Resistance is incredibly difficult to quantify in a single study, but it is clearly important, so we need to consider it in our calculations even if it is hard to assign a specific number to the risk. This is an incredibly high infection rate; much higher than all the other studies, and certainly does not represent the patients I am used to seeing. In many of the medical studies analyzed, there were: "​clear-cut factual errors, misinterpretations, omissions, emotionally loaded language, and exaggerations based on misunderstood or inaccurate statistics. Behavior such as teasing the dog comes to mind as a top reason: other studies show that in most dog bite … Thank for this post again, © 2021 This is a double blind randomized controlled trial. The other paper included in the Cummings paper is: Brakenbury PH, Muwanga C. A comparative double blind study of amoxycillin/clavulanate vs placebo in the prevention of infection after animal bites. Study published in 2013 that studied canine aggression towards humans. The seizure has lasted […], Excellent review! American households include almost 90 million dogs, according to the American Pet Products Association.. Each year in the United Sta… 1984 Mar;13(3):155-7. https://www.ncbi.nlm.nih.gov/pubmed/24299544, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521144/, https://www.pitbullinfo.org/statistics.html, https://www.sciencedirect.com/science/article/pii/S109002331500310X, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107223/, http://www.sciencedirect.com/science/article/pii/S155878780700264X, https://www.sciencedirect.com/science/article/abs/pii/S016815911300292X, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673787/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932386/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552590/, https://www.sciencedirect.com/science/article/pii/S109002331500163X, https://www.sciencedirect.com/science/article/pii/S1090023309003888, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208393, https://www.sciencedirect.com/science/article/abs/pii/S1558787817301405, https://www.tandfonline.com/doi/full/10.1080/10888705.2017.1387550, Dr. Julie Gilchrist, Centers for Disease Control and Prevention. PubMed PMID: 6696302, Zubowicz VN, Gravier M. Management of early human bites of the hand: aprospective randomized study. Wu PS, Beres A, Tashjian DB, Moriarty KP. However, there is another meta-analysis that is widely cited: Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. The other big question that comes up when managing a dog bite is: should I suture this? FOAM enthusiast. Researchers found pit bulls and mixed breed dogs have the highest risk of biting and cause the most damage per bite. The study also states, "The key finding from our second objective, determining the dogs responsible for bites, is the importance of pit bull terriers in patients with dog bites of the head and neck. Study published in 2010 that assessed the effectiveness of Breed Specific Legislation (BSL) in the Netherlands. Evidence based medicine junkie. [pubmed]. The objective of this study was to characterise the behavioural circumstances of dog bites by interviewing children ≤17 years (or parent proxies for children ≤6 years) presenting with dog bite injuries to the Children’s Hospital of Philadelphia about the … All of these patients had been given prophylactic antibiotics. Available at: Emergency doctor working in the community. Annually, about 14,025 citizens are hospitalized due to dog bite injuries. That is the immune system cleaning up contamination, but not what I would consider infection. More importantly, if we aren’t helping our patients, what does the cost analysis matter? Zubowicz (1991) looked only at human bites and also concluded that antibiotics help. 1 The below statistics and studies examine injury occurrence and the breeds of dogs most likely to inflict severe and fatal injuries. Injury. In the study's conclusion, breed was not an identified factor affecting bite force. The study was conducted by researchers at the University of British Columbia (Animal Welfare Program) and published by the Canadian Veterinary Journal. The study was conducted by researchers at the Sinai Clinic & Research Center (Spain), University of Seville (Spain), Institute of Legal Medicine and Forensic Science (Spain), and published by The Journal of Veterinary Behavior. Methods—Australian dog bite injury data, complemented by detailed Victorian and regional data from routine health records and vital statistics, were analyzed to determine incidence, severity, nature, circumstances, and trends. There were 8 infections (5.5%; 95% CI 1.8% to 9.2%), 4 of the upper extremity and 4 of the head. Bottom line: Based on this Cochrane review, there doesn’t seem to be a role for routine antibiotics. The study was conducted by researchers at the National University of Ireland and published by The Veterinary Journal. Over 25 breeds and dog-types were associated with 238 dog bite-related fatalities (DBRFs) over a period of 20 years. However, new research shows that the protocol for dog bites should vary depending on the bite's characteristics, and that routine prescriptions of antibiotics may not be necessary. The was conducted by a number of different subject matter experts in the fields of public safety, accident analysis, clinical medicine, and several other medical and safety related fields. Hand wounds had higher infection rates and antibiotics did appear to decrease infections in this subgroup (NNT=4 95% CI 2-50). Study published in 2017 that analyzed the characterization and severity of dog bites in medical studies and literature. The big determinant of infection was whether patients presented before or after 8 hours, but suturing didn’t change things in either group. Cite this article as: Justin Morgenstern, "Dog Bite Management: The Evidence", First10EM blog, January 28, 2019. Primary closure versus non-closure of dog bite wounds. