<%BANNER%>

This is a title

University of Florida Institutional Repository
Permanent Link: http://ufdc.ufl.edu/IR00000147/00001

Material Information

Title: This is a title
Physical Description: Journal Article

Notes

Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Jennifer Lyon.

Record Information

Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: Permissions granted to the University of Florida Institutional Repository and University of Florida Digital Collections to allow use by the submitter. All rights reserved by the submitter.
System ID: IR00000147:00001

Permanent Link: http://ufdc.ufl.edu/IR00000147/00001

Material Information

Title: This is a title
Physical Description: Journal Article

Notes

Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Jennifer Lyon.

Record Information

Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: Permissions granted to the University of Florida Institutional Repository and University of Florida Digital Collections to allow use by the submitter. All rights reserved by the submitter.
System ID: IR00000147:00001


This item is only available as the following downloads:


Full Text

PAGE 1

Society of Black Academic SurgeonsEquine-related injury: a retrospective analysis of outcomes over a 10-year periodCallisia N. Clarke, M.D., Betty J. Tsuei, M.D., Karyn L. Butler, M.D.*Department of Surgery, Division of Trauma/Critical Care, University of Cincinnati, 231 Albert B. Sabin Way, Cincinnati, OH 45267-0828, USA Abstract BACKGROUND: Morbidity and nancial loss caused by equine-related injuries may be signicant. The purposes of this study were to determine the patterns of equine-related injury and the impact on outcomes. METHODS: A 10-year retrospective review of equine-related injuries was performed. Age, gender, mechanism, injury severity score, Glasgow Coma Score, length of stay, surgical interventions, and mortality were assessed. RESULTS: Of 80 emergency department evaluations, 76 patients were admitted and form the basis of this study. The most frequent mechanism of injury was fall (68%), followed by crush injuries (15%), kicks (8%), and trampling (5%). Musculoskeletal injuries were most common (64%). Thirty-eight (50%) patients required surgical intervention. Thirty-seven (52%) patients were discharged home; 34% required outpatient physical therapy, and 14% required inpatient rehabilitation. The mortality rate was 7%. CONCLUSIONS: Equine-related injuries resulted in signicant morbidity; most victims required outpatient or inpatient rehabilitation. The use of preventive strategies may minimize mortality and reduce the nancial impact of postinjury morbidity. 2008 Elsevier Inc. All rights reserved. KEYWORDS:Equine-related injuries; Horse activities; Equine injuriesEquine-related trauma accounts for a small percentage of emergency department visits in the United States. National data from the Centers for Disease Control, from 2001 to 2003, estimated that approximately 100,000 emergency room visits each year are attributed to equine-related activities [1] Further, the data from the Centers for Disease Control concluded that women were more likely to be injured from horse-related activities than men, and 66% of all injuries occurred while riders were attempting to mount the horse. Although the mortality rate is low ( 10%) relative to other causes of blunt trauma, morbidity can be signicant as a result of the increased incidence of skeletal fractures and head injury [2] Moreover, areas with large numbers of equine activities potentially may incur signicant nancial loss owing to injury-related morbidity and mortality. Internationally, a large proportion of health care dollars are expended investigating strategies to reduce equine-related injury. In one Australian study, equine-related injury was among the top 20 recreational activities resulting in emergency evaluations, and, more signicantly, these injuriesrankedthirdinrecreationalactivityrequiringhospitalization [3] .IntheUnitedStates,ahighinjuryrate hasbeenreportedincompetitivehorseracing.Theactual incidenceofinjuryreported,however,maynotinclude *Correspondingauthor.Tel.: 1-513-558-8931;fax: 1-513-558-0456. E-mail address: Karyn.butler@uc.edu ManuscriptreceivedJuly11,2007;revisedmanuscriptNovember26, 2007 0002-9610/$-seefrontmatter2008ElsevierInc.Allrightsreserved. doi:10.1016/j.amjsurg.2007.11.007 TheAmericanJournalofSurgery(2008)195,702

