Human fatalities resulting from dog attacks in the United States, 1979-2005

A Multidisciplinary Approach to a Complex Fatal Attack Due to a Pack of Maremma Sheepdogs: Is It Always an Accident?

Deaths due to dog attacks are a worldwide issue. Fatal dog attacks may occur in various environments, including the dog owner's property. A lot of difficulties emerge when the attack involves a pack of dogs, of different species and sizes. In this case, it becomes much more difficult for forensic investigators to evaluate the event, especially regarding the identification of the dog or dogs that caused the death as well as the identification of the owner and the reconstruction of the dynamics for forensic purposes. In this paper, we analyze a specific case of an attack by a herd of Maremma sheepdogs. A crime scene investigation has been carried out. In the first phase of this case, the victim interacted with dogs that had non-aggressive attitudes. Then, after an escape attempt, she was assaulted by about 20 Maremma dogs of different sizes, leading to multiple injuries all over her body. The greatest difficulty was precisely that of reconstructing the dynamics due to the numerous injuries and dogs involved in the attack. The dynamics were divided into several stages following the analysis of the injuries found on the victim. This case study highlights how the forensic multidisciplinary approach has made it possible to precisely reconstruct the event. The analysis of the dogs' state of malnutrition and their suddenly aggressive attitude towards the victim revealed profiles of responsibility of the owner attributable to improper management and training of the animals to defend their property.

Community factors and animal shelter outcomes

This research explores connections between the nature of a community, the type of animal shelter it has, how animals arrive at the shelter, and outcomes for the animals in terms of adoption or euthanasia. Based on data from Shelter Animals Count, the study concludes that the nature of the local community is related to the type of shelter it is served by, how dogs arrive at the shelter, and directly to outcomes. Areas with greater economic stress and lower educational attainment are more likely to have a municipal shelter, which increases stray intake, and ultimately euthanasia. Community economic stress is also directly associated with lower adoption and higher euthanasia rates. The findings of the study suggest a multi-pronged strategy to increase adoptions and reduce euthanasia focusing on both animal shelters but also using a One Health approach to improve the welfare of both humans and non-human animals.

Dog bite-induced necrosis of lymph nodes: A case report and literature review

Dog bite is a common skin injury, which mainly causes structural damage, infection, and psychological trauma. Among these complications, infection by oral flora from animals has a major effect on later treatment. Each animal has a relatively unique oral microbial flora, which has a potential risk of infection and affects the formulation of treatment plans. Although lymph node necrosis is a common disease in the medical field, distant metastatic abscess and lymph node necrosis caused by dog bite are still worthy of early clinical suspicion after a patient presents with a dog bite disease. A high index of suspicion is greatly significant in shortening the patient's hospital stay, promoting wound healing, and reducing psychological trauma of patients.

Animal welfare deserts: human and nonhuman animal inequities

Residents of distressed areas of inner cities have less access to many of life's necessities and amenities than their more well-off counterparts. Geographic proximity has been identified as a primary barrier to accessing care for pets potentially creating animal welfare deserts. This project addresses three questions: Are there visible animal welfare deserts in distressed urban centers?; What human inequities are most strongly related to animal welfare deserts?; and What might be done to address these inequities? Using business location and census data in the city of Detroit, this research identifies distinct animal welfare deserts finding that more prosperous areas have more pet support resources and that the need for services is not related to the location of pet stores and veterinary offices. The study concludes that the overlap between human economic distress and pet resource deserts presents a threat to the goals of One Health. Potential policy solutions are proposed to address inequities in the distribution of animal welfare resources.

US Adults' Perceptions of Dog Breed Bans, Dog Aggression and Breed-Specific Laws

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.

Characterization of the Variables Related to Reports of Death Due to Canine Bites in Scientific Articles during the Years 2013-2017: A Systematic Review

Simple Summary

Dog bites are a major public health problem throughout the world. The main consequences for human health include physical and psychological injuries of varying proportions, secondary infections, sequelae, risk of transmission of zoonoses and surgery, among others, which entail costs for the health care system and those affected. The objective of this review was to search and analyze the indexed scientific literature on canine bites resulting in death, published during the period 2013–2017. The results show that most of the articles on bite accidents resulting in death analyzed in this study have details about the victims, their injuries and the treatment received by the victim. These results reflect that most of these accidents are suffered by adults, in public spaces and by only one animal. The analysis of these antecedents, as well as others incorporated in this review, will be of great help to fully understand the incidents of dog bites resulting in death published in the scientific literature.

