Dog bites in children

Dog Bites in the United States from 1971 to 2018: A Systematic Review of the Peer-Reviewed Literature

BACKGROUND

Surgical specialists in plastic, head and neck, hand, trauma surgery, and emergency medicine physicians bear the burden of treating the most serious injuries caused by animals. Most of these incidents result from an attack by a known dog, and breed has been proposed, but not proven, to be a controllable factor. The authors summarize the peer-reviewed literature on dog bites in the United States, specifically as related to the breeds implicated.

METHODS

A systematic review of all peer-reviewed publications reporting on dog bites in the United States was performed. MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Library searches were conducted through May 8, 2018, for studies from the United States implicating a specific dog breed as responsible.

RESULTS

Forty-one articles met inclusion criteria, the majority of which were single-institution retrospective reviews. Main outcomes were any dog bite reported in the peer-reviewed literature where a specific breed was implicated. Secondary measures included dog bites reported in areas where breed-specific legislation was enacted. The most common pure breed identified was German Shepherd, followed by Pit Bull-type breeds (i.e., American Staffordshire Terrier, American Pit Bull Terrier, Staffordshire Bull Terrier, American Bully), Labrador, Collie, and Rottweiler, respectively. Pit bull-type and German Shepherd breeds are consistently implicated for causing the most serious injuries to patients in the United States across heterogeneous populations, and this remained consistent across multiple decades.

CONCLUSIONS

The authors' results indicate that German Shepherd and Pit Bull-type breeds account for the largest subset of pure breeds implicated in severe dog bites inflicted on humans in the medical literature. The role and complexity of mentioning breed in relation to human injuries are also discussed.

Genital injuries acute evaluation and management

Genital trauma may result in external injuries to the labia, vulva or vagina, urethra and anus and internal injuries to the bony pelvis, bladder, bowels and reproductive organs. Worldwide, the most common cause of genital trauma in reproductive age women is injury sustained during childbirth, but in this chapter we will focus on accidental genital injuries as well as those arising from sexual violence, and female genital mutilation. While genital injuries alone rarely result in death; if not properly managed, chronic discomfort, dyspareunia, infertility, or fistula formation may result. Clinicians need to be able to recognize these injuries and provide initial management, and assure that the patient's mental, emotional and physical needs are addressed.

Animal Bite Injuries in Children: Review of Literature and Case Series

Introduction

Maxillofacial region in children is particularly vulnerable to animal bite injuries. These injuries may range from insignificant scratches to life-threatening neck and facial injuries. Children are the common victims, particularly of dog bites.

Materials and methods

Three cases of animal bite injuries in children with their clinical presentation and their management are being presented along with review of literature. Surgical management included cleansing and primary closure of the wound. Rabies and tetanus prophylaxis were given.

Discussion

The most common site of injury was the face. For the facial injuries, the most frequently affected area was the middle third (55%), also called as the “central target area.” The small stature of children, the disproportionate size of the head relative to the body, their willingness to bring their faces close to the animal, and limited motor skills to provide defense are believed to account for this. The resulting soft-tissue injuries can vary in relation to their extent. Treatment involved initial surgical exploration, and secondary repair later depending on the severity of the injury.

Conclusion

Prompt assessment and treatment can prevent most bite wound complications. Early management of such injuries usually guarantees satisfactory outcome. Prevention strategies include close supervision of child-dog interactions, better reporting of bites, etc.

How to cite this article

Agrawal A, Kumar P, Singhal R, Singh V, Bhagol A. Animal Bite Injuries in Children: Review of Literature and Case Series. Int J Clin Pediatr Dent 2017;10(1):67-72.

Dog bites of the head and neck: an evaluation of a common pediatric trauma and associated treatment

PURPOSE

To identify which patients and canines are involved in dog bites of the head and neck, and how they impact health systems.

MATERIALS AND METHODS

This is a single center, retrospective cohort study conducted from January 2012 to June 2013 in an academic, tertiary care center situated between multiple suburban and urban communities. Patients were identified by queried search for all bite-related diagnoses codes.

