Dog and Cat Bites to the Hand: Treatment and Cost Assessment

doi:10.1016/j.jhsa.2005.12.011

The Journal of Hand Surgery

Volume 31, Issue 3, March 2006, Pages 468-473

https://doi.org/10.1016/j.jhsa.2005.12.011 Get rights and content

Purpose

To assess the demographic patterns, clinical morbidity, and treatment costs associated with domestic animal bites to the hand.

Methods

A retrospective review was performed on 111 patients who suffered either a dog or cat bite to the hand. Demographic data were collected for both the patient and the animal involved.

Results

The patient population had suffered 71 dog bites and 40 cat bites. Two scenarios were identified that increased the likelihood of a bite: (1) attempting to separate fighting animals and (2) attempting to aid an injured animal. More than half of the victims (61 of 111) were bitten by an animal with which they were familiar. Bite injuries ranged from relatively minor wounds to major injuries that included open fractures, persistent deep infection including osteomyelitis, nerve laceration, tendon laceration, or tissue loss. Approximately two thirds of patients required hospital admission at least for intravenous antibiotics. Approximately one third of animal bite victims required at least 1 surgical procedure. Thirteen patients required long-term intravenous antibiotics and/or multiple surgeries and incurred medical expenses in excess of $77,000.

Conclusions

Domestic animal bites to the hand are common injuries that can produce considerable morbidity. Stray animals did not account for the majority of incidents. Bite prevention strategies should focus on careful handling of animals that are fighting or injured. Animal bite wounds often require intravenous antibiotics and hospitalization and the cost of care for deep infections can be enormous. Our patient population was selected from a small geographic area over a relatively short collection period, suggesting that domestic animal bite injuries may represent a major public health issue.

Type of study/level of evidence

Prognostic, Level IV.

Section snippets

Materials and Methods

The charts of 111 patients who had been treated for a domestic dog bite or cat bite by 1 of 3 hand surgeons from the same practice from 1997 to 2003 were reviewed retrospectively. There were 38 male and 73 female patients.

Each patient chart was reviewed for patient age at the time of the injury and the circumstances surrounding the event including breed of animal (if known), how the bite occurred, and whether the animal was known to the victim. The treatment course also was documented. This

Results

Of the 111 charts reviewed 40 were from patients with cat bites and 71 were from patients with dog bites. Twenty dog bite victims were male and 51 were female. Thirteen of the cat bite victims were male and 27 were female. The age range of the dog bite victims was 9 to 100 years (mean, 50.0 y). The age range of the cat bite victims was 15 to 80 years (mean, 48.7 y).

Eleven of the patients reported the following breeds of dogs involved in the attack: German shepherd (n = 2), Rottweiler (n = 3),

Discussion

Domestic animal bites represent a noteworthy public health issue in the United States. As dog and cat ownership increases this problem will continue to escalate. Animal bites are responsible for 0.5% to 0.65% of emergency room visits.¹³ The incidence of domestic animal bites is difficult to determine because not all bites are reported. Assuming a 50% reporting rate it is estimated that there are 3.5 million to 4.7 million domestic animal bites every year in the United States.1, 4, 14

Analysis of

References (17)

E.J. Goldstein
Management of human and animal bite wounds
J Am Acad Dermatol
(1989)
K.W. Kizer
Epidemiologic and clinical aspects of animal bite injuries
J Am Coll Emerg Phys
(1979)
R.D. Griego et al.
Dog, cat, and human bitesa review
J Am Acad Dermatol
(1995)
R.V. Aghababian et al.
Mammalian bite wounds
Ann Emerg Med
(1980)
R.M. Elenbaas et al.
Evaluation of prophylactic oxacillin in cat bite wounds
Ann Emerg Med
(1984)
D.J. Dire
Emergency management of dog and cat bite wounds
Emerg Med Clin North Am
(1992)
M.L. Callaham
Treatment of common dog bitesinfection risk factors
J Am Coll Emerg Phys
(1978)
J.J. Sacks et al.
Dog biteshow big a problem?
Inj Prev
(1996)

There are more references available in the full text version of this article.

