Factors associated with delay to emergency department presentation, antibiotic usage and admission for human bite injuries

Abstract

Objectives: Evidence and consensus on best practices on the management of human bite injuries is lacking. Our objective was to identify factors that are associated with delay to emergency department (ED) presentation, antibiotic usage and patient admission. Methods: We present a retrospective chart review of adults treated for human bites. Multivariable logistic regression models used demographic characteristics and bite circumstances and characteristics as factors associated with ED presentation more than 24 hours after the bite, antibiotic usage and hospital admission. Results: Of the 388 patients evaluated for a human bite, 66.5% were bitten during an altercation; 23.8% presented more than 24 hours after the bite; 50.3% were bitten on the hands or fingers, 23.5% on an extremity and 17.8% on the head or neck. Only 7.7% of all patients sustained closedfist injuries; the majority had occlusional or other kinds of bites. The majority of patients (77.3%) received antibiotics and 11.1% were admitted to hospital. Patients who had greater odds of presenting more than 24 hours after the bite were black (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.02-3.13), Hispanic (OR 2.68, 95% CI 1.22-5.89) and those who had a non-occupational bite (OR 3.87, 95% CI, 1.68-8.90). Patients had a greater chance of receiving antibiotics if they were bitten during an altercation (OR 1.87, 95% CI, 1.09-3.20) and were bitten on the hands or fingers (OR 2.23, 95% CI 1.31-3.80). Patients had a greater chance of being admitted to the hospital if they were bitten during an altercation (OR 4.91, 95% CI 1.65-14.64), bitten on the hands or fingers (OR 5.26, 95% CI,) and if they presented ≥ 24 hours after the bite. Conclusion: Most patients presented to the ED within 24 hours of their injury and received antibiotics. The circumstances surrounding the bite appeared to be associated with delay to ED presentation, receipt of antibiotics and admission to the hospital. There are ethnic background differences in delay to ED presentation. ED clinicians in our study favour antibiotic usage and admission based on the body location of the bite, despite little evidence to support these practices.

Orofacial Human Bite: A Six Year Review of Cases from Komfo Anokye Teaching Hospital

“…This finding is however contrary to a similar study conducted in Ghana where victims of human bite usually presented during the first two days of the injury [1]. Patients with human bite injury are often either intoxicated [2] or are known to their assailant [1] making the process of obtaining a reliable history especially about the aetiology difficult. In 2002, a study estimated the rate of infection secondary to human bite to be about 10% Perron et al [3].…”

“…Studies have shown that human bites are more common among males [1] with the peak incidence between 18 and 78 years according to Merchant et al [2]. In a study of 388 patients with human bite by Merchant et al [2], 76.2% of patients presented to emergency within 12 hrs of injury [2]. This finding is however contrary to a similar study conducted in Ghana where victims of human bite usually presented during the first two days of the injury [1].…”

“…This region of the human body is usually not protected during a fight making it prone to several injuries including human bite. Studies have shown that human bites are more common among males [1] with the peak incidence between 18 and 78 years according to Merchant et al [2]. In a study of 388 patients with human bite by Merchant et al [2], 76.2% of patients presented to emergency within 12 hrs of injury [2].…”

Case Report of a Newborn Injured By Human Bite

“…Bazı yazarlar bütün insan ısırığı yaralanmalarının yüksek enfeksiyon riski taşıdığına ve antibiyotik profilaksisine alınmasının uygun olduğuna inanırken diğerleri kapalı yumruk yaralanmaları gibi özel durumlarda profilaksi yapılmasının gerekli Resim 1. İnsan ısırığına bağlı, sağ yanak bölgesinde 3x3 cm boyutlarında, hiperemik, ekimotik, üzerinde diş izleri bulunan ve yer yer kurutlanmaya başlamış lezyonun yandan görünümü olduğunu savunurlar (9,10). Medeiros ve Saconato bir derlemelerinde profilaktik antibiyotik kullanımının kedi ve köpek ısırıklarında infeksiyon hızında bir azalma sağlamazken insan ısırıklarında anlamlı bir düşüşe sebep olduğu sonucuna vardılar (11).…”

Mammalian Bite Injuries to the Hand and Their Management

“…Studies have suggested that closed fist injuries account for around 50% of human bite injuries to the hand [17]. The metacarpophalangeal joint is at risk of injury.…”