PAGE 2

thosejockeysevaluatedandtreatedbymedicalpersonnel atthetrack [4] Ohioishometo8thoroughbredracetracksthroughout thestateandthegreaterCincinnatiareaishometo6 professionalracingtrackswithina100-mileradius.AlthoughthesetrackspredominantlyresidewithinKentucky, theUniversityofCincinnatiistheprimarylevelItrauma centerforthiscatchmentarea.Moreover,enthusiasmfor horse-relatedactivitiesextendsoutsidetheprofessional arenaofthoroughbredracing.Therefore,thepurposesof thisstudyweretodeterminethepatternsoftheequinerelatedinjuriesandtheirimpactonpatientoutcomes.MethodsThestudydesignwasreviewedandapprovedbythe UniversityofCincinnatiInstitutionalReviewBoard.Patientswithequine-relatedinjurieswereidentiedbythe UniversityHospitalRegionalTraumaCenterTraumaRegistryDataBase.Aretrospectivereviewofthemedical recordsofthesepatientsfromJuly1993toJuly2004was performed.Demographicdatacollectedandanalyzedincludedage,gender,injuryseverityscore(ISS),Glasgow ComaScore,hospitallengthofstay,surgicalinterventions, mortality,andtheneedforrehabilitationafterdischarge fromthehospital.Dataareexpressedasmean standard errorofthemean.ResultsDuringthe10-yearstudyperiod,80adultpatientswith equine-relatedinjurieswereevaluatedbythetraumaservice attheUniversityofCincinnatitraumacenter.Fourpatients (5%)weredischargedhomedirectlyfromtheemergency department.Theremaining76patientswereadmittedtothe hospitalandformthebasisofthisstudy.Theirdemographicsaredisplayedin Table1 .Therewereanequalnumber ofmaleandfemalepatients,andthemeanageatpresentationwas42 1years(range,1581y).Themost commonmechanismofinjurywasafallfromthehorse, accountingformorethantwothirds(68%)ofallinjuries sustained( Fig.1 ). Injurypatternswerecharacterizedbytraumatothehead andfacemostfrequently(38%)followedbythoracicinjuries(26%),spinalcolumnorcordinjuries(22%),andpelvis andextremityinjuries(21%each).Whenallinjuriestothe musculoskeletalsystemwerecombined,theyaccountedfor 64%ofallinjuriessustained;farsurpassingthefrequency ofheadtrauma( Fig.2 ).Ofthe76patientsadmittedfor managementoftheirinjuries,38patients(50%)required surgicalintervention.Orthopedicprocedureswereperformedmostfrequently(19%);however,othersurgicalservicesincludedneurosurgery(6%),generalsurgery(5%), andurology/vascularprocedures(8%).TherewasnosignicantdifferenceinISSinpatientsrequiringsurgicalinterventioncomparedwithpatientswhodidnotrequiresurgery(15.5 2vs12.3 1; P .14). Themortalityrateinthestudygroupwas7%(5patients);themeanISSof35 8innonsurvivorsreectsthe severityofassociatedinjuries.Fourpatientsdiedfromsevereheadtraumaand1patientdiedfrombluntabdominal traumawithinjuriestotheliverandspleen.Ofthe 7 1 survivingpatients,37(52%)weredischargedhomewithout theneedforfurtherintervention;however,24(34%)patientsrequiredoutpatientphysicaltherapy.Theremaining 10(14%)patientsweretransferredtoaninpatientrehabilitationcenter.Theirinjuriesincludedclosedheadinjury(3 patients),musculoskeletaltrauma(3patients),spinalcord injury(3patients),andmultisystemtrauma(1patient).Table1 Demographicdata Age,y42 1 ISS13 1 Hospitallengthofstay,d5 1 Gender50%male GlasgowComaScore14 0.2 Figure1 Mechanismofinjuryinvictimsofequine-related trauma.Fallswerethemostcommonmechanismofinjuryfollowedbybeingcrushed,kicked,ortrampled. Figure2 Distributionofinjuriessustainedinequine-related events.Injuriestothemusculoskeletalsystemweremostfrequent. Othervulnerablebodyareasincludedthehead/faceandthethoracicregion.Musculoskel musculoskeletal;GU genitourologic.703 C.N.Clarkeetal.Equinerelatedinjury

