Dog Bite Injuries In Children Research Articles

Retrospective Analysis of Dog Bite Injuries in Children with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) may suffer a dog bite injury, but the frequency and its clinical impact is unknown. We sought to evaluate the (1) subject characteristics; (2) injury type; (3) clinical care provided; and (4) mortality in children with ASD who suffer a dog bite injury. We hypothesized that children with ASD have higher mortality and require more clinical care than children without ASD. This is a retrospective observational cohort study utilizing the TriNetX ® EHR database of subjects aged 0 to 18 years with dog bite diagnostic codes. Data were analyzed for demographics, diagnostic, medication, procedural codes, and mortality. We analyzed 38,337 subjects (n, %) coded for a dog bite injury [619 (1.6%) with ASD and 37718 (98.4%) without ASD]. Children with ASD had a higher odds of a traumatic injury to the head [1.34 (1.15, 1.57), p < 0.0001] compared to those without. There was no difference in critical care services, hospitalization, mechanical ventilation, and rabies vaccine administration. All-cause mortality at 1 year was low with no deaths reported within the ASD cohort and 37 (0.1%) deaths reported within the no ASD cohort. Children with ASD that suffer dog bite injuries have similar clinical needs to children without ASD but are more likely to suffer a traumatic injury to the head. Future studies are needed to better understand inciting factors for injuries in this population.

Domestic dog attacks on livestock referred to a Veterinary Teaching Hospital.

Losses and the economic impact of dog attacks (DAs) on livestock are often overlooked and include factors such as decreased production, expenses for treatment and handling, and death of injured animals. This study evaluated the epidemiological, therapeutic, and pathological findings of DAs on livestock over an 11-year survey using the records of farm animals referred to a Veterinary Teaching Hospital. Livestock attacked by dogs included 31 sheep, 11 horses, 3 cattle, 3 goats, and 2 pigs, totaling 50 animals. Anatomical locations injured by dog bites were identified as head/neck, thoracic/pelvic limbs, abdomen/flank, rump/tail, and multiple affected regions (two or more bite sites). Additionally, the severity of the injuries was classified into four degrees adapted from the classification of dog bite injuries in children. Most livestock presented Grade 1 (26%) and Grade 2 (28%) injuries, while Grade 3 and Grade 4 injuries were observed in 46% of DAs. Furthermore, 35 animals (70%) were discharged, 9 (18%) died, and 6 (12%) were humanely euthanized. DAs may represent a significant cause for referring livestock species to clinical care, severe injuries, and a considerable number of deaths. In this study, we provide information regarding DAs on livestock for the first time in Midwestern Brazil.

Dog bite injuries in children seen at a tertiary care hospital in Bolivia.

Introduction. The objective of this study is to describe the characteristics of dog bite injuries in children seen at a children's hospital in Bolivia. Population and methods. This was an observational, retrospective study in patients seen between 2017 and 2021. Results. A total of 769 patients were studied. Dog bite injuries accounted for 5.6% of emergency visits and 0.8% of hospitalizations. They were more frequent in children younger than 5 years (55.1%), in whom the following were observed: greater injury severity (p = 0.008), history of animal provocation (p = 0.048), known attacking animal (p < 0.036), domestic accident (p = 0.021), greater frequency of post-exposure prophylaxis with anti-rabies serum (p = 0.005), and maxillofacial area as the main region involved (p < 0.001). There were 3 deaths due to human rabies and 1 due to hypovolemic shock. Conclusion. Dog bite injuries are a frequent cause of visit to the emergency department and hospitalization in pediatrics and have specific characteristics in children younger than 5 years.

