Article

Dog bite injuries to the hand

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Abstract

Dog bites to the hand and forearm are common. Although bites are usually minor, aggressive dogs may cause extensive bites developing to a public health problem. In a database review of dog bites to the hand applied to Emergency Department or to the Department of Hand Surgery in Malmö, Sweden 2008-2009, we found 81 cases [42 men and 39 women; median age 45 (range 2-88) years]. Three of 81 (4%) were children younger than 11 years. Six of the 81 (8%) patients included had bilateral injuries. Seventy-five patients were treated at the Department of Hand Surgery, where 31 of 75 (41%) were admitted to hospital in 181 days (median 4, range 1-20). The injuries included lacerations of the skin, muscle, and tendons as well as fractures, arterial and nerve injuries, and traumatic amputations of fingers. Some cases developed infections, necrosis of muscle and skin, arthritis, osteomyelitis, and even sepsis. A total of 96 operations were done for 51 patients (median 1, range 1-8) and the patients had 343 (median 2, range 0-22) outpatient visits. Almost half of the bites occurred when the patients was trying to separate two fighting dogs. The size of the lacerations increased with the size of the dog. Serious infections were found independently of size of dog. We suggest that education of owners and the public, reporting of all bites, and control of animals are some of the actions to reduce the number of attacks. At least one serious case could have been prevented if the dog had been put down after a previous serious attack.

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... Hunde können ihre menschlichen Begleiter aber auch attackieren und lebensgefährliche Verletzungen verursachen [4,5,7,17,22,23]. In den Vereinigten Staaten von Amerika werden 80-90 % aller Bissverletzungen von Hunden hervorgerufen [12]. In den meisten Fällen greifen Hunde ihre Besitzer oder eine dem Hund bekannte Person an [7,8,24]. ...
... Vor allem sehr junge Kinder sind aufgrund der Unerfahrenheit im Umgang mit Hunden besonders gefährdet, da sie nicht zwischen verspieltem, ängstlichem oder abwehrendem Verhalten des Hundes unterscheiden können [3,19]. Kinder können Hunde durch ungestüme, verspielte oder laute Verhal-tensweisen sogar provozieren und weisen längere Reaktionszeiten und eine geringere Abwehrfähigkeit auf [12]. Hundebisse betreffen in 60-70 % der Fälle deshalb Kinder; ein Viertel der Kinder ist hierbei jünger als 6 Jahre [4,11]. ...
... Die Lokalisation von Hundebissen korreliert mit der Körpergröße und den motorischen Fähigkeiten des Opfers [12,15]. Im Gegensatz zu Erwachsenen weisen v. a. Kinder unter 6 Jahren schwere Bisswunden im Kopf-Hals-Bereich auf [7,17,23]. ...
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Article
Zusammenfassung Durch Hundeangriffe können lebensgefährliche Verletzungen verursacht werden. Die Lokalisationen von Hundebissen korrelieren mit dem Alter und den motorischen Fähigkeiten des Opfers. Bei Kindern unter 6 Jahren finden sich im Vergleich zu Erwachsenen und älteren Kindern häufiger schwere Bisswunden, v. a. im Kopf-Hals-Bereich. Es wird der Fall eines 20 Tage alten Neugeborenen mit einer schweren Form der Osteogenesis imperfecta vorgestellt, das mit 2 Hunden allein gelassen und attackiert wurde und eine isolierte, bilaterale Kopfschwartenverletzung und intrakranielle Verletzungen erlitt. Besonderheiten von Hundebissen werden mit besonderem Augenmerk auf Säuglinge und Kinder diskutiert. Isolierte schwere Kopfverletzungen nach Hundebissen sind ein seltenes Phänomen.
... This is in keeping with the results of other similar studies [3,6,11]. However, some researchers did not demonstrate a sex difference [12,13]. A possible reason for the higher incidence among males may be that males tend to be naturally more fearless than females and hence are likely to venture closer to an unknown or stray dog [14]. ...
... The overall median age for all patients in this study was 27 years, which is similar to the study conducted at the Ngwelezane Hospital in the KwaZulu-Natal province of South Africa in which the median age was 25 years [7]. In contrast, the median age was reported as 15 years in a study conducted in the US [3]; two Swiss studies among adult patients reported a median age of 36 years and 45 years, respectively [11,12]. In studies that included only children, the median age ranged from 5.7 to 7.4 years [6,13,15,16]. ...
... In this study, the percentage of dog-bite wounds varied minimally from month to month. There was no obvious evidence of a seasonal trend, which is in contrast to many studies that have demonstrated an increase in dog-bite wounds during the summer months when people and dogs spend more time outdoors [3,12,13,15,16]. A possible reason for this difference may relate to the fact that the South African winter is not as severe as that in other countries, making it more likely for both humans and dogs to be found outdoors in the South African winter. ...
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Article
Background Dog-bite wounds are a common emergency department (ED) presentation, accounting for approximately 5% of traumatic wounds in the US. However, only 20-50% of patients actually present to the ED for medical attention following a dog-bite wound. Methods This was a transverse, retrospective audit of medical records of patients that had presented to the Tembisa Provincial Academic Hospital ED with dog-bite wounds during the 2014 calendar year. Results Of the 269 patients that were included in the study, 148 (55%) were male. The median age of all study patients was 27 years (range: 3-77 years). Most patients presented between 18h00-24h00 (n = 111, 41.3%). Most wounds were sustained on the lower limbs (n = 80, 68.18%), followed by the upper limbs (n = 74, 28.03%). Patients who were ≤12 years of age had a higher prevalence of buttock/perineum (p = 0.0002) and head/face/neck (p = 0.009) wounds, whereas patients who were >12 years of age had a higher prevalence of lower limb wounds (p = 0.0006). Only 15 (5.6%) wounds were sutured, and antibiotics were prescribed to 120 (45.1%) patients. Tetanus toxoid vaccine (TTV) and the first dose of the rabies vaccine (RV) were administered to 152 (57.4%) and 240 (89.1%) patients, respectively. Conclusion Children are more likely to present with wounds to the head/face/neck or buttock/perineum regions, while adults are more likely to present with wounds to the lower limbs. Proper strategies should be implemented to ensure that clinicians adhere to the current antibiotics protocols as well as rabies and tetanus post-exposure prophylaxis (PEP)-prescribing guidelines.
... 2 The upper extremity is frequently affected, and hand injuries occur in 30% of cases. 3,4 The superficial location of nerves, blood vessels, tendons, and small joints in the wrist and hand renders these structures vulnerable to injury. 3,5 Moreover, bite wounds to the hand have been shown to be more susceptible to infection than those in other anatomical regions, in part owing to the presence of multiple closed spaces including tendon sheaths and fibrous septa in the fingertip and thenar and midpalmar spaces. ...