Abstract

Canine bites are an important public health problem, with consequences such as physical injuries, psychological trauma, transmission of zoonoses, infections and they can even cause death. To avoid deaths caused by this type of bite, multiple factors related to this issue must be considered. The objective of this review was to search and analyze the indexed scientific literature on canine bites resulting in death, published during the period 2013–2017. A search was carried out in various databases of indexed literature, in Spanish and English. After selecting and excluding items using PRISMA, they were classified according to SIGN guidelines to filter out the level of evidence and potential biases. Thirty-three scientific articles were retrieved and analyzed. In most of these, victims between 50 and 64 years of age (28.6%, 8/28) were registered. Additionally, in most of the articles, only one animal participated (80%, 16/20). The highest number of events occurred in public spaces (58.5%, 7/12). In conclusion, most of the scientific articles that report incidents of dog bites resulting in death, provide details about the victims, their injuries and the treatment received; however, few articles provide background information on the context of the attack and the biting animal.

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.

Dog Tethering in Slovakia: Legal, Ethical and Behavioral Aspects and Dog Welfare Implications

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.

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.

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.

Understanding Dog Bites: The Important Role of Human Behavior

This research contributes to extant knowledge about dog bites by using police department bite incident data to explore three sets of potential correlates of bites: traits of the victim, traits of the dog including the circumstances surrounding the bite, and traits of the neighborhood in which the bite occurred. It employs data on 478 bites, over a period of 8 years, in an urban setting that includes significant numbers of roaming dogs (both feral and owned), and incorporates a number of variables not included in past research. While environmental variables such as structural abandonment contribute to dog bite risk human error is most commonly at fault.

The burden of bites and stings management: Experience of an academic hospital in the Kingdom of Saudi Arabia

Purpose

The main aim of this study is to estimate the economic burden and prevalence of bites and stings injuries in Saudi Arabia.

Methods

A retrospective, cross-sectional study was conducted at King Saud University Medical City (KSUMC) for all bites and stings cases presented to the Emergency Department (ED) between the period June 2015 and May 2019.

Results

A total of 1328 bites and stings cases were treated in the ED at KSUMC. There were 886 insect bites and stings cases, 376 animal bites, 22 human bites, 34 scorpion stings, and ten snakebites. Most cases were reported in April - June. Females account for 62% of the reported cases, and the mean age was 24 years old. The total management cost of bite and sting cases during the study period was 3.4 million Saudi Riyal (SR). The spending cost of the management of animal bites was the highest as it cost 1,681,920.76 SR, followed by insect's management costing 1,228,623.68 SR.

Conclusion

Bites and stings have a considerable health care burden on our society. Although the vast majority of the cases were not associated with a severe life-threatening condition, many were visit ED and associated with high medical costs. Increased awareness of the hazards of animal-related injuries, especially during spring and summer, where most cases take place may lower its incidence and decrease EDs visits.

Ouch! A cross-sectional study investigating self-reported human exposure to dog bites in rural and urban households in southern Ontario, Canada

This study investigated self-reported dog bites in humans in rural and urban households in southern Ontario, Canada. Our objectives were to determine, and compare, the incidence of dog bites in rural and urban households, and to describe the profile of bite victims, biting dogs, and the proportion of biting dogs that respondents self-reported as being not up to date on rabies vaccination. We conducted a cross-sectional observational study using an online questionnaire. The 2,006 respondents, each representing one household, included 1,002 rural and 1,004 urban residences. The incidence risk of at least one person in the household being bitten over the previous year in rural households (6.09% per year) was less than in urban households (10.76% per year). In 53.20% of households from which at least one person had been bitten within the past year, only a single person had been bitten. Mostly, victims were 25 to 34 years old (21.67%), male (54.19%), and playing with or interacting with the biting dog at the time of the incident (59.11%). Most biting dogs were 3 to 5 years old (32.02%), males (53.69%), and unleashed (76.85%). Based on self-reporting by respondents, 83.33% of respondent-owned biting dogs were vaccinated against rabies at the time of the biting incident. Irrespective of dog ownership, the odds of an individual in a rural household being bitten by a dog were 0.53 (95% CI: 0.38-0.73) the odds for an individual in an urban household. Dog bites constitute a serious, yet preventable, public health concern that requires targeted, community-specific efforts. Public health organizations could consider findings in developing messaging, particularly as we highlight biting dogs reported by their owners as not up to date on rabies vaccination.

