Equine-related injuries in rural Oklahoma: a 10-year experience emphasizing genitourinary trauma

Equine-related injuries are a significant yet under-researched cause of trauma in rural areas, particularly in high-equine-density states like Oklahoma. This study describes patterns, severity, and outcomes of equine-related injuries over a 10-year period at a Level II trauma center, with emphasis on genitourinary (GU) trauma.

This retrospective cohort study included all patients admitted with equine-related injuries from May 2015 to December 2025 (n = 259). Data were abstracted from the trauma registry, including demographics, injury mechanisms, anatomic locations (with GU injuries consolidated as kidney, ureter, bladder, penis, and scrotum), Injury Severity Score (ISS), length of stay (LOS), and mortality. Severe injuries were defined as ISS > 15. Only descriptive statistics are reported.

The mean age was 48.0 years (SD 17.5); 56.0% were male. Mean ISS was 9.1 (SD 6.0), with 12.4% of cases classified as severe (ISS > 15). The most common mechanisms were falls from a horse (44.8%) and being struck by a horse (32.8%). Predominant injury locations included brain/craniofacial (35.5%), chest (28.2%), and spinal (25.1%). Genitourinary injuries occurred in 9.3% of all cases and were more frequent among patients with severe trauma. Kidney injuries specifically accounted for 3.1% overall. Median hospital LOS was 2.0 days (IQR 3.0) overall and longer among severe cases. In-hospital mortality was 1.5% (4 cases), all attributable to traumatic brain injury.

In rural Oklahoma, equine-related trauma commonly involves head and torso injuries. Genitourinary injuries represent an under-recognized but clinically relevant subset, particularly in severe cases. These findings underscore the need for targeted prevention strategies in high-equine-density rural communities, including mandatory helmet use and education regarding risks of direct horse contact.