Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution

Abstract

Dog bite injuries remain a common form of pediatric trauma. This single-institution study of 1616 consecutive dog bite injuries over 4 years revealed a much higher prevalence of dog bites as compared with other similar centers. Though inpatient admission was rare (9.8%), 58% of all patients required laceration repair, primarily in the emergency department. Infants were more than 4 times as likely to be bitten by the family dog and more than 6 times as likely to be bitten in the head/neck region. Children ≤5 years old were 62% more likely to require repair; and 5.5% of all patients required an operation. Pit bull bites were implicated in half of all surgeries performed and over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds. The relatively high regional prevalence and younger age of injured patients as compared with other centers is a topic of further study but should draw attention to interventions that can minimize child risk.

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Clinical Pediatrics
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DOI: 10.1177/0009922816657153
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Article
Introduction
Dog bite repairs were among the top 5 reconstructive
procedures performed by plastic surgeons, and this num-
ber, nearly 27 000 annual repairs, exceeded head/neck
and lower-extremity reconstruction.1 The management
of dog bite injuries range from simple washouts and lac-
eration repair to more complex procedures such as cra-
niotomies or replantation. Interestingly, the first partial
face transplant was performed on a woman who had
been attacked by her Labrador.2,3
From reviewing the statistics in Table 1, it is likely
that plastic surgeons interact with only a small fraction
of patients who have been injured by a dog and often the
most severe. It is emergency department (ED) physi-
cians, pediatricians, primary care providers, and parents,
however, who are the vital frontline in education, treat-
ment, and prevention regarding dog bite injuries.
Although precautions can be taken to prevent injury,
the trends in the personal and financial cost of dog bite
injuries have only increased in recent years. There was
an 86% increase in hospitalizations from 1993 to 200810
and an 82% increase in fatal dog attacks from the 1980s
to 2012.11 Paid homeowners’ insurance claims too have
increased from $324 to $478 million in just 8 years.12
This study stemmed from the high prevalence of dog
bite injuries treated at our pediatric tertiary hospital,
with an aim to quantify the scope of the problem and
identify potential targets of intervention for primary care
providers. For surgeons managing extremity and facial
trauma, the ultimate goal is to reduce the amount of
severe injury encountered by drawing both clinician and
lay attention to what may be a preventable threat to chil-
dren’s safety.
Methods
After institutional review board approval, a 4-year retro-
spective chart review was conducted from ED charts at the
Children’s Healthcare of Atlanta (CHOA), the only pediat-
ric level I trauma center in the state. Inclusion criteria were
the following: patients <20 years old, male or female, ini-
tial triage in the CHOA ED for a dog bite or transfer from
another center where primary treatment had not been
657153CPJXXX10.1177/0009922816657153Clinical PediatricsGolinko et al
research-article2016
1Arkansas Children’s Hospital Division of Plastic Surgery, University
of Arkansas for Medical Sciences (UAMS) Little Rock, AR, USA
2Children’s Healthcare of Atlanta (CHOA) at Scottish Rite, Atlanta,
GA, USA
3Emory University School of Medicine, Atlanta, GA, USA
Corresponding Author:
Michael S. Golinko, Arkansas Children’s Hospital Division of Plastic
Surgery, 1 Children’s Way, Little Rock, AR 72202, USA.
Email: msgolinko@uams.edu
Characteristics of 1616 Consecutive
Dog Bite Injuries at a Single Institution
Michael S. Golinko, MD, MA1, Brian Arslanian, MD2,
and Joseph K. Williams, MD, FAAP2,3
Abstract
Dog bite injuries remain a common form of pediatric trauma. This single-institution study of 1616 consecutive
dog bite injuries over 4 years revealed a much higher prevalence of dog bites as compared with other similar
centers. Though inpatient admission was rare (9.8%), 58% of all patients required laceration repair, primarily in the
emergency department. Infants were more than 4 times as likely to be bitten by the family dog and more than 6
times as likely to be bitten in the head/neck region. Children ≤5 years old were 62% more likely to require repair;
and 5.5% of all patients required an operation. Pit bull bites were implicated in half of all surgeries performed and
over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds. The relatively high
regional prevalence and younger age of injured patients as compared with other centers is a topic of further study
but should draw attention to interventions that can minimize child risk.
