Exploring the Severity of Craniomaxillofacial Injuries From Horseback Riding
Authors: Stanbouly Dani , Besmer Alexander V. , Chuang Sung-Kiang 
Published: August 2021

Purpose:
The purpose of our study is to assess the severity of craniomaxillofacial injuries from horseback-riding accidents.

Materials and Methods:
This is a 20-year retrospective cross-sectional study of the National Electronic Injury Surveillance System. Injuries from the activity of horseback-riding were included if they occurred in the craniomaxillofacial complex. Study predictors were derived from both patient and injury characteristics. The study outcome was the presence or absence (probability) of hospital admission from the emergency department. A multiple logistic regression model was created to model the odds of admission using all significant univariate predictors.

Results:
The final sample consisted of 6730 patients. The decrease in horseback riding injuries from 2000 to 2019 was significant (P = 0.042).
The mean age of the sample was 27.80 years (range: 2–91 years). Gender-wise, females composed the majority of injured horseback riders (71.9%). Over two-thirds of the sample consisted of White patients (68.1%). Over three-fourths of the injuries occurred in the head (80.9%), rendering it the most frequently injured region of the craniomaxillofacial complex. The most common primary diagnoses were internal organ injury (40.2%). On univariate analysis, the admission rates were significantly associated with gender (P < 0.01), age group (P < 0.01), body part injured (P < 0.01), diagnosis (P < 0.01), location of injury (P < 0.01) and mechanism of injury (P < 0.05). Relative to young adults, children (odds ratio [OR], 1.579; 95% OR confidence interval [CI] [1.31, 1.91]; P < 0.01), adults (OR, 1.857; 95% OR CI [1.55, 2.22]; P < 0.01), and seniors (OR, 3.738; 95% OR CI [2.73, 5.12]; P < 0.01) were each independently associated with an increased odds of admission. Relative to the mouth, the head had 4.8 odds of admission (P < 0.01) and the face had 2.5 odds of admission (P < 0.01). Relative to contusions/abrasion, concussions (OR, 3.542; 95% OR CI [2.28, 5.49]; P < 0.01) and internal organ injuries (OR, 9.020; 95% OR CI [5.90, 13.79]; P < 0.01), lacerations (OR, 1.946; 95% OR CI [1.17, 3.24]; P < 0.05), and fractures (OR, 32.068; 95% OR CI [20.53, 50.09]; P < 0.01) were each independently associated with increased odds of admission relative to contusions. Direct trauma from a horse (OR, 1.422; 95% OR CI [1.06, 1.91]; P < 0.05) was associated with independently increased odds of admission relative to other injuries. Injuries that took place in a farm (OR, 1.617; 95% OR CI [1.25, 2.09]; P < 0.01) and a street (OR, 2.735; 95% OR CI [1.83, 4.09]; P < 0.01) were each independently associated with increased odds of admission. Finally, relative to females, males (OR, 1.374; 95% OR CI [1.20, 1.57]; P < 0.01) were independently associated with increased odds of admission.

Conclusions:
Many variables contribute to the chance of hospital admission from horseback riding. Fractures seem to be the leading risk factor for hospital admission, therefore, future study may look into how to reduce the incidence of fractures through the employment of more protective equipment than helmets for horseback riders.