Mammalian Bite Wounds in Children: Evidence-Based Management in the Emergency Department - Trauma EXTRA Supplement (Trauma CME and Pharmacology CME) -

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Publication Date: September 2023 (Volume 20, Supplement 09)

CME Credits: 4 AMA PRA Category 1 Credits™ and 4 AOA Category 2-B CME credits. CME expires 09/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma and .25 Pharmacology credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Mammalian bites in children carry risk for infection, adverse cosmetic outcomes, and emotional distress. Emergency clinicians must carefully assess bite wounds and consider any risk factors for serious infection or other complications in order to make appropriate treatment decisions. This review provides evidence-based recommendations for the evaluation and treatment of mammalian bite wounds in children in the emergency department, including guidelines for empiric antibiotic therapy, wound management, and prophylaxis for infectious disease and bloodborne pathogens. The unique considerations in the management of human bite wounds are also discussed.

Case Presentations

A 15-year-old boy arrives in the ED with his mother for treatment of animal bites on his hands and leg…

• The boy was carrying the family cat into the house when it became frightened by an unleashed dog. The cat bit the boy on the left hand before running into the bushes. The dog ran after the cat and the boy followed them. As the patient retrieved his cat, the dog bit him on the right calf.
• The dog’s owner, an unhoused man who was often in the neighborhood, was nearby. The patient confronted the man right after being bitten by the dog; during this confrontation, the boy punched the man in the face and sustained a bite wound to the third MCP joint on his right hand.
• The patient’s mother reports that the cat is healthy and up to date on vaccinations. The histories of the dog and the dog’s owner, however, are unknown.
• On examination, you determine that the cat and dog bites are superficial and require only exploration and irrigation. A small, open wound without any bleeding is visible on the patient’s right third MCP joint, but the finger’s range of motion is significantly limited by pain.
• The mother requests “some antibiotics and a tetanus shot.”
• You order analgesics and wonder whether the patient needs antibiotic prophylaxis, viral prophylaxis, or both…

A 22-month-old girl with bites on each arm is brought to the ED by her father…

• The father reports that the toddler was playing with the family’s new kitten, which became agitated and bit the toddler on the left forearm.
• Following the bite, the patient ran across the room toward her parents but tripped on the carpet and fell. As she landed, she accidentally bit herself on her right forearm.
• The patient is tearful and does not want to allow you or the nurse to examine the bites. She is keeping both arms behind her back.
• You wonder how you’re going to examine these bites on a stubborn toddler, and how each wound should be treated…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.