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Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution

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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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... 17 Dog bite repairs were amongst the top five reconstructive surgeries performed by plastic surgeons; it exceeds head and neck and lower extremity reconstructions. 18 Plastic surgeons interact with a small fraction of patients with dog bite injuries and often only with severe cases. 15 The emergency care physicians, paediatricians, primary care physicians and the parents are the vital front line in treatment, education and prevention of dog bite injuries. ...
... 15 The emergency care physicians, paediatricians, primary care physicians and the parents are the vital front line in treatment, education and prevention of dog bite injuries. 18 Data on the prevalence of dog bite injuries in South Africa are lacking. However, studies in other countries show varying incidences ranging from 500 000 to 1 million animal bites per year. ...
... There were no cases of human rabies disease recorded by the regular surveillance of rabies throughout the Northern Cape during the study period.The prevalence of dog bite injuries in this study was found to be 0.4% (4/1000 people). This is not consistent with the study performed in Belgium and the United States which demonstrated higher prevalence rates (22 per 1000 and 15 per 1000, respectively).18,19,20 A possible explanation for the low prevalence rate at KHC could be as a result of the healthseeking behaviour of the individuals affected, with some cases, for example, seeking help at the private healthcare institutions and other not seeking medical help.Of the 433 cases with dog bite injuries during the study period, less than half (47.9%) were notified to the appropriate authorities. ...
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Background: Dog bite injuries in humans remain a public health problem. There is limited nationally representative data on the magnitude of the problem and the epidemiological profile of dog bite injuries in South Africa. Aim: To describe the profile of dog bite injuries in patients presenting to Kimberley Hospital Complex (KHC) emergency and gateway centres. To determine the prevalence of dog bite injuries amongst all patients presenting to these centres and the compliance of mandatory notification of dog bites. Setting: Kimberley Hospital Complex emergency and gateway centres. Methods: A retrospective review of all dog bite cases who presented to KHC from August 2015 to July 2017. The total number of all patients who presented were taken into consideration for calculating the prevalence of dog bite cases. Results: During the study period, 433 dog bite cases were identified out of 107 731 patients seen at emergency and gateway centres, giving a prevalence of 0.4%. Of all cases, 62.4% were male patients and 37.6% were female patients. Most affected age group was between 10 and 19 years (19.6%). Category II exposure type accounted for the majority of the cases (59.4%). Unvaccinated dogs were incriminated in 61.9% of cases. Stray dogs were responsible for 83.1% of all injuries. More than half of the cases (47.9%) were notified by the treating doctors. Conclusion: Dog bite injuries in Kimberley were commonest in children and adolescents. The prevalence tended to decrease in adulthood with advancing age groups. Most bites resulted from unvaccinated stray dogs. Only about half of the cases were notified to the appropriate authorities. Prevalence of dog bite injuries amongst patients presenting at KHC resulted in the low rate of 0.4%. Awareness needs to be created amongst health care providers on the importance of notification of all exposure to rabies. More efforts are required at the prevention of dog bites in children and adolescents through stringent measures to limit the number of free-roaming dogs.
... ED physicians and primary care providers are the vital front line in the treatment of dog bite injuries. 4 Wounds from dog bites are often complex and can present as a combination of lacerations, punctures, avulsions, and crushed tissue. Some wounds may not appear severe externally if the superficial tissue remains intact. ...
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Background There is little consensus on the management of dog bite victims. Few studies have examined long-term patient outcomes. This study was designed to evaluate two outcomes: infection and unfavorable scar formation. Methods A retrospective study of dog bite cases from January 2013 to May 2016 was conducted at our level I pediatric trauma center. Forty-five patients were identified who received definitive repair and had long-term follow-up for reasons other than rabies vaccination. Variables recorded were wound characteristics including presence of tissue loss, location in the hospital of the wound repair procedure, personnel performing the repair, postrepair infection, and a binary assessment of unfavorable scar formation. Results Unfavorable scarring was not significantly related to either repair location or personnel. Rate of infection was not significantly related to repair location. However, infection rate was significantly related to personnel performing the repair (p=0.002), with 8 of 11 (73%) infections after repair by emergency physicians compared with surgeons. Discussion The presence of infection was significantly related to bedside repair by emergency physicians. The data are suggestive of differences in wound preparation and repair technique between emergency department and surgical personnel. Standardizing technique could reduce infectious complications and long-term morbidity associated with repairing dog bites and other contaminated wounds. A robust and practical classification system for dog bite wounds would be helpful in stratifying these wounds for research comparison and healthcare triage. Level of evidence The level of evidence for this retrospective study is level III.
