1
|
Schneider AL, Ritter Schenk C, Zimmermann P. Fifteen-minute consultation: Management of mammalian bites in children-from local wound care to prophylactic antibiotics. Arch Dis Child Educ Pract Ed 2024; 109:222-227. [PMID: 38448218 DOI: 10.1136/archdischild-2023-326403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
Animal and human bites are a common reason for emergency consultation, especially in children. The most common complication of bite wounds is local infection. Systemic infections are much rarer. The key in reducing the risk of infection after a mammalian bite is local wound management with either primary or delayed closure. The benefit of administering prophylactic antibiotics is controversial.In this review, we provide a summary of the current evidence for the management of mammalian bites in children, including recommendations for appropriate investigations, wound management, administration of prophylactic and therapeutic antibiotics and the prevention of systemic infections.
Collapse
Affiliation(s)
| | | | - Petra Zimmermann
- Department of Paediatrics, Fribourg Hospital, Fribourg, Fribourg, Switzerland
- Department of Community Health, University of Fribourg, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
2
|
Peifer SJ, LoTurco H, Duffield SJ, Zhang K, Javier N, Herman B. Pediatric Head and Neck Dog Bites in the United States: A NEISS Database Investigation of Risk Factors and Escalation of Care. J Craniofac Surg 2024:00001665-990000000-01607. [PMID: 38767368 DOI: 10.1097/scs.0000000000010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Pediatric patients experience increased morbidity secondary to head and neck dog bites. The authors examined risk factors among pediatric head and neck dog bite patients and which factors are associated with admission to inform prevention efforts. All patients who suffered head and neck dog bites from 2013-2022 in the National Electronic Injury Surveillance System (NEISS) database were reviewed. Demographics among discharged and escalation of care (EOC) patients were compared using multinomial logistic regression (MLR), and linear regression was employed to analyze yearly emergency room (ER) visit incidence. Among 949 pediatric patients, 57.2% were male, 43.4% were 2-6 years old, and 77.7% sustained face or mouth injuries. Attacks were commonly provoked (60.5%), occurred in the home (82.3%), and involved a dog known to the patient (61.7%). The most common dog breed involved was Pitbull (33.1%). MLR revealed increased EOC among patients with neck injury (OR=11.82, SE=0.68, P<0.001), orbital injury (OR=12.91, SE=0.55, P<0.001), unprovoked attacks (OR=2.67, SE=0.16, P<0.001), and those under 2 years old (OR=1.83, SE=0.19, P=0.002). There was a significant yearly rise in the number of pediatric head and neck dog bites (model coefficient=6.467, SE=1.40, P=0.002). Overall, increased caution around particular dog breeds in households with children under 2 years old may decrease head and neck dog bite injuries. While pediatricians should perform general safety education, enhanced knowledge of risk factors is essential for proper inpatient counseling by surgical specialists.
Collapse
Affiliation(s)
| | - Holly LoTurco
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Karen Zhang
- University of Miami Miller School of Medicine, Miami, FL
| | - Nadine Javier
- University of Miami Miller School of Medicine, Miami, FL
| | - Bjorn Herman
- Department of Otolaryngology, University of Miami Health System and Jackson Memorial Hospital, Miami, FL
| |
Collapse
|
3
|
Alessio-Bilowus D, Kumar N, Donoghue L, Ridelman E, Shanti C. Factors affecting length and complexity of hospital stay in pediatric dog bite patients. Trauma Surg Acute Care Open 2023; 8:e001071. [PMID: 37529295 PMCID: PMC10387659 DOI: 10.1136/tsaco-2022-001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/02/2023] [Indexed: 08/03/2023] Open
Abstract
Background Dog bite injuries are a source of significant morbidity and expense in the USA, and rates of hospitalization have been rising. Children are at increased risk of dog bites compared with adults, yet there is a lack of published material on factors affecting hospital course. The objective of this study is to explore factors associated with increased length of stay (LOS), more complex course of care and post-discharge return rates in this population. Methods A retrospective review was conducted of all patients presenting to our urban, academic children's hospital for dog bite injuries between January 2016 and May 2021. Only those patients admitted for inpatient care were included, as identified through our institution's trauma registry, and variables were examined prior to, during, and after hospital stay. Results 739 pediatric patients in total were treated for dog bites during the study period, of which 349 were admitted. Analysis revealed two pre-admission predictors of increased LOS: bone fracture (mean LOS=5.3 days vs. 2.5 days, p=0.013) and prior medical comorbidity (4.3 days vs. 2.8 days, p=0.042). After admission, fractures were associated with a higher rate of postoperative complications (16% vs. 5.6%, p=0.014) and return (13% vs. 2.0%, p<0.001), primarily due to wound infection. Although the facial region represented the largest proportion of fractures, long bone fractures of the arm and leg were noted to have comparatively higher LOS and complication rates. Postoperative complications were not associated with any documented infection at admission. Conclusions Our findings suggest that long bone fractures in pediatric dog bites can be an underappreciated source of latent wound infection associated with late-presenting negative outcomes. Increased awareness of these relationships could lead to earlier detection of infection in this vulnerable population. Level of evidence Level III, Prognostic / Epidemiological.
