Dog bite injuries in the USA: prevalence, correlates and recent trends

A Pediatric Level III Trauma Center Experience With Dog Bite Injuries

Dog bite injuries often present to Emergency Departments (ED), and between 2001 and 2003, approximately 4.5 million adults and children were injured. Injuries may range from puncture wounds to deep tissue lacerations or avulsions. Deaths have been described. Our objective was to describe dog bite injuries, the overall location of injuries, and need for vaccination among children who presented to a Pediatric ED designated as a level III trauma center with a robust facial surgical infrastructure. This was a 6-year retrospective study. Charts were identified by International Classification of Diseases, Tenth Revision (ICD-10) codes for lacerations or injuries secondary to animal bites and accessing the hospital's trauma database. Variables abstracted were age, sex, type of injury, location, need for antibiotics, immunization states and requirement of tetanus or rabies vaccine, disposition from ED to the operating room, home, or any in-patient unit. We excluded children older than 17 years of age and children who had a post-bite injury infection or injury not initially managed in our facility or medical system. The final cohort consisted of 152 children. The median age was 52 months and age ranged from 2 to 215 months. Children with a single bite injury were older when compared with those with numerous injuries, 81 and 62 months of age, respectively. Among young children, 75% of injuries occurred above the neck and 15.1% were managed in the operating room. Twenty-four percent of children required either a tetanus or rabies vaccination. Most dog bite injuries occurred to facial structures. Comprehensive care of dog victims included awareness of both dog and injured child vaccination status.

Cat bite injuries to the hand and forearm: the impact of antibiotic treatment on microbiological findings and clinical outcome

INTRODUCTION

Patients and physicians often underestimate cat bite injuries. The deep and narrow wound seals quickly and provides an environment for the inoculated saliva and bacteria. Interestingly, the literature reports no bacterial growth in the microbiological workup of wound swaps in up to 43%. The time between bite injury and the first clinical presentation, the start of antibiotic treatment and surgical debridement might affect these findings. Therefore, the current project examines if (1) these factors impact the outcome of microbiological results following cat bite injuries and (2) the detection of bacterial growth leads to higher complication rates, longer hospital stays, longer total treatment time, or higher total treatment costs.

MATERIALS AND METHODS

This single-center retrospective study analyzed data from 102 adult patients. All patients received antibiotic and surgical treatment following a cat bite injury. Microbiological samples were collected during surgery in all cases. The time from the bite incident to the first presentation, beginning of antibiotic administration, and surgical debridement was calculated. Demographic data, complication rate, length of hospital stay, total treatment time, and total treatment costs were recorded. (1) A generalized linear model was fitted using the microbiological outcome as the dependent variable. (2) Two groups (negative or positive microbiological results) were formed and statistically compared.

RESULTS

The median age was 50 (SD 16), and 72% were female. (1) The time from the bite incident to the first clinical presentation, antibiotic administration, or surgical treatment was not associated with the outcome of the microbiological result. (2) No significant differences were observed between the two groups.

CONCLUSIONS

Our data do not suggest that early antibiotic administration or delayed surgical treatment affects the outcome of the microbiological workup following cat bite injuries to the hand and forearm. The microbiological outcome did not affect the complication rate, treatment time, and total treatment costs.

The epidemiology of dog bite injuries in Greece: preliminary results of a surveillance scheme

Background

Dog bite injuries commonly fall under the radar of the public health surveillance systems. Nevertheless, these incidents may result in emotional distress, disfigurement, functional deficit, or exposure to zoonotic agents and therefore may have a considerable impact on public health.

Methods

A pilot surveillance scheme was launched in Greece to assess the epidemiology of dog bite injuries. Physicians in hospital-based emergency room departments and primary health care centers were required to report bite cases via a reporting form. The collected data were analyzed cross-sectionally.

Results

From January to June 2023, 1,656 dog bite victims attended the healthcare settings in Greece. The rate was estimated at 15.8 cases per 100,000 population. The frequency of healthcare visits varied significantly among the regions (p <0.0001), ranging from 0.9 to 45.2 per 100,000 inhabitants. The median number (interquartile range in brackets) of visits concerning dog bite victims for the examined period per reporting hospital was nine (2, 21) and per reporting health center three (1, 10), respectively. The ownerless-to-owned dogs ratio was almost equal (1.04). According to the Abbreviated Injury Scale, 67.3 % of the injuries were classified as minor, 27.7 % as moderate, 4.9 % as serious, and 0.1 % as critical. The lower limb was the most frequently affected anatomical site (50.6 %). Head/neck injuries were associated with younger patients (p <0.0001). Macroscopic tissue loss occurred in 11.9 % of the cases, with the majority presenting areas of damaged or missing skin (50.9 %); partially or completely amputated hand digits occurred in nine of these cases (8.5 %). Among dog bite victims, 2.8 % were hospitalized (inpatients), and 1 % were referred to other hospitals.