Caution: aggressive! Dog bite injuries in clinical forensic medicine

Younger children in particular are at risk of becoming victims of dog attacks due to their small size. Such abiting incident can fulfil various criminal offences. In order to be able to satisfy possible legal claims, the injuries should be documented by forensic medicine and thus be legally binding. Therefore, close cooperation between the treating surgeons and forensic experts is recommended. Aretrospective analysis of the cases of dog bite injuries in children and adults treated by clinical forensic medicine at the University Medical Center Rostock was carried out under various aspects. Adult casualties were predominantly injured on the lower extremities. The children examined were predominantly bitten on the head, neck and face region as well as the upper extremities. Injury severity ranged from skin redness to severe substance defects with loss of body structures. The biting dog was known in about half of the cases. In order to avoid dog bites in children, parents as well as children should be trained in dealing with dogs.

COVID-19 pandemic and lockdown increase the frequency and severity of periorbital dog bite injuries in children.

ObjectiveTo determine whether the COVID-19 pandemic and lockdown increase the risk of head, neck, and face (HNF) dog bite injuries in children.MethodsUsing a retrospective cohort study design, the investigators enrolled a sample of children presenting with HNF dog bite injuries during 22 weeks before and 22 weeks during the COVID-19 pandemic in a German level 1 trauma center. The predictor variables were COVID-19 pandemic and lockdown. The outcome variables were grouped into demographic, anatomic, injury-related, and therapeutic. Appropriate statistics were computed, and statistical significance was set at P ≤ .05.ResultsThe sample included 36 subjects (19.4% girls; 97.2% Caucasians; 50% isolated periorbital injuries; 61.1% during the lockdown; 16.7% after the lockdown) with an average age of 8 ± 3.3 years. Compared to the pre-COVID-19 period, pediatric HNF dog bite injuries increased ca. 5.5- and 1.5-fold during and after the lockdown, respectively. The COVID-19 pandemic was significantly associated with severe household injury from a pet dog, number of inpatients and treatments in the operating room, and prolonged hospitalization. Isolated periorbital injury was common during the COVID-19 pandemic (P = 0.04; relative risk [RR], 4.86; 95% confidence interval [95% CI], 0.76 to 31.12), especially during the lockdown (P = 0.02; RR, 4.36; 95% CI, 0.72 to 26.6).ConclusionDuring the COVID-19 pandemic, especially during the lockdown, there is an increasing tendency of frequency and severity of domestic HNF dog injuries in children, and periorbital region is the most injury-prone.

Frequency, Pattern and Management of Dog Bite injuries in Children in a Developing Country

Aims: To collect and analyze data regarding frequency, pattern, and management of dog bite injuries in children so that it can be reported to health authorities to launch preventive measures plan against dog bite trauma in children and make sure availability of immunoglobulin and vaccine in proper quantity at proper place to prevent its misuse and expiry. Study design: Observational descriptive study. Setting: Department of Pediatric Surgery King Edward Medical University/ Mayo Hospital Lahore. Duration of study: One year from January 2018 to December 2018. Methods: All patients with dog bite injuries admitted through emergency in department of Pediatric Surgery King Edward Medical University/ Mayo Hospital Lahore were included in the study. Demographic data regarding age, gender, mechanism and severity of dog bite trauma and management recorded on detailed Performa. Results: During one year period a total of 445 patients with dog bite injuries presented in pediatric surgical emergency. Out of these 37.8% patients were admitted and 62.2% patients with minor injury were discharged on same day after proper wound management and vaccination in emergency department. Majority were males and most common age at presentation was from 4-8 years. Conclusion: As dog bite injuries are preventable so there is need to give education to children and families about preventive measures against dog bite injuries and proper treatment like immunoglobulin and vaccination. Keywords: Dog bite trauma, children, Frequency, management

Child safety programs for primary school children decrease the injury severity of dog bites

This study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994–2003 to 9.0% in the period between 2014 and 2018 (p < 0.05).Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites.What is Known:• Dog bites are a substantial healthcare problem especially in children.What is New:• This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.

