Pediatric dog bite outcomes: infections and scars

Drumright, Benjamin; Borg, Breanna; Rozzelle, Arlene; Donoghue, Lydia; Shanti, Christina

doi:10.1136/tsaco-2020-000445

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…Our outcome of interest was clinically significant dog bites, characterized by indicators of higher morbidity based on the care provided or injuries sustained. We defined this as any of the following: hospital admission, operating room charge or use of sedation medications, fractures, and dislocations (Khan et al 2020 ; Saadi et al 2018 ), intracranial injury and skull fractures (Steen et al 2015 ), injuries to the eyeball (Hurst et al 2020 ), skin/soft tissue infection (Drumright et al 2020 ), and in-hospital mortality.…”

Section: Methodsmentioning

confidence: 99%

“…While dog bites occur at all ages, these events are particularly common among preadolescent children and account for a higher rate of injury among this group (Weiss et al 1998 ; Ramgopal et al 2018a ; Ramgopal and Macy 2021 ). Dog bites can result in cosmetic and infectious (Drumright et al 2020 ) sequelae in many; furthermore, they can occasionally lead to significant craniofacial injury (Khan et al 2020 ), fractures, and rarely, death (Sarenbo and Svensson 2020 ). In developing countries, dog bite injures carry the risk of transmission of the rabies virus, though rates of this disease are low in the USA (Centers for Disease Control and Prevention 2020 ).…”

Section: Introductionmentioning

confidence: 99%

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Pediatric patients with dog bites presenting to US children’s hospitals

Ramgopal

Macy

2021

Inj. Epidemiol.

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Background To characterize pediatric dog bite injuries presenting to US children’s hospitals and identify factors associated with clinically significant injuries. Methods We performed a multicenter observational study from 26 pediatric hospitals between July 1, 2010, and June 30, 2020, including patients ≤ 18 years with dog bites, consolidating together encounters from patients with multiple encounters within 30 days as a single episode of care. We characterized diagnoses and procedures performed in these patients. We used generalized linear mixed models to identify factors associated with a composite outcome that we term clinically significant injuries (defined as admission, operating room charge, sedation, fractures/dislocations, intracranial/eye injury, skin/soft tissue infection, or in-hospital mortality). Results 68,833 episodes were included (median age 6.6 years [interquartile range 3.5–10.4 years], 55.5% male) from 67,781 patients. We identified 16,502 patients (24.0%) with clinically significant injuries, including 6653 (9.7%) admitted, 5080 (7.4%) managed in the operating room, 11,685 (17.0%) requiring sedation, 493 (0.7%) with a skull fracture, 32 (0.0%) with a fracture in the neck or trunk, 389 (0.6%) with a fracture of the upper limb, 51 (0.1%) with a fracture in the lower limb, 15 (0.0%) with dislocations, 66 (0.1%) with an intracranial injury and 164 (0.2%) with an injury to the eyeball, 3708 (5.4%) with skin/soft tissue infections, and 5 (0.0%) with in-hospital mortality. In multivariable analysis, younger age (0–4 years, 5–9 years, and 10–14 years relative to 15–18 years), weekday injuries, and an income in the second and third quartiles (relative to the lowest quartile) had higher odds of clinically significant injuries. Black patients (relative to White), Hispanic/Latino ethnicity, and private insurance status (relative to public insurance) had lower odds of clinically important injuries. When evaluating individual components within the composite outcome, most followed broader trends. Conclusion Dog bites are an important mechanism of injury encountered in children’s hospitals. Using a composite outcome measure, we identified younger, White, non-Hispanic children at higher risk of clinically significant injuries. Findings with respect to race and ethnicity and dog bite injuries warrant further investigation. Results can be used to identify populations for targeted prevention efforts to reduce severe dog bite injuries.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pediatric patients with dog bites presenting to US children’s hospitals

Ramgopal

Macy

2021

Inj. Epidemiol.

