Epidemiology of race-day distal limb fracture in flat racing Thoroughbreds in Great Britain (2000-2013).

BACKGROUND: A key focus of the racing industry is to minimise the number of race-day distal limb fractures although no studies have identified risk factors for both fatal and non-fatal distal limb fractures. OBJECTIVE: To determine risk factors for race-day distal limb fractures experienced by Thoroughbred racehorses participating in flat racing in Great Britain (GB). STUDY DESIGN: Retrospective cohort. METHODS: Information was collected from all flat racing starts occurring on GB racecourses between 2000 and 2013, including horse, race, course, trainer and jockey data for each horse start and race-day injury data as reported by on-course veterinarians. Associations between exposure variables and cases of distal limb fracture were assessed using mixed-effects logistic regression analyses using data from all starts, and turf starts only. RESULTS: A total of 806,764 starts and 624 cases of distal limb fracture were included, of which 548,571 starts and 379 cases of distal limb fracture occurred on turf surfaces. In both models, increasing firmness of the going, increasing racing distance and horses in their first year of racing were at a higher risk of distal limb fracture while increasing number of previous race starts were protective. Trainer performance was associated with distal limb fracture. Generally, the risk of distal limb fracture increased with increasing horse age. Starts in selling or claiming races or Group 1, Group 3 or claiming races were at higher odds of distal limb fracture in the all starts and turf models, respectively. MAIN LIMITATIONS: Clinical diagnosis of distal limb fracture and all types of distal limb fracture considered as one outcome. CONCLUSIONS: This study confirmed previously identified risk factors for distal limb fracture including going, race distance and number of horse starts. Novel risk factors were related to trainer and horse performance, and race type. Identification of at risk groups will help inform interventions to reduce distal limb fracture occurrence in flat racing horses.

Risk factors for race-day fatality, distal limb fracture and epistaxis in Thoroughbreds racing on all-weather surfaces in Great Britain (2000 to 2013).

The incidence of race-day injuries in Great Britain (GB) is higher on all-weather (AW) surfaces than on turf. However, to date no studies have focused on identifying risk factors for injury specific to AW racing. Therefore, the objective of the current study was to determine risk factors for fatality, distal limb fracture (DLF) and episodes of epistaxis in flat racing Thoroughbreds racing on AW surfaces in GB. Data included all flat racing starts on AW surfaces (n=258,193) and race-day veterinary events recorded between 2000 and 2013. Information on additional course-level variables was gathered during face-to-face interviews with racecourse clerks. Horse-, race- and course-level risk factors for each outcome were assessed using mixed-effects multivariable logistic regression including horse as a random effect. A classification tree method was used to identify potential interaction terms for inclusion in the models. During the study period, there were 233 fatalities resulting in a fatality incidence of 0.90 per 1000 starts; 245 DLF with a resultant DLF incidence of 0.95 per 1000 starts and 410 episodes of epistaxis resulting in an epistaxis incidence of 1.59 per 1000 starts. Risk factors varied for each outcome, although some factors were similar across models including the going, racing intensity, horse age, age at first race start, horse and trainer performance variables. Generally, older horses and those that had started racing at an older age were at higher risk of an adverse outcome, albeit with an interaction between the two variables in the fatality model. Faster going increased the odds of epistaxis and DLF but not fatality. Increasing race distance increased the odds of fatality but reduced the odds of epistaxis. Epistaxis was associated with type of AW surface (Fibresand versus Polytrack®), but DLF and fatality were not. This study provides further evidence of the association between the risk of race-day injuries and fatalities and current age, age at first start, race distance, going and horse performance. These findings provide the racing industry with information to develop strategies to reduce the occurrence of race-day events on AW surfaces.

Description of veterinary events and risk factors for fatality in National Hunt flat racing Thoroughbreds in Great Britain (2000-2013).

