Analysis of Pediatric Dog Bite Injuries at a Level 1 Trauma Center Over 10 Years

Abstract

Background Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center. Methods This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries. Demographic information, injury details, management, outcomes, and financial information were analyzed. Results Most pediatric dog bite injuries afflicted male children (55.6%), ages 6 to 12 years (45.7%), by a household dog (36.2%). The most common offending breed was a pit bull or pit bull mix (53.0%). Infants and grade schoolers were more likely to sustain bites to the head/face (P = 0.001). Usual management consisted of primary repair (75.9%), whereas approximately 25% of the patients required advanced reconstructive techniques. Most patients healed uneventfully, but prolonged antibiotics, additional wound care, or procedures were necessary in 8.4% of the patients. Hospital charges per patient averaged US $8830.70 and tended to be higher in the younger age groups. Insurance status was statistically associated with use of conscious sedation, surgical consult placement, and surgical repair. Conclusions Although most pediatric dog bite injuries in this study healed uneventfully from primary management in the emergency department, 25% required additional interventions. Furthermore, patient care for these injuries was associated with significant but potentially avoidable personal and financial burden to families. Our data reflect a need for safety education on animal care, behavior, and interaction.

Epidemiological profile of dog attacks to patients under 14 years old assisted at the pediatric referral emergency unit of a tertiary hospital in Campinas, Brazil

“…When the age increased, we noticed an increase in the frequency of accidents with unknown dogs. This data also agrees with the literature ( 5 , 6 , 10 , 12 , 14 , 23 , 31 , 32 , 34 ).…”

“…Male children in school age are the most affected group ( 3 , 5 , 12 – 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 ). Most accidents with babies and pre-school children occur inside their homes, and with dogs that the child is familiar with, while adolescents are usually involved in accidents with dogs, they do not know ( 3 , 5 , 10 , 12 – 14 , 16 ).…”

“…In addition to acute injuries, these attacks might cause fractures, infections, scars, and psychological traumas ( 14 , 15 , 17 ). Around 50% of the victims need some type of repair, many requiring sedation or anesthesia for procedures from sutures to surgeries such as debridement and grafts, in addition to the use of antibiotics and hospital care ( 5 , 9 , 12 , 14 , 15 , 18 , 19 ). Even with suitable treatment of the injuries, some physical and psychological consequences might remain.…”

“…Some dog breeds are more commonly involved in reports of attacks to human beings. Dogs of the breeds Pit Bull, Rottweiler, and German Shepherd, probably due to their specific characteristics such as strength and jaw shape, usually present more severe bites that require medical care and are frequently cited in studies ( 5 , 11 , 12 , 14 , 16 , 17 , 19 , 20 , 22 , 23 ). Curiously, dogs of the breeds Labrador, Golden Retriever, Border Collie, Jack Russel, and Shih-Tzu, despite being considered good pets for families with children, also present a high incidence of attacks with bites ( 5 , 11 , 14 , 16 , 17 , 22 ), but these injuries are usually less serious.…”

“…Most children victims of dog bites are attacked by their own dogs or dogs they are used to ( 3 , 5 , 12 , 14 , 24 ), which shows that regardless of the breed, child/dog interaction is a relevant factor in the occurrence of an attack. Even apparently positive activities might not be completely safe (for example, the child trying to play, hug, or feed the animal).…”