An Epidemiological Analysis of Pediatric Dog Bite Injuries Over a Decade

BackgroundAn estimated 800,000 dog bites require medical attention every year. The purpose of this study is to review the characteristics of dog bite injuries in children and examine temporal trends. MethodsThe Kids’ Inpatient Database was used to identify pediatric patients with dog bite injuries over a 10-y period. Demographic data, primary payer, injury characteristics, length of hospitalization, and treatments were recorded. Statistical analysis was performed in SAS 9.3 (SAS Institute Inc, Cary, NC). ResultsA total of 6308 patients were identified. Average age at time of injury was 6.4 ± 4.3 y. Children under age 5 y were the most affected subgroup (39.3% in 2000 versus 44.7% in 2009, P < 0.001). Most bites were to the head/neck and significantly increased from 53.9% in 2000 to 60.1% in 2009. Cellulitis complicated many injuries (33.7% in 2000 versus 44.8% in 2009, P < 0.001). Overall, 50% of patients underwent a procedure; 31% had an invasive surgical procedure; and 5.1% of patients required skin grafts or flaps. ConclusionsDog bites are a common cause of pediatric injuries and are a significant burden on families and the health care system. Evaluating the characteristics of these injuries can guide educational efforts.

Microvascular Replantation Following Facial Dog Bites in Children: Systematic Review and Management Algorithm.

Pediatric dog bite injuries account for 1% of emergency department visits per year and represent an underrecognized and underreported public health problem. Reconstructive surgery is frequently utilized, and in the most extreme injuries, microvascular replantation may be considered. We sought to systematically review the available literature on microvascular replantation after facial dog bite injuries in children, with particular attention to perioperative morbidity and long-term follow-up. We reviewed a case of microvascular replantation after a facial dog bite injury in a child from our own institution and conducted a systematic literature search to identify other similar reports. Clinical variables were collected from the reported cases, and descriptive statistics were calculated. A management algorithm was developed from the reviewed published experience. We report the youngest child to date in the literature to undergo replantation after a facial dog bite injury. Nineteen other cases were found involving children aged 18 months to 17 years, with follow-up ranging from 2 weeks to 28 years. Anastomosis techniques varied considerably and included both an artery and vein in only 9 (47%) of 19 cases. Venous congestion was nearly universal, and multimodal techniques were used until native venous outflow was reestablished. Blood transfusion was common, but intensive care unit utilization was not frequently reported. Long-term outcomes were excellent, with growth of the replanted part and recovery of function; however, minor revision procedures were common. Microvascular replantation following facial dog bite amputation injuries in the pediatric population is the ultimate step in the reconstructive ladder. Strong consideration should be given to microvascular exploration with involvement of large or whole segments of the lip, nose, or ear; however, parents should be counseled extensively regarding the known morbidity of replantation surgery. With meticulous surgical technique and careful postoperative care, replantation after facial dog bite amputation injuries may successfully achieve dramatic and lasting results for pediatric patients.

A Community based cross sectional study of dog bites in children in a rural district of Tamil Nadu

Background: Worldwide dog bites are becoming a significant public health problem and the annual frequency of dog bite injuries in children is estimated to be 22 per 1000 children of which less than half of them are reported in medical facilities. Objective: To study the period prevalence of dog bites in children, its risk factors and treatment seeking behavior. Materials and Methods: The present cross sectional study was conducted in field practicing areas of rural health centre covering 4150 households in 34 villages involving 5841 children. Data was collected by trained medical interns and social workers. Collected data was entered and analyzed using EPI_INFO software (3.5.3). Result: The period prevalence of dog bites episodes in last one year is 17.9 per 1000 children. Most of bites happened in male children (51.5%), less than 10 years of age (56%), and children below poverty line (80%). Almost 78% of bites are unprovoked and the most common place of bites is in and around the house (70%). The most common site of bite is lower limb (53.6%) followed by upper limb (27.6%). The most common treatment source for bites is primary health centre followed by traditional faith healers. Almost 67% of wounds belonging to class 3 wounds but only 4% of dog bite victims received immunoglobulins. Conclusion: Period prevalence of dog bites is high and it is common in children belonging to poor socioeconomic conditions. In a country with very high population of unvaccinated dogs, health education program focusing on prevention of dog bites, correct methods of local wound treatment, vaccine, and rabies immunoglobulin’s are needed.

