Domestic animal bites to hand are common and costly

[Guest guest]

Rheumawire

Mar 15, 2004

Domestic animal bites to hand are common and costly

San Francisco, CA - Domestic animal bites to the hand are highly common

and can cause significant morbidity, including open fractures and

osteomyelitis, according to research presented at the 71st annual

meeting of the American Academy of Orthopaedic Surgeons [1].

The cost of care, too, can be prohibitively high, the study showed.

In the study of 90 cases of domestic animal bites to the hand, 56% of

patients required hospitalization and 23% suffered permanent impairment,

including loss of a fingertip, loss of joint motion, or major sensory

impairments. Injuries include minor wounds, open fractures, persistent

deep infection including osteomyeltis, nerve laceration, cuts and tendon

lacerations, or tissue loss.

About 42% of patients incurred costs of $1800, which included a visit to

the emergency room, 1 dose of antibiotics, 3 office visits, and oral

antibiotics. In more complicated bites, 22% incurred costs exceeding $17

000 and 9% had bills in excess of $75 000.

Dog bites account for 368 245 emergency visits each year, according to

the federal Centers for Disease Control and Prevention in Atlanta, GA.

Cat scratches, too, can cause significant morbidity.

Patients should " present to the doctor right away after a bite, " lead

researcher Dr Leon Benson (Northwestern University, Chicago, IL) tells

rheumawire. " Within the medical environment, starting antibiotics right

away and arranging earlier follow-up even if the injury looks minor [are

crucial]. "

There is a general sense in the public that a bite is " no big deal, but

it can turn into one, " he says. " If you present when it's not a big

deal, you will have a better chance of keeping it not a big deal, " he

says.

Often victims will not want to present right away because most of the

time it's their own animal and the animal did not do anything wrong, he

says. Often the bite occurs when someone is attempting to separate 2

fighting animals or helping a hurt animal, the study found.

" The owners may also have an element of embarrassment and may be worried

about what will happen to the dog if they report a bite, " he says.

In the research presented, 39% of bite victims were the animals' owners

and more than 50% were bitten by an animal that they knew.

If a bite cuts through the tendon or nerve and needs to be repaired,

doctors can't repair it if the wound may become or already be infected,

he says. First, doctors must wash out the wound, wait until it heals and

is clearly not infected, and then go back and repair, Benson explains.

If a bone infection develops, a 6-week course of antibiotics must be

given intravenously, he says. This can cost up to $75 000 to $80 000

even if it's done via pump on an outpatient basis.

" Plus, you can be left with enough stiffness and problems associated

with not using the hand that occupational therapy is needed, " he says.

" One things leads to another. "

Now Benson and colleagues have recruited another 100 patients to further

assess the morbidity and medical costs of people bit by domestic

animals.

Mann

Source

1. Benson LS, Schiff A, CS, et al. Presentation: Hand injuries

due to domestic animal bites. San Francisco: American Academy of

Orthopaedic Surgeons: 2004 meeting; March 10-14, 2004:P455.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org