BACKGROUND: No large-scale studies have described veterinary events occurring in National Hunt (NH) flat racing or investigated risk factors for fatality in this race type. OBJECTIVES: To describe injuries and conditions requiring veterinary attendance on race day and to determine risk factors for racehorse fatality in NH flat racing in Great Britain. STUDY DESIGN: Retrospective cohort study (2000-2013). METHODS: Information from all NH flat races held over the study period, including horse, race and veterinary event report details, was combined. Veterinary events were described by type and anatomical structure(s) affected. Incidence per 1000 starts were calculated for all veterinary events and by event group, and stratified by certain horse- and race-level variables. Risk factors for fatality were determined using multivariable logistic regression modelling. RESULTS: Over the 14-year study period, 544 veterinary events were recorded, providing an overall incidence of 13.0 events per 1000 starts. The most common events were bone injuries (23.5%) and tendon or ligament injuries (16.4%). A fatal outcome was recorded for 117 horses (21.5% of all events), resulting in an incidence of 2.9 deaths per 1000 starts. Odds of fatality were 4.33 (95% confidence interval [CI] 1.59-11.82; P = 0.02) times higher in races restricted to conditional jockeys compared to those that were not. Horses starting in their first race experienced 1.44 (95% CI 1.00-2.08; P = 0.05) times the odds of death compared to those that had raced before. MAIN LIMITATIONS: Classification of veterinary events frequently relied upon presumptive diagnosis. CONCLUSIONS: This study provides a benchmark for the ongoing surveillance of veterinary events in NH flat racing. These results support the phasing out of NH flat races restricted to conditional jockeys and highlight the need for further work to establish why NH flat racing Thoroughbreds competing in their first race are at increased risk for death.

Descriptive epidemiology of veterinary events in flat racing Thoroughbreds in Great Britain (2000 to 2013).

BACKGROUND: To date, no large scale studies have reported race-day events requiring veterinary attention in British Thoroughbreds racing on the flat. Quantifying and describing common injuries and health conditions affecting racehorses will enable targeted risk factor analysis aimed at reducing their occurrence. OBJECTIVE: To describe the type and incidence of race-day veterinary events experienced by Thoroughbred racehorses participating in flat racing in the UK. STUDY DESIGN: Retrospective cohort study (2000 to 2013). METHODS: Veterinary events recorded by race-day veterinarians were retrieved and linked to race start data. Race-day veterinary events were described by type, location and anatomical structure(s) affected and whether the outcome was fatal or not. Incidence per 1000 starts was calculated, both overall and by year. Stratified incidence rates were calculated for selected event categories by specific course- and horse-level variables. RESULTS: There were 7993 events experienced by 6727 horses, with an incidence of 9.37 events per 1000 starts. Soft tissue injuries other than tendon and ligament injuries were the most commonly occurring veterinary events (24.1%), followed by gait observations (21.2%) and respiratory conditions (21.2%). In total, 13.8% of events were bone injuries. The incidence of fatality (n = 628) was 0.76 per 1000 starts. Most (485/628, 77.2%) fatal events were bone injuries, 64 were due to cardiac conditions and 54 due to tendon and ligament injuries. All-weather tracks had a higher incidence of veterinary events and fatalities than turf tracks. Firmer (turf) or faster (all-weather) going were associated with a higher incidence of all veterinary events. MAIN LIMITATIONS: Events were based on presumptive, rather than definitive, veterinary diagnosis. CONCLUSION: The most common events experienced by racehorses on race-day were relatively minor and not career-ending. Although more severe bone, joint, tendon and ligament injuries were less common, they had a greater impact on whether the outcome of the event was fatal.

Accuracy of distal limb fracture diagnosis at British racecourses 1999-2005.

Accurate diagnosis of racing injuries can be difficult. The objectives of this study were to describe the postmortem (PM) defined distribution of fatal distal limb fractures (DLF) affecting Thoroughbreds racing in Great Britain between February 1999 and August 2005 and then assess the accuracy of veterinary racecourse diagnoses and examine whether these improved following introduction of a computerised recording system. PM examinations were performed on limbs distal to radius or tibia from all cases of fatal DLF occurring on British racecourses during the study period. Results of these examinations were described and compared with the diagnoses made at the racecourses. Over the study period, fatal DLF prevalence in all race types was 0.63 per 1000 starts (344/545,335), with the lowest frequency (0.34 per 1000 starts) in flat racing on turf and the highest frequency (1.56 per 1000 starts) in national hunt flat races. The prevalence of fatal DLF in steeplechase racing had reduced from that reported previously: from 2.3 to 1 per 1000 starts. Racecourse veterinary identification of fracture presence was good (>93 per cent); however, identification of all fractured bones was poor (<55 per cent). Introduction of a computerised recording system did not significantly improve diagnostic accuracy. The prevalence of fatal DLF has not significantly altered since the 1970s. Techniques such as on course digital radiography to help improve racecourse fracture diagnoses could be introduced.