Dog bite injuries in children: Clinical implications for head involvement

Background Given the popularity of dogs in the United States, children with dog bite injuries represent a significant health concern. While dog bite injury in any area of the body can lead to significant morbidity and potential mortality, dog bite injury to the head tends to occur in younger children and leads to more significant pathology. Methods This study presents data obtained from retrospective analysis of a trauma database from a single, urban pediatric hospital system. Data were gathered over more than eight years and includes 236 patients. We examined patient demographics, dog breed involved, hospital course and treatment, infection rate, antibiotic use, and disposition. Results Of the 236 total patients, 174 patients had head involvement with the injury. The dog involved tended to be an animal owned by a family member or family friend. Patients who had head involvement tended to be younger than those without head involvement. Head injury correlated with a significant increase in the number of surgeries required. The two deaths were exclusively in children under three months of age who had head involvement. Patients given antibiotic prophylaxis with amoxicillin/clavulanic acid were associated with a lower rate of post-injury infection than patients on other forms of antibiotic prophylaxis, and patients treated without antibiotic prophylaxis had a lower infection than those treated with prophylactic antibiotics. Conclusions Dog bites in children represent a significant, preventable cause of morbidity and mortality. Our data suggest that young children are especially vulnerable and dog–child interactions should be monitored closely, even when the dog is familiar to the child.

Retrospective review of dog bite injuries in children presenting to a South Australian tertiary children's hospital emergency department.

To describe the characteristics, circumstances and consequences of dog bite injuries in children in order to inform the discourse concerning preventative approaches. A retrospective review of children presenting to the emergency department (ED) of the Women's and Children's Hospital (WCH) in South Australia between the years 2009 and 2011 was performed. A total of 277 children presented to the WCH with dog bite injuries between 2009 and 2011. Of those, 141(51.0%) were referred for admission. Injury rates were highest in those aged 0-4, declining thereafter with age. In the 0-4 year age group, 89.5% of children presented after being bitten by a familiar dog with 92.5% occurring at home. The head/neck region constituted the most common location for injuries. We found that 67.5% of dog bite injuries were provoked and occurred between the child and a familiar dog (78.0%). Dogs from the bull terrier group (20.0%) and Jack Russell Terriers (11.0%) were the two most documented breeds. Almost half of the children presenting during the specified timeframe required at least one operation under a general anaesthetic. Two children were referred to a psychologist for management of post-traumatic stress. Dog bite injuries are common in children and often require admission for inpatient care. This presents as a significant public health burden. For this reason, prevention initiatives need to be implemented on an ongoing basis.

Facial Dog Bite Injuries in Children

Dog bite injuries to a child's face are not an infrequent occurrence. They may require primary and revisional surgery. All result in permanent facial scars. This report describes the treatment and outcomes of dog bites of the face, scalp, and neck based on a case series of 107 children over a 10-year period.The average children's age was 5.9 years. In cases where the dog was identified (95%), it was known to the victim and their family. The events leading to the dog bite were categorized as provoked (77%) in the majority of the cases.The majority of wounds could be closed primarily without a significant risk of wound infection. Complex reconstructions were required in more severe cases. The majority of families (77%) opted for scar revision between 9 and 18 months after initial treatment to improve the aesthetic outcome.Lawsuit actions resulted in 39 of the cases making good documentation an essential part of treatment. Dogbite injuries to the face in children frequently require multiple scar revisions to obtain the best possible aesthetic outcome, and the family should be so counseled at the onset of treatment.

