and 1995.

 

Table Three
Head Injuries as Percent of Total Injuries

Year

Percent of Total

1991

12.0

1992

11.1

1993

10.9

1994

11.8

1995

12.7

1996

11.7

1997

11.0

1998

13.8

1999

12.2

 

Since 1991, there has been a variance of the percent of head injuries to the total number of injuries with the smallest percentage in 1993, increasing to 1995, with a two-year decrease to 1997, with the highest percent of head injuries in 1998. In 1999, the percent is below the high of 1995, making it the third highest of the years recorded.

Face injuries have varied over the years 1991 through 1999. [Table Two] Except for polo, where face masks are sometimes used, no face protection has been available to equestrians. We have the fewest number of face injuries in 1997, with the number increasing in 1998 and 1999. However, unlike head injuries, the numbers are below that of 1991 and 1992. We do not have the answer to why face injuries have decreased more than head injuries.

The upper trunk (chest) has the third largest number of injuries. [Table Two] 1997 had the lowest number of injuries and 1999 the highest. These same increase is seen in the total number of injuries as well as in head injuries. If there has been increased use of protective vests in 1999, these figures do not show any decrease that might have been the result of this use. The horse community beginning this year has an ASTM standard vest. Previously, the body protectors were industry certified, varied in the padding, the area of body covered, and claims for protection.

 

Table Four
Type of Injury

Injury Type Number Percent
Contusion/Abrasion 186635 30.7
Fracture 176975 29.1
Sprain/Strain 100227 16.5
Laceration 48930 8.0
Internal 22692 3.7
Concussion 20596 3.4
Dislocation 12416 2.0
TOTAL 598471 93.4

 

Contusion/abrasions understandably are the most common injury. Following closely is fracture with sprain/strain considerably less. Concussion is a far sixth, following internal injuries. Many concussions never arrive at the emergency room, and if the concussion is mild and associated with other injury, such as fracture, laceration or internal injury, the concussion may never be entered on the discharge diagnosis.

 

Table Five
Fractures

Body Part 1995 1996 1997 1998 1999 Total
U. Trunk 3376 2793 1994 2497 2776 13437
L. Arm 2302 3129 2396 2710 2894 13432
Wrist 3142 1965 2397 2771 2420 12695
Shoulder 1645 2153 993 1749 1852 8391
L. Trunk 937 1468 1121 1331 2065 6922
Finger 957 1138 1068 773 1558 5495
Ankle 1197 1004 1083 985 1034 5303
L. Leg 757 946 1535 217 1056 4511
U. Arm 646 652 819 1407 1043 4567
Elbow 1054 653 554 618 856 3735
Face 823 429 304 751 889 3196
Foot 472 520 505 218 642 2357
Hand 390 310 506 610 693 2508
Toe 337 292 265 255 205 1354
Head 318 172 253 223 303 1269
U. Leg 319 128 55 217 170 889
Knee 271 172 19 106 165 733
Neck 146 22 134 161 0 463
25-50% 43 0 0 0 86 129
Pubic 0 43 84 66 0 193
Mouth 0 0 68 0 0 68
Total Known 19133 17989 16153 17665 20706 91646
Unknown 0 112 0 0 0 112
Total 19133 18101 16153 17665 20706 91758

 

The total number of fractures had the lowest figure in 1997 and the highest figure in 1999. The same trend is also showing in the United States Pony Club accident study.

Fractures of the upper trunk would include rib, clavicle, shoulder and thoracic spine. These fractures have the lowest figure in 1997, but have increased in the last two years. The figures in 1998 and 1999 are below those of 1995 and 1996.

We know that vests will not prevent fractures of the spine. As most of the clavicle fractures are from forces transmitted from the upper extremity these would not be prevented by a protective vest. The only fractures of the clavicle that would be prevented would be those from a direct blow, and these might only be prevented by the use of properly located shoulder pads. Rib fractures from crushing or the body hitting an object or from the horse falling on the rider would not be expected to be reduced. To date we have not seen a study of rib fractures that might be reduced by a protective vest.

The greatest increase in the number of fractures is in the lower trunk. [Table Five] This would be the pelvis, hip, coccyx and lumbar spine. These fractures have increased more than those of the upper trunk. Prevention of the lower trunk fractures has not been addressed specifically. Orthopedists and physiotherapists should look for training procedures to reduce these fractures.

Wrist and shoulder fractures have both decreased. [Table Five] As riders fall on their outstretched arms, they are taught to keep their hands turned in. This tends to keep the elbows flexed and provides more give in the arm. With the hands turned outward, the tendency is to lock the elbow in extension, making the arm rigid and more likely to fracture. Vaulting and practicing the emergency dismount teaches this skill.