Risk factors for superficial digital flexor tendinopathy in Thoroughbred racehorses in steeplechase starts in the United Kingdom (2001-2009).

The objective of this study was to identify risk factors for superficial digital flexor (SDF) tendinopathy in Thoroughbred horses in steeplechase races in the United Kingdom. Potential risk factors for SDF tendinopathy were studied between 1st January 2001 and 31st December 2009 using a cohort study design with 648 injuries sustained in 102,894 starts. Potential risk factors were screened using univariable logistic regression prior to multivariable model building. In the final multivariable model, 12 statistically significant risk factors were identified. Variables that increased the odds of SDF tendinopathy included firmer going, increased horse age, and racing in the summer compared to other seasons. Variables that decreased the odds included having a higher official rating and the number of starts in the preceding days. Fewer and different risk factors were identified than in an equivalent model of SDF tendinopathy in hurdle racing, highlighting potential differences between these disciplines. Further collection of training and racecourse information would be beneficial and may help to explain further some of the associations identified in this study. The results will facilitate the development of strategies to improve overall safety of horses in UK steeplechase racing.

Risk factors for superficial digital flexor tendinopathy in Thoroughbred racehorses in hurdle starts in the UK (2001-2009).

REASONS FOR PERFORMING STUDY: Superficial digital flexor (SDF) tendinopathy is a common injury in Thoroughbred horses racing over hurdles. Identification of risk factors may allow the introduction of measures to minimise the incidence of this injury. OBJECTIVE: To identify risk factors for SDF tendinopathy in Thoroughbred horses in hurdle races in the UK. METHODS: Potential risk factors for SDF tendinopathy were studied between 1 January 2001 and 31 December 2009 using a retrospective cohort study design with 1031 case starts and 168,637 control starts. Potential risk factors were screened using univariable logistic regression prior to multivariable model building. RESULTS: IN the final multivariable model, 20 statistically significant risk factors were identified. Variables found to be associated with increased odds of SDF tendinopathy included: firmer going; increased horse age at first race; having had a previous SDFT injury; and racing in the summer compared to other seasons. Variables found to be associated with decreased odds included: being trained by a more successful trainer; and having raced more frequently in the preceding 9-12 months. CONCLUSIONS: This study identified multiple risk factors associated with SDF tendinopathy, some of which are difficult to explain with the current data source. Factors resulting in increased cumulative horse and tendon fatigue (increased years in racing; carrying increased weight; and racing over longer distances), firm ground, and the presence of previous tendon injury should be considered when attempting to reduce the likelihood of sustaining SDF tendinopathy. POTENTIAL RELEVANCE: The results will facilitate the development of strategies to improve the overall safety of horses in hurdle racing in the UK.

Risk factors for race-associated sudden death in Thoroughbred racehorses in the UK (2000-2007).

REASONS FOR PERFORMING STUDY: Sudden death adversely affects racehorse welfare, jockey safety and the public perception of horseracing. OBJECTIVE: To describe the risk of racing-associated sudden death in Thoroughbred racehorses in the UK from 2000 to 2007, to identify whether there were risk factors uniquely associated with sudden death and to improve the understanding of the pathogenesis of racing-associated sudden death by identification of risk factors for such cases. METHODS: A sudden death was defined as an acute collapse and death, in an apparently healthy Thoroughbred racehorse, during or immediately after racing, in the absence of clinical data indicative of a catastrophic orthopaedic injury. The retrospective study included 201 case race starts and 705,712 control race starts. Univariable and multivariable logistic regression were used to identify risk factors for sudden death at any one start. RESULTS: In the multivariable model, age, distance, race type, season and number of starts in the 60 days prior to the race were associated with sudden death. CONCLUSIONS: The risk factors identified in this study are not uniquely associated with sudden death and have been also been identified in studies using all causes of fatality as the outcome. These data suggest that a generic approach to reduce fatal musculoskeletal injury and sudden death may be possible. POTENTIAL RELEVANCE: The identification of risk factors allows speculation on the underlying mechanisms of sudden death in racing. This may stimulate hypothesis-led investigations into the pathogenesis of exercise-related arrhythmias, exercise-induced pulmonary haemorrhage and blood vessel rupture.

