Dire D J, Hogan D E, Riggs M W
Department of Surgery, University of Oklahoma Health Sciences Center, USA.
Acad Emerg Med. 1994 May-Jun;1(3):258-66. doi: 10.1111/j.1553-2712.1994.tb02442.x.
To define risk factors for infections from dog- bite wounds and to model the probability of wound infection in patients presenting without infection who are treated as outpatients.
A prospective survey of 769 consecutive dog-bite victims presenting over a two-year period to a community hospital emergency department (ED) with an emergency medicine residency program. A standardized wound-cleaning protocol was used, which included debridement and wound closure when indicated. Wounds were examined for infection at follow-up. Variables analyzed included demographic data (patient age, gender, race); wound information (wound age, type, number, location, depth); and treatment (prior to hospital, ED debridement, suturing, tetanus or rabies shots, antibiotics).
There were 734 patients with complete records. These patients had a mean age of 13.4 +/- 13.2 years (range, 4 months to 71 years). Infection was evident in 2.5% of the wounds upon presentation. There were 704 patients (765 wounds) managed as outpatients and without wound infection upon presentation. Wounds were distributed as follows: 26.7% head/neck, 20.4% hand, 15.7% arm, 10.1% trunk, 9.5% thigh, 15.9% leg, and 1.7% foot. There were 32.9% puncture, 39.9% full-thickness, and 60.1% partial-thickness wounds. Wound infections were diagnosed in 2.1% Of these wounds at follow-up. Wounds requiring surgical debridement had a sevenfold higher infection rate (p = 0.01). Patients more than 50 years of age had a sixfold higher infection rate than younger patients (p = 0.05). Stepwise logistic regression found the following variables to be the best predictors for wound infection: full-thickness [p = 0.006, odds ratio (OR) = 6.23], female gender (p = 0.048, OR = 2.88), and wound debridement (p = 0.024, OR = 5.01). Combinations of these three variables predict infection rates from 0.35% to 23.9%.
A low wound infection rate was seen in this cohort of dog-bite victims who were treated on an outpatient basis. Wound depth, patient gender, and wound debridement were the clinical variables that best predicted the likelihood of developing infection. Future interventional studies should concentrate on wounds with high probabilities of infection.
确定犬咬伤伤口感染的危险因素，并建立模型以预测门诊治疗的未感染患者伤口感染的概率。
对连续两年到一家设有急诊医学住院医师培训项目的社区医院急诊科就诊的769例犬咬伤受害者进行前瞻性调查。采用标准化的伤口清洁方案，包括必要时的清创和伤口缝合。随访时检查伤口是否感染。分析的变量包括人口统计学数据（患者年龄、性别、种族）；伤口信息（伤口时长、类型、数量、位置、深度）；以及治疗情况（院前处理、急诊科清创、缝合、破伤风或狂犬病疫苗接种、抗生素使用）。
734例患者有完整记录。这些患者的平均年龄为13.4±13.2岁（范围为4个月至71岁）。就诊时2.5%的伤口有明显感染。704例患者（765处伤口）作为门诊患者处理，就诊时无伤口感染。伤口分布如下：头/颈部26.7%，手部20.4%，手臂15.7%，躯干10.1%，大腿9.5%，腿部15.9%，足部1.7%。穿刺伤占32.9%，全层伤口占39.9%，部分厚度伤口占60.1%。随访时这些伤口中有2.1%被诊断为伤口感染。需要手术清创的伤口感染率高7倍（p = 0.01）。50岁以上患者的感染率比年轻患者高6倍（p = 0.05）。逐步逻辑回归分析发现以下变量是伤口感染的最佳预测因素：全层伤口[p = 0.006，优势比（OR）= 6.23]、女性性别（p = 0.048，OR = 2.88）和伤口清创（p = 0.024，OR = 5.01）。这三个变量的组合预测感染率为0.35%至23.9%。
在这组接受门诊治疗的犬咬伤受害者中，伤口感染率较低。伤口深度、患者性别和伤口清创是最能预测感染可能性的临床变量。未来的干预性研究应集中于感染概率高的伤口。