Conclusions

Dog bite surveillance offers important epidemiological information on the respective traumatic impact. HIPPOKRATIA 2023, 27 (2):82-88.

The risk of being bitten by a dog is higher on hot, sunny, and smoggy days

Humans commit more violent crimes when temperature and air pollution is higher. Here, we investigate if also the day-to-day rates of dogs biting humans is influenced by environmental factors. 69,525 reports of dogs biting humans, sourced from public records on animal control requests and from ER records, were analyzed. The impact of temperature and air pollutants were evaluated with a zero-inflated Poisson generalized additive model, while controlling for regional and calendar effects. Exposure-response curves were used to assess the association between outcome and major exposure variables. We find that the rates of dogs biting humans increases with increasing temperature and ozone, but not PM2.5 exposure. We also observed that higher UV irradiation levels were related to higher rats of dog bites. We conclude that dogs, or the interactions between humans and dogs, are more hostile on hot, sunny, and smoggy days, indicating that the societal burden of extreme heat and air pollution also includes the costs of animal aggression.

Spatial patterns and risk of aggression of dogs and cats in a central township of Mexico City

Dog and cat aggressions are public health concerns associated with rabies transmission to the human population. The social and environmental conditions of marginalized and urban areas stand a risk due to people's contact with dogs. This study aimed to identify spatial patterns related to dog and cat aggression in a densely populated area in the center of Mexico City, analyzing the risk of aggression at the census unit level in the 2018-2020 triennium. This cross-sectional study was carried out in Coyoacán, in the south-central area of Mexico City's urbanized region. The total number of cases (n = 1,078) was obtained from monthly records of aggressions by dogs and cats, from the Control and Prevention of Zoonoses-Rabies Program of the Coyoacán Sanitary Jurisdiction. The information collected was related to the victims and the aggressors. Associations between the occurrence of bites and the characteristics of the victim were evaluated using a geographic information system (GIS), as well as the spatio-temporal distribution of the aggressions to the census unit level. Out of 1,078 cases reported, 977 (90.6%) were caused by dogs and 101 (9.4%) by cats, 55.1% (n = 587) occurred within the same household, and 13.7% (n = 148) were categorized as severe injuries. Adult men were the most affected group. Attacks on the street had a higher risk of resulting in a severe injury, compared to those that occurred at home (OR 1.63, 95CI 1.15 - 2.31, p <0.006). According to the standardized rate of the triennium, the values ​​ranged between 54.1 and 619 aggressions per 100,000 inhabitants, and summer was the season with a higher probability of occurrence. These results provide a basis for the analytical investigation of the spatial patterns of dog and cat aggression, highlighting the need to implement efficient surveillance systems and public health strategies.

Canine-to-Human Transmission of Mycoplasma canis in the Central Nervous System

Dog bites remain a common occurrence in our society, particularly in toddlers and small children under the age of 2. Injuries to the head and face, more common in younger children, can often lead to significant morbidity. Additionally, there continues to be considerable clinical equipoise for standardized post-dog bite injury management. Here, we present the only reported pediatric case in the literature of Mycoplasma canis-associated central nervous system (CNS) infection in an 11-month-old infant who sustained a dog bite to the calvarium. The prevalence of dog bites during the SARS-CoV-2 pandemic had interestingly tripled in number after stay-at-home orders in 1 particular pediatric emergency department in Colorado. This observation paired with advances in microbiological identification like MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass spectrometer) may lead to the identification of future cases of uniquely canine pathogens that play a role in human infection.

US estimates for dog bite injuries presenting to emergency departments

OBJECTIVES

Dog bites are a frequent source of injury requiring emergency department (ED) management. We sought to evaluate the longitudinal burden of dog bites presenting to US EDs.

STUDY DESIGN

Cross-sectional study of a complex survey.

METHODS

We evaluated the National Hospital Ambulatory Medical Care Survey, a complex survey of non-federal US ED encounters between 2002 and 2017. Dog bites were identified via ICD-9-CM and ICD-10-CM codes. We report trends in dog bites (adjusted to US Census population data) overall and among patients younger than 18 years using the Spearman rank correlation test.