Can Children of Different Ages Recognize Dog Communication Signals in Different Situations?

The presented study examines the ability of 265 children aged 4–12 years to correctly assign contextual cues and inner state values to a set of audio and audio-visual recordings of dog vocalizations and behaviors in different situations. Participants were asked to mark which situation each recording captured, what inner state of the dog it showed, and what inner state a human would feel in the same situation. Recognition of the inner state of dogs was affected by the age of the child when evaluating the audio recordings (p < 0.001), and such a tendency was revealed in evaluating the audiovisual materials (p = 0.08). The inner state of dog evaluation was associated with both the situation assessment (p < 0.01) and human inner state (p < 0.001) in the case of audio recordings, but it was only correlated with situation assessment in audio-visual recordings (p < 0.01). The contextual situations were recognized by the participants only in the audio materials, with “stranger” being the best recognized situation, while “play” was the least recognized. Overall, children aged 4–5 years showed a limited ability to understand dog signals compared to children aged 6–12 years, who were successful in recognizing the dogs’ stimuli more than 80% of the time. Therefore, children younger than 6 years of age require increased supervision when interacting with dogs.

Scoping decades of dog evidence: a scoping review of dog bite-related sequelae

OBJECTIVES

There has been considerable literature published focusing on various sequelae to dog bites over the last three decades. Much of the literature has focused on rabies, particularly canine rabies variant, which accounts for the majority of rabies deaths worldwide. This paper describes the complications, the pathogens, and other sequelae resulting from dog bites documented in the literature.

METHODS

This paper used evidence found through a scoping review which charted the published peer-reviewed and non-peer-reviewed gray literature and online information relating to dog bite incidents. Each complication or sequela was additionally assessed from the viewpoint of Canadian Indigenous, rural, and geographically remote communities, which experience a high number of dog bite incidents annually.

SYNTHESIS

Peer-reviewed literature (N = 693; case report, original research, and review articles) provided detailed information on specific pathogens, infections, and diseases of interest, especially rabies. However, in addition to these, the sequelae from dog bites may include moderate to severe injuries that further result in anxiety around dogs or post-traumatic stress disorder (PTSD).

CONCLUSIONS

While a lot of focus in the literature is on rabies as a sequela to dog bites, the impacts of anxiety and PTSD are not as well articulated. Treatment of dog bite injuries may be standardized; however, improved collaborations between diverse health professionals (physicians, veterinarians, counseling services, animal behaviourists, and others) could be of considerable benefit in decreasing the effects of dog bites.

Pit Bull attack causing limb threatening vascular trauma -A case series

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Canine attacks by Pit Bull Terriers and Rottweiler’s can occur at any age and in any anatomical area of the body particularly the limbs.

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Any attack by these large canines can result in limb loss or loss of life.

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The most common injury to a vessel was an occlusion, although penetrating injuries usually cause a puncture or laceration, the blunt injury may be the more clinically significant one.

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Immediate surgical exploration is required to prevent catastrophic outcomes, especially limb loss, since arterial thrombosis is noted to be one of the most common finding in crush injuries.

Introduction

Non-fatal human dog bites are commonplace amongst animal attacks on human beings and these present with mainly skin and soft tissue injuries. However, they can also present with life threatening head and neck injuries, massive soft tissue trauma, as well as combined orthopedic and vascular extremity injuries where a high possibility of limb loss exists.

Presentation of cases

We present two adult dog bite victims with multiple bites inflicted by large canines identified as Pit-Bull Terriers. They were presented with deep lacerations to the axillary area resulting in limb ischemia and loss of upper limb pulses. The right axillary artery was crushed in both patients whilst the axillary vein was lacerated in one. The vessels were repaired; the wounds debrided and both limbs were salvaged.

Discussion

Canine attacks by Pit Bull Terriers and Rottweiler’s can occur at any age and in any anatomical area of the body particularly the limbs. Injuries involving the extremities presenting with no pulses or pulsatile bleeding demand an urgent exploration as any undue delay is intolerable especially if there are bony injuries like fractures or fracture/dislocation. All patients with complex neurovascular injuries should be managed by a multidisciplinary team for an optimal outcome.