... It is known that adults however are the most affected unprovoked animal bites. A study found out that children were six times more likely to be bitten by a family dog [22]. As high as 66.2% of all cases of animal bites are due to animals living in the home of the victims. ...
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Introduction. Each year, an estimated 25000 rabies death occurs in Africa. Post-exposure prophylaxis (PEP) remains the only proven approach in preventing rabies deaths. Most of rabies deaths occur among those who delayed, did not receive, or complete rabies PEP. The aim of this study was to determine the pattern of animal bite, factors associated with delays in initiating, and nonadherence to rabies PEP regimen. Method. Data on clients reporting for rabies PEP in a tertiary hospital setting in Ghana were collected from 2013 to 2016. Demographics, place, and source of exposure were collected. Other information obtained included adherence to the PEP protocol and GPS coordinates of the town of animal bites. The shortest distance between the GPS coordinates of town of animal bite and the site of administration of the rabies PEP was calculated. A total of 1030 individuals received rabies PEP over the period. Results. Overall, 52.9% (545) were males while 47.1% (485) were females. Majority of the cases were between the age group 1–10 years accounting for 29.2%. Dog bites accounted for 96.5% (n = 994). Cats, nonhuman primates, human bites, respectively, accounted for 1.8% (n = 18), 1.2% (n = 12), and 0.6% (n = 6) of all bites. Majority of bites occurred at home (66.2% (n = 646)). Also, 31.6% (n = 308) and 2.3% (n = 22) of bites occurred on the streets and neighbors/friends’ homes, respectively. Only, 18.7% initiated PEP within 24 hours of bite. Rabies PEP regimen completion rate was 95.2% (n = 976). The median distance travelled to access rabies PEP was 7.87 km (IQR, 3.58–16.27) km. Overall, 34.7% (n = 344) had the animal bite within 4.99 km radius of the treatment room of KBTH. Clients who delayed in initiating rabies PEP were 2.6 (95% CI, 1.3–5.1) times more likely to be males and 2.0 (1.1–3.9) times more likely to receive bites in a location more than 5 km radius from the KBTH treatment room. Gender, age, and distance of bite from the treatment room were not associated with the likelihood of not completing rabies PEP schedule. Discussion. Bites from suspected rabies infected animals remain a problem in southern Ghana. There are significant delays in initiating PEP for rabies prevention. Most animal bite victims are children ten years and below. Male gender and bites more than 5 km radius from the site of rabies PEP administration were most significant factors associated with delays in initiating rabies PEP. There is the need for adopting strategies to encourage prompt initiation and adherence to PEP. 1. Introduction Rabies is a fatal infection caused by a virus that can affect almost all mammals. However, dogs accounts for about 99% of human rabies cases [1]. Worldwide death from rabies is estimated at about 59,000 annually [2, 3]. A significant proportion of rabies deaths occur in Africa. Each year, 44% (n = 25000) of worldwide rabies death occurs in Africa [4]. In Ghana, the incidence of rabies has been on the increase [5, 6]. Rabies infection is associated with extreme suffering characterized by convulsions, violent muscular spasm, aggression, hydro and photophobia [7]. Most of the victims of rabies are children [7, 8]. The World Health Organization has announced the global goal of eliminating rabies death by the year 2030; however, with the pace of development, this target may not be met if drastic measures are not taken [9, 10]. Rabies has an almost worldwide distribution, currently present in about 100 countries in all continents except Antarctica and Australia [11]. The rabies virus belongs to the genera Lyssavirus and the family Rhabdoviridae [12]. Bites from rabid animals are the significant route of transmission of rabies. The incubation period of rabies is highly variable ranging from 2 weeks to 6 years; and the average incubation period however is within 2-3 months [13]. Greater risk for rabies bites are bites on the hands, neck, and face because of shorter length and increased number of neurons within such areas [13]. Rabies still poses a significant public health challenge throughout Africa. In Africa, the best approach in preventing human rabies has been attributed to dog rabies parenteral vaccination [14]. However, most dogs are not vaccinated due to weak legislative and enforcement issues prevalent in most parts of Africa. Laboratory confirmation of suspected rabies cases in rabies endemic countries is rarely carried out due to financial constraints, lack of requisite training, and resources and even when available, takes too long a time to receive results making it impractical for clinical use [15]. With all this challenges, postexposure prophylaxis remains the most efficient