Emergency Management of Animal-Related Injuries in Children: An Observational Multicenter Italian Study

Objectives: Animal-related injuries (ARIs) represent a common reason for emergency department (ED) visits in children. Limited data regarding treatment in Italian EDs are available. The aims of the study were to assess the epidemiological features of these patients and to investigate the association between their characteristics and therapeutic approaches, particularly antibiotic prescription. Materials and methods: Patients presenting to 13 pediatric EDs from 11 Italian regions because of ARIs were prospectively enrolled for 20 months. Patients' clinical data, injury characteristics, and performed treatment were recorded. Results: We enrolled 442 patients aged 6.1 years (3.9) who were grouped in non-insect-related injuries (non-IRIs, n=236) and insect-related injuries (IRIs, n=206). Most injuries occurred in an outdoor setting during the afternoon. Except for IRIs, the most frequently involved animals were pets, mostly dogs (91.5%). In 59.1% of cases, the injury extent was <15 mm. The antibiotic prescription was more likely in children presenting with a lesion by a wild animal [odds ratio (OR): 5.8 (CI 95%: 1.27-26.57), P=0.02], in those with lacerations [OR: 2.90 (CI 95%: 1.13-6.54), P=0.01], and in those with larger injuries [OR: 2.66 (CI 95%: 1.49-4.76), P<0.01]. Antibiotics were more frequently prescribed in non-IRIs compared with IRIs (P<0.001), whereas IRIs more commonly received oral or topical steroids, topical antibiotics, or antihistamines (P<0.001). Conclusions: Most pediatric ARIs require limited emergency management. Antibiotic prescriptions are more likely in large lesions determined by wild animals. Monitoring non-IRIs and IRIs may provide useful information to improve and uniform therapeutic management and to plan public health preventive interventions.