... 3,4 The superficial location of nerves, blood vessels, tendons, and small joints in the wrist and hand renders these structures vulnerable to injury. 3,5 Moreover, bite wounds to the hand have been shown to be more susceptible to infection than those in other anatomical regions, in part owing to the presence of multiple closed spaces including tendon sheaths and fibrous septa in the fingertip and thenar and midpalmar spaces. 5 Approximately 30% to 40% of all hand bites develop clinical infection, and over half of these are caused by dog and cat bites. ...
... 1,6 Other hand infections after animal bites include septic tenosynovitis, arthritis, and osteomyelitis. 3,5 Disseminated infections with severe sepsis are rare. 1 One pathogen that has been associated with life-threatening septicemia after dog bites is Capnocytophaga canimorsus, a fastidious gramnegative bacillus that colonizes the oral cavity of animals, particularly dogs and cats. 1,7 Although C. canimorsus sepsis is rare, case-fatality rates have been reported to be 26% to 30% with mortality rates of 60% in patients presenting in septic shock. 1 We describe a case of severe sepsis caused by C. canimorsus after a minor dog bite. ...
Article
Capnocytophaga canimorsus is a gram-negative bacillus present in the oral cavities of 22% to 74% of healthy dogs. Capnocytophaga canimorsus has unique virulence factors that enable it to evade the human immune system and cause life-threatening sepsis following a dog bite. We report a previously well 68-year-old woman who presented with septic shock and multiorgan failure following a seemingly minor dog bite to the finger. The patient required intensive care treatment, intravenous antibiotic therapy, and multiple surgical procedures including amputation of the affected finger. The septicemia and coagulopathy that ensued resulted in gangrene and amputation of additional fingers and toes. The purpose of this report is to raise awareness of this organism among hand surgeons when faced with a patient presenting in septic shock and minimal signs at the site of a dog bite. © 2016 American Society for Surgery of the Hand. All rights reserved.
... 4 However, the true incidence is difficult to ascertain because minor injuries are often selftreated without the advice of a healthcare provider. 5 Population studies suggest that, in the United States, approximately 4.5 million people (1.5% of the population) are bitten annually by dogs alone. 3 The estimated healthcare cost associated with management of cat and dog bites in the United States is .$850 million annually and does not take into account the costs to the patient in terms of time off work, rehabilitation, and permanent impairment. ...
... 7 Whether specific breeds are more dangerous than others is a subject of controversy. 5,[8][9][10][11] The American Veterinary Medical Association and US Centers for Disease Control and Prevention have argued against breed-specific legislation and advocate instead for community measures for bite prevention. 9,10 In most cases, the patient is familiar with the animal responsible for the bite injury. ...
... During wound exploration, the hand is assessed for tendon disruption, bone or joint penetration, open fracture, neuro-vascular injury, and deep tissue infection. 5,7 In patients with acute clenched fist injuries (fight bites), the wound can be extended to provide adequate exposure for inspection. Arthrotomy and inspection of the joint surface may be beneficial even if the capsule appears to be intact because puncture wounds can quickly seal off. ...
Article
The hand is the most common site for bite injuries. Because of specific characteristics of hand anatomy, bite mechanics, and organisms found in human and animal saliva, even small wounds can lead to aggressive infections. Failure to recognize and treat hand bites can result in significant morbidity. Human and animal bites most commonly lead to polymicrobial bacterial infections with a mixture of aerobic and anaerobic organisms. Pasteurella species are commonly found in dog and cat bite wounds, and Eikenella is characteristic of human wounds. Staphylococcus, Streptococcus, and anaerobic bacterial species are common to all mammals. Although public health measures in developed countries have been highly effective at reducing rabies transmission, dog bites remain the most common source of rabies infection worldwide. Human bites can transmit HIV, hepatitis B, or hepatitis C, especially when contaminated blood is exposed to an open wound. Appropriate management of any mammal bite requires recognition, early wound cleansing, evaluation of injured structures, and infection prophylaxis. Structural repair is performed as indicated by the severity and contamination of the injury, and wounds may require delayed closure. Wound infections typically require débridement, empiric antibiotics, and delayed repair or reconstruction. Copyright 2014 by the American Academy of Orthopaedic Surgeons.
... The most frequent microorganism isolated in cat bites is Pasteurella multocida, which is part of the natural oral flora of domestic cats. The most frequent microorganism in dog bites is Staphylococcus aureus after P. multocida.12,14 Other microorganisms frequently involved are Gram-positive cocci, such as Staphylococcus and Streptococcus, anaerobes such as Fusobacterium and Bacteroides and Capnocytophaga canimorsus, which, although rare, can cause a serious and potentially fatal infection.10,12 ...
... A common scenario is when trying to separate 2 dogs fighting12 and there are often cases of provoked attacks, especially in children.3,8,11 Although breeds such as Jack Russell terriers, German Shepherds, Chow Chows, and Pit Bull terriers are more prone to attack without provocation, any dog can be aggressive when threatened and the severity of the injury correlates with the size of the animal.6,9,12 Cats, because of their sharp teeth and weaker biting force, usually cause puncture wounds, although dogs, with their larger teeth and stronger biting force, cause more crush injuries, lacerations, and abrasions, resulting in more severe structural damage.6,10,13,14 ...
... Attention-deficit hyperactivity disorder has been associated with an increased risk of injury.15 Children are usually admitted to hospital, although it is more difficult to assess the extent of the injury and therefore more often require wound exploration; however, adults are usually admitted only when there is serious tissue damage or infection.12 Adults are more likely to sustain bite wounds to the upper and lower extremities,5 whereas children are more likely to sustain bite injuries on the face, usually in the middle third at the “central target area.” ...
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Article
Objective: Animal bites represent a significant global health issue. The evidence in the literature regarding their management in many areas is conflicting and unclear. This project attempts to identify current evidence in the literature on the management of animal bites and assess if current practice in the United Kingdom is evidence based. Materials and methods: A literature review on the management of animal bites was performed, and a national UK survey was contacted using a questionnaire based on the available evidence in the literature. Results: The results from this survey show that 98% of plastic surgery units routinely use prophylactic antibiotics in all animal bite wounds; 58% close low-risk injuries primarily after initial washout, and there are conflicting opinions regarding the management of associated fractures and soft tissue injuries. The available data in the literature suggest that appropriate wound management is the most important factor for prevention of infection in animal bites. Antibiotic prophylaxis should only be given in high-risk wounds and primary closure should be performed in low-risk wounds. Conclusions: The management protocols of many plastic surgery units often diverge from the available evidence within the literature. On the basis of a thorough literature review, a guideline for the management of animal bites is presented. Future studies should investigate the management of associated fractures and soft tissue injuries.
... [34][35][36][37] Other common sequelae include lacerations, fractures, arterial injuries, amputations, and arthritis. 38,39 Most sequelae are of cosmetic nature and associated with female gender, larger dog weight, and severity of dog bite injury. 40 Children are 4.2 times more likely to sustain ocular injuries as well as facial trauma as compared to adults. ...