Collapse
Affiliation(s)
- Dominic Alessio-Bilowus
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Nishant Kumar
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Lydia Donoghue
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Elika Ridelman
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Christina Shanti
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Michigan, Detroit, Michigan, USA
| |
Collapse
|
4
|
Patterson KN, Beckmeyer A, Bourgeois T, Horvath KZ, Pratt AL, Armour L, Wang L, Minneci PC, Deans KJ, Thakkar RK, Parasidis E. Legal epidemiology of paediatric dog bite injuries. Inj Prev 2023; 29:142-149. [PMID: 36332979 DOI: 10.1136/ip-2022-044675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dog bite injuries cause over 100 000 paediatric emergency department visits annually. Our objective was to analyse associations between regional dog ownership laws and incidence of paediatric dog bites. METHODS This observational study used an online search to locate local dog-related policies within Ohio cities. Data collected by Ohio Partners For Kids from 2011 through 2020 regarding claims for paediatric dog bite injuries were used to compare areas with and without located policies and the incidence of injury. RESULTS Our cohort consisted of 6175 paediatric patients with dog bite injury encounters. A majority were white (79.1%), male (55.0%), 0-5 years old (39.2%) and did not require hospital admission (98.1%). Seventy-nine of 303 cities (26.1%) had city-specific policies related to dogs. Overall, the presence of dog-related policies was associated with lower incidence of dog bite injury claims (p=0.01). Specifically, metropolitan areas and the Central Ohio region had a significantly lower incidence when dog-related policies were present (324.85 per 100 000 children per year when present vs 398.56 when absent; p<0.05; 304.87 per 100 000 children per year when present vs 411.43 when absent; p<0.05). CONCLUSIONS The presence of city-specific dog-related policies is associated with lower incidence of paediatric dog bite injury claims, suggesting that local policy impacts this important public health issue. There are limited dog-related policies addressing dog bite prevention, with inconsistencies in breadth and depth. Creating consistent, practical requirements among policies with vigorous enforcement could ameliorate public health concerns from paediatric dog bite injuries.
