Shark attack-related injuries: Epidemiology and implications for plastic surgeons

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Summary

Background and aim

The increased media attention to shark attacks has led to a heightened fear and public awareness. Although few sharks are considered dangerous, attacks on humans can result in large soft tissue defects necessitating the intervention of reconstructive surgeons. This study aims to evaluate and describe the characteristics of shark-related injuries in order to improve treatment.

Methods

The Global Shark Accident File, maintained by the Shark Research Institute (Princeton, NJ, USA), is a compilation of all known worldwide shark attacks. Database records since the 1900s were reviewed to identify differences between fatal and nonfatal attacks, including: geography, injury pattern, shark species, and victim activity.

Results

Since the 1900s, there have been 5034 reported shark attacks, of which 1205 (22.7%) were fatal. Although the incidence of attacks per decade has increased, the percentage of fatalities has decreased. Characteristics of fatal attacks included swimming (p = 0.001), boating (p = 0.001), three or more bite sites (p = 0.03), limb loss (p = 0.001), or tiger shark attack (p = 0.002). The most common attacks were bites to the legs (41.8%) or arms (18.4%), with limb loss occurring in 7% of attacks. Geographically, the majority of attacks occurred in North America (36.7%) and Australia (26.5%). Most attacks in the USA occurred in Florida (49.1%) and California (13.6%).

Conclusions

Although rare, shark attacks result in devastating injuries to patients. As these injuries often involve multiple sites and limb loss, this creates a significant challenge for reconstructive surgeons. Proper identification of the characteristics of the attack can aid in providing optimal care for those affected.

Introduction

Sharks have both intrigued and terrified society for decades because of increased media attention and thrilling Hollywood drama. America's infatuation with sharks began following the release of the blockbuster movie Jaws 40 years ago. Since its debut, the film has had a broad cultural impact and has been criticized by many scientists for fueling negative stereotypes about sharks and their behavior toward humans.1 Worldwide, many conservationists have echoed the sentiment that the film has hindered efforts to convince the public that sharks should be protected, rather than feared and hunted. Fortunately, this perception has begun to shift over the past decade with subsequent interest in protecting these animals.

Recent studies have focused on quantifying shark populations in various locations, and several have demonstrated population growth for the first time in decades.2 Interestingly, the ocean surrounding Cape Cod, Massachusetts, has been identified as having one of the fastest-growing shark populations. Coincidentally, this portion of the state also represents a major referral area for our center.2, 3, 4 Due to a growing population of gray seals (Halichoerus grypus), it has been suggested that the Cape Cod area is home to a previously unrecognized breeding ground for some large species of sharks. These reports have frequently been sensationalized by local media, like other shark-related stories, as more sightings occur.4, 5, 6

As attacks occur infrequently, the impact of shark attacks does not typically merit the degree of apprehension they inspire. Nonetheless, when attacks occur, the victims present with significant tissue defects, requiring early intervention by reconstructive surgeons after initial resuscitation. This study aims to report the details of both fatal and nonfatal shark attacks in an effort to improve the treatment of shark-attack victims by plastic surgeons and highlight some of the reconstructive challenges inherent in the treatment of these patients.

Section snippets

Patients and methods

Using The Global Shark Accident File, maintained by the Shark Research Institute (Princeton, NJ, USA), investigation was conducted on the available data regarding shark attacks worldwide.7 This database represents a compilation of all known worldwide shark attacks dating back to the 1800s and contains approximately 6000 incidents. The database was queried for attacks occurring from 1900 through September 2014, with 5034 incidents being documented. All known forensic data associated with each

Results

Since the 1900s, a total of 5034 shark attacks on humans have been recorded. Of these incidents, 1205 (23.9%) were fatal and 3829 (76.1%) were nonfatal (Table 1). The victims were 80.4% male (4049) and 10.0% female (495); the gender was not reported for 9.8% of cases (490). The average age of all victims was 26.1 years (Table 1). Overall, since the 1900s, the number of shark attacks reported per decade has been on the rise (Figure 1). The relative number of fatal attacks has decreased. The

Discussion

Shark attacks have become a source of public interest in the latter half of the 20th century.8 Before the 1930s, sharks were not thought to pose any danger to humans.8 Sharks first came to the public's attention following attacks on navy crewmembers during World War II and spiraled into a media sensation following the release of the movie Jaws.1, 9 Since then, much effort has been made to catalogue data about shark attacks in an attempt to better understand them. To date, no database has more

Conclusion

The severity of the injuries sustained following shark attack is on a par with military injuries and high-speed motor vehicle accidents.8, 16, 20, 24 Advancements in medical care have led to improved outcomes for shark-attack victims. Plastic surgeons play a key role in the management of these patients; a heightened awareness of the circumstances of their attack and treatment of these victims may improve outcomes when this uncommon problem presents. Early resuscitation, appropriate antibiotics,

Author contribution statements

All authors contributed equally to the literature search, study design, data collection, data analysis, data interpretation, writing, and critical revision of this manuscript.

Conflict of interest

None.

Funding

None.

Disclosures

The authors have no financial disclosures and report no conflicts of interest with any of the companies or products mentioned in this paper. This paper has not been previously published nor presented. No sources of funding were used to support this research.

Acknowledgments

The authors thank the Shark Research Institute (Princeton, NJ) for their permission to analyze the Global Shark Accident File.

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