Radiological assessment of equestrian-related trauma: A retrospective cohort study.

Overview

• This study retrospectively analyzed equestrian-related trauma cases over ten years, focusing on injury patterns, use of whole-body computed tomography (WBCT), treatment, and protective equipment usage among both children and adults admitted to trauma centers in Gothenburg, Sweden.
• The researchers aimed to evaluate how often WBCT was used in these injuries, the severity and types of injuries sustained, and the frequency of protective gear use in patients sustaining equestrian trauma.

Study Background and Purpose

• Equestrian sports are associated with a high rate of injuries, often requiring complex trauma assessments.
• Typically, patients with polytrauma (multiple traumatic injuries) undergo imaging protocols including whole-body CT scans and specific scans of critical body parts (chest, abdomen, pelvis, cervical spine, and brain).
• The study’s purpose was to investigate the use and adequacy of WBCT in patients with equestrian-related trauma, alongside analyzing injury mechanisms, injury severity, treatment approaches, and the use of protective equipment such as helmets and vests.

Methods

• Retrospective cohort review of patients admitted between 2010 and 2020 to two trauma centers in Gothenburg, Sweden—Queen Silvia Children’s Hospital (patients <16 years) and Sahlgrenska University Hospital (patients ≥16 years).
• Includes 1341 patients admitted due to equestrian-related injuries.
• Data collected from medical records included:
  • Patient demographics (age, gender)
  • Mechanism of injury (MOI) details
  • Use of protective equipment (helmets, vests)
  • Type and severity of injuries (using Injury Severity Score, ISS)
  • Treatment given, including surgeries
  • Length of hospital stay and intensive care need

Key Findings

• A total of 1341 patients with equestrian injuries:
  • 97% female, reflecting a female predominance in equestrian activities
  • 43% were pediatric patients (<16 years)
• Polytrauma (multiple severe injuries) identified in 262 patients:
  • 77% adults (median age 38 years)
  • 23% pediatric (median age 13 years)
• Whole-body CT (WBCT) performed in roughly half of polytrauma patients:
  • 54% of adults
  • 52% of pediatric patients
• Mechanism of Injury:
  • Fall from a horse accounted for 92% of polytrauma cases (241 out of 262)
  • In 11% of those falls, the horse also fell on the rider, increasing injury risk
• Injury Characteristics:
  • Spine injuries in 32% of polytrauma patients
  • Thoracic (chest) injuries in 29%
  • Cerebral hemorrhages (bleeding in the brain) in 8%
  • Tetraplegia (paralysis of all four limbs) in 0.8% and paraplegia (paralysis of lower limbs) in 0.4%
  • Abdominal injuries frequently involved the liver (5%)
  • Median Injury Severity Score was 4 (on a scale where higher scores indicate more severe injuries)
• Hospitalization and Treatment:
  • 59% of pediatric and 48% of adult patients were hospitalized, median length of 2 days
  • 14 patients required intensive care
  • 33 patients underwent surgery related to their trauma
• Protective Equipment Usage:
  • Helmet use was recorded in 56% of cases
  • Protective vest use recorded in only 22%
  • Overall documentation on safety equipment use was low, indicating possible gaps in recording or adherence

Conclusions and Implications

• Despite the high risks of severe injury after equestrian trauma, only about half of patients with polytrauma received the recommended whole-body CT scans, suggesting underutilization or inadequate assessments in trauma management.
• The low documentation rates for helmet and vest use highlight a need for improved recording and possibly increased emphasis on the usage of protective equipment in equestrian sports to potentially mitigate injury severity.
• The study underscores the importance of thorough trauma protocols and safety practices in managing and preventing equestrian injuries.

Significance of the Research

• Provides insights into injury patterns and severity in a large cohort of equestrian trauma patients.
• Highlights potential gaps in trauma assessment practices—specifically diagnostic imaging with WBCT.
• Points to areas for improvement in safety policy and clinical practice, including better documentation and promotion of protective gear.
• Supports trauma centers in reviewing their protocols for imaging and protective equipment use awareness in equestrian-related injuries.