approach at preventing human rabies deaths postexposure. It is estimated that about 15 million receives rabies PEP annually [16]. Most often, rabies PEP is not available in rural areas where it is most needed [3]. Some clients often report late due to long travel distance from site of bite to center for rabies PEP, which constitute significant delays in initiating rabies PEP. Studies have found significant delays in the initialization of rabies PEP [17] which affect the efficacy of rabies PEP. Delays in rabies PEP initiation affect the overall quality of the efficacy of the PEP. However, some rabies exposed individuals in Ghana initiate rabies PEP late and others do not complete the schedules for rabies PEP. For the purpose of better counseling for clients reporting for rabies PEP, it is essential to undertake this review and find out-patient characteristics that predispose to noncompliance to rabies PEP schedule so as to intensify adherence counseling for such individuals. The treatment room of Korle-Bu teaching hospital’s (KBTH) medical out-patient department (OPD) is the center for rabies PEP in Korle-Bu teaching hospital attending to about 350 rabies exposed clients annually. Over the past three years, over 1000 rabies exposed individuals received rabies postexposure prophylaxis. The aim of this study was to determine the pattern of animal bites presenting for rabies PEP, patient characteristics, and factors, which predispose to noncompliance to rabies PEP schedules. 2. Materials and Methods 2.1. Study Design This is a retrospective study that reviewed service data generated as part of rabies postexposure prophylaxis. Data on animal bite; type of animal, date of bite, place, and demographic characteristics of the person were captured routinely as part of service data. This study reviews the data generated so as to obtain useful information that might influence patient counseling process within the treatment room and in Ghana. The available data, which spanned a three-year period, from January 2013 to December 2016, was reviewed and analyzed. 2.2. Study Sites The study took place in the treatment room of the central out-patient department. Most animal bites client within Accra are referred to the treatment room of Korle-Bu Teaching Hospital (KBTH), Medical out-patient Department (OPD) for postexposure prophylaxis. The treatment room currently has about six nurses and carries out other functions such as vaccination of other antigens, out-patient based wound dressing and injections. Other activities that take place in the treatment room include counseling. 2.3. Study Population and Sample Size The study population for this data review included all patients that took rabies postexposure prophylaxis in the treatment room of the central OPD of KBTH. All clients that took PEP from January 2013 to December 2016 were eligible to be included in the study. This study aimed at a complete enumeration and review of all data captured within the period under review. About 1030 clients’ records were available over the three-year period (2013–2016). All clients that used the service over the period under review for which the data was available and eligible were included in the study. 2.4. Data Collection Methods The already available data were entered in to the EPIDATA and exported in to the STATA for analysis. Personal identifiers such as names were not entered save serial numbers generated as part of the rabies PEP administration. Ages, sex, place of bite, type of animal bite, date of bite among others were entered for each client. The coordinates (longitude and latitude) of town of aggression were obtained by entering the place of bite into Google Maps. The coordinates were obtained one by one. All addresses were geo-referenced. 2.5. Statistical Analysis Descriptive statistics were obtained for most variables. This included the percentage of bites that occurred at home, street, or neighbor’s house. We also obtained percentages for types of bites. GPS coordinates of town of bite were obtained by entering the place of bite into mapping software online, Google Map. The approximate straight-line distance in kilometers from the place of bite to the treatment room was determined using STATA. The distances were grouped for analysis. Inferential statistics displayed odds ratio as measure for association in a logistic regression of factors associated with delay in initiation rabies PEP. 2.6. Ethical Issues Ethical clearance was obtained from the institutional ethical review board of Korle-Bu teaching hospital. Permission to carry out the study was granted by the scientific and technical committee of Korle-Bu teaching hospital. There were no direct patient contacts in the entire process of this retrospective review. Confidentiality was maintained. Data were password-protected. Patient identifier such as name of patient was not entered during the data entry process. The study followed the data protection guidelines of KBTH. 3. Results 3.1. Background