Keywords
dog bite injury, pediatric trauma, repair of dog bites
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2 Clinical Pediatrics
administered, and at least 1 full-thickness wound.
Exclusion criteria were as follows: young adults >20 years
old, triage visits for suture removal from a dog bite, treat-
ment of a dog bite where initial treatment took place at
another center, and bites from animals other than dogs.
Statistical Methods
All data were stored in Microsoft Excel (Microsoft
Corporation, Redmond, WA) and aggregate statistics,
such as means and SDs, were calculated using Excel.
Contingency tables were created for categorical vari-
ables (eg, attack by pit bull vs non–pit bull); odds ratios
(OR) and CIs were calculated using http://statpages.org/
ctab2x2.html. Statistical significance (P < .05) was
reported with a standard 2-tailed P value, using Fisher’s
exact test. Standard t tests were used in statistical com-
parison of means and proportions.
Results
Triage Characteristics
A total of 1616 consecutive patients were included.
Patients were bitten in 118 unique cities; however, in
320 (19.8%) cases, the city of bite could not be deter-
mined. Also, 10 patients (0.6%) were from out of state,
and 192 patients (11.8%) were referred from, but not
treated at, an outside facility.
As Table 2 summarizes, the majority of patients were
young males of school age, and half of all patients were
between 5 and 12 years of age. Approximately the same
percentage of family dogs and dogs familiar to the child
were implicated in injuries. Head and neck injuries
(56.5%) were the most prevalent. It was found that 1477
(91.3%) children were bitten in 1 anatomical area, 98
(6.1%) in 2 areas, 31 (1.9%) in 3 areas, and 3 (0.1%) in
4 areas. Canine breed was identified by patient or family
report in 31.3% of medical charts.
Of the 46 breeds identified, the 3 most prevalent were
38.5% pit bull (also identified as Staffordshire bull ter-
rier, American Staffordshire terrier, or bull terrier),
13.0% mixed breeds, and 8.1% Labradors. Of the mixed
breeds (n = 66), 11 were pit bull mixes, 12 Labrador
mixes, and 4 Labrador/pit bull mixes. Figure 1 illus-
trates the relative frequency of biting breeds, with font
size being a function of relative proportion.
Characteristics of Injury After Triage
Although more than 90% of patients were ultimately
discharged, approximately 50% of those still required
laceration repair. Approximately 10% of patients
required inpatient admission, and 50% of those required
an operation; 4.0% (n = 65) of patients returned to the
ED with a soft-tissue infection (see Figure 2).
Age-Group Analysis
Contingency tables were calculated to compute the OR
of the association of a specific age group or groups (risk
Table 2. Patient- and Dog-Related Outcome Variables.
Patient Variables Value (%)
Patients 1616
Percentage male 56.3%
Percentage female 43.7%
Patient age group 6.8 Years (5 days to 20
years)
0-1 Years old 144 (8.9)
1-5 Years old 428 (26.5)
5-12 Years old 808 (50.0)
>12 Years old 236 (14.6)
City of bite identified 1296 (80.2)
Bite injury variables
Family dog 753 (46.6)
Known to the child (not family) 655 (40.5)
Unknown dog 205 (12.7)
Dog breeds identified 509 (31.3)
Anatomical area
Head/Neck 1004 (56.5)
Upper extremity 398 (22.4)
Lower extremity 252 (14.2)
Trunk 98 (5.5)
Other 25 (1.4)
Table 1. Recent Statistics on Dog Bite Injuries.