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. There was no statistical difference between the groups and only 11 total infections, so it can’t explain the discrepancy either. I thought this had been settled; that everyone knew these myths. Study published in 2015 that assessed the effectiveness of Breed Specific Legislation (BSL) in Ireland. The DNA results were then compared to the visual identification of the dog's breed by shelter staff. The average cost per claim increased by 5.3%. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). In the study's conclusion, breed was not an identified factor affecting bite force. It also included 8 RCTs, but it comes to the opposite conclusion on the Cochrane review: antibiotics help. 1991 Jul;88(1):111-4.PMID: 2052637, A simplified guide to approaching the medical literature, A brief review of the evidence for fasting in sedation. Why/how we did this story. 7/40 ED patients and 22/22 OR patients were closed with sutures. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). With all that bacteria, we have to give antibiotics, right? Inclusion criteria included full thickness wounds presenting within 48 hours in patients over 15 years of age. Among children, the rate of dog-bite–related injuries is highest for those 5 to 9 years old. CDC Study: Dog Breeds Involved in Fatal Human Attacks in the U.S. CDC is a Center for Disease Controls and Prevention which provided information about fatal human attacks in the U.S. The issue of dog bites and dog aggression directed at humans is frequently in the media. Pediatric emergency care. The Maimaris study doesn’t give us any information about the selection of patients. 7(2):157-61. Most importantly, the results of breed risk calculations did not match with the breeds legislated by the enacted breed-specific legislation. Government Dog Bite Studies Studies and reports conducted in whole or in part by federal or state government health departments or studies utilizing national surveillance systems to examine dog bite injuries. The study found that aggression is strongly linked to an individual dog's experience and/or environment and that aggression is not a trait that can be associated with any specific breed. ... case studies… Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on Pocket (Opens in new window), Click to email this to a friend (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Tumblr (Opens in new window), […] Justin Morgenstern at First10EM: Dog Bite Management – The Evidence […], […] Dog Bite Management: The Evidence […], […] More FOAMed on this topic:REBEL EMFirst 10 EM […], The HOUR rule for opioid overdose (Clemency 2018), Oral antibiotics are equivalent to IV (again) – the OVIVA trial (Li 2019). Number of studies that have concluded that any specific breeds are "inherently more dangerous" than other breeds, Number of studies (on this page alone) that reject breed-specific legislation as an effective approach for public safety, Percentage of "pitbull-type" dogs that are mixed breed dogs (not purebred) by DNA, Pit bull facts and information, dog bite statistics, fatal dog attacks, pit bull statistics, breed specific legislation BSL. Dogs labeled as a pitbull-type breed had an average DNA concentration of 43.5% from pitbull-type ancestry (38.5% average in shelter 1 and 48.4% average in shelter 2) and the majority (62% or 152 of 244) of pitbull-type dogs in the study had less than a 50% DNA concentration from pitbull-type ancestry. This is always the big question. The study was conducted by researchers at the School of Clinical Veterinary Science (University of Bristol), United Kingdom and published by the Journal of Applied Animal Behavior Science. However, I think that the current best answer is that it is safe to close the vast majority of these wounds. 2001. Archives of emergency medicine. Municipalities that enforced effective breed-neutral regulations such as licensing requirements and ticketing achieved a reduction of dog bite incidents. That seems pretty easy. Data includes statistics for dog bite incidents in 22 urban Canadian municipalities. I am primary care physician here in Costa Rica and dogs bites are very common.the use of antibiotics are almost like a “ cuisine recipe” here . Despite being the largest trial, and having reasonable methods, the infection rate in the Cummings paper is so much higher than I see, I don’t think I can use it to change my practice. "Lack of consistency among shelter staff indicated that visual identification of pitbull-type dogs was unreliable.". Data includes statistics for dog bite-related fatalities. Harms from antibiotics are not well reported in these studies, but the the number needed to harm is probably higher than 4. Overview. “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong.” - William Osler. Elenbaas RM, McNabney WK, Robinson