title: Clinical features of 27 shark attack cases on La Réunion Island.
abstract: Between January 2000 and September 2016, there have been 27 documented shark attacks on La Réunion Island. The insular nature of La Réunion has allowed us to perform 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.
  
  
  
  This was a retrospective observational study of the 27 cases of nonprovoked 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.
  
  
  
  Among the 21 victims, eight died (38%) despite rapid use of resuscitation techniques in five 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, five of whom died. Twelve injuries to major vascular structures were found in 11 victims, six of which died. A prehospital tourniquet was applied in four of the five surviving victims who had injuries to major vascular structures (including one victim with major humeral and femoral artery damage) and in one victim who died (the very proximal wound was not controlled).
  
  
  
  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 Réunion Island are worse than in the rest of the world.
  
  
  
  Epidemiological, level V.
authors.affiliation: From the Service de chirurgie orthopédique (R.B., C.P.), Centre Hospitalier Gabriel Martin, Saint Paul; Laboratoire IRISSE (EA4075) (R.B.), UFR SHE, Université de La Réunion, Le Tampon; Seprodom S.A.R.L. (G.S.), La Possession; Service de chirurgie orthopédique (P.E.), CHU Réunion-Site Sud Réunion, Saint-Pierre Cedex; and Service de chirurgie orthopédique infantile (E.P.), CHU Réunion-Site Nord, Ile de La Réunion, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Ballas
authors.forename: Ghislain
authors.initials: G
authors.lastname: Saetta
authors.forename: Charline
authors.initials: C
authors.lastname: Peuchot
authors.forename: Philippe
authors.initials: P
authors.lastname: Elkienbaum
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Poinsot
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017508:Reunion / Q000453:epidemiology; D012754:Sharks; D014111:Tourniquets; D055815:Young Adult