Injuries caused by animals

The nature and consequences of camel-related injuries: A scoping review with special reference to Arab Middle Eastern countries

Animal-related injuries are a substantial but under-reported, emerging public health problem contributing considerably to worldwide morbidity and death. Understanding the behavior of big animals may help in injury prevention. Camels are large long-neck ungulates of the genus Camelus that have been domesticated for millennia as a mode of transportation, race, and food source. Camel-related injuries are not well studied when compared with other animals' injuries. Camels can occasionally be very hostile to humans, inflicting serious injuries. These injuries can be caused by camel bites, falls from their backs, kicks, or collisions with motor vehicles. The relative magnitude of each mechanism has never been extensively studied in the literature. Furthermore, the incidence of camel-related injuries is not well reported worldwide. Camels remain a potential cause of serious injuries and a public health problem for some countries in the Middle East. There are gaps in the incidence, risk factors and mechanism, distribution of camel-related injuries. We aimed to summarize the data and draw conclusions pertaining not just to the most common mechanism of injury but to demographics, incidence, severity, and appropriate methods of prevention of camel-related injuries. This scoping review findings will help for better understanding of the nature and consequences of camel-related injuries, and to improve the existing preventive and management strategies.

Cattle-Related Trauma: A 5-Year Retrospective Review in a Adult Major Trauma Center

Introduction:

Bovine injuries are a common and significant cause of trauma, often requiring admission and operative treatment. We review all bovine-related injuries over 5 years, both emergency and general practitioner (GP) referrals at an adult major trauma center in England.

Methods:

Retrospective evaluation was undertaken using the keywords through radiology referrals and hospital admissions speciality databases. By searching patient notes, demographics were collected as well as the mechanism and the situation of injury; trauma scores were calculated using: injury severity score (ISS) and probability of survival (Ps19). The results were divided into emergency patients and GP referrals.

Results:

Sixty-seven patients were identified retrospectively over 5 years, 44 emergency patients (including 23 major traumas), and 23 GP referrals. Combined (emergency and GP) mean age 52 years old; 67% male; and mean ISS 11. Most common combined mechanism of injury, kicked (n = 23). In emergency patients, trampling injuries were the most common. Eighty-six percent of the trampled patients were major traumas and associated with increased ISS (mean 13). Indirect injuries mainly involved farm gates (92%). Seventy-three percent of bull-related injuries were major traumas and had increased ISS scores (mean 17). Orthopaedics was the most common admitting speciality followed by cardiothoracic and neurosurgery. In emergency patients, fractures were the most common primary injury (n = 20), upper limb followed by spine. In GP, soft-tissue injuries were the most common primary injury. Seventy percent of the emergency referrals required admission and 50% operations. Fracture fixation was the most common operative procedure. Only, one GP referral required an operation. There were significant delays in GP patients presenting. Two patients had a Ps19 score <90. There were two mortalities.

Conclusion:

Cattle-related injuries are a significant cause of severe morbidity and mortality. They are under-reported. Patterns of injury are similar to high-velocity road traffic collisions and bull-related injuries or trampling in particular, should alert the clinician to more significant trauma. Farm gates are a frequent cause of trauma associated with cattle. GP referrals with ongoing symptoms for more than 2 weeks seeking medical advice should alert the clinician to a more serious diagnosis.

Animal Injuries; a Case Series of Bull Induced Injuries in India

Introduction:

Bull injuries are common in India. An injury by a bull is more common in rural and agriculture dependent regions of the country. The incident causing injury by a bull can be sports related or work related. Work related injuries are almost mostly seen in farmers.

Case presentation:

We would like to present six cases of bull injury over a period of three years who reported to our EM. All six patients were admitted. Five out of six patients survived the hospital stay.

Conclusion:

Trauma sustained due to being hit by a large animal should be treated akin to a high velocity trauma and such a patient definitely warrants a period of observation even if the injuries are not life threatening. A high index of suspicion is needed for suspecting occult injuries. Fluid resuscitation and age of the patient are important considerations.

