History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors for animal bites include age <14 years and having a pet. Risk factors for severe infection include previous medical procedures or underlying medical conditions.
circumstances of animal bite
Useful for determining rabies risk and for public health reporting.[18]
Information about the type of animal, domestic or feral status, circumstance of injury, current location, ownership, and vaccination status is essential.[10] The likelihood of capturing the animal for quarantine should be established; quarantine allows for the animal to be assessed for the risk of rabies.
wound description
Precise location and dimensions should be recorded. Full documentation of the size and depth of the wound is important, as well as the proximity to bone and neurovascular structures. Neurovascular functional assessment and a check for avulsed tissue are also essential.
Photographs are sometimes helpful. Given the circumstance of the injury (i.e., suspicion of crime, violence, or potential litigation), forensic documentation may be necessary.
erythema
A sign of superficial infection that, when present, should elicit evaluation and documentation of involvement of deeper structures.
induration
A sign of superficial infection that, when present, should elicit evaluation and documentation of involvement of deeper structures.
fluctuance
A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.
purulent drainage
A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.
regional adenopathy
A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.
necrotic tissue
A sign of superficial infection, that, when present, should elicit evaluation and documentation of involvement of deeper structures.
uncommon
vital signs unstable
Vital signs may be unstable in the setting of severe trauma and/or sepsis.
Risk factors
strong
age <14 years
Children have the highest incidence of dog bites treated in accident and emergency departments, with admissions peaking in 5 to 9 year olds.[2][25] In one US accident and emergency department between 2013 and 2018, children 1 to 5 years old were most frequently bitten by dogs (53%), and the risk for dog bite injury decreased with aged up to 14 years.[26] Some factors may encourage a dog to act aggressively towards a child, including small size and play activity. In addition, children may lack judgment about how to interact safely with dogs, and are less likely to be able to fend off an attack.[27]
pet ownership
high-risk groups (for rabies infection)
Includes veterinarians and their staff, animal handlers, workers in rabies laboratories, wildlife personnel, cave explorers (spelunkers), hikers, and field military or non-governmental organisation personnel in rabies-endemic countries. Also includes international travellers likely to come into contact with animals in areas where rabies is enzootic (and access to medical care may be limited), and children living in, or visiting, rabies-affected areas. Individuals in high-risk groups are eligible for rabies pre-exposure prophylaxis.[18][28][29]
weak
previous medical procedures (increased risk of infection if bitten)
underlying medical conditions (increased risk of infection if bitten)
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