Emergency department visits for dog bite injuries in Missouri municipalities with and without breed-specific legislation: a propensity score-matched analysis

Breed-Specific Legislation is a type of law that bans or restricts ownership of specific dog breeds. Some local governments - including over seventy municipalities in the state of Missouri - have enacted Breed-Specific Legislation to prevent injuries from dog bites. Several studies from the peer-reviewed literature have found that aggressive behavior is not associated with any particular dog breeds and, since 2018, at least a dozen municipalities in Missouri have repealed these laws. To evaluate the impact of Breed-Specific Legislation on public safety, the 2010-2015 rates of emergency department visits for dog bite-related injuries in Missouri municipalities with and without Breed-Specific Legislation were compared. Propensity-score matched negative binomial regression models were used to assess the effect of breed restrictions on injury rates while balancing the samples on population characteristics and estimates of dog ownership. After matching the sample on population, housing and dog ownership estimates, no association was found between emergency department visits for dog bite injuries and whether the municipality enacted Breed-Specific Legislation. However, the incidence rate ratio of emergency room visits for dog bite-related injuries increased by 13.8% for every 1% increase in the percentage of males aged 5 to 9 in the population (p < 0.01). This study has found breed discriminatory laws have not reduced the risk of emergency department visits for injury from dog bites in Missouri. There appears to be no greater risk to public safety as local governments move to repeal existing breed bans.

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.

The Use and Structure of Emergency Nurses' Triage Narrative Data: Scoping Review

BACKGROUND

Emergency departments use triage to ensure that patients with the highest level of acuity receive care quickly and safely. Triage is typically a nursing process that is documented as structured and unstructured (free text) data. Free-text triage narratives have been studied for specific conditions but never reviewed in a comprehensive manner.

OBJECTIVE

The objective of this paper was to identify and map the academic literature that examines triage narratives. The paper described the types of research conducted, identified gaps in the research, and determined where additional review may be warranted.

METHODS

We conducted a scoping review of unstructured triage narratives. We mapped the literature, described the use of triage narrative data, examined the information available on the form and structure of narratives, highlighted similarities among publications, and identified opportunities for future research.

RESULTS

We screened 18,074 studies published between 1990 and 2022 in CINAHL, MEDLINE, Embase, Cochrane, and ProQuest Central. We identified 0.53% (96/18,074) of studies that directly examined the use of triage nurses' narratives. More than 12 million visits were made to 2438 emergency departments included in the review. In total, 82% (79/96) of these studies were conducted in the United States (43/96, 45%), Australia (31/96, 32%), or Canada (5/96, 5%). Triage narratives were used for research and case identification, as input variables for predictive modeling, and for quality improvement. Overall, 31% (30/96) of the studies offered a description of the triage narrative, including a list of the keywords used (27/96, 28%) or more fulsome descriptions (such as word counts, character counts, abbreviation, etc; 7/96, 7%). We found limited use of reporting guidelines (8/96, 8%).

CONCLUSIONS

The breadth of the identified studies suggests that there is widespread routine collection and research use of triage narrative data. Despite the use of triage narratives as a source of data in studies, the narratives and nurses who generate them are poorly described in the literature, and data reporting is inconsistent. Additional research is needed to describe the structure of triage narratives, determine the best use of triage narratives, and improve the consistent use of triage-specific data reporting guidelines.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2021-055132.

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.

Demographic and urban environmental variables associated with dog bites in Detroit

OBJECTIVE

To identify demographic and urban environmental variables associated with prevalence rates of dog bites per zip code in Detroit.

DESIGN

Retrospective ecological study.

SAMPLE

6,540 people who visited any 1 of 15 hospital emergency rooms in the 29 zip codes in Detroit between January 1, 2006, and December 31, 2013, with a primary complaint of dog bite.

PROCEDURES

The number of dog bites over the study period was determined per zip code. Data for the human population in each zip code in 2011 and demographic and urban environmental variables were obtained from federal, state, and municipal databases. The prevalence rate of dog bites in each zip code was calculated, and regression analysis was used to identify variables associated with this outcome.

RESULTS

Results of multivariate analysis indicated that demographic variables (eg, gender, age, and education) accounted for 23.2% (adjusted R² = 0.232) of the variation in prevalence rates of dog bites per zip code, whereas urban environmental variables (eg, blight, crime with weapons, and vacancy rate) accounted for 51.6% (adjusted R² = 0.516) of the variation.

CONCLUSIONS AND CLINICAL RELEVANCE

Findings suggested that demographic variables had poor association with variation in prevalence rates of dog bites per zip code, whereas urban environmental variables, particularly crime, vacancy rate, and blight, were better associated. Thus, public health and education policies need to address these urban environmental issues to lower the prevalence of dog bites in distressed urban areas.

