ArticlePDF Available

Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution

Authors:

Abstract and Figures

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.
Content may be subject to copyright.
A preview of the PDF is not available
... American data has shown that around 4.5 million dog bites occur every year in the United States of America, and half of them involve attacks to children (5,6). The chances of a child experiencing a dog attack during their lives is estimated to be around 50% (7,8). ...
... The chances of a child experiencing a dog attack during their lives is estimated to be around 50% (7,8). Approximately 800 thousand cases of dog bites require some type of medical care, generating costs of up to two billion dollars a year to health services (3,5,7,9). ...
... Several studies have shown that lesions caused by dog bites are more common in specific demographic groups. Male children in school age are the most affected group (3,5,(12)(13)(14)(15). Children under 5 years old are usually bitten on the head and neck, while the older ones have their upper and lower limbs mostly bitten (3, 5-7, 9, 10, 14, 16, 17). ...
Article
Full-text available
Introduction Accidents involving dog attacks are very common, which makes this type of accident a global public health issue. The estimates point to 20% of the victims of such accidents seeking care in health units, and half of them being children. In addition to acute injuries, dog attacks might result in fractures, infections, scars, and psychological traumas. This study aimed to describe the epidemiological profile of dog attacks to children under 14 years old assisted in a pediatric emergency service in Brazil. Methods The database of the Information and Toxicological Assistance Center of Campinas was surveyed to identify cases of children under 14 years old assisted after a dog attack in a 9-years period. Demographic data, number and type of lesions, type of exposure, part of the body affected, dog origin and condition, and the accident location and cause were analyzed. The data were presented in a descriptive way, and the age groups were classified as follows: 0–3 years old, 4–6 years old, and 7–14 years old. The different age groups were compared one to another regarding the markers evaluated using the chi-square test and the Fisher’s exact test. A 0.05 alpha was adopted in all analyses. Results The number of children assisted in the study period totaled 1,012. The 7–14-year-old group was the most affected ( n = 498; 49.2%), male patients were also majority ( n = 660; 65.2%). Most injuries were found on the head/neck area ( n = 378; 37.4%). However, the older the patients were, the higher the frequency of lesions on upper and lower limbs was, as well as attacks occurred in external environments, thus involving animals that could not be observed. A significant increase in accidents with provoked causes was observed in younger patients. Conclusion Accidents involving dog attacks are more likely to happen among boys. Younger children run higher risks of becoming victims of these accidents inside homes, being attacked by pets, and showing a greater incidence of head and neck lesions. Older children present more injuries on their limbs, which are caused by dogs that cannot be observed.
... Based on large cohort reports from the late 1990s to early 2000s, the 5 to 9 age range has been regarded as the highest risk 4,6,9 ; however, our findings corroborate more recent, albeit smaller series, indicating that children 0 to 3 years old fall victim to dog-bites more frequently. 12,21 Almost half of included patients suffered bites to multiple body regions, which correlated with greater severity and had a significant association with need for operative repair. Patient age was not predictive of multi-site injuries, though the head and neck area remained the most commonly involved. ...
Article
Introduction: Although single institution studies have analyzed various animal attacks, there has not been multicenter investigation into dog bites in children. The purpose of this study was to characterize national trends and investigate the characteristics of pediatric dog bites. Methods: Aretrospective cohort study was conducted of pediatric dog bite injuries in the United States from 2015 to 2020 using the Pediatric Health Information System national database. Patient characteristics, injury locations, and need for intervention were analyzed. Mann-Whitney U test, Pearson chi-square, and Fisher exact test, and linear multivariate regressions were performed for statistical analysis of data values; statistical significance was maintained at P < 0.05. Results: A total of 56,106 patients were included, majority male (55.1%) with a median age 6.8 years (interquartile range 3.5-10.6). Incidence peaked in July (median =1217) with nadirs in February (median = 760). A substantial increase in bites was seen per overall Emergency Department presentations during the pandemic. Most common bite location was the head (62.1%), followed by the upper extremity (25.1%). Relative proportions of dog bites to the face gradually decreased with age (B = -3.4%/year, P< 0.001), whereas proportions to the upper extremities (B = + 1.9%/year, P < 0.001) and lower extremities (B = + 1.6%/year, P = 0.002) gradually increased with age. Overall, 8.0% patients required repair in the operating suite. injuries isolated to the head (OR= 2.6, P< 0.001) and those to multiple anatomic regions were more likely to require operative intervention [operating room (OR= 2.6, P< 0.001)]. Conclusions: Dog bites most commonly occur during the summer in school-aged boys. Toddlers disproportionately suffer injuries to the head, with a trend towards upper extremity bites in teenagers. The coronavirus disease 2019 pandemic ushered a spike in dog bite presentations among Emergency Department visits, further underscoring the need for targeted educational initiatives to halt the persistence of these preventable injuries.