Prevalence, heritability and significance of musculoskeletal conformational traits in Thoroughbred yearlings.

REASONS FOR PERFORMING STUDY: The assessment of belief that equine conformation is associated with performance and durability is a fundamental concept of horsemanship. Surprisingly, there is almost no quantitative evidence to support these beliefs. OBJECTIVES: To assess the prevalence and heritability of conformational traits in Thoroughbred yearlings, and investigate their significance for subsequent turf flat-racing performance and durability. METHODS: Nine selected conformational traits were assessed in a consistent, qualitative manner by a single veterinary observer and entered into a database together with details of pedigree and racing records. RESULTS: Conformational data were collected from 3916 Thoroughbred yearlings sold at public auction during the 7 year period 1993-1999. Most of the horses (72%) raced in the UK in turf flat races; just 7% of the yearlings failed to race. Prevalence of conformational defects for the UK horses was reported, with turned out feet the most commonly recorded defect (30% of all horses). There was a tendency towards a greater proportion of horses with defects in the group of unraced horses compared with horses that raced, but this was not statistically significant. There were some significant associations between racing performance and conformational defects but these were found to be almost completely explained by an effect of sire. All of the conformational traits showed considerable evidence of genetic influence, with heritability indices ranging 0.16-1.00. CONCLUSIONS AND POTENTIAL RELEVANCE: Overall, there were only weak associations between performance and conformation that could not be accounted for by the very strong relationship between pedigree and conformation. Further study of potential association between highly heritable conformation traits and racing durability and racing performance should be undertaken utilising validated, quantitative methods and technology.

Horse injuries and racing practices in National Hunt racehorses in the UK: the results of a prospective cohort study.

A prospective cohort study was conducted on horses starting in hurdle and steeplechase races on six UK racecourses in 2000 and 2001. Trainers or carers were questioned on the horses' pre-race routine and observational data were collected in the stables and parade ring. Some practices were common to many starters, such as withholding food and water before racing whereas other practices, such as schooling frequency, were more variable. There was a total of 2879 starts and a total of 83 injuries or medical events (28.8/1000 starts). The commonest types of injury were tendon/suspensory injuries and lacerations/wounds. Multivariable logistic regression models were used to identify the relationship between predictor variables and the risk of injury. Risk of injury or medical event was associated with distance of the race and weight carried. The risk of injury, excluding medical events, was associated with the speed of the race and foot conformation.

Paralympics--Barcelona 1992.

The British Team at the 9th Paralympic Games in September 1992 in Barcelona comprised 151 men and 54 women athletes in a total of 15 sports. They were supported by a staff of 86 including a 12-strong medical team. The athletes were selected from the National Championships of the five disability organizations: British Wheelchair Sports Federation; British Blind Sport; Cerebral Palsy Sport; British Amputee Sports Association; and the British Les Autres Sports Association. This article outlines the organization and experience of the medical support team. The injury/illness profile was similar to those in able bodied sport. The team went on to achieve 40 gold, 47 silver and 41 bronze medals, maintaining third place on the medal table as achieved in Seoul in 1988.

A retrospective study of proliferative interstitial lung disease of horses in Florida.

Proliferative and fibrosing interstitial lung disease was diagnosed in 20 horses submitted for necropsy between 1982 and 1985. Most of the horses were foals ranging from 3 days to 6 months in age. Six adult horses were affected. The macroscopic and microscopic characteristics of the lesions consisted of proliferative interstitial pneumonia and were similar to those of atypical interstitial pneumonia of ruminants. Based on morphologic features of the lesions, a toxic etiology is suspected for the induction of this naturally acquired primary equine lung disorder, but could not be specifically discovered by historical information.