Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
LETTER TO EDITOR  
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 69-70
Horsing around: A retrospective review of horse-related trauma


1 Touro University, Vallejo, CA, USA
2 Natividad Medical Center, Salinas, CA, USA

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Date of Submission10-Jan-2019
Date of Acceptance12-Feb-2019
Date of Web Publication22-Apr-2019
 

How to cite this article:
Serio F, Fujii Q, Shah K, McCague A. Horsing around: A retrospective review of horse-related trauma. J Emerg Trauma Shock 2019;12:69-70

How to cite this URL:
Serio F, Fujii Q, Shah K, McCague A. Horsing around: A retrospective review of horse-related trauma. J Emerg Trauma Shock [serial online] 2019 [cited 2019 May 24];12:69-70. Available from: http://www.onlinejets.org/text.asp?2019/12/1/69/256628




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.[2],[3] 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 [Table 1] and [Table 2].[5]
Table 1: Demographic data

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Table 2: Admission data

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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 [Table 3] and [Table 4].
Table 3: Injury severity by age

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Table 4: Average Injury Severity Score by length of stay

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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 [Table 5] and [Table 6].
Table 5: Injury by body region

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Table 6: Injury by mechanism

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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.



 
   References Top

1.
Clarke CN, Tsuei BJ, Butler KL. Equine-related injury: A retrospective analysis of outcomes over a 10-year period. Am J Surg 2008;195:702-4.  Back to cited text no. 1
    
2.
Papachristos A, Edwards E, Dowrick A, Gosling C. A description of the severity of equestrian-related injuries (ERIs) using clinical parameters and patient-reported outcomes. Injury 2014;45:1484-7.  Back to cited text no. 2
    
3.
Bilaniuk JW, Adams JM, DiFazio LT, Siegel BK, Allegra JR, Luján JJ, et al. Equestrian trauma: Injury patterns vary among age groups. Am Surg 2014;80:396-402.  Back to cited text no. 3
    
4.
Davidson SB, Blostein PA, Schrotenboer A, Sloffer CA, VandenBerg SL. Ten years of equine-related injuries: Severity and implications for emergency physicians. J Emerg Med 2015;49:605-12.  Back to cited text no. 4
    
5.
Quick Facts. U.S. Census Bureau Quick Facts: Monterey County, California; Salinas City, California. Available from: https://www.census.gov/quickfacts/fact/table/montereycountycalifornia, salinascitycalifornia/INC110216. [Last accessed on 2018 Jan 07].  Back to cited text no. 5
    

Top
Correspondence Address:
Dr. Andrew McCague
Natividad Medical Center, Salinas, CA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_5_19

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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