Abstract
<title>Abstract</title> <p>Background Animal bite and scratch injuries are common presentations to rabies-prevention clinics. Although rabies is preventable through timely wound care and post-exposure prophylaxis, routine hospital data are often underused for identifying local epidemiological patterns and prevention priorities. Objective To describe the epidemiological characteristics of animal bite and scratch injuries treated in a large urban hospital in Hangzhou, China, and to identify routinely recorded factors associated with WHO category III exposure. Methods We conducted a retrospective cross-sectional analysis of 38,537 visit records from the Binjiang District Campus of the Second Affiliated Hospital, Zhejiang University School of Medicine. The dataset covered 1 January 2017 to 27 October 2020. Variables included sex, age, preliminary diagnosis, triage grade, exposure grade, exposure site, and visit date derived from the triage serial number. Exposure source and injury mechanism were classified from diagnosis keywords. Descriptive statistics, chi-square tests with Cramer's V, and multivariable logistic regression were used. The unit of analysis was the visit record. Results Among all records, 21,515 (55.8%) were female and the mean age was 30.5 ± 14.4 years. Cat-related injuries accounted for 19,137 records (49.7%), followed by dog-related injuries (16,844, 43.7%). Bite and scratch injuries were almost equally represented (19,025 [49.4%] and 19,172 [49.7%], respectively). Among 38,439 records with valid exposure grading, category II exposure predominated (33,214, 86.4%), whereas category III exposure represented 2,456 cases (6.4%). Upper-limb injuries were most common (28,180, 73.3% of valid site records). Visits increased from 6,934 in 2017 to 12,131 in 2019; 2020 data were incomplete. Monthly visits peaked in July and August. Among the examined variables, exposure grade showed the most evident association with anatomical site, although the effect size was small (Cramer's V = 0.118, p < 0.001). In adjusted analysis, head/neck injuries had higher odds of category III exposure than upper-limb injuries (OR 1.23, 95% CI 1.03–1.47), while lower-limb and trunk injuries had lower odds. Conclusions The local profile of animal injuries was characterized by high outpatient volume, a large proportion of cat-related and upper-limb injuries, predominance of category II exposure, and clear summer peaks. Rabies prevention should combine public education on immediate wound washing and timely post-exposure prophylaxis with improved pet management, source control, and more complete clinic surveillance fields, including vaccination timing, rabies immunoglobulin use, animal vaccination status, and outcome follow-up.</p>