Conclusion

Attacks by Pit Bull Terriers are more likely to cause severe morbidity than other breeds of dogs. Immediate surgical exploration is required to prevent catastrophic outcomes, especially limb loss. Stronger animal control laws, public education and responsible dog ownership may reduce deaths from these canines.

Human fatalities caused by animal attacks: A six-year autopsy study

Deaths caused by animal attacks in urban as well as rural areas are rising. With dwindling forest cover and with more interaction of animals with humans in day-to-day life, we need to understand the reasons, manner and causes of these fatal events. We studied 151 cases of fatal animal/human conflicts and in particular, the manner and mechanism of causation of injuries with respect to different types of animals. In this region there were more fatal snake bites followed by cattle attacks. Humans are at some risk while in the vicinity of animals whether in the wild or in human settlements. Human/animal conflicts occur due to reducing habitat for animals and the demands of humans. One must be aware of the potential dangers from animals and as a health care provider it is our duty to educate the public at large. They need to be cautious when around animals, seek medical care after an animal injury and wear protective equipment when working around or with animals.

Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution

Dog bite injuries remain a common form of pediatric trauma. This single-institution study of 1616 consecutive dog bite injuries over 4 years revealed a much higher prevalence of dog bites as compared with other similar centers. Though inpatient admission was rare (9.8%), 58% of all patients required laceration repair, primarily in the emergency department. Infants were more than 4 times as likely to be bitten by the family dog and more than 6 times as likely to be bitten in the head/neck region. Children ≤5 years old were 62% more likely to require repair; and 5.5% of all patients required an operation. Pit bull bites were implicated in half of all surgeries performed and over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds. The relatively high regional prevalence and younger age of injured patients as compared with other centers is a topic of further study but should draw attention to interventions that can minimize child risk.

Reconstruction of face and scalp after dog bites in children

ABSTRACT Objective: to evaluate the immediate reconstruction of face and scalp after canine bites in children. Methods: we conducted a prospective series of cases treated at the Emergency Unit of the Asa Norte Regional Hospital, Brasília - DF, from January 1999 to December 2014. At the time of patient admission to the emergency, the primary wound closure of the face and scalp bite was performed, regardless of the time or day of the event. The primary treatment of the bites was by means of direct suture, flaps rotation or grafting, depending on the type of wound and surgeon's decision. Results: the study comprised 146 children, with the zygomatic region and scalp being the main sites of head bites. All patients received surgical treatment within the first 24 hours after admission. There were no infectious complications in the cases studied. Conclusion: the findings suggest that the immediate closure of canine bites on the face and scalp in children is safe, even when carried out several hours after injury.

A 51-year-old woman crushed by an elephant trunk

Wild and exotic animal attacks are not common in the United States. Animal-related injuries in the United States are usually caused by dog bites, followed by cattle and horse injuries. Exotic animal attacks can occur when the animals are provoked, depressed, or housed improperly by owners. We report the case of a 51-year-old woman who sustained multiple systemic traumatic injuries after she was pinned to a fence by an elephant's trunk. Upon arrival in the emergency department, she was hypothermic with a temperature of 35.1ºC (95.1ºF), hypotensive to 94/60 mm Hg after 5 L crystalloid, tachycardic at 108 beats/min, and intubated with oxygen saturation of 100%. Tranexamic acid was administered in addition to starting a massive transfusion protocol. Injuries included bilateral multiple rib fractures, left abdominal wall degloving injury, right pneumothorax, right hemothorax, left chest wall puncture wound, grade IV splenic laceration, 3 grade III liver lacerations, retroperitoneal hematoma, and degloving injuries to bilateral posterior thighs requiring more than 30 operations. Why should an emergency physician be aware of this? Several factors need to be considered when evaluating animal-related injuries, including type, age, and sex of the animal. Multisystem traumatic injuries should be assumed when a large animal is involved. Prehospital care and transport time are vital to a patient's survival in both urban and rural settings. During the initial resuscitation, administering antibiotics tailored to the specific animal can greatly decrease risk of infection and morbidity. Additionally, tetanus immunoglobulin, tetanus toxoid, and rabies immunoglobulin and vaccine may be needed, unless the victim has been previously vaccinated.