Collapse
Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Tran Bourgeois
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kyle Z Horvath
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amy L Pratt
- Moritz College of Law, The Ohio State University, Columbus, Ohio, USA
| | - Lisa Armour
- Moritz College of Law, The Ohio State University, Columbus, Ohio, USA
| | - Ling Wang
- Partner for Kids, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Oh, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Oh, USA
| | - Rajan K Thakkar
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Oh, USA
- Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Efthimios Parasidis
- Moritz College of Law, The Ohio State University, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
5
|
Kogan LR, Packman W, Erdman P, Currin-McCulloch J, Bussolari C. US Adults' Perceptions of Dog Breed Bans, Dog Aggression and Breed-Specific Laws. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10138. [PMID: 36011770 PMCID: PMC9408513 DOI: 10.3390/ijerph191610138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Dog aggression directed towards people is a leading reason for relinquishment and a major public health hazard. In response to the threat of dog aggression and dog bites, breed-specific legislation has been introduced in numerous cities within the United States and countries throughout the world. There is limited evidence, however, to suggest that such laws are effective. This study explored, through an online, anonymous, cross-sectional survey, US residents' views about the bite risk of common dog breeds, breed-specific legislation, and alternative options for improved public safety. A total of 586 surveys were completed by adult US residents, 48.8% female and 48.6% male. Approximately half of the respondents reported feeling that dog bites are a serious public health issue. Although 70% of respondents were opposed to a breed ban, only 56% felt that banning specific breeds creates an animal welfare issue. Females were less likely to support a ban or agree that specific breed bans improve public safety. When participants were asked to indicate their support of several alternatives to breed-specific legislation, the most frequently endorsed options included public education about animal welfare and animal behavior, and stricter leash laws. Further research pertaining to the most effective public education dissemination methods is warranted.
Collapse
Affiliation(s)
- Lori R. Kogan
- Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Wendy Packman
- Department of Psychology, Palo Alto University, Palo Alto, CA 94304, USA
| | - Phyllis Erdman
- College of Education, Washington State University, Pullman, WA 99163, USA
| | | | - Cori Bussolari
- Counseling Psychology, University of San Francisco, San Francisco, CA 94117, USA
| |
Collapse
|
6
|
Pediatric Dog Bite Injuries: A 5-Year Nationwide Study and Implications of the COVID-19 Pandemic. J Craniofac Surg 2022; 33:1436-1440. [PMID: 35758430 PMCID: PMC9275798 DOI: 10.1097/scs.0000000000008670] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/06/2022] [Indexed: 11/26/2022] Open
Abstract
Although single institution studies have analyzed various animal attacks, there has not been multicenter investigation into dog bites in children. The purpose of this study was to characterize national trends and investigate the characteristics of pediatric dog bites.
Collapse
|
7
|
Massand S, Giglio M, Patel A, Shen C, Tashima A, Rizk E, Samson T. Uncovering a Failed Pediatric Patient Population in Rural America: A Statewide Analysis of Over 1,000 Dog Bite Injuries. Cureus 2022; 14:e25734. [PMID: 35812636 PMCID: PMC9270082 DOI: 10.7759/cureus.25734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/04/2022] [Indexed: 11/05/2022] Open
|
8
|
Templet T, Allen L, Conlee I, Hightower B, McIntyre M, Rivers T. Preventing dog bites with L.O.V.E. Nursing 2022; 52:50-52. [PMID: 35452043 DOI: 10.1097/01.nurse.0000823268.00945.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Children can be vulnerable to dog bites when they don't recognize aggressive cues, highlighting the importance of safe child-dog interactions. This article explains how anticipatory guidance with L.O.V.E. can be used to educate children and families about preventing dog bite injuries.
Collapse
Affiliation(s)
- Tricia Templet
- Tricia Templet is an associate professor of nursing at the University of Louisiana at Lafayette, from which Leslie Allen , Ian Conlee , Blake Hightower , Molly McIntyre , and Taylor Rivers graduated in May 2021
| | | | | | | | | | | |
Collapse
|
9
|
Patterson KN, Horvath KZ, Minneci PC, Thakkar R, Wurster L, Noffsinger DL, Bourgeois T, Deans KJ. Pediatric dog bite injuries in the USA: a systematic review. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000281. [DOI: 10.1136/wjps-2021-000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022] Open
Abstract
IntroductionDog bites are one of the leading causes of non-fatal emergency room visits in children. These injuries not only cause physical harm but can lead to long-term psychological stress. This study evaluated the current literature related to pediatric dog bite injuries to identify research gaps which should be prioritized to improve a major public health concern.MethodsWe performed a keyword search of PubMed, Scopus, and OVID Medline databases (January 1980– March 2020) for all published studies focused on dog bite injuries in the pediatric population (≤18 years of age) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsOut of 1859 abstracts screened, 43 studies involving 86 880 patients were included. Twenty-nine studies were retrospective chart reviews characterizing the epidemiology of dog bites and their associated treatment outcomes; six were prospective cohort studies; two were cross-sectional studies; and six were experimental studies. Synthesized results demonstrate that children <9 years of age suffer the greatest burden of injuries, with children <6 years of age at higher risk of more severe injuries involving the head, neck, and face.ConclusionStudies analyzing the prevention or psychosocial consequences of dog bites injuries are needed.
