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It was the purpose of this study to review equestrian-related injuries using a large nation wide database and analyze predictors of significant injury.The National Electronic Surveillance System database was queried for equestrian injuries from 2002 to 2004. The presence of a fracture, dislocation, traumatic brain injury, musculoskeletal injury, orthopedic injury, and spinal injury, as well as injury mechanism, geographical location, and emergency room disposition were noted. Bivariate, cosinor seasonal, and multiple logistic regression analyses were performed. p < 0.01 was considered significant.Emergency room visits because of equestrian-related injuries from 2002 to 2004 from the NEISS database were reviewed; there were 5,033 visits during this time span. The average age was 30.0 ± 17.0 years; 66% were women. The injuries occurred at home (36%), recreation/sporting facility (30%), on a farm (19%), and other public property (12%). The injury was due to a fall (59%), thrown/bucked from the horse (22.0%), and while riding the horse (9%). The most common injuries were contusion/abrasions (31%), fractures (28%), sprain/strains (18%), traumatic brain injuries (12%), and lacerations (6%). The body area injured was the head and neck (24%), trunk (29%), upper extremity (30%), lower extremity (16%), and multiple locations (1%). Most injuries occurred in the summer. Predictors of hospital admission were age >18 years, traumatic brain injury, fracture, or occurrence on other public property (odds ratios 1.4, 6.25, 7.7, and 1.5, respectively).The largest number of equestrian injuries occur in white females in the 2nd, 4th, and 5th decades of life. Serious injuries are due to falling or being bucked off a horse and most commonly occur at home or at a recreational/sporting facility. Prevention strategies (educational and passive protection equipment) should be especially targeted to this high risk group.