Fruchtman Yariv, Perry Zvi, Elmaquai Omer, Schwartz Dagan, Leibovitz Eugene
Pediatric Division, Soroka University Medical Center, Beer-Sheva, Israel.
Epidemiology and Health Management Department, Ben-Gurion University, Beer-Sheva, Israel.
Harefuah. 2020 Dec;159(12):876-881.
Annually in the US, about 2 million patients who are animal-related casualties go to the Emergency Medicine Department (ER), which accounts for 0.5-1.5% of the ER visits; 25% of these casualties are children. Similar numbers are also seen in Europe and the UK. In a single-center study in Israel, it was found that the percentage of ER visits for animal injuries was about 2.1%. Soroka University Hospital is the only Level I trauma center in the Negev, serving a population of over 1,250,000, and as such it treats about 175,000 ER visits each year, of which about 27% are pediatric visits. The population treated in our hospital is diverse in terms of socioeconomic origin and status, and includes Jewish patients mainly situated in urban settlements and Arab-Bedouin population living in familiar and unfamiliar villages (the Bedouin diaspora). In light of this, in the present study, we have tried to investigate animal injuries in children, emphasizing scorpion bites which are common in our area.
We retrospectively reviewed the medical records of all children aged 0-17 years during an 18-month study period - from January 2009 until the end of June 2010 - to identify children who have been referred to the ER at the Soroka Hospital due to animal injury. Demographics, characteristics of the injury, incidence times and referral to treatment, and data on the course of assessment and treatment of the injury and hospitalization were recorded. Data was typed and processed using Microsoft Excel 2007 software and we used SPSS 23.0 for Windows for the statistical analysis.
A total of 729 pediatric injuries caused by animals were reported, which accounted for about 1% of the total number of children's visits to the pediatric ER during the study period. Twenty-six cases were omitted because they did not meet the inclusion criteria in the study. Of the remaining 703 referrals, 66.1% of the patients were boys, the peak age was in the 6-8-year age group (26%); 44.1% lived in a Jewish settlement, 31.2% in an unrecognized Arab-Bedouin settlement and 24% in a recognized Arab-Bedouin settlement. In both forms of Bedouin settlements, the most frequent injuries were dog bites n = 166, (23.60%), yellow scorpion bites = 163 (23.2%) and black scorpion bites n = 44 (6.25%); 97 of the children were admitted (13.8%), of whom 44 were admitted to the ICU, with 84.1% of those admitted to the intensive care unit (ICU) were treated due to yellow scorpion injury. The 2-5-year age group was the most prevalent among inpatients, accounting for 32.
Pediatric animal injuries are a common cause of ER visits and even hospitalization. A relatively high percentage of hospitalizations were in the ICU. The most common cause of animal injury seen in our cohort was dog bites, but yellow scorpion bites resulted in most hospitalizations, especially in the pediatric ICU. The incidence of yellow scorpion injuries was significantly higher in the Arab-Bedouin population and even more so in those living in unrecognized settlements, and 87% of the pediatric hospitalizations were seen in Arabic-Bedouin children. Animal-related injuries are a serious health problem in the Arab-Bedouin population and in the unrecognized villages in particular, and there is room to emphasize the prevention of these injuries in this impoverished sector.
在美国，每年约有200万因动物致伤的患者前往急诊科就诊，占急诊就诊人数的0.5 - 1.5%；其中25%为儿童。欧洲和英国也有类似的数字。在以色列的一项单中心研究中发现，因动物伤害前往急诊就诊的比例约为2.1%。索罗卡大学医院是内盖夫唯一的一级创伤中心，服务人口超过125万，因此每年接待约17.5万次急诊就诊，其中约27%为儿科就诊。我院治疗的人群在社会经济来源和地位方面具有多样性，包括主要居住在城市定居点的犹太患者以及生活在熟悉和不熟悉村庄的阿拉伯 - 贝都因人群（贝都因散居群体）。鉴于此，在本研究中，我们试图调查儿童动物致伤情况，重点关注我们地区常见的蝎子蜇伤。
我们回顾性分析了18个月研究期间（从2009年1月至2010年6月底）所有0 - 17岁儿童的病历，以确定因动物致伤而被转诊至索罗卡医院急诊科的儿童。记录了人口统计学信息、损伤特征、发病时间和转诊治疗情况，以及损伤评估和治疗过程及住院的数据。数据使用Microsoft Excel 2007软件录入和处理，我们使用SPSS 23.0 for Windows进行统计分析。
共报告729例儿童动物致伤病例，约占研究期间儿童前往儿科急诊就诊总数的1%。26例因不符合研究纳入标准而被排除。在其余703例转诊病例中，66.1%的患者为男孩，发病高峰年龄在6 - 8岁组（26%）；44.1%居住在犹太定居点，31.2%居住在未被承认的阿拉伯 - 贝都因定居点，24%居住在被承认的阿拉伯 - 贝都因定居点。在两种形式的贝都因定居点中，最常见的损伤是狗咬伤n = 166（23.60%）、黄蝎子蜇伤 = 163（23.2%）和黑蝎子蜇伤n = 44（6.25%）；97名儿童住院（13.8%），其中44名入住重症监护病房，入住重症监护病房的患者中84.1%是因黄蝎子蜇伤接受治疗。2 - 5岁年龄组是住院患者中最常见的，占32%。
儿童动物致伤是急诊就诊甚至住院的常见原因。住院患者中相当高的比例入住了重症监护病房。我们队列中最常见的动物致伤原因是狗咬伤，但黄蝎子蜇伤导致了大多数住院病例，尤其是在儿科重症监护病房。黄蝎子蜇伤的发生率在阿拉伯 - 贝都因人群中显著更高，在居住在未被承认定居点的人群中更是如此，87%的儿科住院病例发生在阿拉伯 - 贝都因儿童中。动物相关伤害在阿拉伯 - 贝都因人群中，尤其是在未被承认的村庄，是一个严重的健康问题，在这个贫困地区有必要强调预防这些伤害。
