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Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution


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.
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Clinical Pediatrics
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DOI: 10.1177/0009922816657153
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.
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
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,
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.
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
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.
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
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.
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
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.
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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Table 3. Characteristics by Age Group, as Percentage of the Total in Each Group.a
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
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
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
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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Table 5. Selected Studies of Dog Bite Injuries With Select Variables That Could Be Targets of Public Health Intervention.
Length(years) Patients (n) City (Type of Site)
Two Most Prevalent
Breeds Documented
Family Dog
Familiar (But
Not Family)
Mean or Most
Prevalent Age
Range (years)
et al,13 2007
13 1871 Cape, Town South
Africa (1 Children’s
•  PB 28%
•  GS 21%
•  1%
6.8 years old
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
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
Chen et al,16
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
Bini et al,17
15.5 228
San Antonio, TX
(trauma hospital)
PB 35% 44.8% 43.1% 12.1% 21 Years old
et al,18 2000
1 204 Pittsburgh, PA
(children’s hospital)
•  PB 19%
•  GS 12%
•  47%
27% 28% 6.8 Years old;
<5 Years:
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
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
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.
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
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
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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... 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). ...
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.
... The five studies included were retrospective chart reviews [9][10][11][12][13]. The reviews were conducted at four level one pediatric trauma centers and two pediatric tertiary emergency departments. ...
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This study presents a case series and systematic review of pediatric patients who sustained long bone fractures following dog bites. A systematic review of the studies on “pediatric fracture dog bite” based on a search of PubMed and OVID Medline databases was performed by adhering to PRISMA guidelines. Articles in English describing pediatric long bone fractures due to dog bites were included. Studies not differentiating pediatric from adult patients and not describing long bone fractures due to dog bites were excluded. Study characteristics, fracture epidemiology, management decisions, and follow-up data were extracted. Additionally, a seven-year retrospective chart review of cases treated at our level one pediatric trauma center was performed. Data on fracture characteristics, surgical management, choice of antibiotic therapy, and follow-up were collected. Five studies that met our criteria were analyzed. Pediatric long bone fractures from dog bites were identified in 0.35% (11/3,156) of patients. Such fractures most commonly involved the upper extremity (9/11, 82%). None of the studies described the choice of antibiotics, surgical decision-making, or wound closure preference for an underlying fracture. Our chart review elicited three cases of long bone fractures due to dog bites. Pediatric long bone fractures after dog bites are a rare injury pattern in the United States. These injuries should be treated as contaminated open fractures, and urgent immunization, intravenous antibiotic administration, wound care, and fracture stabilization should be provided. We recommend meticulous surgical debridement in the operating room, as wounds often probe deep into the bone. Nevertheless, there is much that remains unclear about these injuries. Hence, further research with greater power is needed to improve treatment decisions.
... 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. ...
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.
... The majority of the dog bite incidents results in minor injuries including superficial lacerations, abrasions, and closed tissue injuries ( Jakeman et al., 2020 ;Cornelissen and Hopster, 2010 ;Oxley et al., 2018 ;Westgarth et al., 2018 ). Among the major injuries, some of them do require surgical treatment ( Dwyer et al., 2007 ;Pfortmueller et al., 2013 ;Golinko et al., 2017 ). In the USA, a national study suggests that an estimated 4.37 million people were bitten annually between 20 01-20 03, and 19% of these incidents required the medical attention ( Gilchrist et al., 2008 ). ...
Dog bites are a public health problem worldwide, and Portugal is not an exception. Thus, it is fundamental to develop effective prevention programs and interventions strategies using evidence-based information. Therefore, in the present study, we investigated single dog bite incidents in Portugal retrospectively through an online survey. To the best of our knowledge, this is the first study analyzing dog bite consequences for both people and dogs at a national level in Portugal. A total of 729 valid responses of bite incidents were received. The characteristics of the people, dogs, and consequences of the incidents for both were analyzed. The mean age of the people was 28.2 years (range: 9 months - 89 years), and 78.1% of the people were female. The majority of dogs involved were male (71.1%), and were familiar to the person (78.7%). More than half of the bites were on the upper extremities (58.1%). In 78.3% of the incidents, the bites did not require medical intervention. Among the incidents requiring medical care, 18.6% of the incidents required surgical intervention. Single bites were more frequent (87.2%). While 75% of the single bite incidents resulted in minor injury, this number was reduced to 61% for multiple bite incidents. Children who are under 12 years old had a relatively higher number of head injuries (22.3%) than the other age groups. While in 58.3% of the incidents, nothing happened to the dog as a consequence, eleven dogs (1.9%) were euthanized. The odds of major injuries leading to the dog´s euthanasia were 4.3 times higher than that of the minor injuries (95% confidence intervals (CI95), 1.3 - 14.2). Biting is a natural and preventable behavior, that deserves better mitigation strategies with a deeper understanding of the risk and protective factors. The results of this study contribute to creating a scientific basis for the investigation of dog bites in Portugal.