Domestication and large animal interactions: Skeletal trauma in northern Vietnam during the hunter-gatherer Da But period

The aim of this paper is to test the hypothesis that healed traumatic injuries in the pre-Neolithic assemblage of Con Co Ngua, northern Vietnam (c. 6800-6200 cal BP) are consistent with large wild animal interactions prior to their domestication. The core sample included 110 adult (aged ≥ 18 years) individuals, while comparisons are made with an additional six skeletal series from Neolithic through to Iron Age Vietnam, Thailand, and Mongolia. All post cranial skeletal elements were assessed for signs of healed trauma and identified cases were further x-rayed. Crude trauma prevalence (14/110, 12.7%) was not significantly different between males (8/52) and females (5/37) (χ2 = 0.061, p = 0.805). Nor were there significant differences in the prevalence of fractured limbs, although males displayed greater rates of lower limb bone trauma than females. Further, distinct from females, half the injured males suffered vertebral fractures, consistent with high-energy trauma. The first hypothesis is supported, while some support for the sexual divisions of labour was found. The prevalence and pattern of fractured limbs at CCN when compared with other Southeast and East Asian sites is most similar to the agropastoral site of Lamadong, China. The potential for skeletal trauma to assess animal trapping and herding practices prior to domestication in the past is discussed.

A tale of two cities: A comparison of urban and rural trauma in Medieval Denmark

OBJECTIVE

This study explores the differences in frequency and type of trauma found in two Medieval cemeteries in Denmark, as well as the cultural and community implications of those differences.

MATERIALS

We examined 235 skeletons from the cemetery at Tjærby (rural) and 170 skeletons from the cemetery at Randers (urban) for trauma from the Medieval period in Denmark, 1050 to 1536 CE.

METHODS

Trauma was assessed through macroscopic examination and odds ratio and relative risk assessments were run to assess the difference in trauma.

RESULTS

There was no significant difference in the presence of trauma between the rural and urban cemeteries or between males and females. There were some significant differences in relative risk for trauma between the two cemeteries.

CONCLUSIONS

The division and variation in trauma between the two cemeteries is most likely related to differences in economy and occupation.

SIGNIFICANCE

There are relatively few studies that examine the difference in inherent risk of trauma between rural and urban Medieval communities, especially in Denmark. This research also adds to the growing body of literature in paleopathology that uses epidemiology to explore the parallels between patterns of trauma and community lifeways.

LIMITATIONS

The cemeteries are approximately 5 km distance from each other so similarities in the sample could be a result of location.

SUGGESTIONS FOR FURTHER RESEARCH

A wider sample of Medieval cemeteries in Denmark needs be added to this analysis to provide a more complete picture of trauma patterns during this time period.

Cow-related trauma: a 10-year review of injuries admitted to a single institution

INTRODUCTION

Bovine-related injuries to farmers are common in rural communities. Many injuries are significant requiring hospital admission and surgery. We reviewed all cattle-related injuries admitted to a regional trauma centre over 10 years and detail the nature of the injuries.

METHOD

A retrospective review was undertaken, using hospital inpatient coding system (HIPE) to identify patients admitted following cow-related trauma for the last 10 years. From retrieved charts mechanism of injury was identified, demographics recorded and Injury Severity Score (ISS) and Trauma Injury Severity Score (TRISS) calculated based on the injuries sustained.

RESULTS

47 patients were identified, with a median age of 53 years. 4 injuries occurred in children, and 12 in patients over 65 years old. Three-quarters of those injured were male. Kicking was the most common mechanism of injury (n=21), but charge/head-butt injuries and trampling injuries were associated with more serious injury scores. 72% of patients were admitted under Orthopaedics as their primary care team, 25% under General Surgeons, with one patient admitted medically. Mean ISS score was 6.9 (range 1-50). 41 operative interventions were performed on 30 patients during their admission. 6.3% of patients required admission to Intensive Care with a mean length of stay of 12.3 days (range 2-21 days). There was no mortality.

CONCLUSION

Cow-related trauma is a common among farming communities and is a potentially serious mechanism of injury that appears to be under-reported in a hospital context. Bovine-related head-butt and trampling injuries should be considered akin to high-velocity trauma.