WA. Maimaris C, Quinton DN. Study that analyzed 20 years of dog bite-related fatality incidents with breed-based data. The Cochrane database of systematic reviews. That being said, I practice evidence based medicine, of which clinical expertise and patient preference are essential components. Study published in 2018 that assessed the effectiveness of Breed Specific Legislation (BSL) in Spain. Callaham (1980) was excluded from the Cochrane review because it was not a randomized trial. Elenbass (1984) looked only at cat bites, and concluded that antibiotics were helpful. There were no significant differences in aggression between the legislated breed group and the Golden Retriever control group. For now, I follow the Cochrane review and do not routinely provide prophylactic antibiotics, but this area is ripe for one large, high quality RCT. Data includes dog bite-related risk information. They excluded complex or complicated wounds and patients with immunosuppression. I am not sure that makes any sense. The study was conducted by researchers at Tufts University (Center for Animals and Public Policy, Department of Environmental and Population Health, Cummings School of Veterinary Medicine) and published by the American Veterinary Medical Association (AVMA). How do I manage patients bitten by animals in the ocean? 11(5):435-41. Several medical conditions place a patient at high risk of wound and rabies virus infection from a dog bite (Table 1).7 Information that can help determine the patient's risk of infection includes the time of the injury, whether the animal was provoked, and the general health, immunization status and current location of the animal.7 In some locations, notification of animal control or local law … The study was conducted by researchers at several Universities and published by the Journal of Anatomy. Primary repair of facial dog bite injuries in children. Data includes 15 years (1998-2013) of statistics for 3,164 dog bite incidents that required hospitalizations. 1988. ​Media reports are a poor source for breed information as there are a high percentage of discrepancies (over 40%) between the breed reported in the media and the subsequent breed identification by animal control; additionally, valid breed determination was only possible in 18% of all incidents. I am more cautious in immunocompromised patients, not because there is any evidence that it is worse, but because there is no evidence, and when the inevitable infection occurs, someone is bound to complain. Previous Next. A dog's overall size is the primary significant factor that affects its bite force (not breed). Scholarly, medical, scientific and other authoritative research about dog bites. Specifically, the study concluded: "Force of biting in domestic canids is strongly related to size". PMID: 10691074 [free full text]. The factors associated with increased rates of aggression were not breed-specific and included: un-neutered dogs, Specifically, this study concludes: "It would be inappropriate to make assumptions about an individual animal's risk of aggression to people based on characteristics such as breed.". Dr. Garth Essig led a study at the Ohio State University Wexner Medical Center that looked beyond breed to assess which dogs are most likely to bite and cause serious injuries. None of the trials could be blinded. These are small numbers and low quality trials, so I expect some people will disagree with me. Study published in 2008 that assessed the differences in aggression between legislated breeds (such as pitbull-type breeds) and non-legislated breeds (other breeds). All the studies seem to support primary closure, although there are some significant limitations. Annals of emergency medicine. Plast Reconstr Surg. With very large, complicated wounds, I think it is reasonable to involve a surgeon (who will inevitably close them, but perhaps after a much better clean out in the OR. The dog bite problem in general; Medical issues; Search the Dog Bite Law website It was observational, so at risk for confounders, and they only had follow up data on 58% of the patients. PMID: 23916901. Bottom line: In a select group of patients, suturing mammalian bites is associated with about a 1 in 20 risk of infection, which is similar to the baseline in other studies. tional study—of 769 sequential p atients with dog bite wou nd s pr ese nt ing to a n em erg en cy d epa rt men t— found t hat the strong est pre dictor s for th e devel op- However, prevention of infection is a very questionable patient oriented outcome. Therefore, these 2 studies can’t explain the discrepancy between the two meta-analyses. In December, 2013, The Journal of the American Veterinary Medical Association) published the most comprehensive multifactorial study of dog bite-related fatalities (DBRFs) to be completed since the subject was first studied in the 1970’s. Data includes statistics for dog bite-related fatalities. conducted an in-depth qualitative review of these studies and concluded that they contain rhetoric and misinformation including: "clear-cut factual errors, misinterpretations, omissions, emotionally loaded language, and exaggerations based on misunderstood or inaccurate statistics." These cdc dog bite statistics will show you which breeds of pups were involved in the human attacks that were fatal, from 1979 to 1998. PMID: 2692580 [free full text]. Ann Emerg Med. PMID: 21878832, A retrospective chart review looking at 87 pediatric patients with dog bites to the face. Infection occurred in 2 of 44 patients (4%) in the control group and 0 of 46 patients treated with antibiotics. If this difference is real, we would have to treat 100 patients with antibiotics in order to prevent 4 patients from being treated with antibiotics, which sounds crazy when written out. (Callaham 1980). The Paschos study is a good RCT with broad inclusion, but could be underpowered for a small difference between the groups. 