• 83.3 Million dogs living in more than 50 million households4
• 4.5 Million annual dog bites; ~885 000 require medical attention; ~400 000 treated in the ED5
• 64.9% Of bites are to the head and neck6
• Most prevalent age group: 5-9 years old6
• Up to 50% of children may develop posttraumatic stress disorder7
• 55.6% Of all mortalities occur in children <10 years old8
• 78% Of all deaths from dog attacks between 2005 and 2013 were from pit bulls and Rottweilers9
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Golinko et al 3
factor) with the presence or absence of an injury charac-
teristic—that is, injury in the head/neck area. OR regard-
ing anatomical areas assumes the likelihood of at least 1
bite in each area. Table 3 illustrates these data, with sta-
tistically significant results in bold.
Of note, children 5 years old and younger were
approximately 62% more likely to require repair in any
setting and were between 3 and 6 times as likely to suf-
fer a head and neck injury as compared with other
groups. Infants were more than 4 times as likely to be
bitten by the family dog and more than 6 times as likely
to be bitten in the head/neck region. Lower-extremity
injury correlated directly with age. Teenagers were more
than twice as likely to sustain extremity injuries and be
injured by an unknown dog or a pit bull. Bite injury to
the lower extremity was statistically less likely in chil-
dren younger than 5 years and more likely in children
older than 5 years. Dog bites in more than 1 anatomical
location was 1.7 times as likely in children 12 years and
older as compared with all younger groups. No one age
group was any more likely to require operative interven-
tion than another.
Features and Morbidity of Patients With the
Most Severe Injuries
In all, 5.5% (89) of patients underwent surgery; of these,
68.5% involved the head/neck region. Of the breeds
identified, 50% involved pit bulls. The mean age was
6.3 years old (range = 5 days to 17 years). Table 4 enu-
merates the primary procedure performed.
With regard to breed, operative intervention was
most strongly associated with a pit bull injury: OR =
3.361 (CI = 2.011-5.592); P < .001. Pit bull breeds were
also more likely to bite in multiple anatomical locations,
OR = 2.660 (CI = 1.598-4.436); P < .001. Four returns
to the ED from this group were noted, including 2 for an
abscess, 1 for exposed hardware, and 1 for wound necro-
sis. Known operative complications included the fol-
lowing: hand amputation after attempted
revascularization, a growing skull fracture, and wound
dehiscence with return to the operating room for skin
graft placement.
The lone mortality involved a 5 day-old girl attacked
on the head by the family’s pit bull. The child underwent
emergency craniotomy. Her postoperative course was
complicated by acute respiratory distress syndrome,
neurogenic pulmonary edema, and transfusion-related
acute lung injury. Despite maximal ventilator support,
she was persistently hypoxic and succumbed on postop-
erative day 3.
Discussion
Current Literature on Dog Bite Injuries
Dog bite injuries are neither new nor an unstudied phe-
nomenon in children. Table 5 summarizes some of the
recent literature emerging from pediatric centers compa-
rable to our own.
On average, the centers cited saw approximately 120
dog bite injuries per year, per institution (range between
17 and 204 per year).18 Somewhat surprising was that
our center averaged more than 400 patients per year. The
relatively low population density of Georgia, allowing
for larger dogs, and the scarcity of other pediatric trauma
centers in the state may account for this high prevalence,
but further detailed study is needed to see if dogs are
truly biting at a higher rate. There are significant gaps in
the literature, as Table 5 illustrates, including detailed
data on the biting dog, disposition of the child after ED
triage, age in relation to multiple variables, frequency
and type of repair, and types of operations performed.
Age and Injury Patterns
The largest ED survey published found that boys 5 to 9
years old21 are most susceptible to bite injury. In addi-
tion to domestic studies, the world literature is clear: in
reports from Canada,22 Spain,23 Austria,24 South Africa,13
Australia,25 Peru,26 India,27 Hong Kong,28 and Bhutan,29
persons younger than 18 years are most at risk for dog
bite injury. Our study certainly was consistent with oth-
ers findings; however, a breakdown into clinically sig-
nificant age categories provided some new findings.
The age-group analysis in this study indicates that
younger children than previously thought are more at
risk for injury. Infants (≤1 year old), more so than any
Figure 1. Word cloud of the frequency of breeds identified.