... Out of 1616 dog bites, the three most prevalent were found to be Pit Bulls (also identified as Staffordshire Bull Terrier, American Staffordshire Terrier, or Bull Terrier, 38.5%), mixed breeds (Pit Bull mixes, Labrador mixes, Pit Bull/Labrador mixes, 13%), and Labradors (8.1%). 28 Chen et al identified 58 breeds in 68% (366) of cases, with the most common breeds being mixed (23%), Labrador Retriever (13.7%), Rottweiler (4.9%), and German Shepherd (4.4%). ...
Article
Full-text available
Introduction Dog bites are one of the leading causes of non-fatal emergency room visits in children. These injuries not only cause physical harm but can lead to long-term psychological stress. This study evaluated the current literature related to pediatric dog bite injuries to identify research gaps which should be prioritized to improve a major public health concern. Methods We performed a keyword search of PubMed, Scopus, and OVID Medline databases (January 1980– March 2020) for all published studies focused on dog bite injuries in the pediatric population (≤18 years of age) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results Out of 1859 abstracts screened, 43 studies involving 86 880 patients were included. Twenty-nine studies were retrospective chart reviews characterizing the epidemiology of dog bites and their associated treatment outcomes; six were prospective cohort studies; two were cross-sectional studies; and six were experimental studies. Synthesized results demonstrate that children <9 years of age suffer the greatest burden of injuries, with children <6 years of age at higher risk of more severe injuries involving the head, neck, and face. Conclusion Studies analyzing the prevention or psychosocial consequences of dog bites injuries are needed.
... Children between 5 and 9 years of age comprise the bulk of dog bite victims worldwide: Based on hospital admissions for surgical treatment, this trend has been observed in Canada [5], the United States [6,7], Austria [8], Italy [9] Turkey [10] and the Czech Republic [11]. Children are usually bitten on the head, particularly on the face, hands, neck, or throat [5,9,[12][13][14], and these injuries may lead to a lifetime of physical impairment for the victims and considerable financial strain for parents in the form of medical expenses [15]. The most serious attacks result in the death of the victim and often the eventual abandonment or euthanasia of the animal [16,17]. 2 of 12 Generally, aversive and conflict-escalating signals by dogs can be easily interpreted by adults [18][19][20]; however, signals intended to avoid or defuse conflict are much harder to identify for both adults and children [21][22][23]. ...
Article
Full-text available
Dog attacks on children are a widespread problem, which can occur when parents fail to realize a potentially dangerous interaction between a dog and a child. The aim of the study was to evaluate the ability of parents to identify dangerous situations from several everyday child–dog interactions and to determine whether the participants connected these situations to a particular breed of dog. Five sets of photographs depicting potentially dangerous interactions from everyday situations between children and three dogs (one of each breed) were presented via an online survey to parents of children no more than 6 years old. Data from 207 respondents were analysed using proc GLIMMIX in SAS program, version 9.3. The probability of risk assessment varied according to dog breed (p < 0.001) as well as to the depicted situation (p < 0.001). Results indicated that Labrador Retriever was considered the least likely of the three dogs to be involved in a dangerous dog-child interaction (with 49% predicting a dangerous interaction), followed by Parson Russell Terrier (63.2%) and American Pit Bull Terrier (65%). Participants considered one particular dog-child interaction named ‘touching a bowl’ a dangerous interaction at a high rate (77.9%) when compared with the other presented situations, which were assessed as dangerous at rates of 48.4% to 56.5%. The breed of dog seems to be an influential factor when assessing a potentially dangerous outcome from a dog-child interaction. Contrary to our hypothesis, interactions involving the small dog (Russell Terrier) were rated more critically, similarly to those of the Pit Bull Terrier. These results suggest that even popular family dog breeds, such as Labrador Retrievers, should be treated with more caution.
Chapter
Dog bite wounds are an increasingly common occurrence, particularly in children. Providers must be able to manage bite injuries, as well as identify wound infections and how to treat them. This chapter discusses common dog bite injuries, immediate and delayed sequelae of a bite wound, wound closure, and antibiotic treatment regimens. Facial injuries are common in pediatrics and may require surgical consultation. Knowledge of the immunization status of the patient and dog is essential in the prevention and sequala of tetanus and rabies. The subsequent information is essential for any physician working with children and their families, particularly in the emergency setting.
