Dog bites in children admitted to Pennsylvania trauma centers

Pediatric dog bite injuries in the USA: a systematic review

Introduction

Dog 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.

Methods

We 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.

Results

Out 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.

Conclusion

Studies analyzing the prevention or psychosocial consequences of dog bites injuries are needed.

Animal bite injuries in pediatric population: a systematic review

Objectives: To assess the scientific literature pertaining the risk factors for injuries among victims of animal bite injuries. Data and sources: A systematic review of scientific literature published until May 2020 was carried out in the following databases: PubMed, Cochrane Library, Google Scholar and Journals@ovid. Study selection: A total of 924 records were found, of which 29 articles fulfilled the inclusion criteria and were analyzed. There was a male preponderance in most of the studies with male/female ratio ranging from 0.75:1 to 2.1:1. The age range varies from 0 to 19 years with the mean age varying from 3.6 to 8 years. Pitbulls, Rottweiler's, German shepherds, Bull terriers, Labradors and Dobermans were breeds with higher risk of attack. The animals were familiar to the victim (own, friends, neighbors) in 27–98% instances. Most cases of animal bite injuries were recorded during Summer and Spring months. Head and neck followed by extremities was found to be most inflicted area. Conclusions: The sociodemographic characteristics of victim as well as the biting animal affect the circumstances leading to biting episode. However, the results should be interpreted with caution due to the high heterogeneity among studies and moderate quality evidence.

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.

Down boy! A case of acute abdomen following a dog bite to the scrotum

BACKGROUND

Dog bite injuries are an ongoing concern in pediatrics. The majority of these occur in low- and middle-income countries where resources, especially subspecialty support services, are limited. Scrotal bites are relatively rare, and even fewer cases of abdominal viscus involvement have been described. No case has previously been reported of a dog bite to the scrotum leading to abdominal viscus perforation.

CASE PRESENTATION

A 2-year old boy presented with an acute abdomen as the result of a dog bite to his scrotum in the presence of an unrepaired inguinal hernia. Without revisiting a detailed trauma history and exam, this would have been missed, as the dog bite occurred several days prior to presentation and was nearly completely healed. The patient initially had an emergent laparotomy, small bowel resection, and hernia repair. He then suffered from a delayed anastomotic leak requiring repeat laparotomy with creation of an ileostomy. Following a prolonged post-operative course, the patient was discharged home with his ileostomy in place. He returned 3 months later to have his ileostomy reversed and was discharged after an uncomplicated operation in good condition.

CONCLUSIONS

This case demonstrates the primacy of an accurate history and physical, specifically with regards to recent trauma, in the presentation of a pediatric patient with an acute abdomen. Acquiring this may involve multiple re-interviews with the family as new facts may come to light. This is especially important in resource limited areas where advanced imaging and laboratory services are not available.

An analytical study of Mammalian bite wounds requiring inpatient management

BACKGROUND

Mammalian bite injuries create a public health problem because of their frequency, potential severity, and increasing number. Some researchers have performed fragmentary analyses of bite wounds caused by certain mammalian species. However, little practical information is available concerning serious mammalian bite wounds that require hospitalization and intensive wound management. Therefore, the purpose of this study was to perform a general review of serious mammalian bite wounds.

METHODS

We performed a retrospective review of the medical charts of 68 patients who were referred to our plastic surgery department for the treatment of bite wounds between January 2003 and October 2012. The cases were analyzed according to the species, patient demographics, environmental factors, injury characteristics, and clinical course.

RESULTS

Among the 68 cases of mammalian bite injury, 58 (85%) were caused by dogs, 8 by humans, and 2 by cats. Most of those bitten by a human and both of those bitten by cats were male. Only one-third of all the patients were children or adolescents. The most frequent site of injury was the face, with 40 cases, followed by the hand, with 16 cases. Of the 68 patients, 7 were treated with secondary intention healing. Sixty-one patients underwent delayed procedures, including delayed direct closure, skin graft, composite graft, and local flap.

CONCLUSIONS

Based on overall findings from our review of the 68 cases of mammalian bites, we suggest practical guidelines for the management of mammalian bite injuries, which could be useful in the treatment of serious mammalian bite wounds.

[Cutaneous and mucosal graft for labial defect after animal bite in children]

Animal bite is frequently involved in children labial defect. The need for labial surgical repair is to restore anatomy and function. Local and regional flap is usually described for labial reconstructions. Few authors recommend mucosal and skin graft. In the present study, we described skin and mucosal graft for reconstruction of complex labial defect. This surgical technique can be applied in very young children with reasonable expectations of excellent functional and aesthetic outcome.