Horse-related injuries among agricultural household members: Regional Rural Injury Study II (RRIS-II)

PURPOSE

To determine the incidence, associated consequences, and potential risk factors for horse-related injuries among youth and adults residing in Midwestern agricultural households.

METHODS

Demographic, injury, and exposure data were collected for 1999 and 2001 among randomly selected agricultural households within a 5-state region. A causal model facilitated survey design, data analysis, and interpretation of results; directed acyclic graphs guided multivariate modeling.

FINDINGS

From 7,420 households (84% response of eligible), involving 32,601 persons, 5,045 total injury events were reported; 1,016 were animal-related injuries, of which 215 (21%) were horse-related (rate, 6.7 events per 1,000 persons per year). Seventy-seven percent (77%) required health care; comparing those under age 20 and those 20 and older, 49% and 54%, respectively, lost work time on their operation (28% and 26%, one week or more), as a result of injuries largely associated with horse riding activities (70% and 56%). Multivariate analysis for youths under age 20 indicated: increased risks in North and South Dakota, for >0 hours worked, and for having a history of prior agriculture-related injury; and decreased risks for males. For those 20 and older, increased risks were identified for a prior injury history and less than high school education.

CONCLUSIONS

Horse-related injuries, primarily associated with riding activities, are a significant problem among agricultural communities, and greatly impact their operations.

Injuries and deaths occurring as a result of bull attack

Persons whose occupations are in animal husbandry may be seriously injured or killed while tending to animals. Bulls are among the most dangerous of these animals. In this study, seven deaths and 23 traumatic injury cases caused by bull attacks and treated in the General Surgery and Chest Surgery Department of Selcuk University Meram Medical Faculty Hospital are presented. Of the 30 total cases, 24 were male and 6 were female. The ages of the cases ranged from 33 to 86 years and the average age was 60.3 +/- 12.4 (mean +/- standard deviation). All of the death and injury cases occurred while engaged in the care of bulls. It was also determined that the injuries were in the chest region of five (71.4%) and in the head of two (18.6%) out of seven death cases; and in the abdominal region of 14 (60.9%) and in the chest region of nine (39.1%) out of 23 traumatic injury cases. Of the 14 cases that were in the abdominal region and treated surgically, 11 were perforation of small/large intestines, whereas hemorrhages involving the intestinal mesentery, intraabdominal hemorrhage due to perforation of the abdominal wall, and splenic laceration were determined in one case each. There were one or multiple costal fractures in all nine chest injury cases, flail chest in five cases, and hemothorax, pneumothorax, or hemopneumothorax were determined in six cases. Of the chest injury cases, tube thoracostomy was performed in six whereas the other three cases were discharged from the hospital after supportive care. It was concluded that animals such as bulls might be the cause of serious trauma ending with death for those working in the animal husbandry. For this reason, caution is required while feeding and working with bulls. Risk can be reduced by chutes, gates, restraints, special housing, and confinement facilities. Also, wearing protective helmets would be useful especially for preventing head injuries.

[Surgical therapy for hand infections. Part I]

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and beta-hemolytic group A streptococci. We find Pasteurella canis and P. multocida from cat and dog bite wounds and Eikenella corrodens from human bite wounds. The "fight-bite clenched fist" wound, with penetration of the metacarpophalangeal joint and its high risk of septic arthritis, has always to be suspected when patients present with human bites. The therapy of hand infection is based on three principles: surgical treatment, adequate antimicrobial therapy, and early physiotherapy. Early infectious conditions of the hand, e.g. cellulitis and early paronychia, may be treated without surgery. Antimicrobial treatment must be specific for the pathogen and its resistance to antimicrobial agents. Bite wounds should be treated with beta-lactam antibiotics and beta-lactamase inhibitors. Staphylococci and streptococci can be covered by first and second generation cephalosporins. The increasing resistance of staphylococci to antibiotics has to be taken into account. Infections with anaerobic and gas-producing bacteria are rare but occur predominantly in diabetics and immune-compromised individuals.

