COUGAR ATTACKS ON CHILDREN - INJURY PATTERNS AND TREATMENT

Purpose: Cougar attacks on humans appear to be on the rise. A review o f all attacks on children was performed to determine the method of att ack and injury patterns so that a treatment regimen as well as possibl e preventative measures could be determined. Methods: A review of all attacks, including attacks on child ren, was performed, including th r ee recent attacks treated at our institution. Situation, adult supervi sion, patient age, injuries recorded, survival, and mode of attack, if known, were reviewed. Results: There were 50 documented attacks on ch ildren with a 25% fatality rate. Most children were not alone at the t ime of the attack (92%), and in many instances adult supervision was p resent or nearby. Severe head and neck lacerations along with puncture wounds were the most common injury. Examples of typical cervical inju ries include a nonfatal vertebral artery injury, phrenic nerve injury, a fatal internal carotid artery injury, and a fatal cervical spine in jury. The cougar was rabid in two cases. Pasteurella resulted in late infections in two patients. Conclusions: Based on the pattern of injur ies, the authors recommend aggressive evaluation for occult cervical i njuries as well as surgical debridement. Antibiotics should cover orop haryngeal flora including Pasteurella multocida. Rabies prophylaxis is indicated. Adult supervision in wilderness areas is not necessarily p rotective. Copyright (C) 1998 by W.B. Saunders Company.