Preventing Dog Bites: It Is Not Only about the Dog

Simple Summary

Dog bites can have an array of negative health impacts on human victims. Research on the correlates of bites focused on limited sets of variables and produced conflicting findings. Data were drawn from police department reports of dog bites in the city of Detroit between 2007–2015. This project expands knowledge about the correlates of dog bites by exploring a comprehensive set of variables related to the breed type of dog, the nature of its surroundings, and the circumstances surrounding the bite. The greatest risk of bites does not come from wandering feral dogs, nor is it primarily related to the nature of the victim. Based on multiple regression, the victim was most likely bitten in their own yard by a single neighborhood dog that escaped from its home or yard. Human error often contributes to bites.

Abstract

Background: Dog bites can have an array of negative health impacts on victims. Research focusing on the correlates of bites focused on limited sets of variables and produced conflicting findings. Objective: To expand knowledge about the correlates of dog bites by exploring a comprehensive set of variables related to the nature of the dog and the circumstances surrounding the bite not commonly explored in extant research. Methods: Data were drawn from police department reports of dog bites in the city of Detroit between 2007–2015; 478 dog bites were reported. Multiple regression was used to determine the significant correlates of dog bites, focusing on the nature of the dog and the circumstances surrounding the bite. Results: Bites were caused by a neighborhood dog. Thirty-two percent of the reports involved dogs running loose; 25% dogs that had escaped from a fenced or unfenced yard; 9% escaped from their home; and 8% had broken off a chain, were being walked, or were in their own home. Based on multiple regression, the victim was most likely bitten in their own yard by a single neighborhood dog that escaped from its home or yard. Breed of dog was not correlated with bites in multiple regression. Conclusions: The greatest risk of bites does not come from wandering feral dogs. Based on multiple regression, the victim was most likely bitten in their own yard by a single neighborhood dog that escaped from its home or yard. Human error often contributes to bites.

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.

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.

The demographics of dog bites in the United States

Dog bites are a significant public health issue. There is no comprehensive study of dog bite demographics. It was the purpose of this study to perform such an analysis across the US. The National Electronic Injury Surveillance System All Injury Program data for the years 2005 through 2013 was accessed; dog bite injuries were extracted and analyzed. Statistical analyses were performed with SUDAAN 11.0.01™ software to account for the weighted, stratified nature of the data. Incidence values were calculated using population data from the US Census Bureau. A P < 0.05 was considered significant. There was an average 337,103 ED visits each year for dog bites. The average age was 28.9 years; 52.6% were male and 47.4% female. The bites were located on the upper extremity in 47.3%, head/neck in 26.8%, lower extremity in 21.5%, and trunk in 4.4%. Younger patients had more bites involving the head/neck, while older patients the upper extremity. More occurred in the summer and on weekends and 80.2% occurred at home. Hospital admission occurred in 1.7%. Logistic regression analysis demonstrated that the odds of admission was solely dependent upon the age group. The OR for admission was 11.03 [4.68, 26.01] for those >85 years of age, 4.88 [2.89, 8.24] 75–84 years, and 2.79 [1.77, 4.39] those ≤4 years of age, with the 10–14 year age group the reference group. The average annual incidence was 1.1 per 1,000, and was slightly higher in males (1.18 vs 1.02 per 1,000). The estimated cost was at least 400 million US$ per year. Potential prevention strategies are educational programs directed at both children and parents/caretakers outlining the responsibilities of owning a dog. This information can be disseminated in health care facilities, radio/TV/Internet venues, and dog kennels/shelters.

Use of syndromic surveillance data to monitor poisonings and drug overdoses in state and local public health agencies

BACKGROUND

The incidence of poisoning and drug overdose has risen rapidly in the USA over the last 16 years. To inform local intervention approaches, local health departments (LHDs) in North Carolina (NC) are using a statewide syndromic surveillance system that provides timely, local emergency department (ED) and Emergency Medical Services (EMS) data on medication and drug overdoses.

OBJECTIVE

The purpose of this article is to describe the development and use of a variety of case definitions for poisoning and overdose implemented in NC's syndromic surveillance system and the impact of the system on local surveillance initiatives.

DESIGN, SETTING, PARTICIPANTS

Thirteen new poisoning and overdose-related case definitions were added to NC's syndromic surveillance system and LHDs were trained on their use for surveillance purposes. Twenty-one LHDs were surveyed on the utility and impact of these new case definitions.

RESULTS/CONCLUSIONS

Ninety-one per cent of survey respondents (n = 29) agreed or strongly agreed that their ability to access timely ED data was vital to inform community-level overdose prevention work. Providing LHDs with access to local, timely data to identify pockets of need and engage stakeholders facilitates the practice of informed injury prevention and contributes to the reduction of injury incidence in their communities.

