Dog Bite Injuries in the Emergency Department
ABSTRACT & COMMENTARY
Synopsis: Dog bites are an important cause of injury with more than 900 cases requiring ED visits each year. Five- to 9-year-old boys have the highest incidence, and children are often bitten on the face, neck, and head.
Source: Weiss HB,Incidence of dog bite injuries treated in emergency departments. JAMA 1998;279:51-53.
In an effort to define more clearly the incidence and characteristics of dog bite injuries treated in the emergency department (ED) setting, Weiss and colleagues analyzed data from the 1992-1994 National Hospital Ambulatory Medical Care Survey. The survey, which is conducted annually by the Centers for Disease Control and Prevention National Center for Health Statistics, provides data estimates based on probability sampling regarding 274 million ED visits during the years studied. Efforts were made to exclude follow-up visits for the same injury so as to allow for more accurate calculation of incidence figures. Additional information analyzed included patient age, nature of injury, and location where the dog bite occurred.
Based on their analysis, Weiss et al estimated the annual incidence of new dog-bite related injuries treated in EDs to be 333,687-12.9 per 10,000 persons. This represents approximately 914 new dog bites requiring ED care each day. The median age of dog bite victims was 15 years, with the highest rates among children aged 0 to 9 years (in particular, males aged 5-9 years). Children aged 9 years and younger were most commonly bitten about the head and neck region (73% of total injuries in this age group). Only 30% of dog bites in other age groups involved the head and neck. More than half of the dog bite injuries took place at home (58%).
Attempts were made to estimate the costs of ED care for dog bite victims. Based on an average hospital payment of $274 per patient, total annual costs of $102.4 million were derived, with patients younger than 20 years accounting for $58.7 million of these payments. Overall, only 4% of the patients required hospitalization. In their discussion, Weiss et al advocated additional data collection to allow development of effective preventive strategies.
COMMENT BY DAVID T. BACHMAN, MD
As a specialist in pediatric emergency medicine, I applaud the efforts of Weiss et al to provide more accurate information regarding the overall scope and nature of dog bite injuries. They have succeeded in highlighting what may be the underappreciated severity of the problem as well as the predominance of children as victims. Other studies have identified children as being particularly vulnerable to dog bite injuries.
Striking data can be found in studies by Sacks and colleagues, who tracked fatalities from dog bite injuries from 1979 to 1994.1 They identified 266 fatal dog attacks during that period. In 65% of these cases, the victim was younger than 10 years old. Particularly disturbing was the data regarding fatal injuries to infants-21 of whom were attacked while asleep in a crib. These same studies have information regarding the breeds of dogs involved. Not surprisingly, large and medium size breeds and unneutered male dogs were over-represented. Pit bulls were singled out as being the breed responsible for more deaths than any other; German shepherds, rottweilers, and huskies also deserve particular mention.
Additional information regarding the severity of dog bite injuries suffered by children can be found in the study by Brogan and associates, who collated data from the records of 40 children requiring hospitalization for dog bite injuries.2 Eighty-two percent of the children hospitalized suffered head and/or neck injuries; many of them required operative procedures. Once again, German shepherds, rottweilers, pit bulls, and huskies were the predominant breeds involved in the attacks.
That dog bites injuries to children are both common and potentially severe or even fatal is quite clear. What is less apparent is how the number of such injuries can most effectively be reduced. Brogan et al provide anticipatory guidelines for use by families, which certainly should be incorporated into routine preventive pediatric care. Families with new infants should be cautioned to never leave a dog (no matter what the breed) alone with the child. Certain communities have taken the strategy of banning the ownership of pit bulls, which may prove to be a partial approach. Let us hope that others do continue the work begun by Weiss In the meantime, we should all work with our families in individual preventive campaigns against dog bites.
References
1. Sacks JJ, Dog bite-related fatalities from 1979 through 1988. JAMA 1989;262:1489-1492.
2. Brogan TV, Severe dog bites in children. Pediatrics 1995;96:947-950.
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