... 41,42 More serious complications also reported include osteomyelitis, sepsis, neurological injuries, and death. 38,39 Common pathogens and treatments are presented in Table 1. ...
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Article
Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. Methods: A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. Results: The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. Conclusions: Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.
... Several studies have reported more bite cases in spring and summer compared to other seasons. [10,12,[17][18][19] Cases involving children are reported to occur more easily in summer as contact with animals is more probable and children wear lighter clothing at that time. [12,20,21] Stallions mate all year round, but the reproductive period among mares is usually concentrated between May and October. ...
... Cats may also bite following provocation, but this has not previously been reported for horses and donkeys. [1,17,24] Provocative behavior was determined in 12 (33.3%) cases in our study. ...
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Article
Background: The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas. Materials and methods: The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files. Results: The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48-190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin-clavulanic acid was prescribed in 28 (77.8%) cases. Conclusion: Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey.
... In Malmö, Sweden, in 2008-2009, 81 dog bite injuries were reviewed by Nygaard and Dahlin [15], and the dog breed was recorded in 38% of the cases: German Shepherd (n = 6), 3 of which were police dogs; Rottweiler (n = 6), American Staffordshire crossbreed (n = 2, same dog), Golden Retriever (n = 2), Labrador (n = 2), Bull Terrier (n = 2), "fighting dog," St. Bernard, Siberian Husky, Dachshund, terrier (not further specified), and a poodle (n = 1 each). Attempts to separate the two fighting dogs were the reason for human injuries in nearly half of the cases that mentioned the circumstances of the dog bites. ...
... Attempts to separate the two fighting dogs were the reason for human injuries in nearly half of the cases that mentioned the circumstances of the dog bites. Furthermore, an American Staffordshire crossbreed and a Bull Terrier caused the most serious bites [15]. ...
Article
The inspection protocols of the Swedish police, based on the Act (2007:1150) on Supervision of Dogs and Cats, were used to examine the characteristics of 101 seized dogs, their owners, and the circumstances in which the attacks occurred. Most common reasons to seize a dog was that the dog owner was not following a previous order or ban, or that the dog had attacked and caused damage to humans or animals. The most common circumstances of the attacks involved dogs that escaped from gardens, unleashed dogs on walks and attacks by dogs on a leash. Bull breeds caused the highest number of injuries, the most serious injuries, and they were most often categorized as high risk, followed by Rottweilers and German Shepherds. Affenpinscher, Chihuahua, Cocker Spaniel, Japanese Spitz, Pug, Shih Tzu, Shetland Sheepdog and Golden Retriever were identified as victim breeds. The seized dogs had caused substantial harm to humans, animals, and their environment. The largest proportion of dogs returned to owners occurred in the Stockholm region.
... Bei ästhetisch relevanten Stellen wie an Kopf oder Nacken sollte die Wunde bis zu 8 h nach der Verletzung primär verschlossen werden, auch um funktionelle Störungen wie Lidverletzungen und Narbenbildung zu verhindern [16,19,42,43]. Menschen-und Katzenbisse sind in dieser Hinsicht ungünstiger als Hundebisse [16,40,42,45]. ...
... Die meisten Infektionen haben eine polymikrobielle Keimflora mit aeroben und anaeroben Bakterien. Im Falle eines Hundebisses findet sich v. a. Staphylococcus aureus oder Pasteurella multocida sowie Haemophilus influenzae [19]. Bei Katzenbissen wird hauptsächlich das Bakterium Pasteurella multocida gefunden, das in der natürlichen Mundflora von Hauskatzen in >90 % vorliegt [17]. ...
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Article
Objective Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. Indications Acute traumatic and late presented bite injuries. Contraindications General contraindication for anesthesia or surgery. Surgical technique Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. Postoperative management Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10–12 after surgery. Results Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.
... [10] A dog bite can also result in traumatic amputation as well as other limb or life-threatening injuries. [11] Local and systemic wound infections, disfigurement, posttraumatic stress disorder, and other wound healing complications such as hypertrophic scar and keloid are all components of short-and long-term morbidity associated with dog bite injury in humans. [4,12,13] The potential risk of transmission of rabies is even a more serious but preventable burden associated with dog bites. ...
... This is at variance with the preponderance of male victims reported in almost all published studies on dog bite-related injury. [1,6,10,11,[17][18][19] The reason for the predominance of female victims in this series is not evident. ...
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Article
Background: Dog bite injury treated in the emergency room varies from and within sub regions in pattern and potential risk of transmission of rabies. This variation has implications in its morbidity and mortality. The aim of this study was to determine the incidence and pattern of dog bite injuries treated in a teaching hospital emergency room setting of a developing country. Patients and Methods: This was a retrospective study of the entire patients with dog bite injury treated in the emergency room of Federal Teaching Hospital Abakaliki from January 2006 to December 2015. Results: Dog bite injury necessitated visit in 74 patients with an incidence of 2 per 1000 emergency room attendances, and a male to female ratio of 1:1.1. The mean age of the patients was 25.5 ± 1.87 years, and peak age group incidence was 5–9 years. Lower extremity was involved in 77.5% of the injuries, and buttock was the predominant site of injury in 0–4 years old. Fifty‑one (68.9%) owned dogs and 23 (31.1%) stray dogs were involved in the attack. There was unprovoked attack in 81.1% of cases, and 51 (68.9%) sustained Grade II injury. Twenty‑eight (37.8%) of the dogs had anti‑rabies vaccination. Fifty‑four (73%) patients had no pre -hospital care while 64 (86.5%) received post exposure anti‑rabies vaccine. Majority of the patients 73 (98.7%) recovered fully. One (1.4%) patient that presented with clinical rabies self‑discharged against medical advice. Conclusion: The incidence of dog bite injury is within worldwide range though the female gender bias is unprecedented. We recommend preventive strategies based on the observed pattern and improvement in the rate of pre-hospital care and higher coverage of anti‑rabies vaccination of dogs.
... [10] A dog bite can also result in traumatic amputation as well as other limb or life-threatening injuries. [11] Local and systemic wound infections, disfigurement, posttraumatic stress disorder, and other wound healing complications such as hypertrophic scar and keloid are all components of short-and long-term morbidity associated with dog bite injury in humans. [4,12,13] The potential risk of transmission of rabies is even a more serious but preventable burden associated with dog bites. ...
... This is at variance with the preponderance of male victims reported in almost all published studies on dog bite-related injury. [1,6,10,11,[17][18][19] The reason for the predominance of female victims in this series is not evident. ...
