Horsing Around: A Retrospective Review of Horse-Related Trauma.

Dear Editor,

In the United States, an average of 100,000 emergency room visits per year result from horse-related injuries.[1] While riding a horse, the head sits at approximately 3-m height, and the rider can travel at speeds nearing 25–30 mph.[23] Horses can weigh over half a ton, and estimates place the force of their kick at nearly one ton.[4]

The Institutional Review Board approval was granted by Touro University for this retrospective review of the Natividad Medical Center's trauma database. Thirty-two patients were identified who had been treated between July 1, 2014, and August 1, 2017, with 27 patients meeting the inclusion criteria for horse-related trauma. Of those patients, 52% were female; the average age was 51 ± 17 years; racial composition was Caucasian (63%) and Hispanic (37%); 67% required admission to the intensive care unit (ICU), intermediate care unit, or medical-surgical floors; and 41% required ICU admission [Tables 1 and 2].[5]

Table 1

Demographic data

Demographic	Number of patients	Monterey County Data, 2012-2016 (%)
Number of patients	26	-
Number of charts/events	27
Gender, n (%)
Male	13 (48)	50.9
Female	14 (52)	49.1
Age >65, n (%)	8 (31)	12.7
Race, n (%)
Caucasian	17 (63)	30.3
Hispanic	10 (37)	58.3
Admissions, n (%)	18 (67)
ICU admissions, n (%)	11 (41)

ICU: Intensive care unit

Table 2

Admission data

Disposition	Number of patients	Percentage cases (27)
Admissions	18	67
ICU admissions	11	41
Surgery	7	26
ARU (after discharge)	4	15
Death	0	0
	LOS (days)	SD (days)
Average LOS of admitted patients	4.5	5.2
Average LOS in the ICU	2.9	2.1

ICU: Intensive care unit, LOS: Length of stay, SD: Standard deviation, ARU: Acute rehab unit

The average Injury Severity Score (ISS) was 7 ± 8 in all patients, with patients whose ISS score of ≥10 having a longer length of stay (average 9 ± 7). Of patients that were admitted, the average age was significantly higher; however, the average ISS score of patients ≥60 was not higher on average than those with ISS score <60 [Tables 3 and 4].

Table 3

Injury severity by age

	Average age (years)	SD (years)	P
Admitted	58	13	0.005
Not admitted	38	15
Age (years)	ISS score	SD (years)	P
≥60	10	8	0.7
<60	11	4

SD: Standard deviation, ISS: Injury Severity Score

Table 4

Average Injury Severity Score by length of stay

	Average ISS	SD (ISS)	P
ISS score (all patients)	8	7	0.03
ISS score with LOS ≤10 days	2	2
ISS score with LOS >10 days	9	7

SD: Standard deviation, ISS: Injury Severity Score, LOS: Length of stay

Horse-related trauma has the potential to cause significant morbidity and mortality and is especially prevalent in rural or agricultural areas where there is access to horses. In a trauma center such as Natividad Medical Center that treats patients from the entirety of Monterey County, it is important to understand the danger posed by equine activities.

In our retrospective review of 27 cases of horse trauma, we found that, although surprisingly, no fatalities occurred, there were many cases of significant injuries sustained by horses. These injuries most often occurred after falling from a horse (70%) and most often involved the chest (44%) or head (41%). Moreover, of the injuries severe enough to present to the emergency room, 67% were severe enough to be admitted for. Almost 41% of these admissions included time in the ICU, but only 26% required surgical intervention [Tables 5 and 6].

Table 5

Injury by body region

Body region	n (%)
Head	11(41)
Face	6 (22)
Chest	12 (44)
Abdomen/pelvis	9 (33)
Extremity	8 (30)
External	8 (30)

Table 6

Injury by mechanism

Mechanism of injury	n (percentage of patients)
Fall from horse	19 (70)
Fall from horse in motion	6 (22)
Crushed by horse	7 (26)
Stepped on by horse	4 (29)
Kicked by horse	1 (4)

Demographic data demonstrated that our population had similar gender composition to the Monterey County census reports, but was mostly Caucasian (67%) and 31% were over the age of 65, in comparison to a census of 12.7% in patients aged over 65 years. Of patients >60 years, there was no significant difference in ISS in relation to those >60. However, patients aged >60 years who were admitted had a significant increase in length of hospital stay than those admitted patients aged <60. This may reflect that, although on an average, the elderly did not sustain worse injuries, doctors may have been more cautious with their monitoring, as is common with this population.

Horses pose a significant risk for morbidity and mortality when they are involved in traumatic accidents. The results presented here demonstrate the potential for serious morbidity related to horses in our patient population, especially in those over 60 years old.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.