Risk factors for hospitalization after dog bite injury: a case-cohort study of emergency department visits

OBJECTIVES

Dog bite injuries may result in pain, infection, emotional distress, dysfunction, and disfiguration, as well as lead to costly health care utilization, such as emergency department (ED) visits, rabies postexposure prophylaxis, and hospitalizations. Although clinical care guidelines exist, to our knowledge risk factors for hospitalization after a dog bite injury have not been examined quantitatively. Quantifying the magnitude of association between modifiable risk factors, such as infection, and hospitalization after a dog bite injury may guide intervention efforts, improve patient outcomes, and reduce unnecessary hospitalizations.

METHODS

A case-cohort study was conducted to examine the association between the following risk factors and hospitalization: infection, complicated injury, host-defense abnormality, number of previous evaluations for the injury, and anatomic location of the bite. The case-cohort design was chosen because cases could be identified in a well-defined administrative cohort, medical record review was required for each study patient, and the risk ratio was the effect measure of interest. The cohort consisted of ED patients evaluated for dog bite injuries between January 1, 2000 and December 31, 2011, at a large academic medical center. Cases were cohort members who were admitted as inpatients directly from the ED. From the cohort, a simple random sample was selected for the subcohort comparison group. Data on risk factors, the outcome, and covariates were collected from ED medical records. Logistic regression models, informed by directed acyclic graphs, were used to describe the relationship between each risk factor and hospitalization. Effect measure modification was examined by patient sex and race for the relationship between previous evaluation for the dog bite injury and hospitalization.

RESULTS

Cases (n = 111) were more likely to be male, white, or insured by Medicaid than were members of the subcohort (n = 221). The most common type of complicated injury was tendon or ligament injury for cases and fracture for the subcohort. All factors evaluated were associated with increased risk of hospitalization after dog bite injury. Yet, infection at the time of ED visit (odds ratio [OR] = 7.8, 95% confidence interval [CI] = 3.8 to 16.0) and injury to multiple anatomic locations (OR = 6.0, 95% CI = 1.2 to 30.9) were associated with the largest relative risks of hospitalization. For every three ED visits for infected dog bites, one resulted in hospitalization. Having had one or more prior evaluations for the dog bite injury was associated with a lower risk of hospitalization for females than males and for whites than nonwhites.

CONCLUSIONS

This study provides a unique, quantitative examination of risk factors for hospitalization after dog bite injury. The relative risk of hospitalization associated with each factor was substantial. The strongest association was for a modifiable risk factor, infection. This finding may inform best practices for initial care of patients with dog bite injuries and the development of novel protocols for following patients to reduce infections and subsequent hospitalizations.

Methods used to estimate the size of the owned cat and dog population: a systematic review

Background

There are a number of different methods that can be used when estimating the size of the owned cat and dog population in a region, leading to varying population estimates. The aim of this study was to conduct a systematic review to evaluate the methods that have been used for estimating the sizes of owned cat and dog populations and to assess the biases associated with those methods.

A comprehensive, systematic search of seven electronic bibliographic databases and the Google search engine was carried out using a range of different search terms for cats, dogs and population. The inclusion criteria were that the studies had involved owned or pet domestic dogs and/or cats, provided an estimate of the size of the owned dog or cat population, collected raw data on dog and cat ownership, and analysed primary data. Data relating to study methodology were extracted and assessed for biases.

Results

Seven papers were included in the final analysis. Collection methods used to select participants in the included studies were: mailed surveys using a commercial list of contacts, door to door surveys, random digit dialled telephone surveys, and randomised telephone surveys using a commercial list of numbers. Analytical and statistical methods used to estimate the pet population size were: mean number of dogs/cats per household multiplied by the number of households in an area, human density multiplied by number of dogs per human, and calculations using predictors of pet ownership.

Conclusion

The main biases of the studies included selection bias, non-response bias, measurement bias and biases associated with length of sampling time. Careful design and planning of studies is a necessity before executing a study to estimate pet populations.

Dog bite injuries among American Indian and Alaska Native children

OBJECTIVE

To examine dog bites among American Indian (AI) and Alaska Native (AN) children visiting Indian Health Service and tribal health facilities.

STUDY DESIGN

We retrospectively analyzed hospitalizations and outpatient visits with a diagnosis of dog bite between 2001 and 2008 in AI/AN children aged <20 years. Rates of dog bite hospitalizations and outpatient visits were estimated by age group, sex, region, and number and location of open wounds using Indian Health Service data. Analyses of hospitalizations for the general US population aged<20 years used the Nationwide Inpatient Sample.