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4 Clinical Pediatrics
other age group in this study, were most likely to suffer
a head/neck injury and be bitten by the family dog or a
dog the family knows, and least likely to be bitten by an
unknown dog. This was a surprising finding given that
most literature points to older children being more sus-
ceptible. Moreover, the one mortality in this study of a
5-day old baby girl attacked by her family pit bull should
be sobering evidence enough to exercise extreme cau-
tion in this age group when in contact with that particu-
lar breed. Children younger than 5 years were nearly
half as likely to suffer an extremity injury, whereas chil-
dren older than 12 years were over twice as likely to.
These trends may not be merely a matter of total body
surface area and height, but also age-specific behavior
of children toward dogs—that is, young children kissing
or nuzzling the dog and older children playing catch,
feeding, washing, or petting.30,31 Although the data seem
to support a common sense assumption, knowledge of
this propensity can guide parents when supervising their
young children in the presence of the family pet.
The High-Risk Animal: A Dog You Know
Unfortunately, familiarity may lead to injury. The exist-
ing literature reveals that the family dog inflicts injury
between 27% and 45% of the time, more so than a
neighbors’ dog or a stray.14,17-19 Some studies we
reviewed, however, did not distinguish between a dog
known to the family, such as a neighbor’s dog, and the
family dog. This is a potentially important distinction
because we suspect that the more parents (and children)
are familiar with a dog, the less vigilant they may be.
Our data were consistent with others findings that the
family dog was statistically no more likely to be involved
in a bite injury than a familiar dog, however: 46.6% and
40.5%, respectively(P > .05), and again, infants were
most at risk in each of these categories. Whether this
finding is indicative of parents’ level of supervision
around the family dog or whether it is simply because
children have more chances to be bitten by the family
dog as compared with a dog that is not routinely around,
we interpret the data to indicate that parents should dem-
onstrate equal vigilance in all cases. Indeed, in one study
of 56 modifiable risk factors, the strongest was “the
absence of an able-bodied person to intervene”—pres-
ent in more than 87% of injuries reviewed.32
Pit Bull Injuries
Our data confirm what detractors of the breed and child
advocates suggest—that, with rare exceptions, children
and pit bulls do not mix well. Of the 8 studies listed in
Table 5, 6 report pit bulls as the most prevalent breed, and
in many cases, they inflicted the most severe injuries.17 A
large study at Children’s Hospital of Pennsylvania
showed that over a 12-year period, 25% of injuries were
caused by a pit bull, and two-thirds of those required an
operation.33 Our data were consistent with others, in that
an operative intervention was more than 3 times as likely
to be associated with a pit bull injury than with any other
breed. Half of the operations performed on children in
this study as well as the only mortality resulted from a
pit bull injury. Our data revealed that pit bull breeds
were more than 2.5 times as likely as other breeds to bite
in multiple anatomical locations. Although other breeds
may bite with the same or higher frequency, the injury
that a pit bull inflicts per bite is often more severe.
Consistent with these findings is that of Bini et al,17 who
reported on 228 patients and found that attacks by pit
bulls resulted in a higher injury severity score, lower
Figure 2. Patient disposition from the ED.
Abbreviations: ED, emergency department; OR, odds ratio IV, intra-venous ABX, antibiotics .