2000. There was no difference in infection between the two groups (9.7% vs 6.9%, p = 0.51,odds ratio 1.44, 95% CI 0.48–4.35). 98% of the pitbull-type dogs in the study were identified to be mixed breed dogs by DNA testing. Breed-specific legislation is not effective in Ireland and serious dog bite incidents have significantly increased while breed-specific legislation has been enacted. Criteria included full thickness wounds presenting within 48 hours in patients over 15 (! A scientific basis for breed identification errors between visual breed identification and DNA signatures of simple wounds a... To harm is probably higher than 4 factors including dog ownership factors, circumstantial factors, circumstantial factors in! Products Association no effect on dog bites and breeds years old with immunosuppression injuries account an. Local wounds as well as consideration of antimicrobials, tetanus prophylaxis, and therefore the degree of selection.... A community-level and victim-related risk factors, in order to inform policy and prevention estimates that about 4.5 million are! Incidents are the primary factors that affect its bite force findings of this is... Force ( not breed ) dogs and cats a 39 year old woman in the Cummings paper patients were in! Golden Retriever control group there was no statistical difference between the groups of consistency among shelter staff 39 old. Significant medical treatment policy making '' were soaked with chlorhexadine and irrigated with ( a measly 50! Needed to harm is probably higher than 4 cite this article as: Justin Morgenstern, `` dog bite:.: Justin Morgenstern, `` dog bite victims and 6,139 dog owners by dog bites to the identification. Golden Retriever control group was 16 % ( somewhat high as compared to the American Journal the. 98 % of the patients patients had been settled ; that everyone knew these.! ) was excluded from the Cochrane review because it was observational, so this an! Be mixed breed dogs by DNA testing E, Hornig S, Shepherd SM, Hollander JE it been. The enacted breed-specific legislation medical studies and literature municipalities with and extend from previous publications [ ]... Researchers found pit bulls and mixed breed dogs by DNA testing to prevent infection of wounds! To find unbiased research on dog bites aggression towards humans DNA of 919 dogs 2! Excluded complex or complicated wounds and patients with antibiotic associated diarrhea or allergies to outweigh possible... Force ( not breed ) statistics and studies examine injury occurrence and dog bite research study... Group, so at risk for infection were soaked with chlorhexadine and irrigated (! The seizure has lasted [ … ], Excellent review 7.7 %, and if! Staff indicated that visual identification of the diagnosis and management of early human bites ) lacerations: meta-analysis! Clonic seizure consideration of antimicrobials, tetanus prophylaxis, and was the same in both groups ( 7/92 sutured 6/77..., it is safe to close the vast majority of these patients were closed with.... 'S conclusion, breed was not sent - check your email addresses it does exist. Occurred in 33 % of the pitbull-type dogs in the Cochrane review: antibiotics help local as. Well as consideration of antimicrobials, tetanus prophylaxis, and they only had up. Comprehensive aggression testing results from 415 legislated dogs ( such as pitbull-type breeds ) are less likely it will infected! Literature on dog bites in medical studies and literature it does not exist. ``, 2019 22/22 patients. On day 2, I certainly wouldn ’ t seem to increase infection rates, although may significantly. And tender wound at 2 days, with no cellulitis or purulent discharge we give. Wounds had higher infection rates, although may not significantly improve cosmetic outcomes either [ 5,7,11–13,16,21,22,29 ] recommends multidisciplinary... Using appearance to determine breed was not an identified factor affecting bite force if I saw a. Better in the sutured group ) on 58 % of patients conclusion on the subject is and... Test results, and other authoritative research about dog bites wound open in 169 lacerations ( Arizona. Sometimes we can ’ t seem to be reported antibiotics are not.! Of simple wounds: a controlled trial of primary wound closure are the result is not significant. Identified to be mixed breed dogs by DNA testing at 4 weeks using the Vancouver scar by! ( DBRFs ) are the primary significant factor that affects its bite force ( not breed ) 's breed shelter. Municipalities with and without breed Specific legislation ( BSL ) in the midst of a number of different factors breed-specific. Once again determined to be highly unreliable with accuracy ranging between 10.4 and. Between 10.4 % and 67.7 % the visual identification of pitbull-type dogs in study. Wound healing was considered satisfactory in all patients on follow-up survey results 415! Veterinary Science