Patients with bear-associated injuries may vary between countries.

We read with great interest the article by Nath et al. [ [1] Nath A. Gaur N.K. Vathulya M. et al. Bear attack pattern and behavior in the Himalayan region: a study from a tertiary care center. Injury. 2020; 51: 2082-2085 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ], which describes the background of patients with bear-associated injuries. We observed similarities and differences between our experiences and those reported by authors in the aforementioned study. We often encounter and manage bear-associated injuries at a tertiary center for emergency medicine in Akita Prefecture in the northern region of the main island of Japan, which is known for its dense forests. We have treated 23 patients with bear-associated injuries over 13 years (Table 1). We observed similarities between the pattern of injuries in our patients and those reported by Nath et al. [ [1] Nath A. Gaur N.K. Vathulya M. et al. Bear attack pattern and behavior in the Himalayan region: a study from a tertiary care center. Injury. 2020; 51: 2082-2085 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ], although our patients were attacked by Asian black bears and those in the aforementioned study by Himalayan black bears. For example, all individuals in the aforementioned study had scalp, face, or neck injuries, and 22 of the 23 patients included in our study also had such injuries. The similarities in patients’ injury profiles are attributable to similarities in the body size of both species. However, we also observed differences between our patients and those described by Nath et al. [ [1] Nath A. Gaur N.K. Vathulya M. et al. Bear attack pattern and behavior in the Himalayan region: a study from a tertiary care center. Injury. 2020; 51: 2082-2085 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. Our patients were older and had more various causes of action with which they were injured. Patients’ mean age in our study was 68 years in contrast to 41 years in the study reported by Nath et al. [ [1] Nath A. Gaur N.K. Vathulya M. et al. Bear attack pattern and behavior in the Himalayan region: a study from a tertiary care center. Injury. 2020; 51: 2082-2085 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. This difference may be attributed to the social scenario in Akita Prefecture in Japan, specifically the declining birth rate, aging population, and out-migration of young individuals to urban areas. Our patients were injured during involvement in various “fun” activities, such as motorcycle rides, mountain stream fishing, collecting natural products including chestnuts, mushrooms, and edible wild plants. In contrast, patients in the study reported by Nath's group [ [1] Nath A. Gaur N.K. Vathulya M. et al. Bear attack pattern and behavior in the Himalayan region: a study from a tertiary care center. Injury. 2020; 51: 2082-2085 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. were injured during everyday activities, such as mowing, collecting firewood, and animal grazing. The differences between our experiences and those reported by Nath et al. [ [1] Nath A. Gaur N.K. Vathulya M. et al. Bear attack pattern and behavior in the Himalayan region: a study from a tertiary care center. Injury. 2020; 51: 2082-2085 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ] highlight the role of diverse backgrounds and activities that predispose individuals to bear-associated injuries. In our opinion, deeper understanding of activities that increase the risk of bear attacks (as described in our study) is an important “first step” toward establishment of an effective government policy and/or individual activities to prevent serious bear-associated injuries because as highlighted in this study, such activities are closely associated with an individual's social background. Table 1 case Age (years) Sex Injuries Length of hospitalization (days) 1 80 M Scalp soft tissue defect with exposed skull, open fracture of metacarpal bone, and partial defect of ear auricle 11 2 58 M Lacerations of face and left forearm 15 3 57 M Lacerations of right side of neck, breast, and left thigh 13 4 72 M Lacerations of scalp, lateral portion of left eyebrow, right upper arm and left forearm, and left facial nerve injury 12 5 68 M Lacerations of scalp, as well as facial, left thigh, and left zygomatic fractures 18 6 70 M Lacerations of face, breast, and left canaliculus rupture 12 7 61 M Scalp soft tissue defect, and lacerations of the right upper arm, left hand, and left thigh 30 8 37 M Lacerations of the lower lip, right elbow, and abdominal wall 4 9 80 F Lacerations of face and right shoulder and open fracture of the right forearm 20 10 66 F Fractures of the orbital, nasal, and mandibular bones and lacerations of the face, upper arm, left abdomen, and right thigh 29 11 78 F Lacerations of scalp and right upper arm and lumbar vertebral fractures 28 12 56 M Lacerations of scalp, ear auricle, both hands and face, and disorder of the inferior rectus muscle 10 13 49 M Left lower extremity lacerations 6 14 79 M Lacerations of the ear auricle, face, lower lip, right upper extremity and breast 9 15 68 F Scalp skin defect and lacerations of the ear auricle, face, right upper arm, and mandibular bone fractures 14 16 76 M Lacerations of the face, right wrist, and breast and fractures of the nasal bone (Le Fort Type 1) and zygomatic bones, and tooth luxation 20 17 72 M Lacerations of scalp, ear auricle, face, both hands, and left thigh 5 18 83 F Depressed skull fracture, right orbital crush fracture, lacerations of face, and eyeball rupture Died on day 8 19 74 M Lacerations of scalp and upper lip 17 20 63 M Lacerations of ear auricle, face, left forearm, left side of back, and right knee 8 21 84 M Lacerations of scalp, face, and right shoulder, and fracture of the right upper arm 9 22 67 F Lacerations of face, both upper extremities, and right thigh, and fractures of several facial bones 16 23 73 M Lacerations of scalp, both upper arms, breast, and right thigh 22 Open table in a new tab