Clinical features of 27 shark attack cases on La Réunion Island

BACKGROUND: Between January 2000 and September 2016, there have been 27 documented shark attacks on La Reunion Island. The insular nature of La Reunion has allowed us to carry out an extensive survey of these attacks. The objective was to describe the clinical features of these shark attacks, as only case reports have been published up to now. METHODS: This was a retrospective observational study of the 27 cases of non-provoked shark attacks that have occurred between January 2000 and September 2016. Post-humate predation, provoked attacks and isolated attack on devices were excluded. All bone and vascular injuries were documented in the 21 remaining cases. Prehospital tourniquet use was specifically recorded. RESULTS: Among the 21 victims, 8 died (38%) despite rapid use of resuscitation techniques in 5 cases when it was feasible; these techniques were not needed in the survivors. Thirteen patients were immediately treated in the operating room. Amputation or disarticulation occurred 13 times in 10 victims, 5 of whom died. Twelve injuries to major vascular structures were found in 11 victims, 6 of which died. A prehospital tourniquet was applied in 4 of the 5 surviving victims who had injuries to major vascular structures (including 1 victim with major humeral and femoral artery damage) and in 1 victim who died (the very proximal wound was not controlled). CONCLUSION: Our study found that quickly applying a tourniquet to the injured limb(s) contributes to the victim's survival. Disarticulation is a particular feature of shark attacks. The number and severity of shark attacks at La Reunion Island are worse than in the rest of the world. LEVEL OF EVIDENCE: Epidemiological study, IV. Language: en