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Use of statewide emergency department surveillance data to assess incidence of animal bite injuries among humans in North Carolina

Sarah K. Rhea DVM, MPH, PhD1,2, David J. Weber MD, MPH3,4, Charles Poole MPH, ScD5, Anna E. Waller ScD6, Amy I. Ising MSIS7, and Carl Williams DVM, MA8
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  • 1 Department of Epidemiology, Gillings School of Global Public Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27599.
  • | 2 Department of Emergency Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599.
  • | 3 Department of Epidemiology, Gillings School of Global Public Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27599.
  • | 4 Department of Medicine and Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC 27599.
  • | 5 Department of Epidemiology, Gillings School of Global Public Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27599.
  • | 6 Department of Emergency Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599.
  • | 7 Department of Emergency Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599.
  • | 8 Department of North Carolina Division of Public Health, North Carolina Department of Health and Human Services, 225 N McDowell St, Raleigh, NC 27699.

Abstract

Objective—To determine incidence of animal bite injuries among humans in North Carolina by use of statewide emergency department visit data; to evaluate incidence rates on the basis of age, sex, urbanicity, biting species, and month for selected species; and to characterize bite-related emergency department visits.

Design—Retrospective cohort and cross-sectional study.

Sample—Records of 38,971 incident animal bite–related emergency department visits in North Carolina from 2008 to 2010.

Procedures—Emergency department visits were selected for inclusion by means of external-cause-of-injury codes assigned with an international coding system and keyword searches of chief complaint and triage notes. Rates were calculated with denominators obtained from census data. Cross-sectional analysis of incident emergency department visits was performed.

Results—By the age of 10, a child in North Carolina had a 1 in 50 risk of dog bite injury requiring an emergency department visit. Incidence rates for dog bites were highest for children ≤ 14 years of age, whereas the incidence rate for cat bites and scratches was highest among individuals > 79 years of age. Lifetime risk of cat bite or scratch injury requiring an emergency department visit was 1 in 60 for the population studied. Rabies postexposure prophylaxis was administered during 1,664 of 38,971 (4.3%) incident visits.

Conclusions and Clinical Relevance—Emergency department visit surveillance data were used to monitor species-specific bite incidence statewide and in various subpopulations. Emergency department surveillance data may be particularly useful to public health veterinarians. Results may inform and renew interest in targeted animal bite prevention efforts.

Abstract

Objective—To determine incidence of animal bite injuries among humans in North Carolina by use of statewide emergency department visit data; to evaluate incidence rates on the basis of age, sex, urbanicity, biting species, and month for selected species; and to characterize bite-related emergency department visits.

Design—Retrospective cohort and cross-sectional study.

Sample—Records of 38,971 incident animal bite–related emergency department visits in North Carolina from 2008 to 2010.

Procedures—Emergency department visits were selected for inclusion by means of external-cause-of-injury codes assigned with an international coding system and keyword searches of chief complaint and triage notes. Rates were calculated with denominators obtained from census data. Cross-sectional analysis of incident emergency department visits was performed.

Results—By the age of 10, a child in North Carolina had a 1 in 50 risk of dog bite injury requiring an emergency department visit. Incidence rates for dog bites were highest for children ≤ 14 years of age, whereas the incidence rate for cat bites and scratches was highest among individuals > 79 years of age. Lifetime risk of cat bite or scratch injury requiring an emergency department visit was 1 in 60 for the population studied. Rabies postexposure prophylaxis was administered during 1,664 of 38,971 (4.3%) incident visits.

Conclusions and Clinical Relevance—Emergency department visit surveillance data were used to monitor species-specific bite incidence statewide and in various subpopulations. Emergency department surveillance data may be particularly useful to public health veterinarians. Results may inform and renew interest in targeted animal bite prevention efforts.

Contributor Notes

This manuscript represents a portion of the dissertation submitted by Dr. Rhea to the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, as partial fulfillment of the requirements for a Doctor of Philosophy degree.

The authors thank Drs. Charles Cairns and Steve Meshnick for discussion of the study design and manuscript, Dr. Marilyn Goss Haskell for assistance with the North Carolina Disease Event Tracking and Epidemiologic Collection Tool animal bite report development, and Clifton Barnett for technical assistance.

Address correspondence to Dr. Rhea (sarah.rhea@dhhs.nc.gov).