Article
Background: Dog bite injury treated in the emergency room varies from and within subregions in pattern and potential risk of transmission of rabies. This variation has implications in its morbidity and mortality. The aim of this study was to determine the incidence and pattern of dog bite injuries treated in a teaching hospital emergency room setting of a developing country. Patients and methods: This was a retrospective study of the entire patients with dog bite injury treated in the emergency room of Federal Teaching Hospital Abakaliki from January 2006 to December 2015. Results: Dog bite injury necessitated visit in 74 patients with an incidence of 2 per 1000 emergency room attendances, and a male to female ratio of 1:1.1. The mean age of the patients was 25.5 ± 1.87 years, and peak age group incidence was 5-9 years. Lower extremity was involved in 77.5% of the injuries, and buttock was the predominant site of injury in 0-4 years old. Fifty-one (68.9%) owned dogs and 23 (31.1%) stray dogs were involved in the attack. There was unprovoked attack in 81.1% of cases, and 51 (68.9%) sustained Grade II injury. Twenty-eight (37.8%) of the dogs had anti-rabies vaccination. Fifty-four (73%) patients had no prehospital care while 64 (86.5%) received postexposure anti-rabies vaccine. Majority of the patients 73 (98.7%) recovered fully. One (1.4%) patient that presented with clinical rabies self-discharged against medical advice. Conclusion: The incidence of dog bite injury is within worldwide range though the female gender bias is unprecedented. We recommend preventive strategies based on the observed pattern and improvement in the rate of prehospital care and higher coverage of anti-rabies vaccination of dogs.
... Our inpatient length of stay and operative rate are consistent with previously published reports on upper extremity DBIs. 1,8,20,27 In a subset of upper extremity DBIs, nerve, tendon, and vascular abnormalities are noted on physical exam, and there is a paucity of published literature documenting the surgical exploration of these structures. 5,6,16,20,28 In our study, nerve palsy on physical exam was highly predictive of discovering nerve damage during surgical exploration, which ranged from minor contusions to complete lacerations. ...
... 1,8,20,27 In a subset of upper extremity DBIs, nerve, tendon, and vascular abnormalities are noted on physical exam, and there is a paucity of published literature documenting the surgical exploration of these structures. 5,6,16,20,28 In our study, nerve palsy on physical exam was highly predictive of discovering nerve damage during surgical exploration, which ranged from minor contusions to complete lacerations. Of equal importance, the absence of a documented nerve palsy was highly predictive of no intraoperative nerve damage. ...
Article
Background: Dog bite injuries to the upper extremity can result in traumatic neurovascular and musculotendinous damage. Currently, there are no clear guidelines dictating which patients may benefit from early operative exploration. The purpose of this study was to identify clinical variables that were predictive of abnormal intraoperative findings in patients who sustained an upper extremity dog bite injury. Methods: All patients who presented to a level I trauma center between 2007 and 2015 with an upper extremity dog bite injury who underwent subsequent surgical exploration were retrospectively screened for inclusion in our study. Patients with inadequate documentation or preexisting neurovascular or motor deficits were excluded. Abnormalities on physical exam and injuries encountered during surgical exploration were recorded for each patient. Contingency tables were constructed comparing normal and abnormal nerve, tendon, and vascular physical exam findings with intact or disrupted neurovascular and musculotendinous structures identified during surgical exploration. Results: Between 2007 and 2014, 117 patients sustained a dog bite injury to the upper extremity, of which 39 underwent subsequent surgical exploration and were included in our analysis. Sixty-nine percent of patients with neuropraxia on exam had intraoperative nerve damage. Seventy-seven percent of patients with an abnormal tendon exam had intraoperative musculotendinous damage. One hundred percent of patients with an abnormal vascular physical exam had intraoperative arterial injury. Conclusions: To date, there are no clear guidelines on what clinical criteria indicate the need for operative exploration and possible repair of neurovascular structures in upper extremity dog bite injuries. In our study, nerve, tendon, and vascular abnormalities noted on physical exam were strongly predictive of discovering neurovascular and musculotendinous damage during surgical exploration.
... Bite injuries to the hand are predominantly caused by mammals: dogs, cats and humans and represent a common emergency presentation. The estimated lifetime risk of being bitten by a domestic animal is around 50% [2], and these injuries account for 1-2% of emergency attendances in the US with an associated annual medical cost of over $100 million [3]. Approximately 30-40% of all hand infections are attributable to human or animal bites [4]. ...
... Mammalian bite injuries to the hand are often of an occlusive nature. This occurs when the teeth close over the tissue, causing injuries ranging from superficial abrasions, puncture wounds, and lacerations to crushing injuries to tendons and muscle, tissue loss and avulsions, arterial and nerve injuries, fractures, dislocations and traumatic digit amputations [2,13,16]. ...
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Article
Bite wounds are a common form of hand injury with the potential to lead to severe local and systemic sequelae and permanent functional impairment. Mammalian bite wounds may be caused by a variety of animal class and species; injuries resulting from dogs, cats and humans are the most widely discussed and reported in the literature. Bite wounds may be contaminated with aggressive pathogens and the anatomical vulnerability of structures within the hand means that without early recognition and treatment with irrigation and antibiotics, alongside a low index of suspicion for deep structural involvement requiring formal surgical exploration and washout, the consequences of such injuries can be disastrous. We review the literature and discuss the epidemiology, pathophysiology and microbiology relating to these injuries, as well as clinical aspects including signs, symptoms, and management.
... It has been estimated that the risk of being bitten by a domestic animal during a lifetime is about 50%, of which dog bites account for 80-90% [6]. But only 10-50% of all dog bite injuries are reported to medical services [3]. ...
... Therefore dog bites to the hand may be more frequent in the older population as they try to protect themselves by pushing the dog away. In contrast, younger people may interact differently with dogs [15], by playing with them roughly, or they may even attempt to separate two fighting dogs [6]. This makes them vulnerable to injuries to other body regions, such as the lower extremity. ...
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Article
Dog bites in humans are a complex problem, embracing both public health and animal welfare. The primary aim of this study is to examine primary and secondary presentations related to dog bite injuries in adults. Methods. We retrospectively assessed all adult patients admitted with a dog bite injury to the Emergency Department of Bern University Hospital. Results. A total of 431 patients were eligible for the study. Forty-nine (11.4%) of all patients were admitted with secondary presentations. Bites to the hands were most common (177, 41.1%). All patients (47, 100%) with secondary presentations were admitted because of signs of infection. The median time since the dog bite was 3.8 days (SD 3.9, range 1–21). Thirty-one patients had already been treated with antibiotic; coamoxicillin was the most common primary antibiotic therapy (27/47 patients, 57.4%). Patients with injuries to the hand were at increased risk of secondary presentations (OR 2.08, 95% CI 1.21–3.55, P < 0.006). Conclusion. Dog bite injuries to the hands are a major problem. They often lead to infectious complications. Immediate antibiotic therapy should carefully be evaluated for each patient.
... 4,[6][7][8][9] Also, dog bites may cause several physical injuries of tissues including muscle, and be route of entrance for infections. 10 Encounters between primates and dogs are considered stressful events that may exert a negative influence on behavior 6 and health. However, to our knowledge, no pathological data have been published in those cases. ...
