English hospital episode data analysis (1998-2018) reveal that the rise in dog bite hospital admissions is driven by adult cases

Welsh hospital admissions due to dog bites and strikes (2014-2022)

OBJECTIVE

To describe the incidence and victim demographics of Welsh hospital admissions due to dog bites and strikes from 2014 to 2022.

STUDY DESIGN

Descriptive analysis of Welsh hospital admissions data.

METHODS

Residents of Wales admitted to a Welsh National Health Service (NHS) hospital for a dog bite or strike, were identified using ICD-10 codes. The annual incidence of dog bite and strike admissions between 2014 and 2022 was calculated and stratified by child-adult status, sex, and Local Health Boards. Trends over time were analysed using the Chi-square test for trends.

RESULTS

Hospital admissions due to dog bites and strikes have significantly increased from 16.3 per 100,000 to 23.7 per 100,000 population in 2022. This was driven by an increase in non-geriatric adults and an increase in three Local Health Boards. The Swansea Bay area has the highest incidence in Wales (56.1 admissions per 100,000).

CONCLUSIONS

Wales has a higher incidence of dog bites and strikes than England or the Republic of Ireland. Work in the communities where incidence is exceptionally high is needed to understand the reasons behind having the highest incidence of dog bites in the British Isles and to establish the most efficacious methods for bite prevention.

Review of psychological effects of dog bites in children

BACKGROUND

Dog bites are a concerning health problem in children and one of the leading causes of non-fatal injuries in this population. Dog attacks not only cause physical injuries but can also lead to long-term psychological problems. A review was performed to investigate the scope of literature on the psychological effects of dog bites on a paediatric population.

METHODS

A literature search was performed on Web of Knowledge database between 1982 to June 2023, returning 249 results. 14 primary studies reporting the psychological consequences of dog bites in children or adolescents were classed as eligible and 9 further studies were added from prior knowledge and bibliographical searches. 23 studies involving 1894 participants met the criteria and were included in this review.

RESULTS

Of these 23 studies, 8 were case studies or small case series reports (up to n=4), 14 larger descriptive studies and 1 analytical cross-sectional study. There was a mixture of retrospective and prospective data-gathering. The most common psychological consequences of dog bites in children were post-traumatic stress disorder, dog phobia, nightmares and symptoms of anxiety and avoidance behaviours.

CONCLUSIONS

Studies on dog bites in a paediatric population with a specific focus on the psychological consequences associated with dog bites and their management are sparse. Future research and practice should more greatly consider the psychological impact on child victims of dog bites and their family members, as well as their management to avoid the development of mental health issues and improve their quality of life. Future research also needs to ascertain the efficacy of using virtual reality in treating children with dog phobia.

Veterinary students' proximity to and interpretation of a simulated "aggressive" dog before and after training

Dog "aggression" in the veterinary practice is commonplace. Therefore, student knowledge and education about dog behaviour and the ability to interpret "aggressive" behaviour is important from a human injury prevention and dog welfare perspective. The study aimed to compare first-year veterinary students' perceived safest proximity to both an "aggressive" and non-reactive simulated dog, both before and after a teaching intervention about canine behaviour and a handling practical. It also examined student confidence and their ability to identify "aggressive" behaviours. Forty first year veterinary students took part in two surveys. Each survey included two videos: one of a simulated dog displaying "aggressive" behaviour, based on the 'Canine Ladder of Aggression'; and another displaying non-reactive (passive behaviours without reaction to the participants) behaviours. Each video depicted the slow and consistent approach towards the virtual dog within a virtual indoor environment, and participants were asked to press stop if or when they would stop approaching the dog. In the "aggressive" scenario, there was a reduction in the approach-stop time from survey 1 (median = 17.8 s) to survey 2 (median = 15.2 s) in the intervention group (p = 0.018) but not in the control group (p = 0.147). Regarding confidence, there was a significant increase in the self-reported confidence rating relating to a participant's ability to interpret canine behaviour in both the control (p = 0.011) and intervention (p = 0.003). In conclusion, these results indicate that students using approach-stop videos stayed further away from an "aggressive" virtual dog model if they had undertaken a canine behaviour educational intervention. This novel approach has the potential for further use in teaching and assessment of student knowledge and behaviour which may otherwise be difficult to demonstrate.

