Do riders who wear an air jacket in equestrian eventing have reduced injury risk in falls? A retrospective data analysis.

The research examines the efficacy of air jackets in equestrian events in reducing the risk of serious injury or fatality during falls. It highlights the increased odds of such injuries in falls when the rider is wearing an air jacket.

Background Information and Study Design

• The initial research revealed that wearers of air jackets experienced an increased rate of serious or fatal injuries during falls in equestrian events compared to those not wearing such attire.
• There was a response to the original publication suggesting some concerns. A reader pointed out that air jackets are predominantly used in the cross-country discipline of eventing, where injuries tend to be more severe. The person suggested this could have skewed the research findings.

Consideration of Reader’s Concerns

• The authors addressed these concerns, acknowledging that while air jackets are also used in showjumping, riders in dressage largely do not use them. Therefore, injuries in cross-country events, where air jacket usage is the highest, are more likely to be more severe.
• The researchers also mentioned that while a higher proportion of severe injuries happen in cross-country disciplines compared to dressage and showjumping, so do a larger number of falls. This could potentially counterbalance the statistical data, resulting in slightly skewed conclusions.

Data Analysis

• To further examine the potential effects of excluding dressage and showjumping disciplines from the study, the researchers conducted an additional analysis using data from the FEI, which broke down the types of falls for each eventing discipline in 2018. This aided in estimating the number of falls and serious injuries in each discipline during 2015–2017.
• The study made assumptions to adjust for unknown variables. For instance, it simulated two scenarios for falls and injury outcomes in the showjumping discipline—one assuming no one wore air jackets and the other estimating that 20% of the riders did. This helped them to accurately evaluate the risks of injury with and without the safety equipment.

Findings

• The original study found that riders who fell while wearing an air jacket had 1.74 times increased odds of serious or fatal injury. The subsequent analysis, assuming no air jacket usage in showjumping falls, updated this to a 1.67 times increased risk. Assuming 20% of riders wore an air jacket in showjumping falls, the odds were 1.69 times.
• The researchers concluded that there was unlikely to be substantial confounding by not stratifying by discipline, and that the removal of data for the non-cross country disciplines from the original study would not change the study’s conclusions.

Limitations and Future Directions

• The study extrapolated data from 2018 for dressage and showjumping to estimate the discipline-specific outcomes for 2015–2017, given the unavailability of specific historical data. This represents a limitation to the accuracy of the analysis.
• The research called for further investigation into potential confounding variables and stressed the need for more comprehensive research data. The aim of this call to action was to avoid discouraging the use of safety equipment but rather to encourage more precise and safety-conducive use within the sport.