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“…Globally, tens of millions of people are injured by dogs, and in the United States alone, dog bite-related injuries account for over 330,000 emergency room (ER) visits annually [2,3]. A dog bite injury may sometimes present as a complex constellation of injuries, involving neurologic, craniofacial, and orthopedic systems [1,[4][5][6][7]. While pediatric dog bites are well-researched in the fields of emergency medicine, plastic surgery, and neurosurgery, there is scarce data on the orthopedic management of dog bites associated with fractures of the appendicular skeleton.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Long Bone Fractures After Dog Bites: A Case Series and Systematic Review

Brahmbhatt,

Taha,

Nahal

et al. 2023

Cureus

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This study presents a case series and systematic review of pediatric patients who sustained long bone fractures following dog bites.A systematic review of the studies on "pediatric fracture dog bite" based on a search of PubMed and OVID Medline databases was performed by adhering to PRISMA guidelines. Articles in English describing pediatric long bone fractures due to dog bites were included. Studies not differentiating pediatric from adult patients and not describing long bone fractures due to dog bites were excluded. Study characteristics, fracture epidemiology, management decisions, and follow-up data were extracted. Additionally, a seven-year retrospective chart review of cases treated at our level one pediatric trauma center was performed. Data on fracture characteristics, surgical management, choice of antibiotic therapy, and follow-up were collected.Five studies that met our criteria were analyzed. Pediatric long bone fractures from dog bites were identified in 0.35% (11/3,156) of patients. Such fractures most commonly involved the upper extremity (9/11, 82%). None of the studies described the choice of antibiotics, surgical decision-making, or wound closure preference for an underlying fracture. Our chart review elicited three cases of long bone fractures due to dog bites.Pediatric long bone fractures after dog bites are a rare injury pattern in the United States. These injuries should be treated as contaminated open fractures, and urgent immunization, intravenous antibiotic administration, wound care, and fracture stabilization should be provided. We recommend meticulous surgical debridement in the operating room, as wounds often probe deep into the bone. Nevertheless, there is much that remains unclear about these injuries. Hence, further research with greater power is needed to improve treatment decisions.

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“…A despeito de haver diversas pesquisas envolvendo o tratamento ideal para este tipo de lesão, não há evidências sólidas para que um único manejo seja padronizado. As lesões por mordedura canina são de alta complexidade e bastante graves, possuindo também experiências clínicas variadas dos cirurgiões, então, a soma destes fatores leva a falta de consenso sobre qual o tratamento ideal para as vítimas acometidas por esta fatalidade (Drumright, Borg, Rozzelle, Donoghue & Shanti, 2020).…”

Section: Introductionunclassified

Manejo de lesão extensa face decorrente de mordedura canina em paciente pediátrico: Relato de caso clínico

Diógenes

Bezerra

Silva

et al. 2021

RSD

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Os traumas na infância e adolescência constituem um fator importante de morbidade e mortalidade, sendo um enorme problema de saúde pública. Dentre os traumas faciais em crianças, as mordeduras de animais destacam-se, principalmente a canina. E este tipo de ferimento resulta em traumatismos faciais complexos, podendo ter um envolvimento funcional e estético, assim como sucedendo em infecções polimicrobianas. Paciente do sexo masculino, 8 anos de idade, compareceu ao Hospital da Restauração em Recife/Pernambuco, vítima de mordedura canina cursando com lesão lácero-contusa extensa em região de comissura labial do lado esquerdo. O tratamento instituído neste primeiro momento foi por meio de sutura em todo o ferimento e encaminhamento para vacinação anti-rábica após três dias. Foram dadas as orientações pós-operatórias de realização de curativos diários, retorno em 10 dias para remoção das suturas, retorno para acompanhamento da vacinação anti-rábica, repouso por 10 dias e orientação de higiene oral. O trauma promovido pela mordedura canina é definido como um problema de saúde público e que afeta em sua maioria a população pediátrica. Dessa forma faz-se necessário estabelecer a devida atenção ao tratamento e acompanhamento desses pacientes, seguindo os protocolos de atendimento necessários, promovendo também, o controle de potenciais complicações que provém de lesões dessa natureza.

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Pediatric dog bite outcomes: infections and scars

Cited by 9 publications

References 11 publications

Pediatric patients with dog bites presenting to US children’s hospitals

Pediatric patients with dog bites presenting to US children’s hospitals

Pediatric Long Bone Fractures After Dog Bites: A Case Series and Systematic Review

Manejo de lesão extensa face decorrente de mordedura canina em paciente pediátrico: Relato de caso clínico

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