Collapse
|
10
|
Medeiros MM, Marson FAL, Marques LS, Peixoto AO, Fraga ADMA. 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. Front Pediatr 2022; 10:963803. [PMID: 35989986 PMCID: PMC9382190 DOI: 10.3389/fped.2022.963803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Accidents involving dog attacks are very common, which makes this type of accident a global public health issue. The estimates point to 20% of the victims of such accidents seeking care in health units, and half of them being children. In addition to acute injuries, dog attacks might result in fractures, infections, scars, and psychological traumas. This study aimed to describe the epidemiological profile of dog attacks to children under 14 years old assisted in a pediatric emergency service in Brazil. METHODS The database of the Information and Toxicological Assistance Center of Campinas was surveyed to identify cases of children under 14 years old assisted after a dog attack in a 9-years period. Demographic data, number and type of lesions, type of exposure, part of the body affected, dog origin and condition, and the accident location and cause were analyzed. The data were presented in a descriptive way, and the age groups were classified as follows: 0-3 years old, 4-6 years old, and 7-14 years old. The different age groups were compared one to another regarding the markers evaluated using the chi-square test and the Fisher's exact test. A 0.05 alpha was adopted in all analyses. RESULTS The number of children assisted in the study period totaled 1,012. The 7-14-year-old group was the most affected (n = 498; 49.2%), male patients were also majority (n = 660; 65.2%). Most injuries were found on the head/neck area (n = 378; 37.4%). However, the older the patients were, the higher the frequency of lesions on upper and lower limbs was, as well as attacks occurred in external environments, thus involving animals that could not be observed. A significant increase in accidents with provoked causes was observed in younger patients. CONCLUSION Accidents involving dog attacks are more likely to happen among boys. Younger children run higher risks of becoming victims of these accidents inside homes, being attacked by pets, and showing a greater incidence of head and neck lesions. Older children present more injuries on their limbs, which are caused by dogs that cannot be observed.
Collapse
Affiliation(s)
| | | | - Leonardo Souza Marques
- Laboratory of Medical and Human Genetics, São Francisco University, Braganca Paulista, Brazil
| | | | | |
Collapse
|
11
|
Lee CJ, Tiourin E, Schuljak S, Phan J, Heyming TW, Schomberg J, Wallace E, Guner YS, Vyas RM. Surgical Treatment of Pediatric Dog-bite Wounds: A 5-year Retrospective Review. West J Emerg Med 2021; 22:1301-1310. [PMID: 34787555 PMCID: PMC8597704 DOI: 10.5811/westjem.2021.9.52235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Dog bites are a significant health concern in the pediatric population. Few studies published to date have stratified the injuries caused by dog bites based on surgical severity to elucidate the contributing risk factors. Methods We used an electronic hospital database to identify all patients ≤17 years of age treated for dog bites from 2013–2018. Data related to patient demographics, injury type, intervention, dog breed, and payer source were collected. We extracted socioeconomic data from the American Community Survey. Data related to dog breed was obtained from public records on dog licenses. We calculated descriptive statistics as well as relative risk of dog bite by breed. Results Of 1,252 injuries identified in 967 pediatric patients, 17.1% required consultation with a surgical specialist for repair. Bites affecting the head/neck region were most common (61.7%) and most likely to require operating room intervention (P = 0.002). The relative risk of a patient being bitten in a low-income area was 2.24, compared with 0.46 in a high-income area. Among cases where the breed of dog responsible for the bite was known, the dog breed most commonly associated with severe bites was the pit bull (relative risk vs German shepherd 8.53, relative risk vs unknown, 3.28). Conclusion The majority of injuries did not require repair and were sufficiently handled by an emergency physician. Repair by a surgical specialist was required <20% of the time, usually for bites affecting the head/neck region. Disparities in the frequency and characteristics of dog bites across socioeconomic levels and dog breeds suggest that public education efforts may decrease the incidence of pediatric dog bites.