Article
Background: Non-human primates (NHPs) are susceptible to dogs' attacks, events that may cause muscle damage along with stress, and could be in some extent compatible with capture myopathy, a syndrome that results in myoglobinuria and renal damage. Methods: We aimed to evaluate by histopathology pre-existing lesions and subsequent sequelae related to dogs' attacks, acute tubular necrosis (ATN) and myoglobinuria, as well as the usefulness of Pearls Stain and IHC to diagnose it. Histopathology was performed in available organs, and sections of kidney submitted to Prussian blue stain and myoglobin immunohistochemistry. Results: During January 2014-June 2016, 16/145 (11%) of NHPs received by Adolfo Lutz Institute, Brazil were reported as attacked by dogs. A high frequency of young and debilitated animals was found. Myoglobinuria was observed in more than half animals (9/16; 56.2%), from which (5/9; 55.5%) presented ATN. Conclusions: Kidney lesions are plausible findings in NHPs attacked by dogs.
... In 10 patients both limbs were bitten. Upper limbs were involved next in frequency of bites; right limb bitten in [14]. Trunk and abdomen injuries ranked third n=244(14.48%) ...
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Background: This study was conducted prospectively over a period of two years in accident and emergency department of Government Medical College, Srinagar. The main objectives of the study included finding out epidemiological aspects of animal bites, categorising bites and analysing associated injuries.Methods: From April 2009 to April 2011, more than 1800 patients presented to accident emergency department with injuries due to human animal conflict. Out of them, 1673 patients had only bite injuries and were treated on out patient basis were included in the study.Results: Study revealed incidence in males (69.27%) being higher than in females. The age group most commonly involved was 0-10 years and rural population (60.72%) was more affected as compared to urban population. Furthermore, dogs were most common (88.46%) animals to be involved in bites. The commonest bite category was class 2 among all the bites (58.57%) while as type 1 was least common (9.74%). Injury pattern showed that most common site of bite was lower limbs, left leg (56.90%) being more common than the right.Conclusions: We conclude from this study that animal bites usually involve age group of less than 10 years. Males and rural population are more commonly involved. Dog is most common animal involved in such conflicts. We found lower limbs are most common sites involved with left lower limb being more commonly bitten as compared to right.
... Demonization also occurs when dog bite incidents, both serious and minor, are labeled as "attacks" (e.g., Nygaard & Dahlin, 2011), an extremely subjective and pejorative term used synonymously with the term "bites" but having a more sensational tone and usually reserved for extreme and sustained violence. For example, Clarke and Vandenberg (2010) could have simply referred to dog bites rather than making the claim that there are more than 100,000 dog "attacks" annually in Australia. ...
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This article examines the accuracy and rhetoric of reports by human health care professionals concerning dog bite injuries published in the peer-reviewed medical literature, with respect to nonclinical issues, such as dog behavior. A qualitative content analysis examined 156 publications between 1966 and 2015 identified by terms such as “dog bite” or “dangerous dogs.” The analysis revealed misinformation about human–canine interactions, the significance of breed and breed characteristics, and the frequency of dog bite–related injuries. Misinformation included clear-cut factual errors, misinterpretations, omissions, emotionally loaded language, and exaggerations based on misunderstood or inaccurate statistics or reliance on the interpretation by third parties of other authors’ meaning. These errors clustered within one or more rhetorical devices including generalization, catastrophization, demonization, and negative differentiation. By constructing the issue as a social problem, these distortions and errors, and the rhetorical devices supporting them, mischaracterize dogs and overstate the actual risk of dog bites.
... retaliation or extreme aggression, and may be inflicted when the owner tries to intervene in a dog fight. Nygaard and Dahlin (2011) found that half of all injuries to the hand were inflicted while separating two fighting dogs. Certain professions, e.g. ...
... In one study, half of all injuries to the hand were inflicted while separating two fighting dogs. 7 Postal workers are also at increased risk from bites to the arm and hand, and high profile campaigns have attempted to address the problem and reduce the number of injuries ( Figure 3). ...
Article
Background: Understanding the epidemiology of injury caused by dogs is crucial for targeting injury prevention efforts and monitoring their effectiveness. There are no contemporary published New Zealand studies describing the epidemiology of dog-related injuries (DRIs). This study aims to address this gap. Aim: To describe the epidemiology of DRIs in New Zealand. Methods: A review of Accident Compensation Corporation (ACC) new claims for DRIs that required medical attention, and publicly funded hospital discharges identified from the National Minimum Dataset (NMDS) for the period of 1 July 2014 to 30 June 2019. ACC cases were identified using the TE60 READ code and relevant diagnosis or external agency descriptions; NMDS cases with an ICD-10-AM external cause of injury code of W540, W541, or W548 were included. Results: There were 108,324 new ACC claims for DRIs and 3,456 hospitalisations during the five-year review period. The majority of injuries were dog bites (51%, n=54,754 ACC claims; 89%, n=3,084 hospitalisations). The all-age incidence of ACC claims for all DRIs significantly increased by 1.75% per year (p<0.001) during the period reviewed, with a significant increase in claims for dog bite injuries of 1.64% per year (p<0.001), a significant increase in DRI hospitalisations (2.43% per year, p=0.046), and a non-significant annual increase (p=0.217) in dog bite injury hospitalisations. Children aged 0-9 years had similar rates to adults of ACC claims for dog bite injuries; however, children 0-9 years were more likely to be hospitalised. Māori had a higher incidence of ACC claims and hospitalisations for dog bite injuries than non-Māori. ACC claims and hospitalisations for dog bite injuries were more likely to occur in areas of greater deprivation, with substantial regional variation across the country. Conclusion: The incidence of injury from dogs in New Zealand is increasing. Inequity exists with substantial regional variation, in higher rates among those living in areas of greater deprivation, and with Māori in the setting of the ongoing effects of colonisation. Children aged 0-9 years are no more likely than other age groups to present for medical attention but are more likely to be hospitalised. Reasons for these disparities require further investigation.
Article
Bites from animal and humans represent a very small proportion of all the patients presenting to emergency departments, However, they require prompt medical and surgical intervention in order to minimise the risk of infection, that may lead to limb and life-threatening complications. In this review article we synthesise the existing literature for treatment of human and animal bites and offer practical considerations when managing bite injuries.
