Initial management of animal and human bites
- Erin E Endom, MD
Erin E Endom, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Section Editor
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Animal and human bites are a common problem. Proper care requires wound inspection for injury to deeper structures; meticulous wound care at the initial encounter; and decisions regarding primary closure, the provision of prophylactic antibiotics for wounds at high risk for infection, and prophylaxis for tetanus and rabies as indicated.
The clinical manifestations, wound care, and initial management of animal and human bites in children and adults will be discussed here. The microbiology and infectious disease aspects of human, cat, and dog bites is covered in greater detail separately. (See "Soft tissue infections due to dog and cat bites" and "Soft tissue infections due to human bites".)
Animal bites are common worldwide and result in significant morbidity and, in low- and middle-income countries, a significant source of transmission of rabies . In the United States, there is an annual incidence of two to five million occurrences which account for about 1 percent of all visits to emergency departments [2-6]. More than one million victims of bites seek medical attention; medical costs for dog bites alone may be as much as USD $1 billion per year [7-9]. The vast majority of mammalian bites are inflicted by dogs (60 to 90 percent), with the remainder caused by cats (5 to 20 percent), rodents (2 to 3 percent), humans (2 to 3 percent), and rarely, other animals.
Approximately 10 percent of bite wounds presenting for medical attention require suturing and follow-up care, and 1 to 2 percent result in hospitalization [4,10-12]. Animal bites cause 20 to 35 deaths annually in the United States, primarily among infants and small children . Extensive morbidity, including disability and cosmetic damage, can also result from infection.
Epidemiology differs between dog and cat bites:
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- CLINICAL MANIFESTATIONS
- Dog bites
- Cat bites
- Human bites
- - Pediatric wounds
- - Clenched fist injury
- Infected wound
- ANCILLARY STUDIES
- Laboratory studies
- Wound culture
- Plain radiographs and ultrasound
- Head computed tomography
- INITIAL MANAGEMENT
- Wound preparation
- - Puncture wounds
- Primary closure
- - Risk of infection
- - Delayed primary closure
- - Surgical consultation
- Antibiotic prophylaxis
- Tetanus and rabies prophylaxis
- Viral prophylaxis after human bites
- INFECTED BITES
- UNUSUAL ANIMAL BITES
- FOLLOW-UP CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Wound assessment
- Wound management
- Antibiotic therapy
- Virus transmission after human bite