Collapse
Affiliation(s)
- Christine J Lee
- University of California - Irvine School of Medicine, Department of Plastic Surgery, Orange, California.,Children's Hospital Orange County, Division of Plastic Surgery, Orange, California
| | - Ekaterina Tiourin
- University of California - Irvine School of Medicine, Department of Plastic Surgery, Orange, California
| | - Sawyer Schuljak
- University of California - Riverside, School of Medicine, Riverside, California
| | - Jonathan Phan
- University of California - Riverside, School of Medicine, Riverside, California
| | - Theodore W Heyming
- Children's Hospital Orange County, Department of Emergency Medicine, Orange, California.,University of California - Irvine School of Medicine, Department of Emergency Medicine, Orange, California
| | - John Schomberg
- Children's Hospital Orange County, Department of Nursing, Orange, California
| | - Elizabeth Wallace
- Children's Hospital Orange County, CHOC Research Institute, Orange, California
| | - Yigit S Guner
- University of California - Irvine Medical Center, Department of Surgery, Irvine, California.,Children's Hospital Orange County, Division of Pediatric Surgery, Orange, California
| | - Raj M Vyas
- University of California - Irvine School of Medicine, Department of Plastic Surgery, Orange, California.,Children's Hospital Orange County, Division of Plastic Surgery, Orange, California
| |
Collapse
|
12
|
Savu AN, Schoenbrunner AR, Politi R, Janis JE. Practical Review of the Management of Animal Bites. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3778. [PMID: 34522565 PMCID: PMC8432645 DOI: 10.1097/gox.0000000000003778] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
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.
Collapse
Affiliation(s)
- Andrei N. Savu
- From the Ohio State College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Rachel Politi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Jeffrey E. Janis
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| |
Collapse
|
13
|
Reuter Muñoz KD, Powell LE, Andersen ES, Nye AD, Powers JM, Rhodes J, Pozez AL. Analysis of Pediatric Dog Bite Injuries at a Level 1 Trauma Center Over 10 Years. Ann Plast Surg 2021; 86:S510-S516. [PMID: 34100808 DOI: 10.1097/sap.0000000000002928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
Collapse
Affiliation(s)
| | - Lauren E Powell
- From the Virginia Commonwealth University School of Medicine
| | | | | | | | - Jennifer Rhodes
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Richmond
| | - Andrea L Pozez
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Medical Center; Richmond, VA
| |
Collapse
|
14
|
Dog Tethering in Slovakia: Legal, Ethical and Behavioral Aspects and Dog Welfare Implications. Animals (Basel) 2021; 11:ani11030594. [PMID: 33668273 PMCID: PMC7996153 DOI: 10.3390/ani11030594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary On the basis of legislative provisions and the behavioral needs of dogs, the authors describe the potential consequences and negative impacts of the long-term tethering of dogs. Dogs should be kept under conditions that allow them, with respect to their size, temperament, stage of their development, and degree of adaptation, to maintain good health and meet their physiological, ethological, and social needs. Despite the adoption of new legislative provisions, this issue has not yet been resolved and we are still coming across various cases involving cruelty to animals of various character and intensity. The current situation can be changed by adopting legislative regulations that explicitly define the responsibilities of owners/keepers including a ban on the tethering of dogs in order to prevent potential circumvention of the legislative rules. Abstract Long-term tethering of dogs, or their keeping under unsuitable conditions can result in issues related to changes in their behavior as they may not satisfy their basic needs of life. These needs are discussed in this paper, along with cases when dogs unnecessarily have to endure cruelty and pain. The unavoidable tethering of a dog must not cause trauma and must be arranged in a way that it guarantees physical comfort. Failure to meet the basic needs of an animal may result in manifestation of fear and subsequent aggressiveness. Owners of animals are responsible for their life and health, and their obligations include eliminating the possibility of them hurting themselves or other beings. The relevant adopted legislative provisions should provide protection to animals and be enforceable, which currently appears rather difficult. Controlling and observation of the legislative provisions related to the tethering of dogs raises some difficulties for animal protection inspectors. It is necessary to focus on the specificities of keeping conditions of various dog breeds and on their individual features. Based on research and the relevant Slovak legislative provisions, this paper discusses various views on the practice of tethering dogs from the point of view of public safety and the ethical consequences of permanent dog tethering. Data on dog tethering in Slovakia were evaluated based on a survey and Slovak legal rules governing this issue were analyzed along with various views of public safety and the ethical consequences of permanent dog tethering.