[Surgical therapy for hand infections Part 2]

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and ss-haemolytic group A streptococci. But differential diagnosis also includes pyoderma gangrenosum, tumors of the hand, rheumatoid arthritis, and articular gout, as they may mimic hand infections. Infections of the hand can lead to massive tissue damage that needs to be reconstructed. The selection of methods depends on the localization and size of defects and includes primary closure, split- and full-thickness skin grafts, and more complex operations such as local, regional, and distant flaps.

Occupational fatalities due to animal-related events

OBJECTIVE

To better understand the extent of animal-related fatalities in the workplace.

METHODS

This study utilized Census of Fatal Occupational Injuries files from the US Department of Labor for the years 1992-1997 to describe the events surrounding human workplace fatalities associated with animals.

RESULTS

During the 6-year time period, 350 workplace deaths could be associated with an animal-related event. Cattle and horses were the animals primarily involved, and workers in the agricultural industry experienced the majority of events. Many deaths involved transportation events, either direct collision with the animal or highway crashes trying to avoid collision with an animal. Exotic animals, primarily elephants and tigers, were responsible for a few deaths. A small number of workers died of a zoonotic infection.

CONCLUSIONS

We found that approximately 1% of workplace fatalities are associated with an animal-related event. Methods to decrease the frequency of an animal injury are suggested.

Livestock trauma in central Texas: cowboys, ranchers, and dudes

INTRODUCTION

Emergency nurses routinely treat a wide variety of animal-related injuries, yet the trauma literature rarely addresses injuries associated with livestock.

METHODS

The purpose of this retrospective, descriptive study was to examine the incidence, demographics, severity, and other factors associated with trauma related to livestock in persons admitted to one central texas trauma center during a 5-year period. Patients were classified by activity at the time of injury. The following 5 categories were identified: cowboy, rancher, dude, standing near, and unidentified. Groups were further analyzed by the type of animal involved in the injury, mechanism of injury, patient sex and age, body regions injured, indicators of severity, and county in which the injury occurred.

RESULTS

One hundred thirty-six patients met the inclusion criteria. Of these patients, 24% were categorized as cowboys, 18% as ranchers, and 39% as dudes. Six percent were standing near the animal, and activity at the time of injury could not be adequately determined for 13% of patients. Typical demographics, mechanisms of injury, wounds, indicators of severity, and animals were found to be associated with each activity class.

DISCUSSION

Horses were responsible for 75% of the traumas sustained by ranchers and 83% of the traumas sustained by dudes. Bulls were responsible for 94% of the cases involving cowboys. Simply standing near livestock was dangerous for 6% of the sample, including young children. Although helmets and steel-toed boots are currently unpopular, wearing them is a simple and important safety strategy.

Rodeo related large animal injury: is protective head-gear warranted?

To compare rodeo associated large animal injuries to large animal associated trauma from other aetiologies in order to determine whether mandatory protective head-gear during rodeo is warranted. Retrospective analysis related to injury involving large animal admissions between 1 January 1990 and 31 December 1995. The setting is at the University of New Mexico Health Science Center, a level 1 trauma centre. All patients admitted with Injury Severity Scores of 1 or higher following large animal associated injuries. There were 140 admissions for which mechanism of injury was known. Thirty-nine occurred during rodeo competition and 101 occurred during other activities. Bovine associated activities were the aetiology in 34 (87%) of rodeo related injuries while equine related activities were the aetiology in 97 (96%) of non-rodeo related injuries (P<0.001). Rodeo related injuries involved the head and neck in five patients (13%) compared to 42 patients (42%) in non-rodeo activities (P=0.001). Mean Regional Injury Severity Score head and neck was 0.4 for injured rodeo riders and 1.5 for injured non-rodeo riders (P<0.001). Mean admission Glascow Coma Scale was 14.9 for rodeo-injured patients and 13.3 for non-rodeo-injured patients (P<0.001). Total ISS was significantly lower for rodeo injured patients (9.1 vs. 11.7, P=0.03). No rodeo injured patient died as a result of head injury. Mechanism of injury, ISS head, GCS, total ISS, and outcome differ between rodeo and non-rodeo injuries. While routine helmet use during non-rodeo events appears justified, mandatory use of helmets in rodeo events is unwarranted. Orthotics to protect the chest and abdomen are more likely to reduce morbidity and mortality for rodeo participants.