Cited by (91)

Medico-legal implications of dog bite injuries: A systematic review
2023, Forensic Science International
Dog bites pose a significant global public health issue and are the most common type of injury caused by animals. While most dog bites result in minor harm, they can also lead to severe or even fatal consequences. In cases involving serious injury or death, forensic pathologists investigate various aspects, including the crime scene, the injuries sustained by the victim, and the characteristics of the dog suspected to have caused the bite. The aim of this study is to provide a systematic review of the literature on the medical-legal implications of dog bites in forensic practice, in order to recognize the dog bite victim features, the injuries and their consequences related to, and to identify the offending dogs. The literature search was performed using PubMed, Scopus and Web of Science from January 1980 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about dog bites to humans. A total of 116 studies met the inclusion criteria and were included in the review and they were organized and discussed by issue of interest (biting dog features, dog bite victim features, anatomical distribution of dog bites, injuries related to dog bites, cause of death, bite features, dog identification and post-mortem dog depredation). The findings of this systematic review highlight the importance of bite mark analysis in reconstructing the events leading to the attack and identifying the dog responsible. In medical forensic evaluations of dog bite cases, a multidisciplinary approach is crucial. This approach involves thorough analysis of the crime scene, identification of risk factors, examination of dog characteristics, and assessment of the victim's injuries. By combining expertise from both human and veterinary forensic fields, a comprehensive understanding can be achieved in dog bite cases.
Understanding feline feelings: An investigation of cat owners’ perceptions of problematic cat behaviors
2023, Applied Animal Behaviour Science
Undesirable feline behaviors can detrimentally effects on the human-cat relationship, owner satisfaction, and animal welfare. This study explored cat owners’ perceptions of cat behavior and identified specific behaviors that owners found problematic. Cat owners voluntarily completed an online survey about their cat’s behavior (Fe-BARQ) between January 2016 and December 2022 (n = 4941). We examined owners’ perceptions of their cats’ behavior problems on an ordinal scale (no problems, minor problems, moderate to serious problems) relative to cat age, sex, neuter status, declaw status, outdoor access, Fe-BARQ subscales and miscellaneous items using Pearson Chi Square tests, Kruskal-Wallis tests, and mixed effects ordinal logistic regression models. Almost all Fe-BARQ subscales and miscellaneous items were associated with owners’ perceptions of their cats’ behavioral problems in the univariate analysis, excluding predatory behavior, prey interest, vocalizations, location preferences for resting, and lying on items when in use. Multivariate analysis showed owners were more likely to perceive their cat’s behavior as problematic if the cat exhibited owner-directed aggression (OR 2.31, 95% CI 2.01–2.65), familiar cat aggression (OR 1.75, 95% CI 1.55–1.96), urine spraying (OR 1.75, 95% CI 1.53–2.00), crepuscular activity (OR 1.38, 95% CI 1.24–1.53), fear of novelty (OR 1.14, 95% CI 1.05–1.24) or escaping behavior (OR 1.15, 95% CI 1.07–1.23). Cats who readily adapted to change (OR 0.81, 95% CI 0.74–0.89), slept on appliances/elevated spaces (OR 0.88, 95% CI 0.79–0.98), or kneaded (OR 0.90, 95% CI 0.85–0.96) were less likely to be perceived as problematic. Our results suggest cat owners were more likely to view their cat’s behavior as problematic if the behavior directly affected their lifestyle or environment, such as aggression, house soiling or activity during the night, while other behaviors, such as separation-related behavior, excessive self-grooming, and predatory behavior, did not influence owners’ perceptions of cat behavior within the multivariate models. Further education may help cat owners to recognize the importance of these other behaviors as indicators of animal welfare and understand the wider impacts of cat behavior, including through predation on wildlife.
Spatial patterns and risk of aggression of dogs and cats in a central township of Mexico City
2023, Acta Tropica
Dog and cat aggressions are public health concerns associated with rabies transmission to the human population. The social and environmental conditions of marginalized and urban areas stand a risk due to people's contact with dogs. This study aimed to identify spatial patterns related to dog and cat aggression in a densely populated area in the center of Mexico City, analyzing the risk of aggression at the census unit level in the 2018–2020 triennium. This cross-sectional study was carried out in Coyoacán, in the south-central area of Mexico City's urbanized region. The total number of cases (n = 1,078) was obtained from monthly records of aggressions by dogs and cats, from the Control and Prevention of Zoonoses-Rabies Program of the Coyoacán Sanitary Jurisdiction. The information collected was related to the victims and the aggressors. Associations between the occurrence of bites and the characteristics of the victim were evaluated using a geographic information system (GIS), as well as the spatio-temporal distribution of the aggressions to the census unit level. Out of 1,078 cases reported, 977 (90.6%) were caused by dogs and 101 (9.4%) by cats, 55.1% (n = 587) occurred within the same household, and 13.7% (n = 148) were categorized as severe injuries. Adult men were the most affected group. Attacks on the street had a higher risk of resulting in a severe injury, compared to those that occurred at home (OR 1.63, 95CI 1.15 - 2.31, p <0.006). According to the standardized rate of the triennium, the values ranged between 54.1 and 619 aggressions per 100,000 inhabitants, and summer was the season with a higher probability of occurrence. These results provide a basis for the analytical investigation of the spatial patterns of dog and cat aggression, highlighting the need to implement efficient surveillance systems and public health strategies.
