Fédération Equestre Internationale eventing: Fence-level risk factors for falls during the cross-country phase...

The equestrian discipline of eventing tests athletes' and horses' skill over three phases: dressage, jumping and cross-country. Falls during cross-country can be particularly serious and result in serious or fatal injury for both horse and athlete. Cross-country course and fence design are crucial contributory factors to safety.

To provide descriptive statistics and identify fence-level risk factors for horses competing in Fédération Equestre Internationale (FEI) events worldwide.

Retrospective cohort study.

Data were collected for every horse start worldwide in all international (CI), championship (CH), Olympics (OG) and World Equestrian Games (WEG) eventing competitions between January 2008 and December 2018 and univariable logistic regression, followed by multivariable logistic regression were applied. The final model was built in a stepwise bi-directional process, with each step assessed by the Akaike information criterion.

Risk factors were identified at the fence level covering aspects of fence design and course design. Ten fence types were at increased odds of a fall occurring compared with square spread fences, and seven types were at reduced odds. Fences with an approach downhill (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.19-1.52), with landing into water (OR 1.82, CI 1.62-2.01), frangible devices (OR 1.28, CI 1.15-1.41) and later elements of combined obstacles (OR 1.33 CI 1.25-1.42 for the second element, OR 1.21 CI 1.10-1.32 for later elements) were associated with increased risk of falls occurring.

Although the dataset covers every international competition worldwide, it does not include national-level competitions.

It is recommended that the most challenging fences are placed near the beginning of the course, and not in downhill or water settings. The complexity of individual elements in combined fences should be reduced. Adopting evidence-based course design is a crucial intervention for reducing the incidence of horse falls and associated serious and fatal injuries to horse and human athletes.