Dog Bites in Children: A Descriptive Analysis

Fifteen-minute consultation: Management of mammalian bites in children - from local wound care to prophylactic antibiotics

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.

Incidence of facial fractures in association with facial laceration from dog bites in the pediatric patient

INTRODUCTION

Dog bite injuries occur in approximately 102 of every 100,000 population. Pediatric facial injuries due to dog bites are more common than in the adult largely due to height difference and ease of access for the dog to the head and neck region. Although majority are soft tissue injuries, pediatric facial fractures from dog bites are estimated at approximately 5%, with the true incidence unknown. We hypothesize that depth and facial subsite of laceration can indicate likelihood of facial fracture presence in pediatric patients with dog bite injuries.

METHODS

This single-institution retrospective study included 162 patients 18 years or younger (n = 162) who had an ICD-9 code of E906.0 or ICD-10 code of W54.0 for dog bites in the head and neck region between 1/1/2015 and 12/31/2019 and were treated in the emergency department by either an emergency department, otolaryngology, or plastics surgery provider. Multivariable logistic regressions were used to examine the association between patient age, sex, and dog size, and the outcomes: laceration depth (epidermis, dermis, muscle, bone), and facial subsite (upper, middle, lower third).

RESULTS

Males had a lower laceration penetration at the epidermis level (aOR = 0.36; 95% CI 0.19, 0.69) but a higher laceration penetration at the muscle level (aOR = 2.29; 95% CI 1.04, 5.04) compared to females. No significant findings were observed for the levels of dermis and bone. In the multivariable analysis, there were no significant associations to suggest facial fractures found between facial subsites and age, sex and dog size.

CONCLUSION

No significant associations between depth or facial subsite of facial injury from dog bites and the presence of facial fractures in pediatric patients except with regard to male sex and laceration level of epidermis and muscle.

Are children and dogs best friends? A scoping review to explore the positive and negative effects of child-dog interactions

Personal wellbeing is greatly influenced by our childhood and adolescence, and the relationships formed during those phases of our development. The human-dog bond represents a significant relationship that started thousands of years ago. There is a higher prevalence of dog ownership around the world, especially in households including children. This has resulted in a growing number of researchers studying our interactions with dogs and an expanding evidence base from the exploration of child-dog interactions. We review the potential effects of child-dog interactions on the physical, mental, and social wellbeing of both species. A search of the SCOPUS database identified documents published between January 1980 and April 2022. Filtering for key inclusion criteria, duplicate removals, and inspecting the references of these documents for additional sources, we reviewed a total of 393 documents, 88% of which were scientific articles. We were able to define the numerous ways in which children and dogs interact, be it neutral (e.g., sharing a common area), positive (e.g., petting), or negative (e.g., biting). Then, we found evidence for an association between childhood interaction with dogs and an array of benefits such as increased physical activities, a reduction of stress, and the development of empathy. Nonetheless, several detrimental outcomes have also been identified for both humans and dogs. Children are the most at-risk population regarding dog bites and dog-borne zoonoses, which may lead to injuries/illness, a subsequent fear of dogs, or even death. Moreover, pet bereavement is generally inevitable when living with a canine companion and should not be trivialized. With a canine focus, children sometimes take part in caretaking behaviors toward them, such as feeding or going for walks. These represent opportunities for dogs to relieve themselves outside, but also to exercise and socialize. By contrast, a lack of physical activity can lead to the onset of obesity in both dogs and children. Dogs may present greater levels of stress when in the presence of children. Finally, the welfare of assistance, therapy, and free-roaming dogs who may interact with children remains underexplored. Overall, it appears that the benefits of child-dog interactions outweigh the risks for children but not for dogs; determination of the effects on both species, positive as well as negative, still requires further development. We call for longitudinal studies and cross-cultural research in the future to better understand the impact of child-dog interactions. Our review is important for people in and outside of the scientific community, to pediatricians, veterinarians, and current or future dog owners seeking to extend their knowledge, and to inform future research of scientists studying dogs and human-animal interactions.

Use of antibiotics in patients who were attacked by animals that can transmit rabies

Animal bites have a high probability of becoming infected. In high-risk wounds, the use of antibiotics that kill the associated microorganisms is recommended. The aim of this study was to determine the use of inappropriate antibiotics in patients in different regions of Colombia who were attacked in 2020 by animals that can transmit rabies. This was a retrospective follow-up study of a cohort of patients with wounds caused by animals; the patients were affiliated with the Colombian Health System. Sociodemographic, clinical and pharmacological data were collected. A total of 280 patients were analysed. The median age was 28.0 years, and 52.1% were men. The attacks were attributed to dogs (85.0%) and cats (15.0%), and 9.6% were classified as severe exposure. Antibiotics were used in 71.1% of cases for prophylaxis and in 4.3% of the cases for the treatment of superinfection; cephalexin (37.5%), amoxicillin/clavulanic acid (15.7%) and dicloxacillin (10.4%) were the predominant antibiotics used. A total of 72.0% of patients who received antibiotics received inadequate prescriptions, and 49.2% had no indication to receive prophylaxis. Being treated in the Caribbean region (OR: 4.09; 95% CI: 1.79-9.30) and receiving analgesics (OR: 3.15; 95% CI: 1.25-7.94) were associated with a greater probability of being prescribed antibiotics inadequately; attacks resulting in severe exposure were associated with a lower probability (OR: 0.40; 95% CI: 0.16-0.98). A significant proportion of patients had no indication for prophylactic antibiotics or was prescribed antibiotics not recommended by clinical practice guidelines. There was a low prevalence of prescriptions for amoxicillin/clavulanic acid, the most recommended antibiotic.