A Comparative Study of Dog- and Cat-Induced Injury on Incidence and Risk Factors among Children

Background: Millions of people are bitten by animals each year, with approximately 90% of the injuries being caused by dogs and cats. However, few studies focus on risk factors of dog- and cat-induced injury in China. Therefore, the objective of this study was to investigate the rate of dog- and cat-induced injury and its potential risk factors. Methods: The data were from a population-based cross-sectional study conducted in 2015, with a sample of 9380 children 6-19 years of age from two cities, Shenzhen (large city) and Shantou (mid-sized city), in southern China. Multivariate logistic regression models were used to identify the risk factors of injury by dogs and cats. Results: The total rates of dog and cat-induced injury were 15.1% and 8.7% during the lifetime, and 3.4% and 1.7% during the past year, respectively. Dog bites mostly occurred in the dog's residence (49.4%). Cat scratches were more likely to be inflicted by one's own cat (47.5%). Children living in suburban and island county had 2.83 times and 2.53 times more dog-related injuries than central urban children, respectively. After stratification by cities, injuries in Shantou were correlated with non-single child families (OR (odds ratios), 1.46; 95% CI (95% confidence interval), 1.09-1.96) and raising cats (OR, 5.34; 95% CI, 3.88-7.35). Those who disliked animals (OR, 0.62; 95% CI, 0.45-0.88) or had good academic performance (OR, 0.46; 95% CI, 0.35-0.60) had lower risk for injury. Injuries in Shenzhen were related to the mother's educational level (OR, 1.51; 95% CI, 1.11-2.07) and mother being a migrant worker (OR, 2.10; 95% CI, 1.12-3.94). Conclusions: Family factors were important to predict dog- and cat-induced injury among children from Shenzhen, and personal factors were closely associated with injury among children form Shantou.

Burden of Bites by Dogs and Other Animals in Los Angeles County, California, 2009-2011

OBJECTIVES

The objective of this study was to analyze all animal-to-human bite reports during a 3-year period from a regional surveillance database. Results helped to inform local efforts to reduce and prevent animal-to-human bites.

METHODS

We reviewed all cases of animal-to-human bites occurring from 2009 through 2011 that were reported to the Los Angeles County Department of Public Health's Animal Bites Database. We collected data on the bite victim's date of birth, age, and address; bite circumstances (ie, date, time, location, how bite occurred); anatomic site and treatment of bite; type of reporting facility; and breed and management of biting animal.

RESULTS

From 2009 through 2011, 26   169 animal-to-human bites were reported, of which 23   103 (88%) were dog bites. Most animal-to-human bites (n = 7673, 29%) occurred between 4 pm and 8 pm and peaked during the month of July (n = 2663, 10%). Most animal-to-human bites occurred outdoors (n = 8772, 34%) and while victims engaged in recreational activities (n = 4353, 17%). The hands were the most common injury site (n = 9130, 35%), and only 1% of animal bites (n = 267) resulted in hospitalization. A total of 4115 bite victims (16%) received tetanus vaccinations. Of all animal-to-human bite cases, medical organizations reported 13   451 (51%), and animal control agencies reported 10   682 (41%).

CONCLUSIONS

Animal-to-human bites can often lead to medical complications. Surveillance is essential in helping to identify, manage, and reduce these highly preventable injuries and direct public health actions and policies on animal bite risk and prevention.

Emergency department presentations with mammalian bite injuries: risk factors for admission and surgery

OBJECTIVES

The incidence of animal bite injuries in Australia is high. There is currently no established method for reliably predicting whether a patient with a bite injury will require admission to hospital or surgery.

DESIGN

A retrospective audit of mammalian bite injuries at seven major hospitals in Melbourne, Victoria, over a 2-year period. The associations between each predictor and outcome of interest were analysed with univariate and multiple regression analyses.

SETTING

Seven major hospitals in Melbourne, Victoria: the Alfred Hospital, Austin Hospital, Frankston Hospital, Monash Medical Centre, Royal Melbourne Hospital, St Vincent's Hospital and Western Hospital.

PARTICIPANTS

Patients presenting to emergency departments with mammalian bite injuries.

MAIN OUTCOME MEASURES

Hospital admission, intravenous antibiotic therapy, surgery, reoperation, readmission.

RESULTS

We identified 717 mammalian bite injuries. The mean age of the patients was 36.5 years (median, 34 years; range, 0-88 years), with an equal number of males and females. The overall rate of hospital admission was 50.8%, and the mean length of stay was 2.7 days. Intravenous antibiotics were administered in 46% of cases; surgery was undertaken in 43.1% of cases. The re-operation rate was 4.5%, the re-admission rate was 3%.

CONCLUSIONS

Our study provides a detailed epidemiological analysis of animal bite injuries at seven major hospitals in Victoria. Risk factors for hospitalisation and surgery may assist in identifying patients who require admission and surgical intervention.