RESULTS

Of 2.0 billion ED encounters, 6.6 million (0.3%, 95% confidence interval [CI] 0.3-0.4%) were for dog bites. There were 13.5 encounters per 10,000 population (all ages) and 20.8 per 10,000 among those younger than 18 years. Rates of bites increased over time for encounters younger than 18 years (rho = 0.54, 95% CI 0.08, 0.82), but not for those aged 18 years or older (rho = 0.44, 95% CI -0.08, 0.77). Among patients younger than 18 years, the rate of presentations increased from 17.7 to 22.3 per 10,000 encounters during the 16-year period. The highest rate of encounters was among patients aged 6-11 years, where 24.3 per 10,000 presented with dog bites and for which 59.3% (95% CI 49.1-69.6%) were boys. Overall, 75.3% (95% CI 72.3-89.3%) were provided with antibiotics and 4.1% (95% CI 2.5-5.7%) were diagnosed with skin/soft tissue infection.

CONCLUSION

Dog bite presentations demonstrated a small but significant increase in rates of presentation over time among children and youth. Continued efforts are needed to curb this common injury.

Infectious Complications of Bite Injuries

Animal and human bite injuries are a public health burden. Dog bites outnumber cat bites, but cat bites pose the greatest risk for infection. Skin and soft tissue infections are the most frequent infectious manifestations resulting from bite injury, although invasive infection may occur through direct inoculation or dissemination through the bloodstream. Although contemporary, well-designed trials are needed to inform clinical practice, preemptive antibiotic therapy after a bite injury is warranted for injuries posing high risk for infection and for patients at risk of developing severe infection; antibiotics should target aerobic and anaerobic microbes that comprise the oral and skin flora.

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

Dog bites are a global health issue that can lead to severe health outcomes. This study aims to describe the incidence and sociodemographics of patients admitted to English National Health Service (NHS) hospitals for dog bites (1998-2018), and to estimate their annual direct health care costs. An analysis of patient level data utilising hospital episode statistics for NHS England, including: temporal trends in annual incidence of admission, Poisson models of the sociodemographic characteristics of admitted patients, and direct health care cost estimates. The incidence of dog bite admissions rose from 6.34 (95%CI 6.12-6.56) in 1998 to 14.99 (95%CI 14.67-15.31) admissions per 100,000 population in 2018, with large geographic variation. The increase was driven by a tripling of incidence in adults. Males had the highest rates of admission in childhood. Females had two peaks in admission, childhood and 35-64 years old. Two percent (2.05%, 95%CI 0.93-3.17) of emergency department attendances resulted in admission. Direct health care costs increased and peaked in the financial year 2017/2018 (admission costs: £25.1 million, emergency attendance costs: £45.7million). Dog bite related hospital admissions have increased solely in adults. Further work exploring human-dog interactions, stratified by demographic factors, is urgently needed to enable the development of appropriate risk reduction intervention strategies.

Bitten or struck by dog: A rising number of fatalities in Europe, 1995-2016

We analyzed fatal dog attacks in Europe 1995-2016 using official death cause data from Eurostat. The data comprised the number of fatalities assigned The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code W54 "bitten or struck by dog", which includes deaths due to direct attacks but which excludes many complications following dog bites, such as rabies. In 2016, dogs killed 45 Europeans, which translates to an incidence of 0.009 per 100,000 inhabitants. This is comparable to estimates from the USA (0.011), and Canada (0.007), but higher than Australia (0.004). The number of European fatalities due to dog attacks increased significantly at a rate of several percent per year. This increase could not be explained by increases in the human or the dog populations. By taking all fatalities reported 1995-2016 into account, we investigated the effects of age, gender and geography. First, children, including infants, were common victims, but also middle-aged and the elderly, while people between ages 10 and 39 were rarely killed by dogs. Second, boys and men were overrepresented, but only in certain age groups and in certain parts of Europe. Third, there were large national and regional differences, both in the effects of gender and in incidences, which ranged from 0 to 0.045 per 100,000 inhabitants. This study of dog-related fatalities at a European level is the first of its kind and forms a basis for more detailed, national studies.

The changing epidemiology of dog bite injuries in the United States, 2005-2018

Background

In 2018, the most recent year for which data are available, dog bites ranked as the 13th leading cause of nonfatal emergency department visits in the United States. As dog ownership spirals upwards in the United States, it is important to continue to monitor the epidemiology of dog bite injuries. This study provides contemporary data on the incidence of dog bites injuries in the United States and in New York and profiles individuals who have been treated for dog bites in emergency departments. The study also examines the demographic correlates of the rate of injuries at the neighborhood level in New York City and maps the rate in each neighborhood.