RESULTS

334 unique dog bites were identified, of which 101 involved the head and neck. The mean patient age was 15.1±18.1years. Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention. Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+31%), and without provocation (+48%). Injuries of the head and neck had an average follow-up of 1.26±2.4 visits, and average specialty follow-up of 3.1±3.5 visits.

CONCLUSIONS

The patients most likely to suffer dog bite injuries of the head and neck are children. Although a number of dog breeds were identified, the largest group were pit bull terriers, whose resultant injuries were more severe and resulted from unprovoked, unknown dogs. More severe injuries required a greater number of interventions, a greater number of inpatient physicians, and more outpatient follow-up encounters. Healthcare utilization and costs associated with dog bites warrant further investigation.

The management of bite wounds in children--a retrospective analysis at a level I trauma centre

INTRODUCTION

Animal bite wounds are a significant problem, which have caused several preventable child deaths in clinical practice in the past. The majority of bite wounds is caused by dogs and cats, and also humans have to be considered to lead to those extreme complicated diagnosis in the paediatric patient population. Early estimation of infection risk, adequate antibiotic therapy and, if indicated, surgical treatment, are cornerstones of successful cures of bite wounds. However, antibiotic prophylaxis and wound management are discussed controversially in the current literature. In our study, we retrospectively investigated the bite source, infection risk and treatment options of paediatric bite wounds.

METHODS

A total of 1592 paediatric trauma patients were analysed over a period of 19 years in this retrospective study at a level I trauma centre, Department of Trauma Surgery, Medical University of Vienna, Austria. Data for this study were obtained from our electronic patient records and follow-up visits. In our database, all paediatric patients triaged to our major urban trauma centre have been entered retrospectively.

RESULTS

During the 19-year study period, 1592 paediatric trauma patients met the inclusion criteria. The mean age was 7.7 years (range 0-18.9), 878 (55.2%) were males and 714 (44.8%) were females. In our study population, a total of 698 dog bites (43.8%), 694 human bites (43.6%), 138 other bites (8.7%) and 62 cat bites (3.9%) have been observed. A total of 171 wounds (10.7%) have been infected. Surgical intervention was done in 27 wounds (1.7%).

CONCLUSION

Gender-related incidence in bite wounds for dog and cat could be detected. Second, our findings for originator of bite wounds reflect the findings in the published literature. Total infection rate reached 10.7%, primary antibiotic therapy was administered in 221 cases (13.9%) and secondary antibiotic therapy in 20 (1.3%) cases. Observed infection rate of punctured wounds and wounds greater than 3 cm was 3 times higher than for all other wounds. Our findings need to be proven in further prospective clinical trials.

[Facial dog bite injuries in children: retrospective study of 77 cases]

INTRODUCTION

The face is the area most vulnerable for dog bites in children. Surgical management is an emergency to prevent infection, functional and aesthetic outcomes. The aim of this study was to define a new gravity scale, and to determine a prevention policy.

PATIENTS AND METHODS

In our maxillofacial and plastic surgery department, we conducted a retrospective study from 2002 to 2010, including 77 children under 16 years old, victims of facial dog bite. We analyzed epidemiological, clinical data, surgical outcomes.

RESULTS

The mean age was 5.36 years. Dogs were principally represented by class I and II dogs; 27,7% of them had ever bitten before. In almost all the cases, the dogs belong to the family or closers. Twenty-one percent of children belong to an unfavourable social environment; 71.43% of dog bites interested the central area of the face. The bites were deep in 77% of cases with amputation or extensive loss of substance in 31% of cases. The healing time was 10.54 months. Nearly a third of patients required several surgeries; 41.56% of patients had aesthetic and functional sequelae; 35.1% of children had psychological problems afterward.

CONCLUSION

Facial children dog bites require a multidisciplinary approach, and a long-term follow-up. We propose a new classification of dog bite severity, more appropriate to the face.

