Dog Bites Injury

 
More than 4.5 million dog bites occur in the USA annually requiring hospitalization in more than 80% of them. It is estimated that 60 million's dollars are spent annually for dog-related hospitalizations. Children are a specially vulnerable population at higher risk for sustaining dog bite injuries. The most common circumstance for injury involved a child playing with or while petting a dog. This benign initial encounter should be highly monitored during early interactions between a dog and child. Food-related encounters like a dog protecting its food or a child eating near a dog are common circumstances of injury. Dog bites leads to life and limb threatening infections in children due to the ischemic nature of tissue loss and mixed bacterial contamination. Infants are more than four times likely to be bitten by the family dog and most of these occurs in the head, face and neck region. Preschool children dog bites accounts for more than half of the injured population.  Most dog bites can be repaired in the emergency room with primary closure. Complex lacerations, avulsions and shearing injuries will need repair at the operating room. Pit bulls are the most common breed to inflict  dog bite injury requiring direct and reconstructive repair. Children between ages nine and 12 years are the most common victims of pit bulls attacks. Following pit bulls, Labrador retriever, German Shepard and Husky follow in as much as attacking dog breed. Location of dog bites in children is usually the head and face region due to child short stature, larger head circumference and underdeveloped evasive motor skills to protect the face. Simple puncture wounds and abrasions can be managed with wound irrigation and application of nonadherent dressing. Simple lacerations can be sutured in the emergency room under local sedation and analgesics. Complex lacerations, partial flap avulsions or complete full-thickness tissue loss requires operative repair and hospitalization. Broad-spectrum antibiotic coverage is recommended for all dog bite wounds that require operative intervention. Extended hospitalization is usually associated with local wound infection. Dog owners should be held legally and financially responsible for stray dogs that place people, particularly young children at risk for body harm.

References:
1- Alizadeh K, Shayesteh A, Xu ML: An Algorithmic Approach to Operative Management of Complex Pediatric Dog Bites: 3-Year Review of a Level I Regional Referral Pediatric Trauma Hospital. Plast Reconstr Surg Glob Open. 5(10):e1431, 2017
2- Abraham JT, Czerwinski M: Pediatric Dog Bite Injuries in Central Texas. J Pediatr Surg. 2018 Oct 31. pii: S0022-3468(18)30672-9. doi:10.1016/j.jpedsurg.2018.09.022.
3- Chen Y, Tan Y, Yan S, Li L: Dog bite and injury awareness and prevention in migrant and left-behind children in China. Sci Rep. 8(1):15959, 2018
4- Pai D, Kamath AT, Panduranga KP, et al: Survey of knowledge of school children towards the prevalence, severity, management of maxillofacial injuries, and rescue skills in the event of a dog
bite. J Indian Soc Pedod Prev Dent. 36(4):334-338, 2018
5- Arhant C, Beetz AM, Troxler J: Caregiver Reports of Interactions between Children up to 6 Years and Their Family Dog-Implications for Dog Bite Prevention. Front Vet Sci. 4:130, 2017
6- Bykowski MR, Shakir S, Naran S, et al: Pediatric Dog Bite Prevention: Are We Barking Up the Wrong Tree or Just Not Barking Loud Enough? Pediatr Emerg Care. 2017 Apr 11. doi: 10.1097/PEC.0000000000001132.
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