SAN DIEGO – Animal-related trauma is a significant cause of morbidity and occasional mortality, results from a 10-year, single-center study showed.
Nearly half of the injuries required operative intervention and injury patterns varied according to gender, race, and the type of animal involved, Dr. Jason W. Nielsen said at the annual meeting of the American Academy of Pediatrics.
Dr. Jason W. Neilsen
In an effort to investigate pediatric animal-related trauma to compare injury patterns and guide prevention efforts, Dr. Nielsen and his associates performed a retrospective analysis of patients aged 18 years and younger who were admitted to Nationwide Children’s Hospital, Columbus, Ohio, with ICD-9 external cause of injury codes for animal trauma from 2004 to 2013. Of the 14,605 trauma admissions during that decade, 565 (3.9%) were animal related.
Children admitted with other forms of trauma (the baseline group) were similar in age to those admitted with animal-related trauma (a mean of 7.8 years vs. 7.2 years, respectively). However, males predominated in the baseline trauma group (62.8% vs. 37.2% female), while the genders were more balanced in the animal-related trauma group (48.7% male vs. 51.3% female). Racial differences appear to be amplified in the animal trauma group (80.9% white, 6.9% African American, and 12.2% other vs. 72.9% white, 16.3% African American, and 18.8% other in the baseline group). There were two deaths over the 10-year period (0.35%). One was dog-related involving an infant. The other involved an unhelmeted rider on a horse who suffered a devastating head injury.
The mean Injury Severity Score among patients in the animal-related trauma group was 3.6 and their mean hospital stay was 1.98 days, yet nearly half (48.5%) required operations. After presenting to the emergency department, two-thirds (66%) went to the floor, 28.5% went to the operating room, and just 5.5% went to the pediatric intensive care unit.
Most injuries involved dogs (340 cases or 60%) and horses (155 cases or 27%). Dog injuries were more common among boys, compared with girls (57.2% vs. 42.8%, respectively; P< .001), and the most common sites of injury were the face (52%) and the extremities (31%), with 59.7% of cases requiring an operative procedure. The dog breed was reported in 65.3% of cases, of which pit bulls were the majority (25.2%), followed by Labradors (10.8%), German shepherds (9.5%), and Rottweilers (6.3%). More than half of injuries (60%) came from nonfamily dogs, usually when the dog was in the care of a family member or a friend.
Trauma from horse-related injuries occurred in girls more often than in boys (69% vs. 31%; P< .001), and only 26% of those who sustained injuries were wearing a helmet. “Male patients with horse-related injuries tended to be younger, have higher injury severity scores, and also were more likely to be kicked,” added Dr. Nielsen, who is a surgical critical care resident at Nationwide Children’s Hospital. “Females were older (an average of 10.6 years), with falls being the most common injury [in about 60% of cases].” The most common sites of injury were the head and face (35%), the extremities (29%), and the abdomen (17%). “Horse injuries were also associated with fractures and had high rates of lacerations, abrasions, and a significant proportion of traumatic brain injuries,” he said.
Dr. Nielsen concluded his presentation by noting that patterns of injury from animal-related trauma “are based on patient gender and the animal species involved. In general, use of protective equipment such as helmets was low. We found that identification of high-risk situations and populations serve as valuable information for future prevention efforts, as well as for parent and patient education.”
Dr. Nielsen reported having no financial disclosures.
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