A Multidimensional Evaluation of the Factors in the Animal Welfare Assessment Grid (AWAG) That Are Associated with, and Predictive of, Behaviour Disorders in Dogs

Behavioural disorders in dogs are common and have severe welfare consequences for dogs. This study aimed to assess the factors that are significant and predictive of behaviour problems in dogs using the animal welfare assessment grid (AWAG) to further understand what factors influence their welfare. 177 AWAG assessments were undertaken across 129 dogs that clinicians deemed to have a behavioural disorder. Wilcoxon rank-sum tests were used to assess the difference in scores between dogs with behaviour disorders and a cohort of healthy dogs (n = 117). This analysis showed that all physical factors besides body condition, all procedural factors besides procedure pain, and all psychological, and environmental factors were significantly different between healthy dogs and dogs with behaviour disorders. Spearman rank correlation coefficient (RS) revealed several significant strong positive correlations including the procedural impact on the dog's daily routine with aggression towards unfamiliar people and procedure pain, as well as other correlations between the dog's behaviour during assessment with the frequency at which they encounter fears and anxieties, clinical assessment and procedure pain, and reaction to stressors and social interactions. These findings highlight the interdependent nature of the various influences of welfare. Logistic regression analysis identified that aggression towards the caregiver, fears and anxieties frequency, and choice, control, and predictability were all significant predictors of behaviour disorders. The findings have important implications for veterinary, behaviour, and animal welfare professionals as any changes across these factors may indicate poor welfare linked to emotional disorders in dogs.

Audit of animal-related injuries at UK veterinary schools between 2009 and 2018

BACKGROUND

Animal-related injuries pose a significant risk to the veterinary profession. This study aimed to describe the incidence, demographics, context and consequences of animal-related injuries at UK veterinary schools.

METHODS

A multicentre audit of accident records (2009-2018) across five UK veterinary schools was performed. Injury rates were stratified by school, demographics and species. The context and cause of the injury were described. Multivariable logistic models explored factors associated with medical treatment, hospital visits and time off work.

RESULTS

An annual rate of 2.60 (95% confidence interval 2.48-2.72) injuries per 100 graduating students was calculated, varying between veterinary schools. Injuries were more frequently recorded in staff than students, and there were significant differences between staff and students in the activities performed preceding injury. Cats and dogs were associated with the highest number of reported injuries. However, injuries associated with cattle and horses were the most severe, with significantly higher hospital attendances and more time off work taken.

LIMITATIONS

Data were based on reported injuries and likely underestimate the true injury rate. The population at risk was hard to quantify as population size and exposure were variable.

CONCLUSION

Further research is recommended to explore the clinical and workplace management, including recording culture, of animal-related injuries among veterinary professionals.

An Assessment of Scientific Evidence Relating to the Effect of Early Experience on the Risk of Human-Directed Aggression by Adult Dogs

Human-directed aggression by domestic dogs is a major worldwide public health problem. The causes of aggression are complex, and research in this area often has to balance ecological validity with pragmatic controls; accordingly, it often does not meet the thresholds for quality typically used in reviews applying a classical "evidence-based" approach. Here, we propose a method of literature assessment that makes the "best use" of available evidence to identify and synthesise evidence relating to the most likely risk factors reported in the scientific literature. We used a systematic review process to initially identify relevant literature relating to potential early life experience (i.e., in the first six months of life) risk factors in the dog for human-directed aggression in the adult animal. Fourteen papers met our initial screening process and were subsequently analysed in detail, with data extracted and effect sizes calculated where possible. This highlighted the potential importance of the source of the animal, the age at which it was rehomed, the reason for the acquisition, the experience level of the owner, the animal's socialisation experiences, the consistent husbandry and management practices, the training, the sex ratio of the litter and the history of dogs that display aggression in the pedigree as risk factors. Taken together, it seems that early experiences which limit the ability to develop effective coping strategies and routines may be particularly important. We provide guidance for the future standardised reporting of risk related to human-directed aggression by dogs to allow greater synthesis of the literature in the future.

