Pediatric Cases Presenting to the Emergency Department Due to Rabies-Risky Contact and Factors Affecting Immunoglobulin Administration

Aim: The aim of this study is to determine the demographic and clinical characteristics of pediatric cases presenting to the emergency department due to rabies risk animal contact and to analyze the independent risk factors affecting the administration of rabies immunoglobulin.Material and Methods: In this study, 204 pediatric cases between the ages of 0 and 18 who applied to a university hospital emergency department between January 1, 2021 and August 1, 2025 due to rabies risk animal contact were retrospectively analyzed. Contact characteristics, wound types and prophylaxis methods applied to the cases were recorded. Factors affecting immunoglobulin administration were evaluated using bivariate analyses and multivariate logistic regression analysis.Results: The mean age of the cohort was 8.86 ± 4.75 years, with a male predominance (64.2%). The majority of exposures involved cats (50.5%) and dogs (47.1%), and 89.7% of the implicated animals were free-roaming. Notably, despite 99.0% of the cases being classified as Category III exposures, rabies immunoglobulin (RIG) was administered to only 21.1% of the patients. Multivariable logistic regression analysis identified deep wounds, defined as those extending into the dermis and underlying tissues, as the sole independent predictor of RIG administration (OR 2.89; 95% CI: 1.23–6.79; p = 0.015). Patient age, sex, involved animal species, and time to clinical presentation did not independently influence the decision to administer RIG.Conclusion: In pediatric rabies risk contact cases, the prophylaxis decision, especially the use of immunoglobulin, is shaped by wound depth rather than animal species or admission time. The fact that immunoglobulin use remains low despite the very high rate of Category 3 contact suggests that the indication for immunoglobulin in not deep but high risk contacts should be reconsidered in clinical practice.