Acute paediatric bite injuries treated on inpatient basis: A 10-year retrospective study and criteria for hospital admission

Abstract

The aim of this study was to evaluate the acute bite wounds in children treated on an inpatient basis over a 10-year period and the criteria for inpatient treatment. This study comprised all acute mammalian bite injuries in relation to all paediatric bite injuries seen at the Emergency Surgical Department (ESD). Inclusion criteria were: aged between 0-18 years; acute human or animal bite injuries (presenting for the first time); and inpatient treatment. Exclusion criteria were: bite wounds treated elsewhere and referred for complications; bites treated on an outpatient basis referred for complications; and all insect bites. Over 10 years, 12,948 children were seen at the ESD. There were 167 children (0.77%) with mammalian bite wounds. Twelve of them responded to the inclusion criteria. They presented 7.18% of all mammalian bite injuries and 0.09% of all paediatric emergency visits at the ESD. The average age was 3.82 ± 1.63 years (from 1.3-7 years). The time elapsed between the accident to the wound debridement was 118.64 ± 101.39 minutes. There were 10 dogs, one horse, and one rabbit bite. Surgical treatment comprised debridement, saline irrigation, and primary closure or reconstruction. All patients received antibiotics in the postoperative period. The average hospital stay was 5.92 ± 2.39 days. In one case a partial distal flap necrosis occurred. Animal bite injuries treated on an inpatient basis are predominantly dog bites in young children under 10 years of age, with deep, extended, and commonly multiple injuries. Only 7% of paediatric bite injuries require inpatient treatment.

Dog bites to the upper extremity in children

“…found increased incidence of infection in animal bites to the hand and arm; both of these two studies were not confined to children. However a more recent paper that studied only paediatric patients did not find the same results. Despite the small number of patients in both groups in our study (bites to upper and lower extremities); the difference in their needs for hospitalization and/or surgery was very clinically and statistically significant suggesting real difference in the tendency of upper extremity/hand injury to get infected.…”

“…Dog bites are considered a serious medical, community public health and economical problem because of its high incidence worldwide . Dog bites account for approximately 80–90% of domestic animal bites and about 2% of these bites require hospitalization .…”

“…About 4.5 million Americans are bitten by dogs each year, the majority of whom do not seek medical treatment. Approximately 350 000 people in the USA and around 200 000 people in the UK are seen in emergency departments every year because of dog bites . More than half of dog bite victims are children younger than 12 years old .…”