Bear-related injuries in remote western China: seasonal patterns, attack circumstances, injury characteristics, and emergency care outcomes—a retrospective observational study

Abstract Background Bear attacks are uncommon but can cause complex, contaminated, multisystem trauma. Patient-level evidence linking attack circumstances to prehospital access, injury patterns, emergency management, and outcomes remains limited in remote western China. This study characterised bear-related injuries treated at a county hospital in Sichuan Province. Methods We retrospectively analysed 35 verifiable bear-related injury encounters treated at Jiulong County People's Hospital during a formal study period from June 2015 through December 2025. Demographic, temporal, exposure, prehospital, anatomical, severity, management, complication, and outcome variables were summarised descriptively. A prespecified exploratory comparison of Injury Severity Score (ISS) between attacks occurring during mushroom or matsutake harvesting and other recorded activities used the Mann–Whitney U test and a Hodges–Lehmann location shift with a 95% confidence interval. Results Mean age was 39.5 years (standard deviation 10.7), and 19 patients (54.3%) were male. Twenty-six attacks (74.3%) occurred in summer, and 19 (54.3%) occurred during documented mushroom or matsutake harvesting. Median injury-to-hospital time was 4.8 h (interquartile range 3.3–6.6); 13 patients (37.1%) arrived after at least 6 h. Upper-extremity, head or facial, and multiple-region injuries affected 30 (85.7%), 16 (45.7%), and 21 (60.0%) patients, respectively. Median ISS was 11 (interquartile range 7.5–15.5), and 9 patients (25.7%) had ISS ≥ 16. All patients underwent debridement; 33 (94.3%) received systemic antibacterial treatment, 10 (28.6%) underwent surgery, 9 (25.7%) had infection documented during the index hospitalisation, 3 (8.6%) required intensive care, 4 (11.4%) were transferred, and 1 (2.9%) died in hospital. The prespecified ISS comparison did not identify a clear difference (Hodges–Lehmann shift, − 3 points; 95% confidence interval, − 6 to 2; P = 0.213). Conclusions In this hospital series, bear-related injuries clustered in summer and frequently occurred during documented mushroom or matsutake harvesting. The predominance of upper-extremity, head or facial, and multiple-region injuries, together with frequent wound care, highlights the emergency-care burden. These findings support seasonally informed preparedness, systematic trauma assessment, and coordinated referral, but do not establish activity-specific risk or causal effects.