Candida parapsilosis osteomyelitis following dog bite: a case report and review of the literature.
2022, Journal of Medical Mycology
Citation Excerpt :
The upper extremity is frequently affected, and hand injuries occur in 30% of cases [6]. The superficial location of nerves, blood vessels, tendons, and small joints in the wrist and hand makes these structures vulnerable to injury [6,7]. Moreover, bite wounds to the hand have been shown to be more susceptible to infection than those in other anatomical regions, in part owing to the presence of multiple closed spaces including tendons sheaths and fibrous septa in the fingertip and thenar and midpalmar spaces [7].
Candida osteomyelitis is uncommon, especially after dog bites. We describe a case of a 63-year-old man without significant comorbidities presenting progressing swelling of the distal interphalangeal joint (DIJ) of right index finger following a dog bite. Despite empiric antibiotic therapy and local medications, there were no clinical signs of improvement. Clinical examination revealed fistula with purulent drainage on the volar region. Even though laboratory data showed inflammatory markers on range, magnetic resonance imaging (MRI) demonstrated signs of osteomyelitis. The patient was taken to exploration and debridement of the bite wound. Culture of the bone biopsy showed growth of Candida parapsilosis. Therefore, the patient was diagnosed with isolated fungal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective and all symptoms were resolved in 8 weeks after the surgery. There were no signs of recurrence after 20 months of follow-up. The patient had no cosmetic abnormalities or sequelae. Concurrently with the description of the case report a review of the literature was provided.
According to the authors, there are three main etiopathogenesis for this infection. The first pathogenic mechanism is direct inoculation into the deep tissues through the dog bite. The second hypothesis is direct translocation of the pathogen from the skin to the deep tissue and to the bone. The last mode of transmission is hematogenous dissemination. Fungal osteomyelitis are really rare conditions, especially after dog bites, but nevertheless it should be considered as a possible diagnosis when there is no response to antibiotics.
Biting the hand that feeds you: Management of human and animal bites
2022, Injury
Bites from animal and humans represent a very small proportion of all the patients presenting to emergency departments, However, they require prompt medical and surgical intervention in order to minimise the risk of infection, that may lead to limb and life-threatening complications. In this review article we synthesise the existing literature for treatment of human and animal bites and offer practical considerations when managing bite injuries.
The burden of bites and stings management: Experience of an academic hospital in the Kingdom of Saudi Arabia
2020, Saudi Pharmaceutical Journal
The main aim of this study is to estimate the economic burden and prevalence of bites and stings injuries in Saudi Arabia.
A retrospective, cross-sectional study was conducted at King Saud University Medical City (KSUMC) for all bites and stings cases presented to the Emergency Department (ED) between the period June 2015 and May 2019.
A total of 1328 bites and stings cases were treated in the ED at KSUMC. There were 886 insect bites and stings cases, 376 animal bites, 22 human bites, 34 scorpion stings, and ten snakebites. Most cases were reported in April - June. Females account for 62% of the reported cases, and the mean age was 24 years old. The total management cost of bite and sting cases during the study period was 3.4 million Saudi Riyal (SR). The spending cost of the management of animal bites was the highest as it cost 1,681,920.76 SR, followed by insect's management costing 1,228,623.68 SR.
Bites and stings have a considerable health care burden on our society. Although the vast majority of the cases were not associated with a severe life-threatening condition, many were visit ED and associated with high medical costs. Increased awareness of the hazards of animal-related injuries, especially during spring and summer, where most cases take place may lower its incidence and decrease EDs visits.

View all citing articles on Scopus

: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

View full text

Animal biteDog and Cat Bites to the Hand: Treatment and Cost Assessment

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

J Am Acad Dermatol

J Am Coll Emerg Phys

J Am Acad Dermatol

Ann Emerg Med

Ann Emerg Med

Emerg Med Clin North Am

J Am Coll Emerg Phys

Dog biteshow big a problem?

Inj Prev

Animal bite
Dog and Cat Bites to the Hand: Treatment and Cost Assessment