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5
Table 3. Characteristics by Age Group, as Percentage of the Total in Each Group.a
Characteristics
Age Group
0 to ≤1.0 Year Old (144) 1.0 < Age ≤5.0 Years Old (533) 5.0 < Age ≤ 12.0 Years Old (746) <12.0 Years Old (193)
n (%) OR (CI), P Value n (%) OR (CI), P Value n (%) OR (CI), P Value n (%) OR (CI), P Value
Head/Neck injury 109 (75.7) 6.197 (4.122-9.350) 389 (73.0) 3.043 (2.429-3.816) 420 (56.3) 0.991 (0.816-1.204) 87 (45.1) 1.194 (0.879-1.622)
Upper extremity 25 (17.4) 0.962 (0.559-1.536) 102 (19.1) 0.784 (0.605-1.017) 201 (26.9) 1.252 (0.992-1.581) 70 (36.3) 2.348 (1.688-3.263)
Lower extremity 9 (6.3) 0.452 (0.212-0.930) 50 (9.4) 0.529 (0.376-0.743) 145 (19.4) 1.635 (1.234-2.166) 48 (24.9) 2.231 (1.535-3.238)
Trunk 8 (5.6) 1.118 (0.489-2.458) 24 (4.5) 0.675 (0.409-1.106) 53 (717) 1.389 (0.904-2.134) 13 (6.7) 1.198 (0.624-2.260)
Other 1 (0.7) 0.468 (0.023-3.288) 5 (0.9) 0.510 (0.167-1.448) 14 (1.8) 1.488 (0.632-3.531) 5 (2.6) 5.657 (2.7-11.789)
≥2 Anatomical
areas
10 (6.9) 0.846 (0.408-1.703), P = .749 32 (6.0) 0.627 (0.408-0.961) 73 (9.8) 1.310 (0.911-1.883) 24 (12.4) 1.728 (1.052-2.819)
Operative repair 9 (6.3) 1.219 (0.558-2.576) 25 (5.8) 1.364 (0.860-2.160) 48 (5.9) 0.960 (0.611-1.506) 7 (3.0) 0.449 (0.158-1.167)
Family dog 97 (67.4) 4.326 (2.973-6.305) 264 (49.5) 1.644 (1.334-2.025) 306 (41.0) 0.877 (0.721-1.068), P = .188 86 (44.6) 1.611 (1.182-2.195)
Known dog 38 (26.4) 1.617 (1.074-2.427) 206 (26.4) 1.228 (0.992-1.520) 338 (45.3) 1.386 (1.129-1.702) 74 (38.3) 1.441 (1.049-1.979)
Unknown dog 9 (6.3) 0.498 (0.233-1.026) 62 (11.6) 0.940 (0.676-1.306) 101 (13.5) 1.158 (0.855-1.569) 33 (13.5) 1.667 (1.086-2.548)
Pit bull injury 15 (10.4) 0.952 (0.523-1.706) 48 (9.0) 0.706 (0.493-1.009) 99 (13.2) 1.255 (0.919-1.715) 31 (16.1) 1.644 (1.059-2.541)
aOdds ratios (ORs) are reported, calculated with age as the independent variable. Confidence intervals are reported; those that are statistically significant, with P < .05, are in bold.
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6 Clinical Pediatrics
Glasgow coma score, higher risk of death, and higher
hospital charges than attacks by any other breed.17
Morbidity of Dog Bite Injuries
Whereas existing studies focus on only bites repaired in
the ED or only the most severe requiring the OR, this
study sought to follow patients longitudinally through-
out their course from triage to treatment and disposition.
Summarizing from Table 5, national admission rates
range between 6.4%15 and 22.5%,16 and operative rates
range between 3.1%15 and 25.2%.20 This study revealed
that 57.9% of patients required some form of repair fol-
lowing a dog bite, 9.8% of patients required inpatient
admission, and more than 50% of admissions were asso-
ciated with an operation. Younger children (mean age =
6.3 years) tended to require an operation. Although the
majority of injuries required only washout and closure,
revascularization of the hands, ORIF of long bones, and
craniotomies were among the singular reminders of the
severity of trauma a dog can inflict on a child; also,
whereas the common laceration may not be preventable
in many cases, these severe injuries often need not occur.
Regardless of treatment setting, copious irrigation with
betadine and saline, sharp debridement of any macer-
ated or damaged tissues, deep closure with monocryl as
needed, and loose skin approximation with permanent
sutures, along with a 10-day course of amoxicillin/cla-
vulanate potassium or clindamycin is advised. Families
should be counseled that avoidance of secondary infec-
tion is more important in the short term than cosmesis
because an unsightly scar can always be revised.