Characteristics A total of 1030 participants were included in this study. Table 1 displays the background characteristics of all participants. In all, 52.9% (545) were males while 47.1% (485) were females. The median age was 22 years (interquartile range = 27 years). Majority of suspected rabies exposed receiving rabies postexposure prophylaxis were between the age group 1–10 years accounting for 29.2% (n = 290). Also, 18.7% of suspected rabies exposed individuals were between the age group 10 to 19 years. More than 65% of all victims of animal bites requiring rabies PEP were below the age 30. The incidence of reported animal bite requiring rabies PEP decreases with increasing age. The elderly population, >59 years old accounted for 5.6% of all suspected rabies exposed presenting in the KBTH over the period. With regards to the type of animal bites: Dog bites accounted for 96.5% (n = 994) of all cases of animal bites. Cats, nonhuman primates, human bites, respectively, accounted for 1.8% (n = 18), 1.2% (n = 12), and 0.6% (n = 6) of all bites. Majority of bites occurred at home accounting for 66.2% (n = 646). Also, 31.6% (n = 308) and 2.3% (n = 22) of bites occurred on the streets and neighbors/friends’ homes, respectively. This implies that as much as 66.2% of all cases of animal bites are due to animals living in the home of the victims. With regards to time of initiation of rabies PEP, 18.7% initiated PEP within 24 hours of bite. Also, 37.8% and 31.7% initiated PEP within 1-2 days and 3–7 days, respectively. In all, 11.7% initiated treatment after one week. With regards to compliance to PEP schedules, 95.2% (n = 976) completed all five doses of intramuscular postexposure prophylaxis. In the southern sector of Ghana, majority of dog bites occurs from November through to March. The median distance travelled to access rabies PEP was 7.87 km (IQR, 3.58–16.27km). Also, 34.7% (n = 344) had the animal bite within 4.99 km radius of the treatment room of KBTH. Clients initiating rabies PEP within 24 hours travelled a median 4.27 km (IQR, 2.02–9.66 km). Figures 1 and 2 displays the towns/cities of bites in Ghana and a spot map of case distribution in and around Accra, respectively. Figure 3 displays place of animal bites by sex. Characteristics Male Female Total n (%) n (%) Number % All study participants (n = 1,030) 52.9 (545) 47.1 (485) 1,030 Age (years) (n = 993) 1–9 176 (60.7) 114 (39.3) 290 29.2 10–19 101 (54.3) 85 (45.7) 186 18.7 20–29 83 (46.6) 95 (53.4) 178 17.9 30–39 71 (50.7) 69 (49.3) 140 14.1 40–49 43 (53.4) 39 (47.6) 82 8.3 50–59 29 (47.5) 32 (52.5) 61 6.1 Above 59 27 (48.2) 29 (51.8) 56 5.6 Type of suspected rabid animal (n = 1030) Dog 531 (53.4) 463(46.6) 994 96.5 Cat 7 (38.9) 11 (61.1) 18 1.8 Nonhuman primates 5 (41.7) 7 (58.3) 12 1.2 Others 2 (33.3) 4(66.7) 6 0.6 Place of bite (n = 976) Victims home 359 (55.6) 287 (44.4) 646 66.2 Street: stray dog 153 (49.7) 155 (50.3) 308 31.6 Neighbor’s home 12 (54.6) 10 (45.5) 22 2.3 Completion of PEP Schedule (n = 1030) Completed 514 (52.7) 462 (47.3) 976 94.8 Did not complete 30 (61.2) 19 (46.9) 54 5.2 Average distance travelled from site of bite to PEP Centre (n = 992) Less than 5.00 km 176(51.2) 168(48.8) 344 34.7 5.00–9.99 km 112(49.1) 116(50.9) 228 23.0 10.00–14.99 km 91(53.5) 79(46.5) 170 17.1 15.00 km and above 147(53.0) 103(41.2) 250 25.2
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The aim of this study was to characterize and report the epidemiological data regarding pediatric facial dog bites. For this study, a retrospective chart review was used. This study was performed at a large tertiary pediatric hospital. All children younger than 18 years who sought medical attention after a facial dog bite between January 1, 2003, and December 31, 2008, were included. Demographic and epidemiologic data were collected and analyzed. A total of 537 children were identified. The average age was 4.59 ± 3.36 years, with a slight male preponderance (52.0%). The majority of dog bites occurred in children 5 years of age or younger (68.0%). Almost all (89.8%) of the dogs were known to the children. When circumstances surrounding the bite were documented, over half (53.2%) of the cases were provoked. The most common breeds were mixed breed (23.0%), Labrador retriever (13.7%), Rottweiler (4.9%), and German shepherd (4.4%). Inpatient treatment was required in 121 (22.5%) patients with an average length of stay of 2.96 ± 2.77 days. Children 5 years or younger were more likely to be hospitalized than older children. Children 5 years old and younger are at high risk for being bitten in the face by a familiar dog and are more likely to require hospitalization than older children. Certain dog breeds are more likely to bite, and there is often a history of provocation. There is a tremendous financial and psychosocial burden associated with dog bites, and prevention strategies should focus on education with the aid of public policies and better documentation and reporting systems.
