An Algorithmic Approach to Operative Management of Complex Pediatric Dog Bites: 3-Year Review of a Level I Regional Referral Pediatric Trauma Hospital

Abstract

Background:Incidence of dog bites continues to rise among the pediatric population and serves as a public health threat for the well-being of children. Plastic surgeons are at the forefront of initial management and eventual outcome of these devastating injuries. This study set out to determine the nature of dog bite injuries treated over a 3-year period at a large level 1 pediatric trauma center.Methods:A retrospective review of emergency room records of all pediatric patients (age, 0–18 years old) who sustained dog bites between January 2012 and December 2014 were gathered. All details about age of patient, location and severity of dog bites, type of dog breed, antibiotics given, and emergency versus operative treatment were recorded and analyzed.Results:One hundred eight patients aged 5 months to 18 years old were treated in the emergency department after suffering dog bite injuries during the study period. The highest incidence of dog bites occurred in preschool children. The mean age for patients who required operative repair was lower than the mean age for patients who underwent primary closure in the emergency department. The location of injury was most commonly isolated to the head/neck region. Of the 56 cases that had an identified dog breed, pit bulls accounted for 48.2% of the dog bites, and 47.8% of pit bull bites required intervention in the operating room.Conclusion:Children with large dog bite injuries require more immediate care in a level 1 pediatric trauma hospitals in order to optimize their hospitalization course and eventual outcome.

Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study

“…Several authors suggested prophylaxis in high-risk dog bites (i.e., in case of edema or crush injuries, devitalized tissue or full-thickness wounds involving tendons, ligaments and joints, at the level of the face, hands, feet and of the genital area) and in all types of cat bites [51,[79][80][81].…”

“…Looke and Dendle, in a systematic review on the effectiveness and safety of antibiotic prophylaxis in human bites and non-human bites, recommended prophylactic antibiotics only in the case of risk sites, even for a cat bite [81]. The same indication is provided by the Infectious Disease Society of America, in whose guidelines prophylaxis is recommended only in patients or sites at risk (i.e., immune suppression, asplenia, liver disease, edema of the affected area, injuries to the hand or face or lesions that may have penetrated the periosteum or joint capsule) [73].…”

Pediatric Dog Bites: A Review of 1422 Cases Treated at a Level One Regional Pediatric Trauma Center

“…This is in agreement with other studies, in which the attacking dog is most frequently either a household pet or neighbor's dog. 1,3,6,1,14 Since familiarity clearly does not protect children from being bitten, 1 can infer that children are likely approaching these ''known'' and ''friendly'' dogs closer and more intimately than they would a strange dog, resulting in bites that are frequently more severe. This false sense of safety may also account for the high volume of bites that occur on the head and neck regions of many pediatric patients.…”

“…5 Numerous studies nationwide report a higher prevalence of pediatric dog bites victims than adults. 2,6 Children are found to have an increased risk of head and neck bites, with this anatomical location having been linked with increased need for invasive repair and morbidity. 7 Increased awareness towards this injury is necessary for both the lay and medical community to potentially decrease occurrences and morbidities from child dog bites.…”

“…8,9 Although studies exist investigating dog bite occurrence, few investigations focus exclusively on the pediatric population. 1,2,6,7,10 In the recent literature, even fewer studies include over 1000 pediatric patients. 1,2 To the best of the authors knowledge, there is a paucity in the literature regarding predictors of cases, which will require surgical intervention in excess of surgical closure within the ER and which will have a higher incidence of complications.…”