Limitations and Bias
Because this was a retrospective review of triage and
medical record data, certain variables such as breed of
dog could not be independently verified. There may be
a reporting bias for typically “biting” breeds, such as
pit bulls. Although 1616 consecutive children were
included, 1608 of these were unique because 8 children
were bitten at 2 separate time points and returned to the
ED for treatment. Analysis of the same or different dog
responsible for each bite was beyond the scope of this
study but would be important to investigate. Another
source of error is in the city of bite because data
recorded where the bite took place may not necessarily
be where the animal normally resides. Often, bites
occurred at home, for which data would be accurate.
Comparison of admission, ED, and surgical repair rates
are biased by institutional resources and local physi-
cian practice patterns. The authors acknowledge that
etiology of a dog bite is complex and multifactorial,
depending not only on the canine’s characteristics, but
also on owner training, child behavior, and the specific
conditions when the bite occurred. Operative compli-
cations and returns to the ED following a repair for a
soft-tissue infection are likely underestimated as well
because many patients may have sought care at their
local physician’s office and not returned to the original
point-of-service.
Potential Public Health Interventions
The health care providers who see the accidental and
often deleterious effects of dog bite injury are vastly out-
numbered by the heads of the approximately 56.7 mil-
lion households34 who own dogs under the likely
assumption that the dog will not harm them or their
child. Several studies reflect this hypothesis35,36 and
revealed that the majority of parents assumed that their
infants were not at risk for an attack. As a Cochrane
database review suggests, it is often better to educate the
parents and pediatricians rather than children directly.37
Alarmingly, one survey of 254 parents revealed that
only two-thirds believed that a dog could be the cause of
a fatal infant injury.36
At least in the United States, “man’s best friend” is
part of the national psyche and is reinforced for children
in the form of stuffed animals, cartoon characters, and
animated movies. In this milieu, it is all the more impor-
tant for any clinician, using data from this study and oth-
ers, to caution parents appropriately about the potential
hazards that specific canine situations may pose to their
child. Inquiring and counseling about dogs at home and
in the neighborhood should be as important and integral
a part of any pediatric encounter, as would be cautioning
Table 4. Frequency of Operative Procedures in 89 Patients
Suffering Dog Bite Injuries.
Operating Room Procedure n (%)
Irrigation and closure 60 (65.9)
Canalicular repair 11 (12.1)
Wound irrigation and
debridement
4 (4.4)
Craniotomy 3 (3.3)
Dural repair 2 (2.2)
Facial nerve repair 1 (1.1)
Local facial flap 1 (1.1)
ORIF humerus 1 (1.1)
ORIF mandible 1 (1.1)
ORIF radius 1 (1.1)
ORIF phalanx 1 (1.1)
Replant lip 1 (1.1)
Revascularization of hands 1 (1.1)
Tooth extraction 1 (1.1)
Abbreviation: ORIF, open reduction, internal fixation.
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7
Table 5. Selected Studies of Dog Bite Injuries With Select Variables That Could Be Targets of Public Health Intervention.
Authors
(Year
Published)
Study
Length(years) Patients (n) City (Type of Site)
Two Most Prevalent
Breeds Documented
(%)
Percentage
Family Dog
Percentage
Familiar (But
Not Family)
Percentage
Unknown
Percentage
Admitted/
Operating
Room
Mean or Most
Prevalent Age
Range (years)
Dwyer
et al,13 2007
13 1871 Cape, Town South
Africa (1 Children’s
Hospital)
• PB 28%
• GS 21%
• 1%
6.8 years old
Daniels
et al,14 2009
7 1347 Indianapolis, IN (2
children’s hospitals)
• PB 12%
• GS 2.4%
• 28% (inpatient only)
37% 33% 7% 8.1%/4.5% 7.8 Years old
Kaye et al,15
2009
5 551 Philadelphia, PA
(children’s hospital)
• PB 50.9%
• R 8.9%
• 48.8%
68.8% (Family +
dog friend)
6.4%/3.1% 6-12 Years old
(51%)
Chen et al,16
2013
5 537 Aurora, CO
(children’s hospital)
• M 23%
• L 13.7%
89.8% (Family +
dog friend)
11.2% 22.5% Admit 68% ≤ 5 Years
old
Bini et al,17
2011
15.5 228
(Admitted
only)
San Antonio, TX
(trauma hospital)
PB 35% 44.8% 43.1% 12.1% 21 Years old
Bernardo
et al,18 2000
1 204 Pittsburgh, PA
(children’s hospital)
• PB 19%
• GS 12%
• 47%
27% 28% 6.8 Years old;
<5 Years:
49%
Reisner
et al,19 2011
3.5 203 Philadelphia, PA
(children’s hospital)
• M 28%
• PB 22%
72% (Family +
dog friend)
9% 7.2 Years old
Wu et al,20
2011
5 87 Springfield, MA
(tertiary hospital)
25.2% OR 6.8 Years old
Abbreviations: PB, pit bull; GS, German Shepherd; R, Rottweiler Pincher/Rottweiler; M, mixed; L, Labrador.
