EQUINE-RELATED NEUROSURGICAL TRAUMA - A PROSPECTIVE SERIES OF 30 PATIENTS

Thirty million Americans ride horses; 50,000 of these riders are treat ed in emergency rooms annually, Equestrian activities are uniquely dan gerous because the participant is unrestrained, often helmetless, and riding large, unpredictable animals capable of 40-mph speeds and kicki ng with up to 1 ton of force, Neurologic injuries in equestrians const itute the majority of severe injuries and fatalities, We prospectively studied all patients admitted to the University of Kentucky Medical C enter with equine-related neurosurgical trauma from July 1992 to Janua ry 1996, Eighteen of 30 patients were male. Age ranged from 3 to 64 ye ars, Five patients died (17%), and two suffered permanent paralysis, T here were 24 head injuries (80%) and 9 spinal injuries (30%), The majo rity of injuries (60%) were caused by ejection or fall from the horse, Twelve patients (40%) were kicked by a horse, and four patients susta ined crush injuries, Six patients underwent craniotomy, three had oper ative spinal stabilization, and five required ventriculostomy. Eleven patients (37%) were professional riders. Twenty-four patients (80%) we re not wearing helmets, including all fatalities and craniotomy patien ts, Our data show that equine-related neurosurgical injuries can be se vere and fatal because of the significant size, force, and unpredictab ility of these animals as well as the lack of proper headgear, We reco mmend that helmets be worn at all times around horses because a signif icant number of our patients (33%) were injured as bystanders, Risk of serious injury appears to be a function of cumulative exposure to hor ses, not level of expertise, Experience is not protective; helmets are .