Fracture trauma in a medieval British farming village

Farming is among the three most hazardous occupations in modern society and perhaps also held a similar position during the medieval period. The goal of this study was to determine if there is a significant difference in frequencies and patterns of longbone fracture trauma observed between rural and urban activity bases that distinguish farming as a particularly dangerous occupation during the medieval period. The longbones of 170 individuals excavated from Raunds, a rural medieval British site (10th-12th centuries AD) were examined for fractures and compared to data collected from four contemporary British medieval sites, one rural and three urban. The fracture frequency for the Raunds individuals (19.4%) was significantly different from the urban sites (4.7-5.5%). Female fractures were characterized by injury to the forearm, while the males were predisposed to diverse fracture locations. Clinical research provided a source of documented farm-related trauma from North America and Europe where the crops and animals raised, the manual chores performed, and the equipment used in traditional or small-scale farms have changed little in form or function since the medieval period. Nonmechanized causes of injury contribute to approximately 40% of all modern farm-related injuries and are attributed to falls from lofts and ladders, animal assaults and bites, and falls from moving vehicles. These hazardous situations were also present in the medieval period and may explain some of the fracture trauma from the rural sites. A high fracture frequency for both medieval males and females is significantly associated with farming subsistence when compared to craft-orientated urban dwellers.

Fracture patterns at the Medieval Leper Hospital in Chichester

Humans are constantly at risk of bone fractures, not only when threatened by personal violence, but also by the challenge of daily living. Because fractures are a cross-cultural phenomenon and are one of the more commonly observed skeletal lesions in archaeological collections, their presence provides a unique opportunity to compare living conditions, and thereby assess fracture risk in coexisting cultures. This study analyzed long bone fracture patterns of 212 sexed adults from the medieval leper hospital of St. James and St. Mary Magdalene in Chichester, England. The comparison of this hospital sample to other British medieval skeletal samples examined the level of health manifest in fracture etiology. The fracture frequency for this sample was 15.1%, with males accounting for 85.4% of the fractures. The fracture frequencies from the samples not affiliated with hospitals ranged from 3.3 to 5.6%. Because medieval urban lifestyle was notoriously difficult due to inadequate sanitation and living conditions, the overall health of the population at large was inferior, placing all at similar fracture risk. Therefore, more specific complications associated with the fractures were examined. Osseous modifications of the skeletons due to lepromatous leprosy were associated with 28% of individuals sustaining fractures. However, persons with the milder tuberculoid leprosy do not exhibit skeletal lesions, but are more prone to accident due to the earlier loss of sensory perception and visual impairment. It is argued that the presence of leprosy is underestimated in archaeological populations and may be a major contributing factor to the prevalence of fracture resulting from accidental falls.

Deaths resulting from animal attacks in the United States

The objective of this study was to elucidate the etiology and frequency of deaths in the United States from encounters with animals. The number of deaths from venomous and nonvenomous animals is reported annually to the US Department of Health and Human Services and published in Vital Statistics of the United States. This study is a survey of all animal-related fatalities listed as E-codes 905-906 reported in the Vital Statistics of the United States from 1979 through 1990. Data were extracted uniformly from the annual reports and analyzed using descriptive statistics. From 1979 through 1990, there were 1882 animal-related deaths in the United States. Venomous animals caused 718 deaths; nonvenomous animals caused 1164 deaths. Most deaths occurred among white males. The home site was the location of injury for the majority of deaths. The majority of venomous animal-related deaths were from hymenoptera; "other specified animal" caused the majority of nonvenomous deaths. An annual average of 157 deaths from animal attacks occurred in the United States between 1979 and 1990. Both fatal and nonfatal animal-related injuries are under-recognized public health hazards. Health care providers should educate their patients on exercising caution around animals, seeking medical care after an animal injury, carrying epinephrine kits if they have a history of systemic reactions to insect stings, and wearing helmets and other protective equipment when riding or working around large animals.