• Tomona Iso, Fangzheng Yuan, Elsie Rizk, TranAnh ThuATDepartment of Pharmacy, Houston Methodist, Houston, TX, USA; Department of Surgery, Houston Methodist, Houston, TX, USA., R Benjamin Saldana, Prasanth R Boyareddigari, Ngoc-Anh A Nguyen, Daniela Espino, and Joshua T Swan.
• Department of Pharmacy, Houston Methodist, Houston, TX, USA; Department of Surgery, Houston Methodist, Houston, TX, USA.
• Am J Emerg Med. 2022 Dec 1; 62: 556155-61.

ObjectiveThis study described characteristics of wounds caused by animal exposures and evaluated patient factors and wound factors associated with wound infiltration of human rabies immune globulin (HRIG).Materials And MethodsThis retrospective cohort study evaluated wound characteristics among patients who had visible wounds and received HRIG or rabies vaccine for rabies postexposure prophylaxis (PEP) at 15 emergency departments from May 2016 to June 2018.ResultsOf 110 included patients (9 children, 82 adults, and 19 older adults), 21% (n = 23) had ≥2 wounds, and 10% (n = 11) had infected wounds. Twenty-eight (25%) patients had severe wounds, defined as receiving sutures (n = 20) or reaching subcutaneous tissue or bone (n = 20). Wounds were present on upper extremities for 42% (n = 46) of patients, lower extremities for 35% (n = 38), head/face for 3% (n = 3), and in multiple locations for 21% (n = 23). Wounds were < 3 cm in length for 64% (n = 70) of patients. Puncture wounds were present in 60% (n = 66) of patients, abrasions in 45% (n = 49), and lacerations in 38% (n = 42). Among 108 wounds from 82 patients with documented HRIG administration sites, 57% (n = 62) of wounds received HRIG infiltration. Infiltration occurred less frequently for wounds on the face/head/torso (adjusted odds ratio [aOR] = 0.07, 95% confidence interval [CI] = 0.01 to 0.49), wounds on hands/fingers (aOR = 0.20, 95% CI = 0.06 to 0.65), and abrasion-only wounds (aOR = 0.26, 95% CI = 0.08 to 0.80) after adjusting for age.ConclusionsUpon presentation for rabies PEP, most patients did not have severe wounds and did not require emergency services or complex wound management. Wounds on the face, head, torso, hands, or fingers and abrasions were less likely to receive HRIG infiltration.Copyright © 2022 Elsevier Inc. All rights reserved.

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