How Parents Perceive the Potential Risk of a Child-Dog Interaction

Dog attacks on children are a widespread problem, which can occur when parents fail to realise a potentially dangerous interaction between a dog and a child. The aim of the study was to evaluate the ability of parents to identify dangerous situations from several everyday child–dog interactions and to determine whether the participants connected these situations to a particular breed of dog. Five sets of photographs depicting potentially dangerous interactions from everyday situations between children and three dogs (one of each breed) were presented via an online survey to parents of children no more than 6 years old. Data from 207 respondents were analysed using proc GLIMMIX in SAS program, version 9.3. The probability of risk assessment varied according to dog breed (p < 0.001) as well as to the depicted situation (p < 0.001). Results indicated that Labrador Retriever was considered the least likely of the three dogs to be involved in a dangerous dog-child interaction (with 49% predicting a dangerous interaction), followed by Parson Russell Terrier (63.2%) and American Pit Bull Terrier (65%). Participants considered one particular dog-child interaction named ‘touching a bowl’ a dangerous interaction at a high rate (77.9%) when compared with the other presented situations, which were assessed as dangerous at rates of 48.4% to 56.5%. The breed of dog seems to be an influential factor when assessing a potentially dangerous outcome from a dog-child interaction. Contrary to our hypothesis, interactions involving the small dog (Russell Terrier) were rated more critically, similarly to those of the Pit Bull Terrier. These results suggest that even popular family dog breeds, such as Labrador Retrievers, should be treated with more caution.

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.

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

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.

Surgical Treatment of Pediatric Dog-bite Wounds: A 5-year Retrospective Review

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.

Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center's Experience

The objective of the current study is to retrospectively evaluate animal-bite injuries and to gain insight into the epidemiology, accident consequences and treatment concept of these accidents in oral and maxillofacial surgery. Data of patients, who were admitted January 2015 and April 2021, were retrospectively evaluated regarding the patients’ characteristics (age, gender), facial distribution of substance defects/partial amputations, duration of hospitalization, operation treatments and antibiotic treatments. Data of 75 patients were included. Patients were bitten by dogs (n = 69.92%), cats (n = 4) and horses (n = 2). Lower eyelid/cheek complex was the most affected region (n = 37, 32.74%). Most of the patients between 0 and 3 years had to be operated on under general anesthesia (p = 0.011), while most of the adults could be operated on under local anesthesia (p = 0.007). In the age group 0–12 years, 30 patients (68%) were operated on under general anesthesia. Ampicillin/Sulbactam (48%) was the antibiotic most used. Antibiotics were adjusted after wound swabs in case of wound infections or critical wound conditions. This means that resistant antibiotics were stopped, and sensitive antibiotics were used. Structured surgical and antibiotic management of animal-bite wounds in the maxillofacial region is the most important factor for medical care to avoid long-term aesthetic consequences. Public health actions and policies under the leadership of an interdisciplinary committee could improve primary wound management, healing outcome and information status in the general population.

Profile of dog bite injuries in patients presenting at Kimberley Hospital Complex's emergency and gateway centres, 2015 to 2017

BACKGROUND

Dog bite injuries in humans remain a public health problem. There is limited nationally representative data on the magnitude of the problem and the epidemiological profile of dog bite injuries in South Africa.

AIM

To describe the profile of dog bite injuries in patients presenting to Kimberley Hospital Complex (KHC) emergency and gateway centres. To determine the prevalence of dog bite injuries amongst all patients presenting to these centres and the compliance of mandatory notification of dog bites.

SETTING

Kimberley Hospital Complex emergency and gateway centres.

METHODS

A retrospective review of all dog bite cases who presented to KHC from August 2015 to July 2017. The total number of all patients who presented were taken into consideration for calculating the prevalence of dog bite cases.

RESULTS

During the study period, 433 dog bite cases were identified out of 107 731 patients seen at emergency and gateway centres, giving a prevalence of 0.4%. Of all cases, 62.4% were male patients and 37.6% were female patients. Most affected age group was between 10 and 19 years (19.6%). Category II exposure type accounted for the majority of the cases (59.4%). Unvaccinated dogs were incriminated in 61.9% of cases. Stray dogs were responsible for 83.1% of all injuries. More than half of the cases (47.9%) were notified by the treating doctors.

CONCLUSION

Dog bite injuries in Kimberley were commonest in children and adolescents. The prevalence tended to decrease in adulthood with advancing age groups. Most bites resulted from unvaccinated stray dogs. Only about half of the cases were notified to the appropriate authorities. Prevalence of dog bite injuries amongst patients presenting at KHC resulted in the low rate of 0.4%. Awareness needs to be created amongst health care providers on the importance of notification of all exposure to rabies. More efforts are required at the prevention of dog bites in children and adolescents through stringent measures to limit the number of free-roaming dogs.