Management of Dog Bite Injuries

Abstract

Background Dog bite injuries are common within the pediatric population. Currently, there are inconclusive data on best sedation practice, antibiotic regimen, and need for plastic surgery referrals for treatment of dog bite injuries in the emergency department (ED) versus operating room (OR). This study set out to determine sedation practice, infection management, and necessity for plastic surgery referral at a level I pediatric trauma center. Methods A retrospective review of all pediatric (0–18 years old) dog bites documented in electronic medical records from January 1, 2010, to December 31, 2019, was performed. Bitten by dog encounters were identified by International Classification of Diseases, Ninth Revision and Tenth Revision codes E906.0 and W54.0, W54.0XXA, and W54, respectively. Data gathered included age, gender, month of injury, circumstance of injury, injury characteristics, location of repair, person performing repair, sedation (if used, then length of sedation), inpatient admission, antibiotics prescribed, dog characteristics (breed, size, sex, age, relationship to patient), and complications. Summary statistics were calculated as mean ± SD. Comparisons for nominal variables were performed using the χ 2 test. All analyses were performed using Stata v.16. 1. Results A total of 1438 pediatric patients were included in this study over a 10-year period. Of injuries requiring repair (n = 846), most repairs were performed in the ED (97.1% [822/846]), whereas 24 (2.8%) required repair in the OR. Of the bites that required repair (n = 846), 81.1% (686/846) were performed by an emergency medicine physician and 147 (17.4%) by plastic surgeons. Procedural sedation in the ED was performed in 146 repairs (17.3%). Documented sedation time ranged from 10 to 96 minutes. Most patients received a prescription for antibiotics (80.5%), usually amoxicillin/clavulanate (90.8%). Infection was the most common sequela (9.5%). There was no significant difference in infection rates between repairs performed in the ED versus those in the OR. Conclusion Our study indicates that pediatric patient dog bite injuries can be successfully managed in an ED. Procedural sedation has demonstrated no increased safety risks compared with the OR. Rates of infection are also not demonstrated to be significantly higher in repairs done in the ED versus those taken to operating theater.

Pediatric Long Bone Fractures After Dog Bites: A Case Series and Systematic Review

“…The decision to close wounds primarily after wound care either in the emergency department or operating room remains a matter of controversy in the literature [23][24][25]. Overall, there is significant variability in decision-making, which could be related to underlying wound location, depth, and size [23].…”

“…The decision to close wounds primarily after wound care either in the emergency department or operating room remains a matter of controversy in the literature [23][24][25]. Overall, there is significant variability in decision-making, which could be related to underlying wound location, depth, and size [23]. The literature suggests that dog bites may be closed primarily after thorough debridement with a similar infection risk as secondary closure; however, studies do note that primary closure is associated with improved scar appearance and cosmesis [25,26].…”

Establishment of an Animal Model of Dog Bite Injuries

“…Different types of injuries, including penetration, laceration and avulsion, were made on the rabbits in actions that simulated a dog bite. All the injuries caused by the pliers were similar to dog bite injures [34]. All potential sites, particularly the craniofacial region which is the most frequently affected area [35], could be selected randomly.…”