- Bite wounds account for approximately 1% of emergency department (ED) visits each year in the United States.
- The majority of bite wounds occur in children.
- It is important to obtain a thorough history and perform a complete examination of bite injuries.
- Wound infection is the greatest potential complication of bite wounds.
- Thorough wound cleaning including adequate irrigation is the best method to prevent wound infection.
- Antibiotic treatment should be directed at the most likely infective agent.
- Pasteurella species are a common infective agent for both dog and cat bite wounds.
- Eikenella corrodens is a common infective agent in human bite wounds.
- Rabies and tetanus prophylaxis should be considered in animal bite injuries.
- Bite wounds treated on an outpatient basis should be reevaluated within 48 hours.
An estimated two million bite wounds are reported each year in the United States. The actual number is undoubtedly higher. Bite wounds account for approximately 1% of all ED visits and result in numerous hospitalizations. More than half of these injuries occur in children. Dog bites account for the majority, followed by cat bites, with the remainder divided among a variety of animal species (Fig. 133–1). Boys tend to be bitten more often than girls and bite injuries are clustered in the summer months. Because of the frequency of these injuries and the potential morbidity associated with them, it is important that the physician working in the ED be familiar with their management. The general approach to human and common animal bites is outlined in Figure 133–2.1
Distribution of bites by type of animal.
General approach to human and common animal bite wounds.
Proper management of bite wounds begins with a thorough history and physical examination. It is important to obtain a complete history of the injury, including what type of animal caused the wound and the age of the wound. One must also elicit host factors that may affect wound healing. Especially important is a history of diabetes, peripheral vascular disease, chronic use of glucocorticoids, or other immunocompromised states.2
The physical examination should include a full examination and exploration of the wound. The type of wound (laceration, crush, or puncture) and the extent of involvement of deep structures must be determined. If the wound occurs over a joint, the joint should be examined through the full range of motion. When appropriate, radiographs should be obtained to look for fractures, foreign bodies, and air in the joint or soft tissues. One should keep in mind that the canine jaw can generate forces up to 450 pounds per square inch. In children, this force may be sufficient to penetrate the cranium. Computed tomography of the head should be considered in bite wounds to the scalp. ...