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Management Challenges and Outcomes of Traumatic Brain Injury due to Bear Maul in Tribal Areas of Chhattisgarh, India—Man versus WildFunding None.
Objectives Neurosurgeons working in the vicinity of tribal areas face traumatic brain injury (TBI) cases due to bear maul which is on the rise in Chhattisgarh. Most of the literature is focused on the management of maxillofacial injuries. This study intends to describe the challenges in management and outcomes of TBI due to bear maul.
Materials and Methods A retrospective review was conducted from May 2018 to April 2020. The patients without TBI were excluded. The variables studied were age, gender, timing and mode of conflict, Glasgow coma scale (GCS) at arrival, injury spectrum, hospital stay, the modified Rankin score (MRS), mini mental status examination (MMSE), and surgical site infections (SSI).
Results Twenty-eight patients were eligible for analysis. The mean age of presentation was 40.67 ± 13.99 years. There were 23 males (82.15%). Most common time of attack was during dawn (n = 11, 39.28%) followed by dusk (n = 9, 32.14%) and day (n = 8, 28.57%) time. Provoked conflicts were seen in 64.28%. The mean preoperative GCS was 11.07 ± 3.54 and hospital stay was 18.71 ± 9.51 days. Skull fractures were found in 24/28 (85.71%). The mean MRS was 1.67 ± 1.38 at a mean follow-up of 14.53 ± 6.59 months. Favorable outcome (MRS ≤ 2) was seen in 64.28% of patients. The mean MMSE score was 22.28 ± 5.36. Eight patients developed SSI (28.57%).
Conclusion Outcomes of TBI due to bear maul depend on preoperative GCS. There are higher incidences of skull fractures and SSI. Humans need to avoid infiltration in wildlife territory to reduce the number of conflicts.
10 June 2021 (online)
© 2021. Association for Helping Neurosurgical Sick People. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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- 1 Forest and Climate Change Department, Government of Chhattisgarh. Introduction. Accessed February 11, 2021 at http://www.cgforest.com/category/introduction
- 2 Rasool A, Wani AH, Darzi MA. et al. Incidence and pattern of bear maul injuries in Kashmir. Injury 2010; 41 (01) 116-119
- 3 Bashir SA, Rasool A, Zaroo MI. et al. Bear maul craniocerebral trauma in Kashmir Valley. J Craniofac Surg 2013; 24 (01) e2-e5
- 4 Nabi DG, Tak SR, Kangoo KA, Halwai MA. Increasing incidence of injuries and fatalities inflicted by wild animals in Kashmir. Injury 2009; 40 (01) 87-89
- 5 Shah AA, Mir BA, Ahmad I, Latoo S, Ali A, Shah BA. Pattern of bear maul maxillofacial injuries in Kashmir. Natl J Maxillofac Surg 2010; 1 (02) 96-101
- 6 Times of India (TOI). Human-animal conflict on the rise in Chhattisgarh, sloth bear attacks five including minors. Accessed April 2, 2016 at https://timesofindia.indiatimes.com/city/raipur/Human-animal-conflict-on-the-rise-in-Chhattisgarh-sloth-bear-attacks-five-including-minors/articleshow/51662657.cms
- 7 Bargali HS, Akhtar N, Chauhan NPS. Characteristics of sloth bear attacks and human casualties in North Bilaspur Forest Division, Chhattisgarh, India. Ursus 2005; 16 (02) 263-267
- 8 Rajpurohit KS, Krausman PR. Human sloth bear conflicts in Madhya Pradesh, India. Wildl Soc Bull 2000; 28 (02) 393-399
- 9 Ghezta NK, Bhardwaj Y, Ram R, Ahsan R, Arya S. Incidence pattern of bear-inflicted injuries to the maxillofacial region-soft and hard tissue injuries, their management, and sequelae. J Oral Maxillofac Surg 2019; 77 (05) 1043.e1-1043.e15
- 10 Moir DM. Plastic operation on face for bite from a bear. Ind Med Gaz 1891; 26 (03) 74-76
- 11 Siddharth RK, Kujur SP, Shivhare PR, Gulhane PV, Arya RC. Study of bear bite injury and management in tribal belt of Chhattisgarh, India. J Evid Based Med Healthcare 2020; 7 (01) 34-37
- 12 Roka YB, Roka N, Shrestha M, Puri PR, Adhikari HB. Penetrating head injury with bilateral eye avulsion due to Himalayan bear bite. Emerg Med Australas 2012; 24 (06) 677-679
- 13 Prasad SC, Thada ND, Rao P, Thada SR, Prasad KC. Grievous temporal and occipital injury caused by a bear attack. Case Rep Otolaryngol 2013; 2013: 957251
- 14 Wani ML, Ahangar AG, Lone GN. et al. Vascular injuries after bear attacks: Incidence, surgical challenges and outcome. J Emerg Trauma Shock 2011; 4 (01) 20-22
- 15 Naitam J, Mamtani P. Anaesthesia challenges in patients with bear bite. Int J Biomed Res 2017; 8 (12) 694-698
- 16 Lone PA, Kouser T, Iqbal A. Unusual bear maul injuries. J Dent Res Development 2015; 5 (01) 11-22
- 17 Ram R. Maxillofacial injuries due to bear mauling. J Maxillofac Oral Surg 2011; 10 (01) 85-89
- 18 Kunimoto D, Rennie R, Citron DM, Goldstein EJC. Bacteriology of a bear bite wound to a human: case report. J Clin Microbiol 2004; 42 (07) 3374-3376
- 19 Thomas N, Brook I. Animal bite-associated infections: microbiology and treatment. Expert Rev Anti Infect Ther 2011; 9 (02) 215-226
- 20 Floyd T. Bear-inflicted human injury and fatality. Wilderness Environ Med 1999; 10 (02) 75-87
- 21 Pukar M, Hajare A, Krishnaprasad K, Bhargava A. Garenoxacin in skin & skin structure infections complicated by bear bite. Int J Med Res Health Sci 2014; 3 (02) 503-505
- 22 Manning SE, Rupprecht CE, Fishbein D. et al. Advisory Committee on Immunization Practices Centers for Disease Control and Prevention (CDC). Human rabies prevention–United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2008; 57 (RR-3) 1-28
- 23 Vashistha A, Singh M, Kaur G, Gupta S. Bear maul injury in maxillofacial region: a case report. Traumaxilla 2019; 1 (01) 22-25
- 24 Fescharek R, Franke V, Samuel MR. Do anaesthetics and surgical stress increase the risk of post-exposure rabies treatment failure?. Vaccine 1994; 12 (01) 12-13
- 25 Crowcroft NS, Elliman D. Vaccination and anesthesia: the precautionary principle is to vaccinate. Paediatr Anaesth 2007; 17 (12) 1216-1218, 1218–1220
- 26 Short JA, van der Walt JH, Zoanetti DC. Immunization and anesthesia - an international survey. Paediatr Anaesth 2006; 16 (05) 514-522
- 27 Tough SC, Butt JC. A review of fatal bear maulings in Alberta, Canada. Am J Forensic Med Pathol 1993; 14 (01) 22-27
- 28 Phalke B, Waghmare S, Zine KU. Bear bite: a case report. J Forensic MedSci Law 2014; 23 (02) 1-5