This study was conducted to estimate the burden of non-canine-related bite and sting injuries in the U.S.; describe the affected population, injury severity, and bite or sting source; and provide considerations for prevention strategies.
Methods.
Data were from the 2001 through 2004 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) (a stratified probability sample of U.S. hospitals). Records included information about age, body part affected, cause, diagnosis, disposition, and gender. Narrative descriptions were coded for the source of the bite or sting.
Results.
Between 2001 and 2004, an estimated 3.6 million people were treated in emergency departments for injuries related to non-canine bites and stings. Results detail the reported sources of the bite or sting, and examine sources by gender and age group. Common sources included bees (162,000 cases annually), spiders (123,000 cases annually), and cats (66,000 cases annually). Female adults were more likely than male adults to be treated for cat bites. Although rare, of the known venomous snakebites, more than half (58.4%) of the patients were hospitalized.
Conclusions.
Our results demonstrate the public health burden of non-canine-related bite and sting injuries. More than 900,000 people were treated in emergency departments annually for non-canine bite or sting injuries, or roughly 1.7 injuries per minute. Treatment consumes substantial health-care resources. While preventing these injuries should be the first line of defense, resources could be conserved by educating the public about immediate first aid and when warning signs and symptoms indicate the need for professional or emergency care.
References
1.
GlaserCLewisPWongS. Pet-, animal-, and vector-borne infections. Pediatr Rev2000;21:219–32.
2.
HannaTLSelbyLA. Characteristics of the human and pet populations in animal bite incidents recorded at two Air Force bases. Public Health Rep1981;96:580–4.
3.
KizerKW. Epidemiologic and clinical aspects of animal bite injuries. JACEP1979;8:134–41.
4.
LangleyRL. Fatal animal attacks in North Carolina over an 18-year period. Am J Forensic Med Pathol1994;15:160–7.
5.
SinclairCLZhouC. Descriptive epidemiology of animal bites in Indiana, 1990–92—a rationale for intervention. Public Health Rep1995;110:64–7.
6.
SpenceG. A review of animal bites in Delaware-1989 to 1990. Del Med J1990;62:1425–33.
7.
ElstonDM. Systemic manifestations and treatment of brown recluse spider bites. Cutis2004;74:336, 38, 40.
8.
HughesA. Observation of snakebite victims: is twelve hours still necessary?Emerg Med (Fremantle)2003;15:511–7.
9.
StefanopoulosPKaraboutaZBisbinasIGeorgiannosDKaraboutaI. Animal and human bites: evaluation and management. Acta Orthop Belg2004;70:1–10.
10.
ApplegateJAWalhoutMF. Childhood risks from the ferret. J Emerg Med1998;16:425–7.
RiordanCHussainMMcCannJ. Moray eel attack in the tropics: a case report and review of the literature. Wilderness Environ Med2004;15:194–7.
13.
QuinlanKPThompsonMPAnnestJLPeddicordJRyanGKesslerEP. Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments. Ann Emerg Med1999;34:637–45.
14.
VyrostekSBAnnestJLRyanGW. Surveillance for fatal and nonfatal injuries—United States, 2001. MMWR Surveill Summ2004;53(7):1–57.
15.
ClaassenCATrivediMHShimizuIStewartSLarkinGLLitovitzT. Epidemiology of nonfatal deliberate self-harm in the United States as described in three medical databases. Suicide Life Threat Behav2006;36:192–212.
AdamsALSchiffMA. Childhood soccer injuries treated in U.S. emergency departments. Acad Emerg Med2006;13:571–4.
18.
LinakisJGAmanullahSMelloMJ. Emergency department visits for injury in school-aged children in the United States: a comparison of nonfatal injuries occurring within and outside of the school environment. Acad Emerg Med2006;13:567–70.
19.
QaziKGersonLWChristopherNCKesslerEIdaN. Curling iron-related injuries presenting to U.S. emergency departments. Acad Emerg Med2001;8:395–7.
20.
Skarbek-BorowskaSAmanullahSMelloMJLinakisJG. Emergency department visits for sledding injuries in children in the United States in 2001/2002. Acad Emerg Med2006;13:181–5.
21.