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Objective: To examine potentially preventable factors in human dog bite-related fatalities (DBRFs) on the basis of data from sources that were more complete, verifiable, and accurate than media reports used in previous studies. Design: Prospective case series. Sample: 56 DBRFs occurring in the United States from 2000 to 2009. Procedures: DBRFs were identified from media reports and detailed histories were compiled on the basis of reports from homicide detectives, animal control reports, and interviews with investigators for coding and descriptive analysis. Results: Major co-occurrent factors for the 256 DBRFs included absence of an able-bodied person to intervene (n = 223 [87.1%]), incidental or no familiar relationship of victims with dogs (218 [85.2%]), owner failure to neuter dogs (216 [84.4%]), compromised ability of victims to interact appropriately with dogs (198 [77.4%]), dogs kept isolated from regular positive human interactions versus family dogs (195 [76.2%]), owners' prior mismanagement of dogs (96 [37.5%]), and owners' history of abuse or neglect of dogs (54 [21.1%]). Four or more of these factors co-occurred in 206 (80.5%) deaths. For 401 dogs described in various media accounts, reported breed differed for 124 (30.9%); for 346 dogs with both media and animal control breed reports, breed differed for 139 (40.2%). Valid breed determination was possible for only 45 (17.6%) DBRFs; 20 breeds, including 2 known mixes, were identified. Conclusions and clinical relevance: Most DBRFs were characterized by coincident, preventable factors; breed was not one of these. Study results supported previous recommendations for multifactorial approaches, instead of single-factor solutions such as breed-specific legislation, for dog bite prevention.
Article
ISSUES AND PURPOSE. Unintentional injury is the leading cause of death and disability among children. This study sought to describe the characteristics of dog bite injuries to aid in promoting healthy environments for children.DESIGN AND METHODS. This descriptive, retrospective study of one hospital's 1997 emergency department records detailed dog bite injuries to children and adolescents and resultant emergency treatment (N = 204).RESULTS. Children ≤5 years of age accounted for 49% of the injuries. The biting dog's owner was generally a parent or neighbor. Only 2 children received rabies prophylaxis.PRACTICE IMPLICATIONS. Parents and children need information about safe interactions with dogs, including community leash laws and quarantine guidelines. Nurses should know the procedures for reporting dog bite injuries to local health authorities. Interested nurses can find many opportunities to assist with community safety campaigns.
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We present three cases of fatal dog maulings of infants placed in mobile infant swings, a phenomenon not previously described in the literature. In each case, the victim was left in a mobile swing, unsupervised by an adult, and the attacking dog was a family pet. Case 1 involved an 18-day-old male infant attacked by a pit bull; Case 2 involved a 3-month-old male infant attacked by a Chow Chow and/or a Dachshund, and Case 3 involved an 18-day-old female infant attacked by a Labrador–pit bull mix. These cases not only underscore the importance of not leaving young children unattended in the presence of pet dogs, but also raise the possibility that mobile swings may trigger a predatory response in dogs and thus may represent an additional risk factor for dog attack.
Article
The management of dog bite wounds is controversial, and current data on risk of infection are variable and inconsistent. Furthermore, the use of prophylactic or empiric antibiotics for the treatment of these wounds is debatable. We investigate the rate of wound infections and other complications after primary repair of pediatric facial dog bite injuries. We reviewed 87 consecutive patients aged 18 years or younger who had facial dog bite injuries from January 2003 to December 2008. Variables examined were age, sex, setting of repair, number of sutures used for repair, whether surgical drains were used, and antibiotic administration. End points measured were incidence of wound infection, need for scar revision, and any wound complications. The mean age of patients was 6.8 years, and the majority were women (53%). All facial injuries were primarily repaired at the time of presentation either in the emergency department (ED; 46%), operating room (OR; 51%), or an outpatient setting (3%). All patients received an antibiotic course, none of the patients developed wound infection, and no subsequent scar revisions were performed. Three patients repaired in the OR underwent placement of a total of 4 closed-suction drains. The mean (SD) age of patients repaired in the OR was significantly younger than those repaired in the ED (5.7 [3.9] vs 8.0 [4.5] years, respectively; P < 0.01). The number of sutures used were greater for patients repaired in the OR than in the ED (66.4 [39.6] vs 21.7 [12.5], respectively; P < 0.01). Intuitively, younger patients and patients with greater severity injuries are more likely to undergo repair in the OR, and this was supported by our data. Overall, we found that primary repair of pediatric facial dog bite injuries, including complex soft-tissue injuries, is safe when performed in conjunction with antibiotic administration; however, further cross-specialty studies are needed to fully characterize these end points in a larger population.