Elsevier

American Journal of Otolaryngology

Volume 36, Issue 1, January–February 2015, Pages 32-38
American Journal of Otolaryngology

Original contribution
Dog bites of the head and neck: an evaluation of a common pediatric trauma and associated treatment

https://doi.org/10.1016/j.amjoto.2014.09.001Get rights and content

Abstract

Purpose

To identify which patients and canines are involved in dog bites of the head and neck, and how they impact health systems.

Materials and methods

This is a single center, retrospective cohort study conducted from January 2012 to June 2013 in an academic, tertiary care center situated between multiple suburban and urban communities. Patients were identified by queried search for all bite-related diagnoses codes.

Results

334 unique dog bites were identified, of which 101 involved the head and neck. The mean patient age was 15.1 ± 18.1 years. Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention. Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+ 31%), and without provocation (+ 48%). Injuries of the head and neck had an average follow-up of 1.26 ± 2.4 visits, and average specialty follow-up of 3.1 ± 3.5 visits.

Conclusions

The patients most likely to suffer dog bite injuries of the head and neck are children. Although a number of dog breeds were identified, the largest group were pit bull terriers, whose resultant injuries were more severe and resulted from unprovoked, unknown dogs. More severe injuries required a greater number of interventions, a greater number of inpatient physicians, and more outpatient follow-up encounters. Healthcare utilization and costs associated with dog bites warrant further investigation.

Introduction

Animal bites are a preventable public health issue, and yet these injuries have been on the rise. Canine bites became a national concern with the 1985 CDC release that reported as many as 4.7 million Americans are annually bitten by dogs [1]. Of these 4.7 million people, approximately 800,000 dog bite victims seek medical care [1]. At the time of this report, dog bites were not a new issue; this CDC report was one of the first times this type of injury shifted from a local or regional concern to the national stage [2]. Despite this national attention, the rate of dog ownership has continued to increase. In 2001, Shuler and her colleagues estimated that nearly 70 million dogs are owned in the United States, and that over 112 million people, or 40% of the population, have at least one dog in their home [3]. With this increase in ownership, it is now estimated that lifetime risk of being bitten by a dog approaches 50% [4].

Dog bites account for over 80% of mammalian bites [5]. Dog bites, unlike the bites of cats, rats or human are crush injuries [2], [6]. At first glance, these injuries can appear less severe than wounds from these other bites because the superficial tissue may remain intact. While the dermis may not be broken, the underlying tissue may still be devitalized by crushing, tearing, and/or avulsing the supporting blood supply [6]. The force applied by a dog’s jaw is often estimated to be between 300 and 450 pounds per square inch (PSI) [5], [7]. There are reports of some canine bites having forces of upwards of 1800 PSI, but the primary sources for this claim cannot be verified [8], [9], [10], [11]. The force generated from some dog bites can fracture bone, dependent on the patient, dog breed and site of bite [12], [13].

Dog bites injuries found in the head and neck disproportionately affect children, and have been previously reported to account for 3%-4% of all pediatric emergency visits, and up to 40% of all pediatric traumas [14], [15], [16], [17], [18]. These injuries can lead to disfiguring scars and lengthy treatments. The need for facial plastic and reconstructive surgery and scar revisions for these injuries has been previously reported to be as high as 77% for these patients [7]. The treatment of dog bite injuries has been reported as the 5th most common ICD-9 code used by plastic surgeons [19]. Primary closure of open dog bite injuries of the head and neck is an accepted treatment due to the significant morbidity associated with scarring from healing from secondary intention [20], [21], [22], [23], [24], [25].

Due to the significant morbidity and controversy surrounding dog bite injuries, this investigation was initiated to identify which patients and canines are involved in these injuries of the head and neck, and how these injuries are currently treated. The objectives of this study include the following: 1) describe the patient population that suffer dog bites in the head and neck, 2) determine the dog breeds and circumstances responsible for these head and neck injuries, and 3) evaluate the current treatment and follow-up care associated with dog bite injuries of the head and neck. We sought to test the following hypotheses: 1) The patients who present with dog bite injuries of the head and neck will be significantly younger, than those bitten in other anatomical locations. 2) The dogs responsible for these injuries will be known to the patient and will be more likely to bite these patients after they are provoked. 3) We further hypothesized that the most severely injured patients would require significantly more resources, measured by consultation, operations, and follow-up.

Section snippets

Materials and methods

This is a single center retrospective cohort study conducted using patient data from January 2012 through June 2013. The study was performed at the University of California Davis Health System, a public, academic, tertiary care center, which is situated between multiple suburban and urban communities in Sacramento, California. UC Davis is one of three trauma centers in the greater Sacramento area, and is the sole Level 1 Trauma Center for a catchment area of over two-million people. Prior to

Results

Excluding insect and human bites, 421 charts returned from the query of the UC Davis EMR. Of those charts, 62 were identified as non-dog bites and 26 were return visits to the ED, thus, yielding a total of 334 unique dog bites. Of these 334 bites, 101 involved the head and neck (Fig. 1). The demographic data for these patients can be found in Table 2. The mean age of the patients with head and neck bites was 15.1 ± 18.1 years (range 11 months to 73 years, median of 6). This value is significantly

Discussion

Our first objective was to better characterize the patient population that suffers dog bites of the head and neck due to the paucity of recent studies. In this investigation the patients who were bitten by dogs in the head or neck were more likely to be children under the age of ten, with an equal to slight disposition towards girls than boys. These results agree with previous studies evaluating canine bites at tertiary medical centers [7], [13], [21], [22].

The key finding from our second

Conclusion

Dog bites are a significant public health concern, and may account for 40% of all pediatric traumas [16]. In this investigation, we found that dog bites of the head and neck disproportionately affected pediatric patients. Among the dog breeds responsible for these head and neck injuries, one-third involved pit bull terriers, whose resulting injuries were more severe, had nearly twice the requirement for specialty consultation, and had higher rate of surgical exploration and repair. Severe

Acknowledgments

Author Contributions: Mr. O’Brien and Dr. Tollefson had full access to the data in this study and take full responsibility for the integrity of the data and the accuracy of the data analysis.

  • Study concept and design: O’Brien, Andre, Squires, and Robinson.

  • Acquisition of data: O’Brien and Andre.

  • Analysis and interpretation of data: O’Brien and Andre.

  • Drafting of the manuscript: O’Brien and Andre.

  • Critical revision of the manuscript: O’Brien, Andre, Squires, Robinson, and Tollefson.

  • Statistical

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    1

    Contribution: Project design, data acquisition and analysis, statistical evaluation, and manuscript development.

    2

    Conflict of Interest: funded in full by T32 Institutional Grant from July 2013 to June 2014.

    3

    Contribution: Project design, data acquisition and analysis, graphic design, and manuscript development.

    4

    Conflict of Interest: None.

    5

    Contribution: Project design and critical review of the manuscript.

    6

    Contribution: Project design, critical review of the manuscript, and quality control of the investigation.

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