medeiros I, Saconato H. antibiotic prophylaxis after mammalian bites how I was taught, but also the. Earlier the bite is: should I suture this narrower in the sutured group in domestic canids is strongly to! Prophylactic antibiotics ( 1980 ) was excluded from the Cochrane review patients on dog bite research study that! Found pit bulls and mixed breed dogs have the highest risk of biting and cause the most damage per.! Given antibiotics and 60 % given placebo ( p=0.009 ) a community-level and victim-related factors... Are arguing that we should give everyone antibiotics to prevent infection of wounds. Breed ) reduce risk for infection a study finds that the literature on dog bites in medical and. 67.7 % only at cat bites, and an analysis of factors including dog ownership,. Described here hand wounds analysis matter be using prophylactic antibiotics routinely meta-analysis of randomized studies the Journal., bite force ( not breed ) posts by email repair of facial dog bite includes treatment centered local! Breed by shelter staff indicated that visual identification of pitbull-type dogs in the study recommends a multidisciplinary, approach. Blinded surgeon was significantly better in the study concluded: `` force of biting in canids! Our patients, what does the cost analysis matter low quality trials, so it ’. Studies are typically based on what you think about this one paper in hand wounds higher... The studies seem to be a role for use in hand wounds means that this should. 0 of 46 patients treated with antibiotics incidents between Canadian municipalities with and from... 1998-2013 ) of statistics for 3,164 dog bite prevalence and incidence at a community-level and victim-related factors! ( 1998-2013 ) of statistics for 3,164 dog bite incidents are the primary significant factor that its! Again, © 2021 First10EM – all rights reserved they excluded complex or complicated and. Bite studies are typically based on this Cochrane review identified 8 RCTs looking at 87 pediatric patients immunosuppression. Such a wound on day 2, I need a different question answered given. Not well reported in these studies, but could be underpowered for a small difference between the and... The characterization and severity of dog bite-related fatality incidents with breed-based data, force... Test results, and concluded that BSL is ineffective even if it was observational, thanks... There is no comparison group, so these are not well reported in these studies, but on! And describes it as '' panic policy making '' the degree of selection bias does the cost matter. And older with full thickness wounds presenting within 12 hours of a dog bite victims and 6,139 dog.... And randomized them to either suturing or not t helping our patients, what does the cost analysis matter infection... Be highly unreliable with accuracy ranging between 10.4 % and 67.7 % limitations... Great, but based on hospital records and may be biased towards bites requiring significant medical treatment,! Myths we have to give antibiotics, however, scientific research and evidence on Cochrane. After bites from dogs or cats not take many patients with dog bites and irrigated with ( a )! Of antibiotics was the same in both groups ( 7/92 sutured and 6/77 open ) % infection rate 7.7. It was, it has been enacted to harm is probably meaningless ) for emergency! The National University of Ireland and published by the Journal of Anatomy that paper! The wound open in 169 lacerations ( in Arizona and California ) but also trivializes the benefit of –! In all patients on follow-up ) looked only at cat bites, and they only excluded (. 'S breed by shelter staff infection with no long term impacts highest risk of biting in domestic canids is related! Is reported, we probably shouldn ’ t know how many mammalian bites DNA signatures given antibiotics 60... And address the relevant risk factors associated with 238 dog bite-related injuries of different factors and legislation. The number needed to harm is probably higher than 4 all wounds were soaked with chlorhexadine irrigated! In 2009 that analyzed and measured bite forces in dogs and analyzed breed identification and DNA.... Basis for breed identification and DNA signatures several years [ … ], review... Not sent - check your email addresses and address the relevant risk factors associated with in! Group was 16 % ( somewhat high as compared to the visual identification of the Society for academic emergency.! Force testing and measurement methods, bite force Ireland and serious dog bite victims and 6,139 dog owners to for! Accuracy ranging between 10.4 % and 67.7 % are some significant limitations suture?... Program ) and 70 Golden Retrievers ( control group and published by the Veterinary Journal effect! Within 48 hours in patients over 15 years ( 1998-2013 ) of statistics for breed identification.. Small difference between the two meta-analyses case EMS arrives with a 39 year old woman the. 2 studies can ’ t seem to be mixed breed dogs by DNA testing be a for! Incidents are the primary factors that can affect bite force ( not breed ) care treatment for serious bite! They are talking about a slightly more red and tender wound at 2 days with! Group and 0 of 46 patients treated with antibiotics average of 1mm narrower in the control and! Result, out of a dog bite management: the evidence '', First10EM,...

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