Collapse
|
15
|
National Surveillance of Injury in Children and Adolescents in the Republic of Korea: 2011-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239132. [PMID: 33297537 PMCID: PMC7731276 DOI: 10.3390/ijerph17239132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
Understanding age-specific injury patterns allows the continued improvement of prevention strategies. This is a retrospective study analyzing the Korea Emergency Department-Based Injury In-depth Surveillance data, including those aged ≤19 years old between January 2011 and December 2017. In this study, we focused on changes in the modes of injury and severity, and prevention potential by dividing the patients into four age groups: group 1 (0-4 years), group 2 (5-9 years), group 3 (10-14 years), and group 4 (15-19 years). The most common mode of injury in younger age groups 1 and 2 was a fall or slip. Most injuries in older age groups 3 and 4 were unintentional and intentional collisions combined. Traumatic brain injuries (2.1%), intensive care unit admissions (1.8%), and overall death (0.4%) were the highest in group 4. The proportions of severe and critical injury (EMR-ISS ≥ 25) were 7.5% in group 4, 3.2% in group 3, 2.5% in group 1, and 1% in group 2. This study presents a comprehensive trend of injuries in the pediatric population in South Korea. Our results suggest the importance of designing specific injury-prevention strategies for targeted groups, circumstances, and situations.
Collapse
|
16
|
Jakeman M, Oxley JA, Owczarczak-Garstecka SC, Westgarth C. Pet dog bites in children: management and prevention. BMJ Paediatr Open 2020; 4:e000726. [PMID: 32821860 PMCID: PMC7422634 DOI: 10.1136/bmjpo-2020-000726] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Dog bite injuries are a significant public health problem and many are sustained by children. These injuries can be complex, both physically and psychologically, and in rare cases fatal. This paper will review current evidence-based approaches to treatment, explore identified patterns in biting incidents and discuss the effectiveness of prevention strategies. Safe management of these patients requires a comprehensive approach. Physical injuries need to be accurately assessed with a high index of suspicion for underlying injuries, particularly in younger children less able to communicate. Treatment depends on severity and location, but all bites must be irrigated to reduce the risk of infection but may not always require prophylactic antibiotic use. Careful exploration of the circumstances in which the bite occurred is essential to make safeguarding decisions and prevent future bites. Reducing the incidence of paediatric dog bites requires education of both children and parents that any dog can bite, regardless of breed, and all child-dog interactions must be highly supervised. However, education alone is unlikely to prevent dog bites. Policies that support environmental changes need to be developed such as provision of pet dogs less likely to bite (or bite as severely), through breeding for temperament and appropriate socialisation. Additionally, investment in psychological support for bite victims and their families is required to reduce the long-term impacts of being bitten.
Collapse
Affiliation(s)
- Molly Jakeman
- Department of Plastic Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - James A Oxley
- Faculty of Health and Life Sciences, Department of Livestock and One Health, University of Liverpool, Liverpool, UK
| | - Sara C Owczarczak-Garstecka
- Faculty of Health and Life Sciences, Department of Livestock and One Health, University of Liverpool, Liverpool, UK.,Dogs Trust, London, UK
| | - Carri Westgarth
- Faculty of Health and Life Sciences, Department of Livestock and One Health, University of Liverpool, Liverpool, UK
| |
Collapse
|