Objectives: To characterize helmet use, head injury risk, and to examine rider-related factors that influence these variables. Design: Cross-sectional study. Setting: The University of Alabama at Birmingham Equestrian Sports Medicine Collaborative. Patients (or Participants): In total, 357 equestrians competing at the collegiate level participated in this study. Interventions (or Assessment of Risk Factors or Independent Variables): X2 tests were used to evaluate potential associations between a rider's experience level, riding style, and use of helmet designed with MIPS with number of falls, past head injuries, and helmet use frequency. Main Outcome Measures: Data regarding helmet use and equestrian-related injuries were collected. X2 analysis was used to determine potential associations. Results: More than 50% of athletes reported falling off a horse during the course of 1 year. Head injuries occurred with high frequency. Concussion was the most frequently reported type. More than 50% of athletes with self-reported concussion denied receiving medical treatment. The risk of head injury was similar across helmet brands, and between helmets with Multi-Directional Impact Protection System (MIPS) and those without. Riders with the most experience were less likely to report sustaining a head injury than those with less experience. Contrary to current safety guidelines, 78% of equestrians said that they would not replace their helmet after every fall. Conclusions: Collegiate equestrians have a high risk of fall-related traumatic head injury. Despite this risk, they report helmet use practices that are not in line with current recommendations regarding helmet replacement. This suggests that many of the athletes are using protective equipment that does not adequately protect against head injury. Neither helmet brand nor liner type was associated with lower rate of head injury.
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