Importance of bringing dogs in contact with children during their socialization period for better behavior

Much attention has been given to the role that dogs play in the social, physical, and psychological development of children. Furthermore, dogs are now playing a new important role in animal-assisted education (AAE). However, some dogs have difficulty getting along with children. The aim of this study was to demonstrate how dogs' contact with children during and after their socialization period influenced their responses toward children. In total, 31 pet dogs were divided into three groups. Group 1 dogs had been in contact with children during the canine socialization period (between 3 and 12 weeks of age); Group 2 dogs had been in contact with children after this socialization period; Group 3 dogs seldom had contact with children. As soon as a child entered the room, the dog was presented three stimuli by the child over the course of several intervals. The dogs' responses were evaluated by analyzing behavior and heart rates. The dogs that had been in contact with children during their socialization period did not show aggressive behavior or excited behavior toward the child in our test. Moreover, their heart rates were significantly decreased even during the last stimulus, which involved the child running around the dog while calling its name. This study suggested that the dogs having contact with children during socialization period might not show inappropriate responses toward children and could be suitable for taking part in AAE.

Does dog or cat ownership lead to increased gastroenteritis in young children in South Australia?

The aim of this study was to investigate the relationship between dog and cat ownership and gastroenteritis in young children. A diary study of 965 children aged 4-6 years living in rural or semi-rural South Australia was undertaken. Data were collected on pet ownership, drinking water and other risk factors for gastroenteritis. Overall 89% of households had pets and dog ownership was more common than cat ownership. The multivariable models for gastroenteritis and pet ownership indicated that living in a household with a dog or cat was associated with a reduced risk of gastroenteritis (adj. OR 0.71, 95% CI 0.55-0.92; OR 0.70, % CI 0.51-0.97 respectively). This paper adds to the evidence that pets are not a major source of gastroenteritis in the home and lends support to the health benefits of pet ownership. However, this must be weighed against the potential negative consequences, such as dog bites, particularly for this age group.

Dog ownership, health and physical activity: a critical review of the literature

This review examines the association between dog ownership and adult physical activity levels. While there is evidence to suggest that dog ownership produces considerable health benefit and provides an important form of social support that encourages dog owners to walk, there is limited evidence on the physical environmental and policy-related factors that affect dog owners walking with their dog. With the high level of dog ownership in many industrialized countries, further exploration of the relationship between dog ownership and physical activity levels may be important for preventing declining levels of physical activity and the associated detrimental health effects.

A comparison of dog bite injuries in younger and older children treated in a pediatric emergency department

OBJECTIVE

Dog bites account for a significant number of traumatic injuries in the pediatric population that often require medical treatment. Although agent, host, and environmental characteristics of dog bites have been well documented, no attempt has been made to compare these characteristics by patient age group. The purpose of this study is to determine if differences exist in agent, host, and environmental characteristics among younger (< or =6 y) and older (>7 y) patients treated in a pediatric emergency department (ED) for dog bites. Findings from our study could be used to develop age-specific strategies for dog bite prevention.

THEORETICAL FRAMEWORK

The epidemiologic triad of agent/host/environment formed the theoretical framework.

METHODS

The study setting was the ED at Children's Hospital of Pittsburgh. Patients were enrolled between 1999 and 2000 and were identified through a review of ED records (n = 386) of children sustaining dog bites. Records were abstracted with a researcher-designed and validated form for agent (eg, breed, number of biting dogs, owner, rabies status), host (eg, age, gender, number and location of bites, treatment), and environmental (eg, bite month and time, bite location, events leading to the bite, ZIP code) characteristics. Data were analyzed using descriptive and inferential statistical tests.

RESULTS

Children younger than 6 years constituted 52.8% (n = 204) of the sample. As compared with older children, a higher proportion of younger children were bitten by their family dog (chi2 = 27.64, P = 0.001) whose rabies shots were up to date (chi2 = 12.08, P = 0.034). A higher proportion of younger children were bitten on the face (chi2 = 49.54, P = 0.000) and were bitten in their own homes (chi2 = 16.075, P = 0.013).

IMPLICATIONS FOR NURSING PRACTICE

Young children frequently sustain dog bites from their family dog in their own homes. Injuries typically involve severe lacerations to the face. Prevention strategies for young children include close supervision of child-dog interactions.

Playground injuries in children: a review and Pennsylvania Trauma Center experience

ISSUES AND PURPOSE

To describe patient demographics, injury characteristics, and circumstances of playground injuries in children admitted to Pennsylvania trauma centers and to identify injury prevention strategies.

DESIGN AND METHODS

Retrospective, descriptive study of 234 children ages 1 to 18 years sustaining playground-related injuries and whose hospital data were entered into the Pennsylvania Trauma Outcome Study.

RESULTS

Most of the injuries occurred between April and September (77%), and noon to 6 P.M. (69%). Falls from playground equipment constituted the highest proportion of incidents (73%). Of 421 injuries (M = 1.8/patient), most were upper extremity (n = 117) and head (n = 110) injuries.

PRACTICE IMPLICATIONS

Nurses can advocate for playground safety by teaching children to play safely and recommending age-appropriate equipment and protective surfacing.

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 bites in children]

Among children's domestic accidents, dog bites are of major concern. Most dog bites result in low severity injuries but some lead to definite esthetic or functional sequelae and require emergency treatment for wound repair and possibly hospitalization in a trauma center. Recommendations for medical and surgical management are presented. Prevention is important: children must be educated early on dog reactions even from the family dog; young children must never be left alone with a dog.