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A Pediatric Tertiary Referral Center’s Experience with Man’s Best Friend: Presentation, Management, and the Implications for Dog and Owner
Michael R. Bykowski, M.S., B.Phil., Sameer Shakir, B.S., Darren Smith, M.D., Sanjay Naran, M.D., Barbara Gaines, M.D., Janet Squires, M.D., Joseph E. Losee, M.D..
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND:
Despite being valued members of many families, dogs can inflict major physical and psychological burden in children. Serious dog bites often require reconstructive surgery, including multiple procedures throughout childhood. We evaluate the circumstances surrounding dog bites sustained by children and the aftermath of these injuries.
METHODS:
The medical record database of a major metropolitan pediatric hospital was reviewed for children who presented to the emergency department for dog bites within 24 hours of injury. Charts were queried for circumstances of the injury, treatment rendered, and whether or not the dog had previously bitten a person. Data obtained from the local county dog-licensing center were used as an estimation of the dog breed population for our hospital catchment area.
RESULTS:
Over a 4-year observation period, 1017 patients met inclusion criteria (average age= 6.2 years; 54.5% male). Bite injuries were most common to the craniofacial region (66.1%). Pit bulls were the most frequent biters. While pit bulls account for 2.6% of registered dogs in our hospital catchment area, 33.6% of bites were from this breed. At least 71% of dog bites occurred due to a dog known to the child. Furthermore, the family dog was responsible for 44.2% of all bites. 69.7% of patients were sutured in the emergency department, 24.5% underwent local wound care, and 5.8% required surgical admission. One dog bite fatality occurred. Pit bull bites are the most common to require surgical treatment (48.6%). 6.2% of dogs were reported to have previously bitten humans, of which 42.3% were pit bulls. Most (79.3%) pit bull bites were unprovoked. Finally, pit bull bites were more likely to inflict deep lacerations than other breeds (chi-squared; p<0.001).
CONCLUSIONS:
Dog bite-related trauma - particularly to the craniofacial region - is common and occasionally severe in children. Given that some dogs are repeat biters and a high rate of bites are inflicted by family-owned dogs, special attention should be paid to prevent negative child-family dog interactions. As pit bulls are disproportionately involved in serious and repeated injuries, more stringent ownership regulations may be prudent. Moreover, despite being preventable injuries, dog bites continue to occur at unacceptable rates in children. By better understanding the characteristics and patterns of dog bites, these findings will help to improve preventative strategies and to optimize current patient management of dog bites.


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