Article
Candida osteomyelitis is uncommon, especially after dog bites. We describe a case of a 63-year-old man without significant comorbidities presenting progressing swelling of the distal interphalangeal joint (DIJ) of right index finger following a dog bite. Despite empiric antibiotic therapy and local medications, there were no clinical signs of improvement. Clinical examination revealed fistula with purulent drainage on the volar region. Even though laboratory data showed inflammatory markers on range, magnetic resonance imaging (MRI) demonstrated signs of osteomyelitis. The patient was taken to exploration and debridement of the bite wound. Culture of the bone biopsy showed growth of Candida parapsilosis. Therefore, the patient was diagnosed with isolated fungal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective and all symptoms were resolved in 8 weeks after the surgery. There were no signs of recurrence after 20 months of follow-up. The patient had no cosmetic abnormalities or sequelae. Concurrently with the description of the case report a review of the literature was provided. According to the authors, there are three main etiopathogenesis for this infection. The first pathogenic mechanism is direct inoculation into the deep tissues through the dog bite. The second hypothesis is direct translocation of the pathogen from the skin to the deep tissue and to the bone. The last mode of transmission is hematogenous dissemination. Fungal osteomyelitis are really rare conditions, especially after dog bites, but nevertheless it should be considered as a possible diagnosis when there is no response to antibiotics.
Article
While many hand infections are superficial, diligent evaluation, diagnosis, and treatment of these infections are central for preventing disability and morbidity. Maintaining a wide differential diagnosis is important as some hand infections may mimic others. In geographic areas with more than a 10% to 15% prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) hand infections, empiric antibiotics should adequately cover MRSA. Once culture results are available, antibiotic regimens should be narrowed to reduce the development of resistant pathogens.
Article
Purpose: Dog bites to the head, neck, and face (HNF) disproportionately affect children. It is unclear if specific facial regions are uniquely at risk in this population. Both the periorbital region and the central target area (CTA; nose, lips, and cheeks) have been proposed as being at increased risk. This study addressed the following question: Among individuals sustaining a dog bite injury to the HNF, are children, when compared with adults, at greater risk of injury to the periorbital region or CTA? Patients and methods: Using a retrospective cohort design, we enrolled a sample composed of patients presenting with HNF dog bite injuries. The predictor variable was age category: pediatric or adult (≥18 years). The primary outcome variable was injury location: isolated periorbital, isolated CTA, both periorbital and CTA, or other HNF location (neither periorbital nor CTA). Other variables included specific facial structures injured, demographic characteristics, injury circumstances, and clinical course. Descriptive and bivariate statistics were calculated. Results: The sample consisted of 183 pediatric (58.5%) and 130 adult (41.5%) patients. Isolated periorbital injuries were more common in the pediatric group (relative risk [RR], 2.2 [95% confidence interval (CI), 1.3 to 3.7]; P = .003), as was injury to both periorbital and CTA regions (RR, 2.0 [95% CI, 1.2 to 3.5]; P = .01). Isolated CTA injury was the most common injury pattern overall in both children and adults, but children were at significantly less risk than adults (RR, 0.7 [95% CI, 0.5 to 0.9]; P = .002). Children also were less likely to sustain an injury to other HNF regions (RR, 0.6 [95% CI, 0.3 to 0.97]; P = .038). Conclusions: Children were twice as likely as adults to incur a periorbital dog bite, but no such increased risk was observed for the CTA. This may reflect unique anatomic risks in children or targeting of their eyes by attacking dogs, contributing to higher rates of HNF injury in this population. Public health measures should recommend against children being at eye level with dogs, even if familiar or under adult supervision.
Chapter
Verletzungen der Haut im Kindes- und Jugendalter sind sehr häufig. Bissverletzungen nehmen allerdings neben Schnittwunden, Platzwunden, Quetschwunden, Schürfwunden oder eingebrachten Fremdkörpern eine Sonderstellung ein: Bisswunden haben ein hohes Infektionsrisiko (65–80 %) und erfordern daher ein rasches und kompetentes chirurgisches Handeln. Im folgenden Kapitel wird daher ausführlich auf die unterschiedlichen Formen von Bissverletzungen und auf das diesbezügliche Vorgehen eingegangen. Darüber hinaus werden Komplikationen, wie Phlegmonen, Abszesse, Nekrosen und Algorithmen zu deren Erkennung, Therapie und Vermeidung dargestellt.
Article
Dog bite injuries are a common cause of patient presentation to NHS emergency departments (EDs) and minor injuries units, and are generally associated with a low level of acuity, despite an inherent capacity for significant soft tissue damage to be inflicted by canine jaws capable of exerting terrific bite forces. Anatomical sites for injury correlate to victim age, with hand and wrist injuries predominating in the adult population. The most common complication is infection secondary to inoculation of oral flora, with the hands being particularly vulnerable due to their anatomy. Injuries to structures such as tendons can be discreet, and retained foreign bodies can easily be overlooked. Wound care has a propensity to attract a disproportionately high level of malpractice actions, and approaches to the management of dog bite injuries have largely been empirical, which may render the practitioner particularly exposed. In response to increasing pressures on healthcare systems, paramedics with extended scopes of practice, including wound care and suturing, are being utilised to assess, manage, treat, and either refer or discharge patients with apparently minor injuries, in strategies aimed at reducing hospital admissions. This article adopts a case study format to examine and evaluate treatment modalities and the current evidence base informing best practice in terms of dog bite injuries from the perspective of a paramedic practitioner, with critical reflection on the decision making process and complexities of such episodes of care in the pre-hospital setting.
Dog bites are common injuries in children. A large percentage of these dog bites affect the upper extremity. There is little information describing the results of treatment of upper extremity injuries in children. We retrospectively reviewed the medical records for all children less than 19 years old who presented to the emergency department in our level one trauma centre because of dog bites from 2005 to 2011. During the study period, there were 254 paediatric emergency department visits for animal bites, among these there were 118 dog bites, two were excluded because of inadequate documentation leaving 116 patients; 26 of them (22.4%) had bites to the upper extremity. Among the 26 children with dog bites to the upper extremity, 6 (23.1%) were admitted to the hospital for surgery (four patients) or parenteral antibiotics (two patients). Among the four surgeries, two were for extensive laceration and two were for abscess debridement. Of the 41 who presented with bites to the lower extremities, none were admitted to the hospital (P = 0.002). Compared with those who presented the same day they were injured, the relative risk of hospitalization or surgery in patients who presented 1 and 2 days after their injury was 3.5 and 7.0, respectively. Dog bites at the upper extremity are more prone to require surgical intervention and develop infection than those at the lower extremity, and delayed presentation of these injuries is associated with higher incidence of developing infection. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
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To update data on fatal dog bites and see if past trends have continued. To merge data from vital records, the Humane Society of the United States, and searches of electronic news files. United States. U.S. residents dying in the U.S. from 1989 through 1994 from dog bites. We identified 109 dog bite-related fatalities, of which 57% were less than 10 years of age. The death rate for neonates was two orders of magnitude higher than for adults and the rate for children one order of magnitude higher. Of classifiable deaths, 22% involved an unrestrained dog off the owner's property, 18% involved a restrained dog on the owner's property, and 59% involved an unrestrained dog on the owner's property. Eleven attacks involved a sleeping infant; 19 dogs involved in fatal attacks had a prior history of aggression; and 19 of 20 classifiable deaths involved an unneutered dog. Pit bulls, the most commonly reported breed, were involved in 24 deaths; the next most commonly reported breeds were rottweilers (16) and German shepherds (10). The dog bite problem should be reconceptualized as a largely preventable epidemic. Breed-specific approaches to the control of dog bites do not address the issue that many breeds are involved in the problem and that most of the factors contributing to dog bites are related to the level of responsibility exercised by dog owners. To prevent dog bite-related deaths and injuries, we recommend public education about responsible dog ownership and dog bite prevention, stronger animal control laws, better resources for enforcement of these laws, and better reporting of bites. Anticipatory guidance by pediatric health care providers should address dog bite prevention.
