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Beware of the force of the horse

mechanisms and severity of equestrian-related injuries

Van Balen, Pieter-Jana,e; Barten, Dennis G.a; Janssen, Loesb; Fiddelers, Audrey A.A.d; Brink, Peter R.d,e; Janzing, Heinrich M.J.c

European Journal of Emergency Medicine: April 2019 - Volume 26 - Issue 2 - p 133–138
doi: 10.1097/MEJ.0000000000000511

Background Equestrian-related injuries (ERIs) are relatively severe compared with injuries in other popular sports. Previous studies on epidemiology of ERIs vary widely and mainly focus on incidence instead of severity of the injury.

Purpose The aim of this study was to determine incidence, mechanisms and severity of ERIs in two Dutch hospitals (level 1 and level 2 trauma centers) over a 5-year period.

Patients and methods All patients with ERIs who visited the emergency departments of VieCuri Medical Centre in Venlo and Maastricht University Medical Centre+ in Maastricht, The Netherlands, between July 2010 and June 2015 were retrospectively included. Clinical data were extracted from medical records.

Results Most ERIs occurred in mounted riders (646 events; 68%); 94.9% of which involved a fall. Being kicked (42.5%) or trapped (30.1%) was the most common cause of injury in unmounted riders. Most frequently injured body parts were the upper extremities (43.8%) in mounted riders and lower extremities (40.5%) in the unmounted group. A relatively high percentage of facial injuries (9.7%) were found in the unmounted group. Seventeen per cent of all ERIs required admission. The median Injury Severity Score was 5 in the admitted population and 1 in the total population.

Conclusion Horseback riding is a risky activity. Prior studies particularly studied admitted patients in level 1 trauma centers outside of Europe and demonstrated a high risk of significant injury. However, our study demonstrates that these studies in selected groups might have overestimated the severity of ERIs in the general population.

Departments of aEmergency Medicine


cSurgery, VieCuri Medical Centre, Venlo

dNetwork Acute Care Limburg

eDepartment of Traumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands

Correspondence to Pieter-Jan Van Balen, MD, Department of Emergency Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX Venlo, The Netherlands Tel: +31 77 320 5810; fax: +31 77 320 5800; e-mail:

Received April 20, 2017

Accepted October 3, 2017

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