 

Table Six
Gender

Year 1991 1992 1993 1994 1995 1996 1997 1998 1999
Male 29300 27335 28951 29505 28832 27298 25135 23897 27300
Female 42190 46308 40466 41743 36864 33018 33509 40796 45483
Total 71490 73642 69417 71247 65696 60316 58644 64693 72782
Unk. 0 43 0 0 0 0 66 0 0
Total 71490 73685 69417 71247 65696 60316 58710 64693 72782

 

Females have more injuries than males in horse activities. Females had more injuries in 1999 that in any previous year except 1992. Although males had fewer injuries in the years 1996-1998 than 1999, 1999 had fewer injuries than the years 1991-1995

 

Table Seven
Gender Percentage

Year Male Female
1991 38 % 62 %
1992 37 63
1993 41 59
1994 41 59
1995 44 56
1996 45 55
1997 43 57
1998 37 63
1999 38 62

 

If in place of numbers, we look at percent of male-females, the year 1991 has the same percent of male-females as 1999. The smallest difference in percent was in 1996.

 

Table Eight
Age

Age 1991 1992 1993 1994 1995 1996 1997 1998 1999 Total %
0-4 902 1899 1218 1566 1424 1194 1222 964 659 11048 2
5-14 15435 16417 14162 14548 11523 11771 12105 13097 14133 123191 20
15-24 16449 16321 12774 14825 14415 12516 10385 9891 12349 119924 20
25-44 29826 28268 28289 28830 24994 24008 21417 27950 31054 244636 40
45-64 7183 9487 10886 10479 11613 10097 12029 11519 12971 96263 16
65+ 1695 1161 1188 1000 1728 731 1486 1271 1549 11809 2
Total 71490 73553 68517 71248 65697 60316 58644 64692 72715 606871 100

 

The number of horse related injuries relating to age has changed during the nine years of NEISS figures. During this time, the injuries to the 0-4 year old have decreased. This would indicate that parent education and supervision has improved during these years.

Injuries to the 5-14 year old have decreased. This is the result of education both of the parents, the children themselves, and increasing mandates for safety in the youth activities.

An increase in injuries is also seen in the horse community 45-64 years of age. These are the traditionalist who feel that their experience has prevented an accident and they do not need to make any changes in their riding habits or respond to the recommendation for safety. As mentioned under the increase of persons in the riding community, this is the age of the baby boomers and we may be having an increased number of participants in these years. It is possible that each one is having no more accidents than previously but as a group the numbers show an increase.

The ages of 65 and older have a projected varied number of injuries, which relates to the small numbers. The figures would indicate that there has been little change in the absolute numbers, but with the increase of all injuries, their proportion of the total injuries would have decreased.

 

Table Nine
Accident Location

Year 1991 1992 1993 1994 1995 1996 1997 1998 1999
Home 19005 16104 15315 14437 14895 12569 10318 13081 16031
Apart. 0 112 0 0 0 0 0 0 0
Sport 11506 11157 10092 11247 12129 9486 11257 13919 16968
Farm 5228 4335 4337 4983 3417 3133 4087 4176 4754
Public 2774 3504 4478 4832 5699 4090 4242 4756 5859
Street 553 547 551 865 243 585 512 562 532
School 43 225 51 272 363 155 160 19 237
Tot Kno 39109 35984 34824 36637 36746 300318 30576 36513 43381
Unkn 32381 37701 33694 34611 28950 30367 29135 28179 29401
TOTAL 71490 73685 68518 71247 65696 60385 59711 64692 72782

 

The figures on location of the horse related injury proposes other aspects for consideration. After the decrease through 1997, injuries at home have increased, but these figures are at or below those of 1991 and 1992. We believe that injuries at home are related to education and role models for those riding. At home there are no mandates for safety. These figures are encouraging.

NEISS defines as public lands those lands that are not streets or highways. This would include city, state or federal trails, arenas, show rings, parks and forests. Injuries on public property which after a high figure in 1995 and the lower figure in 1996, have increased above the figures of 1991-1994. Until public facilities determine that it is within their interests relating to legal liability to mandate safety measures, this figure may continue to increase.

The greatest increase has been in sports activities. These are the activities that could change their rules and procedures to those that have been shown to increase safety. This is a condemnation for every activity, administration and governing board. The first step would be for the organization to appoint a safety committee, conduct a study of the organization's activities to determine where, when and what type of injuries are occurring in the activities. With this information, recommendations should be made by the study/safety committee, and these recommendations followed by the governing board.

 

CONCLUSIONS

Horse related injuries have increased.

The most common body parts are the lower trunk, the head, and the upper trunk. Lower trunk injuries have had a gradual increase during the years of 1991 to 1999. In 1999 lower trunk injuries exceeded head injuries by a fourth and upper trunk injures by a third. The number of head injuries has varied greatly, with the highest number in 1994 and the lowest number in 1997. The numbers have increased both in 1998 and 1999. Upper trunk (chest) injuries have increased, having the highest number of injuries in 1999.

The highest injury type is contusion/abrasion. The second in frequency is fracture, with the third sprain/strain. The most common fracture is of the upper trunk, second is the lower arm and the third most common fracture is the wrist.

Females have more injuries than males with the spread increasing in 1999. The ages 25-44 years have the greatest number of injuries, but the greatest increase in the number of accidents has been in the years 45-64. The number of accidents in the ages 0-4, 5-14 and 25-44 years have all decreased, with the greatest percent increase in the 15-24 years age group.

Injuries in sports have increased, while at home and on the farm they have decreased.


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