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Article
To estimate the prevalence of dog bites to primary school children between the ages of 8-12 years using a semi-structured interview process. With the increase in the pet population and popularity of dangerous breeds of dog and a high stray dog population combined with a dearth of information on the risk of dog attacks to children in Trinidad, a semi-structured interview process was used to determine risk factors associated with dog attacks. A questionnaire survey of 1109 primary school children between the ages of 8-12 years was conducted in Trinidad from November 2002 to September 2003. The survey was conducted to determine the risk factors such as age, gender, size of dog and relationship of dog and victim, in dog bite incidents. The chi-square statistic and odds ratios were used to estimate risk factors for a bite incident. Twenty-eight percent of children were bitten at least once by a dog. Gender (male) and owning a dog were statistically significant risk factors (p = 0.003 and 0.008 respectively, chi2 df, 95% confidence). Most attacks occurred outside of the home (58.0%) followed by the victims' home (42.0%) and were by a dog known but not owned (54.6%) by the victim. Many victims (33.0%) were bitten without having any interaction with the dog and the majority (61.9%) of victims did not receive professional medical assistance. Overall, the lower leg or foot was most often injured (39.3%). A public educational campaign is needed on responsible pet ownership. In addition, children must be taught effective ways of avoiding attacks or reducing injury in the event of a dog attack. The Dangerous dogs Act 2000 must be proclaimed in parliament by the Government of Trinidad and Tobago to exert more pressure on pet owners to safeguard the public from the menace of dog attacks.
Article
Background Despite the widespread use of police dogs, there is very little objective medical information about the injuries they cause when they bite. Our aim was to statistically describe police dog bite injuries. Methods We described police dog bite injuries by comparing them with domestic (non-police) dog bites. We retrospectively analyzed their demographic and specific injury data drawn from their medical records. The police dog bite victims came from the Los Angeles Police Department K9 Unit from 1988 to 1990. The domestic dog bite victims came from King-Drew Medical Center, an inner-city public hospital from 1989 to 1996. All of the police dog victims’ medical records that could be located were included (595 out of 957). All domestic dog bite victims that arrived for treatment were included (n = 1109). Results Police dog bite victims were usually bitten multiple times, whilst domestic bite victims were not. Police dog bite victims were bitten more often in the head, neck, chest and flank. They were hospitalised more often, underwent more operations and had more invasive diagnostic tests. Conclusions Police dog bite injuries appeared to be more serious than victims of domestic dog bite victims. The reasons for the differences were related to the types of dogs selected and their special training.
Article
The incidence of dog bites in Belgium is one percent a year (900 per 100,000 population). Dog bites have important complications both for the society (costs) and the patient (functional and aesthetic discomfort). A retrospective study of patients who received emergency treatment at the Academisch Ziekenhuis Vrije Universiteit Brussel in Brussels, Belgium, between January 2000 and August 2003 was performed. A register of patients was created, and data were included on age, sex, seasonal distribution, bite type, localisation and management of the wounds. Some clinical cases are presented. In the 44-month period January 2000–August 2003, 252 patients (127 males, 125 females) were treated for dog-bite injuries. The mean age was 34years. Most of the bites were located on the upper extremity in adults and on the face in children. The standard management consisted of extensive rinsing and wound debridement with immunization for tetanus. Eighty-five percent of the patients received antibiotics prophylactically. Almost 20% was seen by a plastic surgeon, and 6% needed a surgical intervention in the operating room. The mean hospital stay was 10days. The infection rate was 5.6% for the total patient population.
Article
The effectiveness and suitability of legislation regarding the issue of dangerous dogs, especially those targeting so-called “dangerous breeds” (DB), have been the object of a lot of criticism. However, the shortage of scientific studies in this field makes an objective assessment of the impact of current legislation difficult. In the present study, dog bite-related incidents from Aragón (Spain) were analyzed for a 10-year periods (1995 to 2004). With the aim of assessing the impact of the Spanish Dangerous Animals Act on the epidemiology of dog bites, data from the non-legislated (1995 to 1999) and the legislated period (2000 to 2004) were compared in 2 different areas (low- and high-populated areas). According to the results, the population density did exert a significant effect on the incidence of dog bites, whereas the legislation in force did not. Popular breeds such as the German shepherd and crossbreed dogs accounted for the great majority of the incidents during the 2 periods of study. Specifically, the German shepherd proved to be over-represented significantly among the canine population. Dogs in the dangerous breeds list, on the other hand, were involved in a small proportion of the incidents both before and after the introduction of legislation. The present results suggest that the implementation of the Spanish legislation exerted little impact on the epidemiology of dog bites. Besides the scarce effectiveness, the results suggest that the criteria to regulate only so-called DB were unsuitable and unjustified. It is hoped that this study will be helpful in the elaboration of future regulation measures in this matter.
Article
The purpose of this paper is to analyse the effects of cranial size and shape in domestic dogs (Canis familiaris) on predicted forces of biting. In addition to continuous size-shape analysis, nine size-shape groups were developed based on three skull shape categories and three skull size categories. Bite forces were predicted from measurements made on dried skulls using two lever models of the skull, as well as simple models derived by regression analysis. Observed bite force values were not available for the database used in this study, so only comparisons between categories and models were undertaken. The effects of shape and size on scaled predicted bite forces were evaluated. Results show that bite force increases as size increases, and this effect was highly significant (P < 0.0001). The effect of skull shape on bite force was significant in medium and large dogs (P < 0.05). Significant differences were not evident in small dogs. Size x shape interactions were also significant (P < 0.05). Bite force predictions by the two lever models were relatively close to each other, whereas the regression models diverged slightly with some negative numbers for very small dogs. The lever models may thus be more robust across a wider range of skull size-shapes. Results obtained here would be useful to the pet food industry for food product development, as well as to paleontologists interested in methods of estimating bite force from dry skulls.
