title: Helmet under-utilization by children during equestrian events is associated with increased traumatic brain injury.
abstract: OBJECTIVE
  Awareness of equestrian related injury remains limited. Studies evaluating children after equestrian injury report under-utilization of safety equipment and rates of operative intervention as high as 33%.
  
  
  METHODS
  We hypothesized that helmets are underutilized during equestrian activity and lack of use is associated with increased traumatic brain injury. We queried the trauma database of a level one pediatric trauma center for all cases of equestrian and rodeo related injury from 2005 to 2015. Analysis was conducted using SAS 9.4.
  
  
  RESULTS
  Of 312 children identified, 142 were assessed for use of a helmet. Only 28 children (19.7%) had documented use of a helmet. Most injuries occurred while riding a horse (83%) or bull (13%) with traumatic brain injury being the most common injury (51%). Helmet use was associated with decreased ISS (7.1 vs. 11.3, p<0.01), TBI (32.4% vs. 55.3%, p=0.03), and ICU admission (10.7% vs. 29%, p=0.05). Multivariable analysis reveals lack of helmet use to be an independent predictor of TBI (OR 2.5, 95% CI 1.1-6.3).
  
  
  CONCLUSIONS
  Helmets are underutilized by children during equestrian related activity. Increased awareness of TBI and education encouraging helmet use may decrease morbidity associated with equestrian activities.
  
  
  METHODS
  Retrospective comparative study, Level III.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 N. Mario Ceppechi Drive, Suite 3800, Salt Lake City, UT 84113, United States. Electronic address: Scott.Short@imail2.org.
authors.forename: Scott S
authors.initials: SS
authors.lastname: Short
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 N. Mario Ceppechi Drive, Suite 3800, Salt Lake City, UT 84113, United States. Electronic address: Stephen.Fenton@imail2.org.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Fenton
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 N. Mario Ceppechi Drive, Suite 3800, Salt Lake City, UT 84113, United States. Electronic address: Eric.Scaife@imail2.org.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Scaife
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 N. Mario Ceppechi Drive, Suite 3800, Salt Lake City, UT 84113, United States. Electronic address: Brian.Bucher@imail2.org.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bucher
mesh_terms: D000293:Adolescent; D000818:Animals; D001265:Athletic Injuries / Q000453:epidemiology* / Q000517:prevention & control; D001364:Awareness; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000517:prevention & control; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006736:Horses; D006760:Hospitalization; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014193:Trauma Centers
keywords: Equestrian; Helmet; Pediatric; Traumatic brain injury