Endurance.Net Ridecamp Archives

Title: Re: [RC]   problems with the study

With all due respect for the distinguished and many-initialed, many-credentialed authors of this study, I hasten to remind us that this type of study is far from the gold standard of medical research, which is large scale, prospective, double-blind, randomized, interventional, case-control studies. Any other type of study is fraught with bias and yeah-buts. Even with gold-standard studies, one is cautioned about generalizing from a study population (e.g., 10 year old, male, left-handed, Zijo islanders) to one’s self.

The AJS report is a retrospective study consisting of about 80 interviews. The self-reporting subjects (interviewees), far from being a large scale, randomized sample are self-selected for—what?--severity of injury, self-(and spousal) recrimination, and many other biases. (We also must look at the 45% of 151 riders who didn’t answer the survey.)

The value of such a study is to suggest an experimental design and questions to be answered for a gold-standard study. This would mean selecting 2,000 subjects who ride the same or similar horses under controlled conditions vs. 2,000 skiers, motorcyclists, football players, and rugby players who perform under equally controlled conditions. Half of each group would be required to undergo a single intervention, such as wearing helmets or using break-away stirrups, that demonstrates that injuries can be prevented by the intervention.

About all I can conclude from this study is: don’t be an experienced rider in Calgary with no helmet.

Personally, I find the anecdotal evidence on Ridecamp to be far more useful in developing myself as a safe and competent rider.

Beverley...constantly in debate w/ hubby motorcyclist about the relative safety of horse vs. mc


_____________________________________________ 
Beverley Kane, MD
Program Director, Medicine and Horses
Stanford School of Medicine
Center for Education in Family and Community Medicine
1215 Welch Road - Modular H
Palo Alto, CA 94305-5408
650-868-3379
bkane1@xxxxxxxxxxxx
http://familymed.stanford.edu/

See Emmy Award-winning Stanford "Medicine & Horses" on NBC-TV
http://www.horsensei.com/nbcnews.html
_____________________________________________ 



On 9/26/07 7:53 PM, "Linda Marins" <coldeye22@xxxxxxxxxxxxx> wrote:

> Here's the abstract from the American Journal of Surgery.
> Note that the "Horseback riding is more dangerous than..."
> statement is in the Background section, not the results.
> This would seem to mean that it was taken as a given at
> the start of the study, and was not one of the study's
> findings (myriad newspaper articles notwithstanding).
> One can't tell without the full journal article and particularly
> the footnotes.
>  
> Linda Mirams
> -----------------------------------------------------------------------------------------------------------------------
>   
>   Volume 193, Issue 5, Pages 636-640 (May 2007)
> Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries
> Presented at the 93rd Annual Meeting of the North Pacific Surgical Association, Spokane, WA, November 10–11, 2006
> Chad G. Ball, M.D., M.Sc., Jill E. Ball, B.H.Sc.O.T., Andrew W. Kirkpatrick, M.D., F.R.C.S.C., F.A.C.S., Robert H. Mulloy,  M. D., F. R.C.S.C.
>
> Received 6 December 2006; received in revised form 21 January 2007
>
> Abstract
> Background 
>
> Horseback riding is more dangerous than motorcycle riding, skiing, football, and rugby. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with severe equestrian trauma.
>
> Methods 
>
> All patients with major equestrian injuries (injury severity score ≥ 12) admitted between 1995 and 2005 were reviewed. A 46-question survey outlining potential rider, animal, and environmental risk factors was administered.
>
> Results 
>
> Among 7941 trauma patients, 151 (2%) were injured on horseback (mean injury severity score, 20; mortality rate, 7%). Injuries included the chest (54%), head (48%), abdomen (22%), and extremities (17%). Forty-five percent required surgery. Survey results (55%) indicated that riders and horses were well trained, with a 47% recidivism rate. Only 9% of patients wore helmets, however, 64% believed the accident was preventable.
>
> Conclusions 
>
> Chest trauma previously has been underappreciated. This injury pattern may be a result of significant rider experience. Helmet and vest use will be targeted in future injury prevention strategies.