PAGE 3

CommentsTheresultsfromthis10-yearretrospectivereviewindicatethatalthoughmortalityfromequine-relatedinjuryis low,morethanhalfoftheinjuredpatientsrequiredrehabilitationafterdischargefromtheacute-carefacility.Moreover, exceptforgenderpredilection,mortalityandinjury patternsweresimilartonationallyreporteddataoverthe sametimeperiod [5] .Importantly,the3bodyregions identiedtobemostatriskforinjuryafterequine-related activitieswerethemusculoskeletalsystem,thehead/face, andthethoracicregion. Variousreportsoverthepast20yearshavedetailed injurypatternsassociatedwithequestrianactivities.Vulnerablebodyregionsincludethehead,hand/wrist,foot/ankle, andspinalcord/columnandpreventivestrategieshaveincorporatedprotectivegeartominimizeinjurytotheseareas [6] .Interestingly,theuseofridinghelmetswasassociated witha5-foldreductioninheadinjuries [7] .Otherstudies similarlyhaveshownareductioninthenumberand severityofheadinjuriesinhelmetedriderswhereasthe incidenceandseverityofinjurytotheunprotectedupper extremities,particularlyinfemaleriders,hasincreased [8] .Theinjurypatternsidentiedinthepresentstudyare consistent withpastreportsandtakentogethersuggestthat theuseofprotectivegeartargetingvulnerablebodyregions mayminimizetheseverityandfrequencyofinjuryinequestrianevents. Mayberryetal [9] stratied679horseridersbyskill levelasdenedbysubjectivetotalhoursofexperience. Theiranalysisshowedthat1in5riderswouldhavesustainedaseriousinjury,denedasaninjuryrequiringhospitalization,surgery,orresultingindisability.Whenriders werestratiedaccordingtoskilllevel,theriskofinjuryfor noviceriders (ie,riderswith 100hoursofexperience) wasincreased3-,5-,and8-foldcomparedwithintermediate,advanced,andprofessionalriders,respectively. Thisstudysuggeststhatmaximalriskreductionmaybe achievedthroughtheuseofpreventivestrategiesby noviceequestrians. Limitationsofthepresentstudyincludedtheretrospectivedesignandthesmallsamplesize.Theretrospective designdidnotallowforstraticationaccordingtoskilllevel orexperiencewithhorses,norwereweabletoidentify whetherprotectivegearwasused.Ourcharacterizationof injurypatternsmaypromotefurtherinvestigationintothe useofpreventivestrategiesspecicallydirectedatbody regionsmostfrequentlyand/orseriouslyinjuredduring equine-relatedactivities.SummaryEquine-relatedtraumaisassociatedwithhighmorbidity secondarytotheprevalenceofmusculoskeletalfractures andclosedheadinjuries.Asadirectresultoftheinjuries sustained,patientspresentingwithequine-relatedtrauma arelikelytorequirerehabilitationafterdischargefromthe acute-carefacility.Furtherinvestigationisnecessaryto identifyhigh-riskindividualsandimplementpreventative strategiesthatmayminimizeannualhealthcareexpendituresincurredfromhospitalizationandrehabilitation.Until additionalresearchisavailable,theuseofhelmetsand protectiveextremitypaddingshouldbeconsideredbynoviceriders.References1.ThomasKE,AnnestJL,GilchristJ,etal.Nonfatalhorse-relatedinjuries treatedinemergencydepartmentsintheUnitedStates.BrJSportsMed 2006;40:61926. 2.KrissTC,KrissVM.Equine-relatedneurosurgicaltrauma:aprospectiveseriesof30patients.JTrauma1997;43:979. 3.FinchCF,Ozanne-SmithJ,WilliamsF.Thefeasibilityofimproveddata collectionmethodologiesforsportsinjuries.Reportno.69.Melbourne: MonashUniversityAccidentResearchCentre,1995. 4.WallerAE,DanielsJL,WeaverNL,etal.JockeyinjuriesintheUnited States.JAMA2000;283:13268. 5.GriffenM,BoulangerBR,KearneyPA,etal.Injuryduringcontactwith horses:recentexperiencewith75patientsatalevelItraumacenter. SouthMedJ2002;95:4415. 6.WhitlockMR.Injuriestoridersinthecrosscountryphaseofeventing: theimportanceofprotectiveequipment.BrJSportsMed1999;33: 2126. 7.ChitnavisJP,GibbonsCL,HirigoyenM,etal.Accidentswithhorses: whathaschangedin20years?Injury1996;27:1035. 8.MossPS,WanA,WhitlockMR.Achangingpatternofinjuriestohorse riders.EmergMedJ2002;19:4124. 9.MayberryJC,PearsonTE,WigerKJ,etal.Equestrianinjurypreventioneffortsneedmoreattentiontonoviceriders.JTrauma 2007;62:7359.704TheAmericanJournalofSurgery,Vol195,No5,May2008