Primary Repair of Facial Dog Bite Injuries in Children

The management of dog bite wounds is controversial, and current data on risk of infection are variable and inconsistent. Furthermore, the use of prophylactic or empiric antibiotics for the treatment of these wounds is debatable. We investigate the rate of wound infections and other complications after primary repair of pediatric facial dog bite injuries. We reviewed 87 consecutive patients aged 18 years or younger who had facial dog bite injuries from January 2003 to December 2008. Variables examined were age, sex, setting of repair, number of sutures used for repair, whether surgical drains were used, and antibiotic administration. End points measured were incidence of wound infection, need for scar revision, and any wound complications. The mean age of patients was 6.8 years, and the majority were women (53%). All facial injuries were primarily repaired at the time of presentation either in the emergency department (ED; 46%), operating room (OR; 51%), or an outpatient setting (3%). All patients received an antibiotic course, none of the patients developed wound infection, and no subsequent scar revisions were performed. Three patients repaired in the OR underwent placement of a total of 4 closed-suction drains. The mean (SD) age of patients repaired in the OR was significantly younger than those repaired in the ED (5.7 [3.9] vs 8.0 [4.5] years, respectively; P < 0.01). The number of sutures used were greater for patients repaired in the OR than in the ED (66.4 [39.6] vs 21.7 [12.5], respectively; P < 0.01). Intuitively, younger patients and patients with greater severity injuries are more likely to undergo repair in the OR, and this was supported by our data. Overall, we found that primary repair of pediatric facial dog bite injuries, including complex soft-tissue injuries, is safe when performed in conjunction with antibiotic administration; however, further cross-specialty studies are needed to fully characterize these end points in a larger population.

O.460 Relevance of primary treatment of dog bite injuries in children

Thailand is a canine rabies endemic country with an annual prevalence above 1000 reported animals diagnosed rabid [1]. Over 345,000 humans are treated for possible rabies exposures annually [2]. Lack of perception of the disease burden, social, cultural and traditional beliefs play an important role in the failure of canine rabies control. It is unfortunate that health care budgets are increasingly allocated to human post-exposure treatment rather than to the eradication of rabies in the canine animal vector. Children under the age of 15 years represent up to one-half of dog bite victims and of human rabies deaths, but accurate data of dog bite prevalence are not available [3], [4], [5], [6]. Large scale pre-exposure immunization of children has been advocated but financial and logistic barriers have hindered implementation. This study analyzes direct medical costs of pre-exposure vaccination (PREP) as a human rabies preventive strategy, against the cost of post-exposure prophylaxis (PEP) in Thai children. Three pre- and post-exposure vaccine regimens are in use and this impacts on cost calculations. It was found that costs of both strategies, PREP of children or PEP of exposed, become equal when the dog bite incidence is 2–30%; depending on which post-exposure treatment regimens (PEP) are used.

Dog bite injuries in children--a review of data from a South African paediatric trauma unit.

Dog bites are a major cause of preventable traumatic injury in the paediatric population. We aimed to determine the epidemiology of dog bite injuries in a group of South African children with a view to developing potential preventive strategies. A retrospective review was done of patients presenting with dog bite injuries to the trauma unit at the Red Cross War Memorial Children's Hospital in Cape Town over a 13.5-year period. We identified 1,871 children treated for 2,021 dog bite injuries during the study period. Dog bites accounted for 1.5% of all trauma unit presentations. Male children accounted for 68% of the patients. Children under 6 years of age were more likely to have sustained injuries to the head, face or neck, while children older than 6 years more commonly received injuries to the perineum, buttocks, legs or feet. Younger children were more likely to be attacked at home and older children outside the home. The most frequent injuries were superficial, and the majority of patients were treated with simple medication, dressing or suturing. There were no dog bite-related fatalities. The relationship between the geographical location of dog attacks on children and the age groups attacked suggests that strategies to prevent dog bites should target both parents supervising younger children at home, and older children who encounter dogs outside the home.