The Use of Antibiotics and Antimicrobial Resistance in Veterinary Medicine, a Complex Phenomenon: A Narrative Review

As warned by Sir Alexander Fleming in his Nobel Prize address: “the use of antimicrobials can, and will, lead to resistance”. Antimicrobial resistance (AMR) has recently increased due to the overuse and misuse of antibiotics, and their use in animals (food-producing and companion) has also resulted in the selection and transmission of resistant bacteria. The epidemiology of resistance is complex, and factors other than the overall quantity of antibiotics consumed may influence it. Nowadays, AMR has a serious impact on society, both economically and in terms of healthcare. This narrative review aimed to provide a scenario of the state of the AMR phenomenon in veterinary medicine related to the use of antibiotics in different animal species; the impact that it can have on animals, as well as humans and the environment, was considered. Providing some particular instances, the authors tried to explain the vastness of the phenomenon of AMR in veterinary medicine due to many and diverse aspects that cannot always be controlled. The veterinarian is the main reference point here and has a high responsibility towards the human–animal–environment triad. Sharing such a burden with human medicine and cooperating together for the same purpose (fighting and containing AMR) represents an effective example of the application of the One Health approach.

Dog-related deaths registered in England and Wales from 2001 to 2021

OBJECTIVE

This study aimed to describe the incidence and demographics of fatal dog bites or strikes, as defined in English and Welsh mortality data (2001-2021).

STUDY DESIGN

A descriptive analysis of the Office for National Statistics registered deaths data set.

METHODS

Individuals whose cause of death was defined as 'bitten or struck by a dog' were identified. The average annual number of dog-related deaths and trends in incidence were calculated. Age and sex demographics of victims were described.

RESULTS

In total, there were 69 registered deaths, a mean of 3.3 (95% confidence interval 0.3-6.3) dog-related deaths per year, and a mean annual incidence of 0.59 (95% confidence interval 0.06-1.11) deaths per 10 million population. There was no year-on-year change in incidence. Of victims, 59% were male, 10% were <5 years, and 30% were ≥75 years.

CONCLUSIONS

Dog-related deaths are rare in England and Wales and have not increased between 2001 and 2021. Further contextual information about the incidents is needed to be able to develop public health strategies and interventions.

The incidence and management of peripheral nerve injury in England (2005-2020)

Peripheral nerve injury (PNI) is a significant health problem that confers lifelong impact on those injured. Current interventions are purely surgical; however, outcomes remain poor. There is a lack of high-quality epidemiological data that is needed to identify populations involved, current healthcare demands, and ensure resources are distributed to the greatest effect, to reduce the injury burden.

METHODS

Anonymized hospital episode statistical (HES) data on admitted patient care was obtained from NHS Digital for all National Health Service (NHS) patients sustaining PNI of all body regions between 2005 and 2020. Total numbers of finished consultant episodes (FCEs) or FCEs/100,000 population were used to demonstrate changes in demographic variables, anatomical locations of injury, mechanisms of injury, speciality, and main operation.

RESULTS

There was a mean national incidence of 11.2 (95% CI 10.9, 11.6) events per 100,000 population per year. Males were at least twice as likely (p < 0.0001) to sustain a PNI. Upper limb nerves at or distal to the wrist were most commonly injured. Knife injuries increased (p < 0.0001), whereas glass injuries decreased (p < 0.0001). Plastic surgeons increasingly managed PNI (p = 0.002) as opposed to orthopaedic surgeons (p = 0.006) or neurosurgeons (p = 0.001). There was an increase in neurosynthesis (p = 0.022) and graft procedures (p < 0.0001) during the study period.

DISCUSSION

PNI is a significant national healthcare problem predominantly affecting distal, upper limb nerves of men of working age. Injury prevention strategies, improved targeted funding and rehabilitation pathways are needed to reduce the injury burden and improve patient care.