Article
Background: Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center. Methods: This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries. Demographic information, injury details, management, outcomes, and financial information were analyzed. Results: Most pediatric dog bite injuries afflicted male children (55.6%), ages 6 to 12 years (45.7%), by a household dog (36.2%). The most common offending breed was a pit bull or pit bull mix (53.0%). Infants and grade schoolers were more likely to sustain bites to the head/face (P = 0.001). Usual management consisted of primary repair (75.9%), whereas approximately 25% of the patients required advanced reconstructive techniques. Most patients healed uneventfully, but prolonged antibiotics, additional wound care, or procedures were necessary in 8.4% of the patients. Hospital charges per patient averaged US $8830.70 and tended to be higher in the younger age groups. Insurance status was statistically associated with use of conscious sedation, surgical consult placement, and surgical repair. Conclusions: Although most pediatric dog bite injuries in this study healed uneventfully from primary management in the emergency department, 25% required additional interventions. Furthermore, patient care for these injuries was associated with significant but potentially avoidable personal and financial burden to families. Our data reflect a need for safety education on animal care, behavior, and interaction.
Article
Dog bites are a serious public health concern internationally and children are often at particular risk of them. Because bites to children often occur during apparently benign interactions with a parent present, the need for dog-bite prevention approaches to address adults’ awareness of, and supervision of, child–dog interactions has been highlighted. The aim of this study was to evaluate a hazard perception test of potential dog-bite hazards within a home setting. Six hazards were incorporated in a 2-minute 41-second video, which was embedded into a web-based interface that enabled respondents to identify hazards by clicking the mouse button or tapping the screen of a tablet computer as the video played. The 268 volunteer respondents also completed a short questionnaire. These respondents were predominantly female and appeared more likely to have undertaken higher education and have greater experience with dogs than the general population. Almost one-third (31.8%) of respondents identified all six hazards, and a further quarter (24.5%) missed only one; a quarter (25.2%) identified 3 or fewer; and 43.8% identified 4 or fewer hazards. No one scored zero, and 5.5% and 6.9% identified 1 and 2 hazards, respectively. A range of factors was associated with the identification of specific hazards. Participants with professional or long-term experience with dogs and those with higher educational attainment were more likely to detect some hazards. Older respondents were less likely to identify several of the hazards, and those living with children were less likely to identify cuddling a dog as a hazard. We find that hazard perception testing could be a useful tool for the assessment of knowledge regarding dog-bite risk situations and potentially an educational tool for increasing knowledge and changing practices around dogs.
Article
Full-text available
Background: Trauma from dog attacks has been associated with mortality rates as high as 23% in some species. However, the prognosis and clinical features of this type of injury have not been described in equids. Hypotheses/objectives: To describe survival rate, signalment, clinical features, and biochemical results in equids presented for emergency care after presumed dog attacks. We hypothesized there would be differences between survivors and nonsurvivors. Animals: A total of 28 equids presented for presumed dog attacks from 3 referral centers. Methods: A retrospective study was performed using data from 3 hospitals between 2008 and 2016. Survival was defined as survival at 14 days postdischarge. Variables were compared between survivors and nonsurvivors using a t test, Mann-Whitney U test, or Fisher's exact test as appropriate. Results: Overall mortality rate was 21%. Ponies and miniature horses represented 16/28 (57%) of the animals in the study. Full-sized equids had a lower risk of nonsurvival as compared to smaller patients (odds ratio = 0.02; 95% confidence intervals = 0.00-0.27; P < .005). Animals with lower body temperatures had increased risk for nonsurvival (P = .0004). Increased admission blood lactate concentrations (P = .003) and decreased serum total protein concentrations (P = .006) were associated with nonsurvival. Conclusions: The mortality rate in equids attacked by dogs was similar to what is reported for other veterinary species. Smaller equids and those with increased admission blood lactate concentration, lower body temperature, and lower total serum protein concentrations were less likely to survive.
Chapter
Dog bites in pediatric populations are of special concern to the facial surgeon because of the propensity for facial bites due to the short height of children. The face often sustains extensive damage in pediatric populations. Proper management of facial dog bites will improve esthetic results and help minimize the potential for infection and disfiguring that often accompany dog bites. This chapter discusses etiology, management, and prevention (including legislation) of dog bites in the pediatric population.