Article
To estimate the incidence of dog bites in the USA and compare it with similar estimates from 1994. Nationally representative cross-sectional, list-assisted, random-digit-dialed telephone survey conducted during 2001-2003. Weighted estimates were generated from data collected by surveying 9684 households during 2001-2003 and compared with results from a similar survey conducted in 1994. Estimates for persons aged 15-17 years were extrapolated on the basis of rates for 10-14-year-olds. Whereas the incidence of dog bites among adults remained relatively unchanged, there was a significant (47%) decline in the incidence of dog bites among children compared with that observed in the 1994 survey, particularly among boys and among those aged 0-4 years. Between 2001 and 2003, an estimated 4 521 300 persons were bitten each year. Of these, 885 000 required medical attention (19%). Children were more likely than adults to receive medical attention for a dog bite. Among adults, bite rates decreased with increasing age. Among children and adults, having a dog in the household was associated with a significantly increased incidence of dog bites, with increasing incidence also related to increasing numbers of dogs. Dog bites continue to be a public health problem affecting 1.5% of the US population annually. Although comparison with similar data from 1994 suggests that bite rates for children are decreasing, there still appears to be a need for effective prevention programs.
Article
Bite wounds, usually by dogs, cats, and human beings, affect one of two Americans during his or her lifetime and 1 to 2 million Americans annually. Despite the relative frequency of bite wounds, there are few prospective studies to define optimal care; consequently, diverse methods are used. In this article I review the incidence, bacteriology, clinical spectrum, complications, and treatment of animal and human bite wounds. The spectrum of pathogenic bacteria that cause bite infections is broader than is generally appreciated and includes both aerobic and anaerobic bacteria. Pasteurella multocida is found in only 20% to 25% of dog bite wounds. In choosing empiric antimicrobial therapy, clinicians must consider the diverse causative bacteria and their characteristic susceptibility patterns. Liberal irrigation and elevation of the injured part are also cornerstones of therapy. Early, aggressive medical and surgical management can minimize, if not prevent, complications.
Article
It is estimated that half of all Americans will be bitten by an animal or another human being during their lifetimes. The vast majority of the estimated 2 million annual mammalian bite wounds are minor, and the victims never seek medical attention. Nonetheless, bite wounds account for approximately 1% of all emergency department visits and more than $30 million in annual health care costs. Infection is the most common bite-associated complication; the relative risk is determined by the species of the inflicting animal, bite location, host factors, and local wound care. Most infections caused by mammalian bites are polymicrobial, with mixed aerobic and anaerobic species. The clinical presentation and appropriate treatment of infected bite wounds vary according to the causative organisms. Human bite wounds have long had a bad reputation for severe infection and frequent complication. However, recent data demonstrate that human bites occurring anywhere other than the hand present no more of a risk for infection than any other type of mammalian bite. The increased incidence of serious infections and complications associated with human bites to the hand warrants their consideration and management in three different categories: occlusional/simple, clenched fist injuries, and occlusional bites to the hand. This article reviews dogs, cat, and human bite wounds, risk factors for complications, evaluation components, bacteriology, antimicrobial susceptibility patterns, and recommended treatments. Epidemiology, clinical presentation, and treatment of infections caused by Pasteurella multocida, Capnocytophaga canimorsus, Eikenella corrodens, and rhabdovirus (rabies only) receive particular emphasis.
Article
Pediatric nurse practitioners frequently provide families with anticipatory guidance. An area often discussed is safety as it relates to growth and development. One topic that may not be covered is safety with dogs. Dog bites, especially by the family pet, are a common occurrence among children. This article assists the nurse practitioner to learn about the unique characteristics of the canine, what to teach families and children about safety around dogs, responsible dog ownership, and dog training.
Article
A review of dog bite injuries referred to one surgeon over a 12 month period demonstrated a significant association between a delay in referral and a prolonged period of subsequent in-patient treatment. Two patients sustained injuries when delivering material through a letter-box.
Article
Almost one half of all dog bites involve an animal owned by the victim's family or neighbors. A large percentage of dog bite victims are children. Although some breeds of dogs have been identified as being more aggressive than other breeds, any dog may attack when threatened. All dog bites carry a risk of infection, but immediate copious irrigation can significantly decrease that risk. Assessment for the risk of tetanus and rabies virus infection, and subsequent selection of prophylactic antibiotics, are essential in the management of dog bites. The dog bite injury should be documented with photographs and diagrams when appropriate. Family physicians should educate parents and children on ways to prevent dog bites.
Article
This paper reviews three studies that have been conducted in Belgium on dog bites on children. (1) A telephone study revealed that 22/1000 children <15 years of age were victims of dog bites annually. (2) Data on the characteristics of dog bites were collected prospectively over a period of 8.5 months in six hospital emergency departments. "Dangerous dogs" were not responsible for the majority of the accidents. In 67/100, incidents documented, the bites appeared to be triggered by an interaction of the child. Education appeared to be the preventive measure with the highest priority. (3) Among 22 child victims of dog bites, 12 had symptoms of post-traumatic stress disorders some seven months following the accident. Based on these local studies, several initiatives have been undertaken to favour both primary and secondary prevention measures. An appropriate psychological preventive intervention should be offered to all victims of dog bites.
Article
To assess the demographic patterns, clinical morbidity, and treatment costs associated with domestic animal bites to the hand. A retrospective review was performed on 111 patients who suffered either a dog or cat bite to the hand. Demographic data were collected for both the patient and the animal involved. The patient population had suffered 71 dog bites and 40 cat bites. Two scenarios were identified that increased the likelihood of a bite: (1) attempting to separate fighting animals and (2) attempting to aid an injured animal. More than half of the victims (61 of 111) were bitten by an animal with which they were familiar. Bite injuries ranged from relatively minor wounds to major injuries that included open fractures, persistent deep infection including osteomyelitis, nerve laceration, tendon laceration, or tissue loss. Approximately two thirds of patients required hospital admission at least for intravenous antibiotics. Approximately one third of animal bite victims required at least 1 surgical procedure. Thirteen patients required long-term intravenous antibiotics and/or multiple surgeries and incurred medical expenses in excess of dollar 77,000. Domestic animal bites to the hand are common injuries that can produce considerable morbidity. Stray animals did not account for the majority of incidents. Bite prevention strategies should focus on careful handling of animals that are fighting or injured. Animal bite wounds often require intravenous antibiotics and hospitalization and the cost of care for deep infections can be enormous. Our patient population was selected from a small geographic area over a relatively short collection period, suggesting that domestic animal bite injuries may represent a major public health issue. Prognostic, Level IV.
Dog-bite-related fatalities – United States, 1995–1996
  • MMWR
  • MMWR
Dog-bite-related fatalities -United States
  • Mmwr
MMWR. Dog-bite-related fatalities -United States, 1995-1996. MMWR Morb Mortal Wkly Rep 1997;46: 463-7.
05-05 SK. Därfor biter hundar människor
  • Räddningsverket
  • Nco
Räddningsverket/NCO 2008-05-05 SK. Därfor biter hundar människor. Räddningsverket 5-5-2008. Report.
Anticipatory guidance: having a dog in the family
  • L Lazzetti