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8 Clinical Pediatrics
parents about the hazards of handguns, trampolines, or
monkey bars.
Though a full discussion of the range of public health
interventions is beyond the scope of this report, several
comments can be made. There is no shortage of passion or
emotion when it comes to the question of banning certain
breeds as many owners of the accused dogs staunchly
defend their “members of the family.” The debate is an
active one because, recently, the parents of children
attacked by pit bulls petitioned state lawmakers in Georgia
for a ban on the breed.38 In certain locations, as in Canada,
breed specific legislation has been shown to decrease the
incidence of bites.39 Consider even that in Aurora,
Colorado, where pit bulls have been banned since 2006, a
recent study of 537 children found that Labradors were the
second most-prevalent biting breed (13.7%), second only
to mixed breeds. In other words, a ban of any particular
dog alone will not necessarily prevent the severe injuries
and mortality, but rather a change in interaction and super-
vision of children with dogs of any breed. Figure 3 offers
some recommendations and is adapted from Reisner et al19
and American Veterinary Medical Association Task Force
on Canine Aggression and Human-Canine Interactions.40
Conclusions
This is the first detailed study of dog bite injuries in
Georgia and one of the largest studies conducted at a
pediatric trauma center. Our study revealed that whereas
more than half of all injuries necessitate repair, only
approximately 5% require operative intervention. The
data also suggest that younger children (<5 years old)
than previously reported, and particularly infants, are at
high risk for the most severe injuries. The study corrob-
orates the largely negative interactions between pit bulls
and children of any age. Parental education and supervi-
sion may be the most important measure to prevent
severe dog bite injuries.
Acknowledgments
We are grateful to Jessica Liu, MD, Varun Katare, MD, and
Greg Melnikoff, MD, for help in acquiring the data and Eric
Golinko, MS for biostatistics analysis advice.
Author Contributions
MSG concieved the study idea and developed the research
design with JKW.MSG wrote the initial drafts of the manu-
script. MSG and BA spear-headed data collection, analysis
and along with JKWwrote and edited all portions of the manu-
script. JKW provided key insights and changes in discussion
and data presentation.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
For Parents:
○ Determine what dogs live in the neighborhood and take appropriate precautions
○ Refrain from leaving children under 5-years-old unsupervised with a dog of any breed, family or otherwise
○ Never leave a child under 1 year-old alone with any dog
○ Exercise identical precautions when children are interacting with the family or a familiar dog
○ Dissuade or prevent children from behavior that brings their face in close proximity to the dogs
○ Avoid interacting with the dog when its’ eating, sleeping or nursing- and allow their children to learn this habit
○ Strong consideration to avoidance of any interaction between pit bull breeds and young children, particularly infants
For Primary Care Providers
○ Counsel parents as above, and that the #1 way to avoid accidental injury is supervision
Emphasize avoidance of secondary infection as opposed to cosmesis on in the initial repair
○ Have a low-threshold for surgical consult to ensure adequate irrigation and debridement under anesthesia
○ Routine patient encounters are an opportunity to inquire about any dog that children could routinely come in contact with, not just the
family dog.
Figure 3. Select recommendations for primary care practitioners and parents based on study findings.
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Golinko et al 9
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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