A 10-year retrospective analysis (2012-2021) of hospitalizations resulting from dog bites in Southern Italy

This study aimed to describe the incidence and characteristics of dog-bite injury hospitalizations (DBIH) in the largest administrative region of Italy (Sicily) over the 10-year period: 2012-2021. Four hundred and forty-nine cases were analyzed. Patients were divided into seven age groups: preschoolers (0-5 years), school-age children (6-12 years), teenagers (13-19 years), young adults (20-39 years), middle-aged adults (40-59 years), old adults (60-74 years), and the elderly (≥75 years). Association among categorical variables (age, gender, principal injury location) was evaluated using chi-square tests, and mean differences for normally distributed variables were assessed using one-way analysis of variance. Finally, a Poisson regression general linear model (GLM) analysis was used to model incidence data. The results revealed that the incidence of DBIH per 100,000 population increased from 0.648 in 2012 (95%CI 0.565-0.731) to 1.162 in 2021 (95%CI 1.078-1.247, P < 0.01). Incidence for both male and female victims also increased over the studied period (P < 0.05). We found an increasing trend of incidence in young and middle-aged adults (P < 0.05 and P < 0.005 respectively). Moreover, the most frequently injured age group by dogs was the preschooler group and, whilst we found a lower risk of being injured for males older than 20 years, no difference with females was observed. The location of lesions depended on the age group (P < 0.001). The number of days of DBIH increased significantly with age (P < 0.01). The increase of DBIH represents a public health problem that requires the development of preventive approaches.

Study of dog control strategies

OBJECTIVES

(1) To explore the relationship between regionally implemented dog control strategies and dog bite injuries (DBIs) and (2) to evaluate current implementation of dog control strategies.

METHODS

Observational study using a nationwide online survey of territorial authorities (TAs). Domains of interest included complaints for attacks on people, dog population, primary and secondary prevention strategies, resourcing and perspectives of current strategies. Quantitative variables were compared with DBI Accident Compensation Corporation (ACC) claims by region from 2014 to 2018.

RESULTS

Two-thirds of TAs (70%; n=47/67) responded to the survey. No clear relationship was observed between DBIs and: registered dog population, proportion sterilisations or microchipping, classifications due to dog behaviour, or existing limited resourcing. Legislated breeds and infringements for failure to control a dog or non-registration were higher in areas with greater DBIs. Educational messages varied widely and were predominantly victim directed (67%; n=71/106). Complaints for dog attacks on people were lower than DBIs in most areas, with no formal cross-agency notification policies. Few prosecutions or dog destruction orders were made.

CONCLUSIONS

Regional inequity in DBIs could not be explained by differences in the registered dog population or dog control strategies. Minimal and inequitable resourcing exists to implement current dog control strategies and provide owner-directed education. Gaps in legislation include environmental barrier requirements for all dogs (leash/muzzle use, adequate fencing), notification of incidents and child protection. Partnership with the Indigenous community (Māori) and other community groups will be required to implement these measures successfully.

Canine Saliva as a Possible Source of Antimicrobial Resistance Genes

While the One Health issues of intensive animal farming are commonly discussed, keeping companion animals is less associated with the interspecies headway of antimicrobial resistance. With the constant advance in veterinary standards, antibiotics are regularly applied in companion animal medicine. Due to the close coexistence of dogs and humans, dog bites and other casual encounters with dog saliva (e.g., licking the owner) are common. According to our metagenome study, based on 26 new generation sequencing canine saliva datasets from 2020 and 2021 reposited in NCBI SRA by The 10,000 Dog Genome Consortium and the Broad Institute within Darwin’s Ark project, canine saliva is rich in bacteria with predictably transferable antimicrobial resistance genes (ARGs). In the genome of potentially pathogenic Bacteroides, Capnocytophaga, Corynebacterium, Fusobacterium, Pasteurella, Porphyromonas, Staphylococcus and Streptococcus species, which are some of the most relevant bacteria in dog bite infections, ARGs against aminoglycosides, carbapenems, cephalosporins, glycylcyclines, lincosamides, macrolides, oxazolidinone, penams, phenicols, pleuromutilins, streptogramins, sulfonamides and tetracyclines could be identified. Several ARGs, including ones against amoxicillin–clavulanate, the most commonly applied antimicrobial agent for dog bites, were predicted to be potentially transferable based on their association with mobile genetic elements (e.g., plasmids, prophages and integrated mobile genetic elements). According to our findings, canine saliva may be a source of transfer for ARG-rich bacteria that can either colonize the human body or transport ARGs to the host bacteriota, and thus can be considered as a risk in the spread of antimicrobial resistance.

