Causes and Circumstances of Horse Related Injuries and Impact on Quality of Life

Introduction and Background:

Horse-related activity (HRA) can be risky. The National Electronic Injury Surveillance System
(NEISS) estimated that in 2006, 68,060 Americans went to a U.S. emergency room with
horse-related injuries (HRI), of which 5,676 were hospitalized. However, Thomas et al
estimated that 102,904 people each year from 2001 to 2003 were treated for HRI in emergency
rooms nationwide. In Oregon, horses are the leading cause of animal-related fatalities in
Oregon and Oregon's annual death rate from animals is 45% higher than the national rate. In a
survey of 679 Northwest equestrians in Oregon, Washington, and Idaho, 81% riders reported at
least one injury during their career, and 1 in 5 equestrians required hospitalization,
surgery, or sustained permanent disability as a result of a HRI.

The long-term goal of our research is to develop a horse-related injury prevention program.
Our preliminary study indicated that lower levels of experience were strong indicators of
greater risk. The period of greatest danger appears to be during the initial 100 hours of
HRA, with the incidence of injury nearly 8 times greater among novices as compared to
instructors or professionals. The extent to which HRI is preventable is currently not clear,
but it may be substantial. 64% of injured, experienced riders believed their incident was
preventable and 47% altered their riding habits as a result.

Rationale:

There is a need to develop specific safety and prevention recommendations to reduce the
number of HRIs. We intend to retrospectively determine what decisions, conditions, or other
influential circumstances occurred that led to the subject's injury incident and to question
the subject whether any measures could have prevented the incident from occurring. By
interviewing injured equestrians, we may be able to determine patterns of decision-making and
behavior from their collective experience and develop useful safety recommendations.

The investigators will also interview injured equestrians to determine the impact that the
injury has had on their quality of life. There is very little information in the literature
on this subject. One study indicated that in the pediatric population, 41% of injured
children and adolescents had residual complaints and were still hampered in their daily
activities an average of 4 years after HRI. If we can document what we suspect will be a high
impact of HRI on quality of life in both adults and children, the imperative to develop
injury prevention measures will be further supported.

2. Briefly summarize how participants are recruited.

The Trauma Service at OHSU keeps a state-mandated registry of all patients admitted to the
Trauma Service that can be searched by injury diagnosis code. Demographic, injury, and
hospital outcome data can be easily obtained and matched. Consenting subjects who were
treated at OHSU between January 1, 2001 and September 20, 2008 will be contacted by mail and
asked to participate in this study. Potential subjects who are currently > 18 years of age
can be included in the study if a Child Assent Form has been completed and a legally
authorized representative (LAR) provides consent for study participation. . Investigators
will be available to answer any questions that subjects may have concerning the study.

3. Briefly describe the procedures subjects will undergo.

This study involves responding to an electronic survey that will be emailed to subjects
agreeing to participate in this research study. Subjects will not undergo any physical
procedures. The researchers may contact study participants by email or telephone if
necessary, to clarify responses from the survey questionnaire.

4. If applicable, briefly describe survey/interview instruments used.

Study participants will respond to an equestrian survey that asks questions about the
horse-related injury, including causes and circumstances surrounding the injury, experience
and skill level at the time of injury, safety equipment used, ideas on how the injury might
have been prevented, how it has impacted quality of life, and current health status, work
status, and activity level. Study participants will also complete the Rand 36-Item Health
Survey, a short survey that evaluates health status. A single survey, emailed to the subject,
will include both the equestrian survey and the Rand 36. Completion of the survey will
require approximately 30 minutes.

5. Briefly describe how the data will be analyzed to address the purpose of the protocol.

The responses to our study questionnaires will allow us to perform statistical analysis to
determine the causes and circumstances surrounding the injury to see if safety prevention
measures can be identified. It will also assess the impact of the injury on the quality of
life.

Inclusion Criteria:

- Subjects must have been treated at OHSU from January 1, 2001 through September 30,
2008 for any horse related traumatic injury.

- The subject will have signed an IRB approved written informed consent and HIPAA
authorization to participate in the study.

- Subjects must have access to the internet and an e-mail account to participate in the
survey.

- Subjects must be able to complete surveys written in English.

Exclusion Criteria:

- Subjects who are deceased.