Objective. To assess the impact of helmet use on the pattern, and seve
rity of pediatric equestrian injuries. Design. A prospective observati
onal study of all children less than 15 years of age who were brought
to the University of Virginia children's Emergency Department with hor
se-related injuries. Results. During the two-year period of the study,
32 children were evaluated. Two children were injured when a horse st
epped on them. Thirty children fell from or were thrown from a horse.
Of these, 20 were wearing a helmet. Head injuries were more frequent i
n those patients not wearing helmets. The mean Modified Injury Severit
y Scale (MISS) score for riders without a helmet (12.9) was significan
tly higher (more severe) than that for helmeted riders (2.8). All thre
e patients with a Glascow Coma Score < 15 on arrival were not wearing
a helmet at the time of injury. The frequency of hospitalization was s
ignificantly higher for those not wearing a helmet. Compared with othe
r common mechanisms of childhood injury the mean Modified Injury Sever
ity Scale score of injured riders was exceeded only by that of pedestr
ians struck by a ear. Conclusion. Equestrian injuries are more severe
than those suffered from other common pediatric mechanisms. Helmet use
is associated with decreased frequency and severity of central nervou
s system injury.