Issues Associated With Dog Bite Injuries in Children and Adolescents Assessed at the Emergency Department

The aim of this study was to determine the pattern of dog bites seen at the emergency department of a university hospital. The information will be used to plan prevention and enhance management strategies. All patients (younger than 22 years) assessed at the emergency department between January 2003 and December 2004 with a discharge diagnosis of animal bites were identified through the computerized discharge network. One hundred forty-four incidents of animal bites (82 males and 62 females) occurred over the 2-year period. Eighty-nine percent was due to dog bites. Among the dog bite victims, the mean age was 11.82 years (SD, 6.39 years; range, 0.06-21.83 years). Family dogs were only involved in 15% of cases. The species of dogs were not recognized in three fifths, and attacks provoked in two fifths of victims. Most bites (90%) of bites involved only single anatomical sites. The extremities were commonly involved (right upper limb [23%], left upper limb [16%], right lower limb [35%], left lower limb [20%]). Torso (4%) and genitalia (0.8%) were uncommonly involved. Pain, erythema, bleeding, and bruising were common symptoms, but 60 patients were asymptomatic at presentation. Compared with older patients, children younger than 10 years had a much higher risk of facial injuries (25% vs. 2%, P = 0.0002; odds ratio, 21.8, 95% confidence interval, 2.9-455.9) and were more likely to be triaged as being urgent (P = 0.01). Most attacks were trivial and did not require hospitalization. Antirabies treatment was given in approximately half, analgesics in two fifths, and antibiotics in one fourth. In mammalian attacks, canines are most commonly involved. Most injuries are trivial, and the limbs are usually involved. However, younger children are at higher risk of facial injuries. Extent of pain and adverse psychological impacts are typically not documented in the emergency assessment.

Surgical Delay in the Management of Dog Bite Injuries in Children, Does It Increase the Risk of Infection?

Surgical Delay in the Management of Dog Bite Injuries in Children, Does It Increase the Risk of Infection?

Surgical delay in the management of dog bite injuries in children, does it increase the risk of infection?

Dog bites are contaminated wounds and convention dictates that any surgical treatment should be performed at the earliest opportunity. This practice, however, may be in direct conflict with NCEPOD guidelines to reduce night time operating. We audited our treatment of dog bite injuries in children over a 5-year period (1998-2002) to determine whether delaying surgery to conform to operating guidelines increased the incidence of infection. A retrospective case note study identified 118 patients admitted to Sheffield Children's Hospital with dog bite injuries. Details of their injury, treatment and outcome were recorded. There were 70 males and 48 females and an average age of 6.6 years (range 1-15 years). The most common type of injury was a single laceration (32%) and the most frequent site of injury was the face (59%). The majority of wounds (68%) were cleaned and dressed before theatre and 89% were closed directly after minimal debridement. All patients received prophylactic antibiotics. Of the 114 patients that required surgery, 57 (50%) were operated on within 12 h of their injury and 57 (50%) after 12 h. There were three cases of infection in the early group (<12 h) and none in the delayed group (>12 h). We suggest that delaying the surgical treatment of dog bites in children to avoid operating at night does not increase the infection rate.

Treatment of facial dog bite injuries in children: A retrospective study

Purpose: The authors assess their approach to immediate surgical repair with general anesthesia of facial dog bites in children over a 10-year period in their pediatric department. Methods: The authors reviewed a series of 100 children (59 boys, 41 girls) who required immediate surgical intervention during the first hours after admission between 1985 and 1995. Strict disinfection was always used to preclude the risk of rabies, and parenteral antibiotherapy was used to avoid aero-anaerobic infections. Results: A total of 68% of children were below 5 years of age. The most frequent injury was to the midface. Associated injuries or death were not observed. One case of postoperative wound infection was noted. Four surgical revisions were performed because of unsightly scars, but in most children the scar had attenuated 1 year after injury. Conclusions: The aim of immediate surgical repair is to obtain a satisfactory cosmetic result and to avoid infections. Better cosmetic results (4 cases of scar revisions) with a minimal risk of wound infections (1 cheek wound infection) are obtained. J Pediatr Surg 35:580-583. Copyright © 2000 by W.B. Saunders Company.