Nonfatal dog bite-related injuries treated in hospital emergency departments—United States, 2001. MMWR Morb Mortal Wkly Rep2003;52(26):605–10.
22.
SchroederTAultK, Commission UCPS, editors. NEISS All Injury Program: sample design and implementation. Washington: U.S. Consumer Product Safety Commission; 2001.
23.
Centers for Disease Control and Prevention (US). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer) [cited 2005 Oct 15]. Available from: URL: www.cdc.gov/ncipc/wisqars wisqars.
24.
DowneyDJOmerGEMoneimMS. New Mexico rattlesnake bites: demographic review and guidelines for treatment. J Trauma1991;31:1380–6.
25.
FarstadDThomasTChowTBushSStieglerP. Mojave rattlesnake envenomation in southern California: a review of suspected cases. Wilderness Environ Med1997;8:89–93.
26.
MorandiNWilliamsJ. Snakebite injuries: contributing factors and intentionality of exposure. Wilderness Environ Med1997;8:152–5.
27.
PlowmanDMReynoldsTLJoyceSM. Poisonous snakebite in Utah. West J Med1995;163:547–51.
28.
TanenDRuhaAGraemeKCurryS. Epidemiology and hospital course of rattlesnake envenomations cared for at a tertiary referral center in Central Arizona. Acad Emerg Med2001;8:177–82.
29.
MorganBWLeeCDamianoLWhitlowKGellerR. Reptile envenomation: 20-year mortality as reported by US medical examiners. South Med J2004;97:642–4.
30.
IsbisterGKWhiteJ. Clinical consequences of spider bites: recent advances in our understanding. Toxicon2004;43:477–92.
31.
WendellRP. Brown recluse spiders: a review to help guide physicians in nonendemic areas. South Med J2003;96:486–90.
32.
ClarkSLongAAGaetaTJCamargoCA. Multicenter study of emergency department visits for insect sting allergies. J Allergy Clin Immunol2005;116:643–9.
33.
DominguezTJ. It's not a spider bite, it's community-acquired methicillin-resistant Staphylococcus aureus. J Am Board Fam Pract2004;17:220–6.
34.
FaganSPBergerDHRahwanKAwadSS. Spider bites presenting with methicillin-resistant staphylococcus aureus soft tissue infection require early aggressive treatment. Surg Infect (Larchmt)2003;4:311–5.
35.
LangleyRL. Animal-related fatalities in the United States—an update. Wilderness Environ Med2005;16:67–74.
36.
SchappertSMBurtCW. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001–02. Vital Health Stat 132006(159).
37.
WatsonWALitovitzTLKlein-SchwartzWRodgersGCJr.YounissJReidN. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med2004;22:335–404.
38.
American Veterinary Medical Association. U.S. Pet Ownership & Demographic Sourcebook. Schaumburg (IL): American Veterinary Medical Association; 2002.
39.
ForresterMBStanleySK. Black widow spider and brown recluse spider bites in Texas from 1998 through 2002. Vet Hum Toxicol2003;45:270–3.
40.
ValentineMD. Anaphylaxis and stinging insect hypersensitivity. JAMA1992;268:2830–3.
41.
MatasarMJNeugutAI. Epidemiology of anaphylaxis in the United States. Curr Allergy Asthma Rep2003;3:30–5.
42.
NeugutAIGhatakATMillerRL. Anaphylaxis in the United States: an investigation into its epidemiology. Arch Intern Med2001;161:15–21.
43.
AghababianRVConteJE. Mammalian bite wounds. Ann Emerg Med1980;9:79–83.
44.
MooreDASischoWMHunterAMilesT. Animal bite epidemiology and surveillance for rabies postexposure prophylaxis. J Am Vet Med Assoc2000;217:190–4.
45.
KrebsJWMandelEJSwerdlowDLRupprechtCE. Rabies surveillance in the United States during 2003. J Am Vet Med Assoc2004;225:1837–49.
46.
Outbreak of multidrug-resistant Salmonella typhimurium associated with rodents purchased at retail pet stores—United States, December 2003-October 2004. MMWR Morb Mortal Wkly Rep2005;54(17):429–33.
47.
Update: Multistate outbreak of monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep2003;52(27):642–6.