Article
Full-text available
Background The city of Winnipeg was the first among several jurisdictions in Manitoba, Canada, to introduce breed specific legislation (BSL) by banning pit-bull type dogs in 1990. The objective of the present work was to study the effectiveness of BSL in Manitoba. Methods Temporal differences in incidence of dog-bite injury hospitalisations (DBIH) within and across Manitoba jurisdictions with and without BSL were compared. Incidence was calculated as the number of unique cases of DBIH divided by the total person-years at risk and expressed as the number per 100 000 person-years. Year of implementation determined the pre-BSL and post-BSL period for jurisdictions with BSL; for jurisdictions without BSL to date, the entire study period (1984–2006) was considered as the preimplementation period. The annual number of DBIH, adjusted for total population at risk, was modelled in a negative binomial regression analysis with repeated measures. Year, jurisdiction and BSL implementation were independent variables. An interaction term between jurisdiction and BSL was introduced. Results A total of 16 urban and rural jurisdictions with pit-bull bans were identified. At the provincial level, there was a significant reduction in DBIH rates from the pre-BSL to post-BSL period (3.47 (95% CI 3.17 to 3.77) per 100 000 person-years to 2.84 (95% CI 2.53 to 3.15); p=0.005). In regression restricted to two urban jurisdictions, DBIH rate in Winnipeg relative to Brandon (a city without BSL) was significantly (p<0.001) lower after BSL (rate ratio (RR)=1.10 in people of all ages and 0.92 in those aged <20 years) than before (RR=1.29 and 1.28, respectively). Conclusions BSL may have resulted in a reduction of DBIH in Winnipeg, and appeared more effective in protecting those aged <20 years.
Article
Full-text available
From 1995 to 2009, 206 cases of dog bites were recorded among hospitalized patients at the Children National Health of, Lima-Peru. The median of age was 4 years, and for hospitalization time was 3 days. Most patients were males (61.7 %). The bites occurred in the house of a third person (39.3 %), on the street (33.5 %), or in the victim's house (27.2 %). A 66.5 % of the bites were provoked and 88.8 % were from animals known to the victim. The dog breed was recognized in 34 % (52.9 % were mongrel dogs). Multiple lesions were identified in 79.1 %, and the most frequently bitten areas were head and neck (79.1 %). Complications were reported in 20.4 % and aesthetic sequelae in 94.7 %.
Article
Full-text available
Dog bites in humans are a public health problem worldwide. The issues of increasing stray dog populations, rabies outbreaks, and the risk of dogs biting humans have been frequently reported by the media in Bhutan. This study aimed to estimate the bite incidence and identify the risk factors for dog bites in humans, and to estimate human deaths from rabies in rabies endemic south Bhutan. A hospital-based questionnaire survey was conducted during 2009-2010 among dog bites victims who visited three hospitals in Bhutan for anti-rabies vaccine injection. Decision tree modeling was used to estimate human deaths from rabies following dog bite injuries in two rabies endemic areas of south Bhutan. Three hundred and twenty four dog bite victims were interviewed. The annual incidence of dog bites differed between the hospital catchment areas: 869.8 (95% CI: 722.8-1022.5), 293.8 (240-358.2) and 284.8 (251.2-323) per 100,000 people in Gelephu, Phuentsholing and Thimphu, respectively. Males (62%) were more at risk than females (P<0.001). Children aged 5-9 years were bitten more than other age groups. The majority of victims (71%) were bitten by stray dogs. No direct fatal injury was reported. In two hospital areas (Gelephu and Phuentsholing) in south Bhutan the annual incidence of death from rabies was 3.14 (95% CI: 1.57-6.29) per 100,000 population. The decision tree model predicted an equivalent annual incidence of 4.67 (95% CI: 2.53-7.53) deaths/100,000 population at risk. In the absence of post exposure prophylaxis, the model predicted 19.24 (95% CI: 13.69-25.14) deaths/year in these two areas. Increased educational awareness of people about the risk of dog bites and rabies is necessary, particularly for children in rabies endemic areas of Bhutan.
Article
Context.— Dog bites that result in injuries occur frequently, but how frequently dog bite injuries necessitate medical attention at a hospital or hospital admission is unknown.Objective.— To describe the incidence and characteristics of dog bite injuries treated in US emergency departments (EDs).Design.— Emergency department survey from the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey for 1992 to 1994.Patients.— National probability sample of patients visiting EDs.Main Outcome Measure.— Incidence of dog bites treated in EDs, defined as a cause of injury recorded as the E-code E906.0.Results.— The 3-year annualized, adjusted, and weighted estimate of new dog bite–related injury visits to US EDs was 333687, a rate of 12.9 per 10000 persons (95% confidence interval [CI], 10.5-15.4). This represents approximately 914 new dog bite injuries requiring ED visits per day. The median age of patients bitten was 15 years, with children, especially boys aged 5 to 9 years, having the highest incidence rate (60.7 per 10000 persons for boys aged 5 to 9 years). Children seen in EDs were more likely than older persons to be bitten on the face, neck, and head (73% vs 30%). We estimated that for each US dog bite fatality there are about 670 hospitalizations and 16000 ED visits.Conclusions.— Dog bite injuries are an important source of injury in the US population, especially among children. Improved surveillance and prevention of dog bite–related injuries, particularly among children, are needed.
Article
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.
Article
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.
Article
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.