... 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%). ...
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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.
Pediatric scalp avulsions represent a reconstructive challenge because of the unique features of scalp tissue. When microsurgical reimplantation is not feasible, alternative approaches such as skin grafting, free flap transfer with latissimus flap, or tissue expansion are considered. Generally, there is no consensus regarding management of this trauma, and, oftentimes, multiple reconstructive techniques may be needed for definitive coverage. This case study describes the reconstruction of a pediatric subtotal scalp avulsion using a dermal regeneration template and novel autologous homologous skin construct. This case was complicated by the absence of original tissue for reimplantation, excessive size of the defect relative to body habitus, and family concerns for future hair-bearing function. The reconstruction successfully provided definitive coverage and significantly reduced the size of the donor site and associated compilations. However, the hair-bearing potential of the tissue has yet to be determined.
Dog bite injuries are common within the pediatric population. Currently, there are inconclusive data on best sedation practice, antibiotic regimen, and need for plastic surgery referrals for treatment of dog bite injuries in the emergency department (ED) versus operating room (OR). This study set out to determine sedation practice, infection management, and necessity for plastic surgery referral at a level I pediatric trauma center. A retrospective review of all pediatric (0–18 years old) dog bites documented in electronic medical records from January 1, 2010, to December 31, 2019, was performed. Bitten by dog encounters were identified by International Classification of Diseases, Ninth Revision and Tenth Revision codes E906.0 and W54.0, W54.0XXA, and W54, respectively. Data gathered included age, gender, month of injury, circumstance of injury, injury characteristics, location of repair, person performing repair, sedation (if used, then length of sedation), inpatient admission, antibiotics prescribed, dog characteristics (breed, size, sex, age, relationship to patient), and complications. Summary statistics were calculated as mean ± SD. Comparisons for nominal variables were performed using the χ2 test. All analyses were performed using Stata v.16. 1. A total of 1438 pediatric patients were included in this study over a 10-year period. Of injuries requiring repair (n = 846), most repairs were performed in the ED (97.1% [822/846]), whereas 24 (2.8%) required repair in the OR. Of the bites that required repair (n = 846), 81.1% (686/846) were performed by an emergency medicine physician and 147 (17.4%) by plastic surgeons. Procedural sedation in the ED was performed in 146 repairs (17.3%). Documented sedation time ranged from 10 to 96 minutes. Most patients received a prescription for antibiotics (80.5%), usually amoxicillin/clavulanate (90.8%). Infection was the most common sequela (9.5%). There was no significant difference in infection rates between repairs performed in the ED versus those in the OR. Our study indicates that pediatric patient dog bite injuries can be successfully managed in an ED. Procedural sedation has demonstrated no increased safety risks compared with the OR. Rates of infection are also not demonstrated to be significantly higher in repairs done in the ED versus those taken to operating theater.
Background Dog bite injuries cause over 100 000 paediatric emergency department visits annually. Our objective was to analyse associations between regional dog ownership laws and incidence of paediatric dog bites. Methods This observational study used an online search to locate local dog-related policies within Ohio cities. Data collected by Ohio Partners For Kids from 2011 through 2020 regarding claims for paediatric dog bite injuries were used to compare areas with and without located policies and the incidence of injury. Results Our cohort consisted of 6175 paediatric patients with dog bite injury encounters. A majority were white (79.1%), male (55.0%), 0–5 years old (39.2%) and did not require hospital admission (98.1%). Seventy-nine of 303 cities (26.1%) had city-specific policies related to dogs. Overall, the presence of dog-related policies was associated with lower incidence of dog bite injury claims (p = 0.01). Specifically, metropolitan areas and the Central Ohio region had a significantly lower incidence when dog-related policies were present (324.85 per 100 000 children per year when present vs 398.56 when absent; p<0.05; 304.87 per 100 000 children per year when present vs 411.43 when absent; p<0.05). Conclusions The presence of city-specific dog-related policies is associated with lower incidence of paediatric dog bite injury claims, suggesting that local policy impacts this important public health issue. There are limited dog-related policies addressing dog bite prevention, with inconsistencies in breadth and depth. Creating consistent, practical requirements among policies with vigorous enforcement could ameliorate public health concerns from paediatric dog bite injuries.
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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.
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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.
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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 %.
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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.
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.
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.
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.
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.
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.
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.