Canine Socialisation: A Narrative Systematic Review

There are over 10 million pet dogs in the UK alone, and they have become a member of modern human families. If not properly socialised as puppies, dogs have a higher risk of problematic behaviours during adulthood, yet socialisation studies are lacking. Much of the experimental research was carried out at least 50 years ago, and the importance of socialisation was demonstrated so clearly that further studies with unsocialised controls would be deemed unethical. In this review, the aim was to evaluate all literature relevant to canine socialisation. This review used PRISMA-P guidelines to identify 29 studies: 14 were questionnaire-based studies (two of which also had a testing element), 15 included some form of experimental manipulation relating to socialisation, and one was a purely observational study. Based on this literature review, we recommend future research into minimum necessary socialisation levels, as well as breed differences in the timing of effective socialisation. Such studies will help owners and breeders produce well-adjusted adult dogs.

A pilot study investigating human behaviour towards DAVE (Dog Assisted Virtual Environment) and interpretation of non-reactive and aggressive behaviours during a virtual reality exploration task

Dog aggression is a public health concern because dog bites often lead to physical and psychological trauma in humans. It is also a welfare concern for dogs. To prevent aggressive behaviours, it is important to understand human behaviour towards dogs and our ability to interpret signs of dog aggression. This poses ethical challenges for humans and dogs. The aim of this study was to introduce, describe and pilot test a virtual reality dog model (DAVE (Dog Assisted Virtual Environment)). The Labrador model has two different modes displaying aggressive and non-reactive non-aggressive behaviours. The aggressive behaviours displayed are based on the current understanding of canine ethology and expert feedback. The objective of the study was to test the recognition of dog behaviour and associated human approach and avoidance behaviour. Sixteen university students were recruited via an online survey to participate in a practical study, and randomly allocated to two experimental conditions, an aggressive followed by a non-reactive virtual reality model (group AN) or vice versa (group NA). Participants were instructed to ‘explore the area’ in each condition, followed by a survey. A Wilcoxon and Mann Whitney U test was used to compare the closest distance to the dog within and between groups respectively. Participants moved overall significantly closer to the non-reactive dog compared to the aggressive dog (p≤0.001; r = 0.8). Descriptions of the aggressive dog given by participants often used motivational or emotional terms. There was little evidence of simulator sickness and presence scores were high indicating sufficient immersion in the virtual environment. Participants appeared to perceive the dog as realistic and behaved and interacted with the dog model in a manner that might be expected during an interaction with a live dog. This study also highlights the promising results for the potential future use of virtual reality in behavioural research (i.e., human-dog interactions), education (i.e. safety around dogs) and psychological treatment (e.g. dog phobia treatment).

Systematic review of dog bite prevention strategies

BACKGROUND

The prevention of dog bites is an increasingly important public health topic, as the incidence of serious injury continues to rise.

OBJECTIVES

To evaluate the effectiveness of interventions to prevent dog bites and aggression.

METHODS

Online databases were searched (PubMed, Cochrane Library, Embase and Google Scholar), using the search terms: dog/s, canine, canis, kuri, bite/s, bitten, aggression, attack, death, fatal, mortality, injury/ies, prevention, intervention, for studies between 1960 and 2021. All study designs were considered. Outcomes of interest were the incidence of dog bites or dog aggression. Non-English studies, and those without full-text access were excluded.

