eMedicine Specialties > Emergency Medicine > Environmental

Bites, Human: Follow-up

Author: Jeffrey Barrett, MD, Assistant Professor, Department of Emergency Medicine, Temple University School of Medicine
Coauthor(s): Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Contributor Information and Disclosures

Updated: Apr 23, 2009

Follow-up

Further Outpatient Care

  • Patients with human bite wounds (other than those with superficial wounds discharged from the ED) should have early, mandatory follow-up care within 1-2 days.

Complications

  • Infection and resulting sequelae are the main complications in human bites. These include serious soft tissue infection, tendon damage, tissue contracture, and osteomyelitis.
  • Cosmetic deformity may be a complication.

Prognosis

  • The prognosis is generally excellent, except for possible sequelae from serious infection.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to elicit a careful history regarding the circumstances of a wound
  • Failure to treat a human bite as a complicated laceration
    • If either of these lead to a poor outcome, the physician can be faulted for taking an improper history. Key points are to be extremely cautious with wounds over the MCP joints, with hand wounds in general, and with small lacerations about the head and forehead in young children.
    • Documentation of the mechanism reported is essential to avoid later questions regarding treatment.
  • Failure to report suspected child abuse (reporting is mandatory for health care professionals in most jurisdictions)
 


More on Bites, Human

Overview: Bites, Human
Differential Diagnoses & Workup: Bites, Human
Treatment & Medication: Bites, Human
Follow-up: Bites, Human
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Harrison M. A 4-year review of human bite injuries presenting to emergency medicine and proposed evidence-based guidelines. Injury. Jan 31 2009;[Medline].

  2. Zubowicz VN, Gravier M. Management of early human bites of the hand: a prospective randomized study. Plast Reconstr Surg. Jul 1991;88(1):111-4. [Medline].

  3. Broder J, Jerrard D, Olshaker J, Witting M. Low risk of infection in selected human bites treated without antibiotics. Am J Emerg Med. Jan 2004;22(1):10-3. [Medline].

  4. Baker MD, Moore SE. Human bites in children. A six-year experience. Am J Dis Child. Dec 1987;141(12):1285-90. [Medline].

  5. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406. [Medline].

  6. Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep. Jan 21 2005;54(RR-2):1-20. [Medline].

  7. Talan DA, Abrahamian FM, Moran GJ, et al. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis. Dec 1 2003;37(11):1481-9. [Medline].

  8. Bunzli WF, Wright DH, Hoang AT, et al. Current management of human bites. Pharmacotherapy. Mar-Apr 1998;18(2):227-34. [Medline].

  9. Chen E, Hornig S, Shepherd SM, Hollander JE. Primary closure of mammalian bites. Acad Emerg Med. Feb 2000;7(2):157-61. [Medline].

  10. Donkor P, Bankas DO. A study of primary closure of human bite injuries to the face. J Oral Maxillofac Surg. May 1997;55(5):479-81; discussion 481-2. [Medline].

  11. Gilbert DN, Moellering RC, Sande MA. Human bites. In: The Sanford Guide to Antimicrobial Therapy. 30th ed. Antimicrobial Therapy Inc; 2000:37.

  12. Kelly IP, Cunney RJ, Smyth EG, Colville J. The management of human bite injuries of the hand. Injury. Sep 1996;27(7):481-4. [Medline].

  13. Lindsey D, Christopher M, Hollenbach J, et al. Natural course of the human bite wound: incidence of infection and complications in 434 bites and 803 lacerations in the same group of patients. J Trauma. Jan 1987;27(1):45-8. [Medline].

  14. Miura I, Ohshima A, Takahashi N, et al. A new non-random chromosomal translocation t(3;6)(q27;p21.3) associated with BCL6 rearrangement in two patients with non-Hodgkin's lymphoma. Int J Hematol. Oct 1996;64(3-4):249-56. [Medline].

  15. Pretty IA, Anderson GS, Sweet DJ. Human bites and the risk of human immunodeficiency virus transmission. Am J Forensic Med Pathol. Sep 1999;20(3):232-9. [Medline].

  16. Schweich P, Fleisher G. Human bites in children. Pediatr Emerg Care. Jun 1985;1(2):51-3. [Medline].

  17. Smith PF, Meadowcroft AM, May DB. Treating mammalian bite wounds. J Clin Pharm Ther. Apr 2000;25(2):85-99. [Medline].

  18. Turner TW. Evidence-based emergency medicine/systematic review abstract. Do mammalian bites require antibiotic prophylaxis?. Ann Emerg Med. Sep 2004;44(3):274-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines

Management of human bite wounds. University of Texas, School of Nursing, Family Nurse Practitioner Program. Management of human bite wounds. Austin (TX): University of Texas, School of Nursing; 2007 May. 22 p.

Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, Cheever L, Johnson M, Paxton LA, Onorato IM, Greenberg AE. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep 2005 Jan 21;54(RR-2):1-26. [126 references] PubMed

Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005 Nov 15;41(10):1373-406. [236 references] PubMed

[ CLOSE WINDOW ]

Keywords

human bites, human bite wound, closed-fist injury, chomping injury, puncture-type wound, infected human bite wounds, bite wounds, bite injury

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jeffrey Barrett, MD, Assistant Professor, Department of Emergency Medicine, Temple University School of Medicine
Jeffrey Barrett, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Samuel M Keim, MD, Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.