Methods

At the national level, the study examines longitudinal data on dog bite injuries from 2005 to 2018 gathered by the Centers for Disease Control and Prevention. For New York, the study analyzes data for 2005–2018 collected by the New York State Department of Health. A negative binomial regression analysis was performed on the state data to measure the simultaneous effects of demographic variables on the incidence of dog-related injuries. A thematically shaded map of the rate of dog bite injuries in New York City’s neighborhoods was created to identify neighborhoods with higher-than-average concentration of injuries.

Results

In both the United States and New York the rate of dog-bite injuries increased from 2005 to 2011 and then underwent a significant decline. Injuries due to dog bites, however, still remain a sizable public health problem. Injuries are more prevalent among school-age children, inhabitants of less-densely populated areas, and residents of poorer neighborhoods. In New York City, poorer neighborhoods are also associated with fewer dogs being spayed or neutered.

Conclusions

To reduce the rate of dog bite injuries, prevention programs – particularly those which center on teaching the dangers of canine interactions with humans – should be targeted at children. Dog bite injuries tend to be clustered in identifiable neighborhoods. Dog bite prevention programs and stricter enforcement of dog laws can target these neighborhoods.

Hospitalizations for pediatric dog bite injuries in the United States

BACKGROUND

Dog bites are a common cause of pediatric trauma requiring hospital admission. We aim to describe pediatric bite victims, associated injuries and interventions.

METHODS

Children (≤18 years old) were identified with an ICD-9 diagnosis of dog bite in the Kids' Inpatient Database for the years 2006, 2009 and 2012. National estimates were obtained using case weighting. Multivariable logistic regression was performed.

RESULTS

We identified 6323 admissions for a dog bite with mean age of 6.63 years. Patients were predominately male (56.9%), non-Hispanic white (61.9%), resided in the South (35.1%), and in an urban environment (59.9%). Almost one third underwent a surgical procedure. Open wounds of the head, neck and trunk were the most common injury and decreased in prevalence with increasing age. Open wounds of the extremities were the second most common and the prevalence increased with increasing age. Children aged 1-4 and 5-10 years were both more than three times more likely to be admitted than those more than age 11.

CONCLUSIONS

Dog bite injuries are common for pediatric patients. Children less than age 11 are at greatest risk, particularly in the summer. Dog safety training should be focused on elementary and middle school children close to the start of summer vacation.

LEVEL OF EVIDENCE

III.

Epidemiological study on animal bite cases referred to Haji Daii health Center in Kermanshah province, Iran during 2013-2017

Background

Over thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013–2017.

Methods

In this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics.

Results

In the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55–45.66 per100000 populations during 2013–2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9, P-trend< 0.001) over a 5-years’ time period. The mean age of the subjects was 32.7 ± 18.3 years. Of the studied subjects 76.3% were male, and 34% had non-governmental jobs. Dogs were found as the cause of animal bites in 72% of the cases. Of the studied cases, 82% had received rabies vaccination for three times.

Conclusion

The results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.

Age- and Sex-Related Differences in Nonfatal Dog Bite Injuries Among Persons Aged 0-19 Treated in Hospital Emergency Departments, United States, 2001-2017

OBJECTIVE

No studies using national data have evaluated changes in nonfatal dog bite injuries among children, adolescents, and young adults during the past 2 decades. We examined estimates of annual nonfatal dog bite injuries among persons aged 0-19 treated in US emergency departments (EDs) from 2001 through 2017.

METHODS

We examined data from the Web-based Injury Statistics Query and Reporting System to compare estimates of the annual rates of nonfatal dog bite injuries in EDs among all persons aged 0-19, by age group (0-4, 5-9, 10-14, and 15-19), and by sex. We determined significance by comparing 95% confidence intervals (CIs), and we standardized rate calculations to the year 2000 population.

RESULTS

During 2001-2017, an estimated 2 406 109 (95% CI, 2 102 643-2 709 573) persons aged 0-19 were treated in EDs for nonfatal dog bite injuries (age-adjusted rate of 173.1 per 100 000 persons aged 0-19). The estimated number of nonfatal dog bite injuries declined significantly, from 181 090 (95% CI, 158 315-203 864) in 2001 to 118 800 (95% CI, 97 933-139 667) in 2017. The highest rate was among children aged 5-9. Male children, adolescents, and young adults were significantly more likely than female children, adolescents, and young adults to be treated in the ED for nonfatal dog bite injuries, driven by male-female differences in children and adolescents aged 5-14.

CONCLUSIONS

Although the estimated number of nonfatal dog bite injuries among persons aged 0-19 declined significantly in the past 2 decades, additional regulatory and educational efforts specific to age and sex may lead to further reductions in nonfatal dog bite injuries.