II. Epidemiology
- Worldwide, Dog Bites are the most common cause of Rabies
- Rabies is responsible for 59,000 deaths worldwide per year
-
Incidence in United States: 4 to 4.5 Million bites per year
- Rate: 103-118 per 100,000 people in U.S.
- Over 330,000 Emergency Department visits per year
- Dog Bites account for 80-90% of Animal Bites in U.S.
- Unprovoked Dog Bites account for 50% of events
- Dogs are known to the victim in 70% of Dog Bite cases
- Mortality: >12 per year in U.S. (most are children)
- Pit bulls accounted for 44% fatalities 1979-1988
- Rottweilers are also responsible for many of the fatalities
- Infection rate: 15-20%
- Children are more likely than adults to sustain bites (esp. school age males)
- Preschool children are typically bitten by their family dogs at home
- Teens are typically bitten by dogs unknown to them outside the home
III. Risk Factors: Bites associated with breed
- Aggressive dogs
- Dogs associated with fatal attacks
- Pit Bull
- Malamute
- Chow-Chow
- Rottweiler
- Siberian Husky
- German Shepherd
- Wolf hybrids
- Other Aggressive dogs
- Bull terrier
- Cocker spaniel
- Collie
- Doberman Pinscher
- Great Dane
- Dogs associated with fatal attacks
- Less aggressive breeds (Family dogs)
- Boxer
- Dalmatian
- English Setter
- English Springer
- Golden Retriever
- Irish Setter
- Labrador Retriever
- Spaniel
IV. Pathophysiology
- Crush or avulsion injuries are more typical from Dog Bite
- Extensive Lacerations and soft tissue avulsions are most common
- Jaw of a dog can generate pressures up to 450 psi (some report up to 1800 psi)
- Occult Fractures may occur with high compression forces
- Foreign body risk
- Dog Bites may leave tooth fragments in wounds
- Carefully examine wounds and consider xray for Retained Foreign Body
V. Signs: Distribution
- Head and Neck (15% of Dog Bites)
- Typical site for Dog Bites in young children, especially ears
- Extremities (arms account for 60% of Dog Bites)
- Typical site for Dog Bites in adolescents and adults
- Perform a careful Hand Exam (esp. Hand Neurovascular Exam)
- Occult hand tendon injuries are common
VI. Imaging
- Imaging is not routinely needed in most Dog Bites
- Extremity
- Consider XRay imaging in extensive, deep wounds to evaluate for Fractures and retained foreign bodies
- Head and Face
- Consider imaging if deformity identified
VII. Management
- Update Tetanus Vaccination as needed
- Perform wound cleaning, copious Wound Irrigation, and foreign body and devitalized tissue Debridement
- See Animal Bite for irrigation and general management
-
Antibiotics
- See Dog Bite Infection for Antibiotic selection
- Confirm dog has up to date Vaccinations including Rabies
- Start Rabies Prophylaxis if Rabies status cannot be confirmed
- Alternatively, quarantine healthy dog and observe for 10 days
-
Wound Repair
- Safe to repair all Dog Bite wounds (regardless of location) presenting within 8 hours of bite injury
- Infection rates increase significantly after 8 hours (22% infection rate versus 4.5%)
- Bite wounds treated with primary closure should be treated with Antibiotics (see Dog Bite Infection)
- Inform patient of risks of infection, closure options
- Primary closure results in significantly better cosmetic results than secondary closure
- Dog Bite Infection rates are similar regardless of management
- Primary closure (6-9.7%)
- Secondary closure (6.9%)
- References
- Safe to repair all Dog Bite wounds (regardless of location) presenting within 8 hours of bite injury
VIII. Complications: General
- Significant morbidity and mortality worldwide (esp. children)
- Dog Bite Infection (see below)
- Retained tooth fragments
- Chronic Scars (50% of Dog Bites)
-
Posttraumatic Stress Disorder
- Short-term Nightmares or avoidance is common (seek medical attention if they persist)
- Rabies
- Tetanus
IX. Complications: Dog Bite Infection
- See Dog Bite Infection
- Complicates 15-20% of Dog Bites
- Pasteurella Canis most common infection (aerobic infection)
- Other common aerobic infections
- Other common anaerobic infections
- Fusobacterium
- Bacteroides
- Prevotella
- Porphyromonas
- Propionibacterium
X. Disposition
- Outpatient Wound Check in 24-48 hours Indications
- Usually indicated over inpatient care
- All hand wounds should be rechecked
XI. Prevention: Dog Bites
- Keep dogs updated on Vaccinations (and other routine veterinary care)
- Socialize dogs as puppies to children and strangers
- Neutered dogs are less likely to bite
- Trained dogs are less likely to bite out of fear
- Do not leave young children alone with a dog
- Exercise caution with ill pets or those in pain (more likely to bite)
- Do not approach an unknown dog without an owner's permission
- Use environmental barriers in and around the home (e.g. baby gates, fences)
- Keep dogs on a leash in public areas (outside of dog parks)
XII. Prevention: Lessons for Children
- Do not approach an unfamiliar dog
- Do not disturb a dog eating or sleeping
- Do not disturb a dog caring for puppies
- When approached by a dog
- Never scream near a dog
- Never run from a dog
- Be still (Like a tree)
- If you fall, become a log
- Allow the dog to first sniff you before petting him
- Do not make direct eye contact with the dog
- Reporting guidelines
- Report Dog Bites to an adult immediately
- Report stray dogs or unusual behavior immediately
XIII. Resources
- Dog Bite Prevention (American Veterinary Medical Association)
XIV. References
- Cowling and House (2017) Crit Dec Emerg Med 31(5): 15-20
- Shivaprakash and Vezzetti (2022) Crit Dec Emerg Med 36(2): 3-10
- Swaminathan in Herbert (2014) EM:Rap 14(3): 4
- Bradshaw (1996) Vet Rec 138:465-8 [PubMed]
- Ellis (2014) Am Fam Physician 90(4):239-43 [PubMed]
- Lazzetti (1998) J Pediatr Health Care 12:73-9 [PubMed]
- Ortiz (2023) Am Fam Physician 108(5): 501-5 [PubMed]
- Presutti (2001) Am Fam Physician 63(8):1567-72 [PubMed]
- Presutti (1997) Postgrad Med 101(4): 243-54 [PubMed]
- Sacks (1996) Pediatrics 97:891-5 [PubMed]