Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T05:18:18.214Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 May 2015

Roland C. Merchant ,
Christopher P. Zabbo ,
Kenneth H. Mayer  and
Bruce M. Becker
Roland C. Merchant*
Affiliation:
Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI Department of Community Health, Warren Alpert Medical School, Brown University, Providence, RI
Christopher P. Zabbo
Affiliation:
Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
Kenneth H. Mayer
Affiliation:
Department of Community Health, Warren Alpert Medical School, Brown University, Providence, RI Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI
Bruce M. Becker
Affiliation:
Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI Department of Community Health, Warren Alpert Medical School, Brown University, Providence, RI
*
Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy St., Claverick Building, Providence RI 02903; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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 closed-fist 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, 1.74–15.87) 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.

Keywords

human bitesprophylaxisantibioticsemergency medicinewound infection
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 6 , November 2007 , pp. 441 - 448
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Weber, EJ. Mammalian bites. In: Marx, J, editor. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia (PA): Elsevier; 2006. p. 882–92.Google Scholar
2.Schwab, RA, Powers, RD. Puncture wounds and mammalian bites. In: Tintinalli, JE, ed. Tintinalli’s emergency medicine: a comprehensive study guide. 6th ed. New York (NY): McGraw-Hill; 2004. p. 324–8.Google Scholar
3.Baddour, LM. Soft tissue infections due to human bites: up to date; 2006. Available: www.uptodate.com.Google Scholar
4.Wolfson, AB, ed. Harwood-Nuss’ clinical practice of emergency medicine. 4th ed. Philadelphia (PA): Lippincott Williams and Wilkins; 2005. p. 1644–7.Google Scholar
5.Martin, LT. Human bites. Guidelines for prompt evaluation and treatment. Postgrad Med 1987;81:221–4.CrossRefGoogle ScholarPubMed
6.Douglas, LG. Bite wounds. Am Fam Physician 1975;11:93–9.Google ScholarPubMed
7.Kelleher, AT, Gordon, SM. Management of bite wounds and infection in primary care. Cleve Clin J Med 1997;64:137–41.Google Scholar
8.Bunzli, WF, Wright, DH, Hoang, AT, et al. Current management of human bites. Pharmacotherapy 1998;18:227–34.CrossRefGoogle ScholarPubMed
9.Demetriades, D. Human and animal bites. S Afr J Surg 1989;27:185–7.Google ScholarPubMed
10.Griego, RD, Rosen, T, Orengo, IF, et al. Dog, cat, and human bites: a review. J Am Acad Dermatol 1995;33:1019–29.CrossRefGoogle Scholar
11.Goldstein, EJ. Bite wounds and infection. Clin Infect Dis 1992;14:633–8.CrossRefGoogle ScholarPubMed
12.Medeiros, I, Saconato, H. Antibiotic prophylaxis for mammlian bites. Cochrane Database Syst Rev 2001;CD001738.CrossRefGoogle Scholar
13.Broder, J, Jerrard, D, Olshaker, J, et al. Low risk of infection in selected human bites treated without antibiotics. Am J Emerg Med 2004;22:10–3.Google Scholar
14.Gilbert, DN, Moellering, RC, Eliopoulos, G, et al., editors. The Sanford guide to antimicrobial therapy, 36th edition. Sperryville, (VA): Antimicrobial therapy; 2006.Google Scholar
15.Callaham, M. Controversies in antibiotic choices for bite wounds. Ann Emerg Med 1988;17:1321–30.Google Scholar
16.Morgan, M. Hospital management of animal and human bites. J Hosp Infect 2005;61:1–10.Google Scholar
17.Talan, DA, Abrahamian, FM, Moran, GJ, et al. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis 2003;37:1481–9.CrossRefGoogle ScholarPubMed