Surgical delay in the management of dog bite injuries in children, does it increase the risk of infection?

Dog bites are contaminated wounds and convention dictates that any surgical treatment should be performed at the earliest opportunity. This practice, however, may be in direct conflict with NCEPOD guidelines to reduce night time operating. We audited our treatment of dog bite injuries in children over a 5-year period (1998-2002) to determine whether delaying surgery to conform to operating guidelines increased the incidence of infection. A retrospective case note study identified 118 patients admitted to Sheffield Children's Hospital with dog bite injuries. Details of their injury, treatment and outcome were recorded. There were 70 males and 48 females and an average age of 6.6 years (range 1-15 years). The most common type of injury was a single laceration (32%) and the most frequent site of injury was the face (59%). The majority of wounds (68%) were cleaned and dressed before theatre and 89% were closed directly after minimal debridement. All patients received prophylactic antibiotics. Of the 114 patients that required surgery, 57 (50%) were operated on within 12 h of their injury and 57 (50%) after 12 h. There were three cases of infection in the early group (<12 h) and none in the delayed group (>12 h). We suggest that delaying the surgical treatment of dog bites in children to avoid operating at night does not increase the infection rate.

Aspectos epidemiológicos de las mordeduras caninas

Animal bites in humans are an important public health problem. Most of these bites are dog bites. The first step in preventing this kind of accident is to identify the associated risk factors. The present article reviews the most important published articles on the incidence of dog bites, their risk factors, and preventive measures. Concerning victim profiles, features such as age, sex, location, and the severity of the wounds are reviewed. Regarding dogs, the most frequent breeds involved and the dog's previous history of aggression are described. In addition, the different contexts in which bites occur are reported. Thus, factors such as dates, number of dogs, places, victim-dog relationship and interaction, and the distinct involved categories of aggression of the canine ethogram are reviewed. The most frequent recommendations found in the literature to reduce and prevent dog bites in the human population are also described.

Tragic case of a dog bite in a young child: the dog stands trial

The authors present the tragic case of an 18-month-old child who was bitten by a dog, causing amputation of the forearm and substantial damage to the cutaneous muscle on his back, shoulder, thorax, and neck. A free latissimus dorsi flap was performed to preserve the humerus from which the periosteum had been torn away. A series of cutaneous expansions were then undertaken to graft skin back onto the back, the armpit, and the shoulder stump, to allow for a mechanical prosthesis. A study of the literature on this subject proves that dog bites are more frequent and serious (sometimes even fatal) in young children than in adults. In view of the current legislation, it would seem that the public health authorities are doing little to resolve this distressing problem.

Life-threatening dog attacks: a devastating combination of penetrating and blunt injuries

BACKGROUND/PURPOSE

Children often are the victims of dog attacks. Although bite injuries sustained in an attack characteristically are attributed to the penetrating component of the bite, the blunt nature of a bite may represent the most serious and devastating component of injury. The purpose of this study was to characterize a group of children suffering life-threatening dog bites and examine the predominant aspect of injury.

METHODS

Thirty-nine children were admitted to the trauma service at a regional pediatric trauma center with the diagnosis of dog bite injury over a 6-year period (1994 through 1999). Patient demographics, site and description of injury, and surgical procedures performed were recorded from a chart review.

RESULTS

Mean age of the 35 children included for analysis was 5.4 years (range, 0.8 to 17 years). Twenty-five (71%) injuries occurred in the head and neck region. Eight (23%) children sustained life-threatening injuries. Of these, blunt force was the predominant injury in 6. This resulted in 1 (20%) arterial occlusion requiring vascular reconstruction, 2 (40%) permanent neurologic injuries (stroke, spinal cord transection), and 1 (20%) death (exsanguination).

CONCLUSIONS

On evaluation of a dog attack, the focus generally is on the obvious penetrating aspect of the bite. Yet, we found the blunt component of injury can have devastating consequences reflected in acute arterial, brain, and spinal cord injury. Even in the absence of significant penetrating trauma, further evaluation should be considered to exclude occult blunt arterial or neurologic injury.