RESULTS

The average annual dog bite hospitalization rate was higher among AI/AN children in Alaska (6.1/100,000 population) and the Southwest region (5.3/100,000) compared with the general US child population (3.1/100,000; 95% CI, 2.9-3.3/100,000). The average annual outpatient visit rate in AI/AN children was highest in the Alaska (596.4/100,000), Southwest (540.0/100,000), and Northern Plains West (537.6/100,000) regions. The hospitalization rate was highest in both AI/AN and US males aged<5 years, and outpatient visit rates were highest in AI/AN males aged 5-9 years. Open wounds diagnoses were most commonly seen on the head, neck, and face in hospitalized children (45.5% of open wounds in AI/AN children, 59.3% in US children; SE, 1.0%) and on the leg in AI/AN outpatients (35.6%).

CONCLUSION

Dog bites represent a significant public health threat in AI/AN children in the Alaska, the Southwest, and Northern Plains West regions of the US. Enhanced animal control and education efforts should reduce dog bite injuries and associated problems with pets and stray dogs, such as emerging infectious diseases.

Animal-related fatalities--part I: characteristic autopsy findings and variable causes of death associated with blunt and sharp trauma

Animals may be responsible for an array of potentially lethal injuries. Blunt force injuries characteristically involve larger animals such as cattle or horses that may kick, crush, or trample a victim causing head and facial injuries. Farm workers in particular are at high risk of lethal injuries involving the head and torso. Significant blunt trauma may be found in vehicle occupants after collisions with large animals such as camels or moose. Rarely, zookeepers may be crushed by particularly massive animals such as elephants. Sharp force injuries usually involve carnivore bites, most often from dogs with a "hole and tear" pattern of wounding. Injuries from animals such as alligators and sharks may have a significant component of crushing. Incised wounds may result in death from exsanguination and air embolism. On occasion, blunt or sharp trauma from animal activity may be confused with postmortem damage or with inflicted injury from an assault.

Dog Bites to Children in the Czech Republic: the Risk Situations

The aim of this study was to analyse dog bites to children in the Czech Republic. Data were obtained from a questionnaire completed with children aged 4 to 13 years in 11 urban and rural primary schools. A total of 103 dog bites sustained by 92 children were analysed using chi square test and F test. There were 58 boys (56.3%) and 45 girls (43.7%) bitten, 57.3% of them once, 42.7% repeatedly. The evaluated answers showed that children were bitten when playing with own dogs (69.2%) or dogs known to them (30.8%) but not by unknown dogs (χ2= 25.397, df = 1,p< 0.001). Children were bitten outdoors by loose running unknown dogs (88.5%), known dogs (11.5%) but not by own dogs (χ2= 55.528, df = 2,p< 0.001). Thirty-two children were bitten indoors by small (53.1%), medium size (21.9) or large (25.0%) dogs. Small dogs were biting mostly indoors (51.5%), medium size (73.1%) and large (80.5%) dogs bit mostly outdoors (χ2= 9.0022, df = 2,p= 0.011). Most of the children that disturbed a resting or sleeping dog were bitten indoors (83.3%; χ2= 7.862, df = 1,p< 0.01), predominantly by small dogs (83.3%, χ2= 7.482, df = 2,p= 0.022). When stroking a dog, children were bitten by a medium size (45.5%), large (31.8%) or small dog (22.7%; χ2= 5.588, df = 2,p< 0.068). Children injured by their family-owned dog had accidentally caused pain to it before being bitten (83.3%; χ2= 7.862, df = 1,p< 0.012).These children were always bitten by a small dog (χ2= 7.482, df = 2,p= 0.022). Three children reported deliberately causing pain to a dog – these were all small dogs (100.0%; χ2= 6.279, df = 2,p< 0.05). Children teasing dogs were bitten most frequently by a small dog (75.0%; χ2= 6.98, df = 2,p< 0.032). Male dogs bit more frequently (66.7%) than females (33.3%; χ2= 6.338, d.f. =1,p= 0.014). These data were the first ones obtained from the bitten children. They suggest that in interactions with own, known and small dogs, children were more daring. The personal space of dogs, their warning signals, and defence were underestimated, the resulting aggression was mostly of possessive, territorial and fear type. Additional suggestions are made to complete the information on preventive measures for parents, children and the public. Importantly, all information types should point out that the dog remains a predator despite its long domestication history and close co-existence with humans.