Traumatic injury patterns in humans from large feline predators: A systematic review and descriptive analysis

Traumatic attacks from large feline predators cause a small yet significant burden of disease in rural populations, are increasing in frequency, cause complex injuries and worsen human–wildlife conflicts. Data on the traumatic injury pattern found in victims of these animals is sparse, and this study aimed to collate and synthesise patterns of injury to inform the care and management of these patients. A multi-ethnographic literature search (PubMed, Embase, Web of Science, Google Scholar, and other sources) was performed on 12/1/21 to capture all available data describing anatomical injury and the mechanism of injury sustained by humans from attacks by lions, leopards and tigers. Quality and bias assessment was performed using the Joanna Briggs Critical Evaluation tools. Of 5110 studies identified, 42 were included in this review totalling 84 individual patient cases. A total of 85% of fatal injuries were due to exsanguination combined with neuroaxis injury of the neck. All wounds were susceptible to tissue loss, infection and long-term neuro-vascular complications. Leopards injured anterior-midline structures of the neck more often than did lions and tigers, while the latter caused high-energy fractures. Time lag to treatment for survivors of wild attacks extended to multiple days, and occult injury was common. In addition to the primary finding of complex neck injury, this study generated specific patterns of injury seen from the included species and highlighted occult injury and healthcare disparity as challenges in providing patient care.