Treatment of facial dog bite injuries in children: a retrospective study

PURPOSE

The authors assess their approach to immediate surgical repair with general anesthesia of facial dog bites in children over a 10-year period in their pediatric department.

METHODS

The authors reviewed a series of 100 children (59 boys, 41 girls) who required immediate surgical intervention during the first hours after admission between 1985 and 1995. Strict disinfection was always used to preclude the risk of rabies, and parenteral antibiotherapy was used to avoid aero-anaerobic infections.

RESULTS

A total of 68% of children were below 5 years of age. The most frequent injury was to the midface. Associated injuries or death were not observed. One case of postoperative wound infection was noted. Four surgical revisions were performed because of unsightly scars, but in most children the scar had attenuated 1 year after injury.

CONCLUSIONS

The aim of immediate surgical repair is to obtain a satisfactory cosmetic result and to avoid infections. Better cosmetic results (4 cases of scar revisions) with a minimal risk of wound infections (1 cheek wound infection) are obtained.

Dog bites in children treated in a pediatric emergency department

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 < or = 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.

Dog Bite Injuries in Children: A Preliminary Survey

Dog bite injuries in children are a preventable health problem. To characterize this type of injury, we have undertaken to define demographic criteria and patterns of injury inflicted by dogs in our pediatric population. A retrospective chart review was conducted of pediatric patients with dog bite injuries admitted to a Level I pediatric trauma center from January 1986 through June 1998. Patient demographics, canine characteristics, and hospital patient data were collected and analyzed using the Excel program and appropriate statistical methodology. There were 67 patient records reviewed. Thirty-eight (57%) of the patients were male, and 29 (43%) were female. There were 43 (64%) white children, 22 (33%) African-American children, and 2 (3%) Hispanic children. The average age of the children was 6.2 ± 4.2 years, with an average weight of 23.3 ± 13.7 kg. More than half the attacks occurred in the afternoon and 55 per cent of these attacks were documented as “unprovoked” attacks. Thirty-one (46%) of these attacks involved family pets, and 30 (45%) dogs were known to the attacked child. The head and neck was involved in greater than 67 per cent of these injuries. Pit bulls caused 25 per cent of the bite injuries. Large dogs were responsible for 88 per cent of the attacks. Forty-four (66%) patients required operative intervention. Twenty-eight of these patients had multiple anatomical areas injured. There were 44 procedures involving the head and neck, 21 involving extremities, and 6 involving other areas of the body. All patients 5 years of age and under had head and neck injuries. Dog bite injuries requiring admission occur more in male children. Caucasian and African American children were the majority of children affected. The children under 5 years of age suffered the most devastating injuries. More than half of these attacks were not provoked. More than two-thirds of the injuries to these children involved the head and neck. We conclude that effective prevention strategies must stress careful supervision of young children and the family or neighbor's dog, a scenario that may easily lead to complacency and set the stage for a severe injury.

Dog bites in children admitted to Pennsylvania trauma centers

Dog bites are a major public health problem in the pediatric population, requiring emergency treatment for wound repair and possible hospitalization in a trauma center. Data from the Pennsylvania Trauma Outcome Study were analyzed, and the records of 183 pediatric dog bite patients from 1990 to 1995 were evaluated. Dog bites were found to constitute a very small proportion of the total pediatric admissions to Pennsylvania trauma centers; however, the findings were similar to other reported studies.

Minor pediatric injuries

Injuries are a common source of childhood morbidity and mortality. The initial evaluation should follow in a sequential fashion to determine the extent of injuries. Most minor injuries can be treated safely and cost-effectively in an office setting. The principles of wound care include adequate hemostasis, tissue debridement, removal of imbedded foreign bodies, and appropriate closure or coverage of the wound to optimize healing. Appropriate use of antibodies, tetanus prophylaxis, and rabies immunization will minimize complications. With proper selection and treatment, the outcome of children with minor injuries should be excellent.