RESULTS

Forty-three studies met the review criteria, including 15 observational and 27 interventional studies. Fifteen studies investigating dog-control legislation, including leash laws, stray dog control and infringements indicated this can reduce dog bite rates. Breed-specific legislation had less of an effect. Six studies investigating sterilisation, showed while this may reduce dog bites through a reduction in the dog population, the effect on dog aggression was unclear. An alcohol reduction programme showed a significant reduction in dog bite rates in one study. Seven studies assessing educational approaches found that intensive adult-directed education may be effective, with one study showing child-directed education was not effective. Eight studies on dog training (two police-dog related), and six evaluating dog medication or diet were generally low quality and inconclusive.

CONCLUSIONS

Multiple strategies including effective engagement with indigenous communities and organisations will be required to reduce dog-bites and other incidents involving dog aggression. This review provides some evidence that legislated dog control strategies reduce dog bite rates. Available evidence suggests greater restrictions should be made for all dogs, rather than based on breed alone. Due to a burden of child injury, protection of children should be a focus of legislation and further investigations. Prevention strategies in children require redirection away from a focus on child-directed education and future research should investigate the effectiveness of engineering barriers and reporting strategies.

"If You Don't See the Dog, What Can You Do?" Using Procedures to Negotiate the Risk of Dog Bites in Occupational Contexts

Dog bites are a health risk in a number of workplaces such as the delivery, veterinary and dog rescue sectors. This study aimed to explore how workers negotiate the risk of dog bites in daily interactions with dogs and the role of procedures in workplace safety. Participants who encounter dogs at work were recruited using snowball sampling. Ethnographic methods (interviews, focus group discussions, participant-observations) were used for data collection. All data were coded qualitatively into themes. Six themes describing dog bite risk management were identified: ‘Surveillance of dogs’; ‘Communicating risk; ‘Actions taken to manage perceived risk’; ‘Reporting bites and near-misses’, ‘Investigating bites and near-misses’, and; ‘Learning and teaching safety’. While the procedures described dog bite risk as objective, when interacting with dogs, participants drew on experiential knowledge and subjective judgment of risk. There was a discrepancy between risks that the procedures aimed to guard against and the risk participants were experiencing in the course of work. This often led to disregarding procedures. Paradoxically, procedures generated risks to individual wellbeing and sometimes employment, by contributing to blaming employees for bites. Dog bite prevention could be improved by clarifying definitions of bites, involving at risk staff in procedure development, and avoiding blaming the victim for the incident.

Paediatric emergency department dog bite attendance during the COVID-19 pandemic: an audit at a tertiary children's hospital

BACKGROUND

Responses to the COVID-19 pandemic include strict public health measures, such as national lockdowns. During these measures, paediatric emergency department attendances have declined and the prevalence of presenting complaints has changed. This study sought to identify whether dog bite attendance and victim demographics changed during COVID-19 public health measures.

METHODS

An audit was conducted of emergency department attendance data from a UK tertiary paediatric hospital between January 2016 and September 2020. Dog bite attendance and victim demographics were explored using χ² tests and multivariable Poisson regression. The mean monthly percentage of attendance due to dog bites in 2020 was compared against predicted percentages based on previous years' data.

RESULTS

Dog bite attendance rose in conjunction with the introduction of COVID-19 public health measures and reached a peak in July 2020 (44 dog bites, 1.3% of all attendances were due to dog bites). This was a threefold increase in dog bite attendance. By September 2020, attendance had returned to normal. The demographic profile of child dog bite victims remained the same. Boys had the highest attendance rates in 7-12 year-olds, girls in 4-6 year-olds. Girls showed higher attendance rates in the summer, while boys' attendance rates were constant throughout the year. COVID-19 public health measures were associated with a 78% increase in attendance for boys and a 66% increase in girls.

CONCLUSIONS

COVID-19 national public health measures were associated with an increase in paediatric emergency department dog bite attendance, and may be due to increased child exposure to dogs via 'stay at home' orders and school closures. National lockdowns are likely to continue globally throughout the COVID-19 pandemic; this is likely to result in more dog bites. Urgent public health communication and injury prevention strategies are needed to help prevent these avoidable injuries.