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. 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. Elenbaas RM, McNabney WK, Robinson WA. Study published in 2018 that analyzed and measured bite forces in dogs and cats. Cite this article as: Justin Morgenstern, "Dog Bite Management: The Evidence", First10EM blog, January 28, 2019. "Lack of consistency among shelter staff indicated that visual identification of pitbull-type dogs was unreliable.". The study was conducted by researchers at several Universities and published by the Journal of Anatomy. ", In many of the medical studies analyzed, there was: "misinformation about the significance of breed and breed characteristics.". A dog's physical characteristics related to size and weight are the primary factors that affect its bite force (not breed). 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. All rights reserved. So why do these 2 meta-analyses come to different conclusions? Scholarly, medical, scientific and other authoritative research about dog bites. In a study of 12 different animal shelters across the USA, 40% of relinquishing owners cited behavioral problems as one of the reasons for surrendering a dog. in … (I think shared decision making is sufficient). A scientific basis for breed specific lists does not exist.". 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. However, prevention of infection is a very questionable patient oriented outcome. Follow up was 77% at day 3. It also included 8 RCTs, but it comes to the opposite conclusion on the Cochrane review: antibiotics help. ), Unfortunately, now that I live in New Zealand, I need a different question answered. Chen E, Hornig S, Shepherd SM, Hollander JE. Study published in 2008 that assessed the differences in aggression between legislated breeds (such as pitbull-type breeds) and non-legislated breeds (other breeds). The seizure has lasted […], Excellent review! Primary repair of facial dog bite injuries in children. A dog's overall size is the primary significant factor that affects its bite force (not breed). 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. 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. However, scientific research and evidence on the subject is scattered and sparse. The studies aren’t great, but based on what is reported, we probably shouldn’t be using prophylactic antibiotics routinely. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). 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. Maimaris C, Quinton DN. However, more than ½ of these patients were repaired in the OR, so these are not necessarily your standard ED dog bites. 23(3):535-40. Data includes statistics for breed identification errors between visual breed identification and DNA signatures. This data is clearly imperfect. PMID: 2692580 [free full text]. Dog bite injuries remain a common form of pediatric trauma. The study, published in the International Journal of Pediatric Otorhinolaryngology, explores the risks of dog bite injuries to the face in children and bite severity by breed, size and head structure. 2000. All patients received prophylactic antibiotics. Inclusion criteria included full thickness wounds presenting within 48 hours in patients over 15 years of age. None of the trials could be blinded. Breed-specific legislation had no effect on dog bite-related injuries. 6(4):251-6. 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." In the study's conclusion, breed was not an identified factor affecting bite force. Previous Next. How do I manage patients bitten by animals in the ocean? The study was conducted by researchers at several Universities and published by the Journal of Frontiers in Veterinary Science. Annals of emergency medicine. Essentially we are arguing that we should give everyone antibiotics to prevent a few from having to take them later. The Victorian studies reported here, together with the literature review, identify the need to reduce exposure by separating young children from dogs, particularly male dogs and certain breeds, particularly in the child's own home or in a home being visited. (Callaham 1980). The study was conducted by University of Florida (College of Veterinary Medicine), Michigan State University (College of Veterinary Medicine), Jacksonville FL Humane Society, Jacksonville FL Animal Care and Protective Services, Tallahassee FL Animal Services, Marion County Animal Services Ocala FL, and published by the The Veterinary Journal. ... case studies… Study published in 2010 that assessed the effectiveness of Breed Specific Legislation (BSL) in the Netherlands. 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). According to research … We don’t know how many mammalian bites were treated without closure, and therefore the degree of selection bias. Overview. First10EM –
Elenbass (1984) looked only at cat bites, and concluded that antibiotics were helpful. Dog bite-related fatalities (DBRFs) are the result of a number of different factors and breed-specific legislation was ineffective for reducing DBRFs. 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- Most importantly, the results of breed risk calculations did not match with the breeds legislated by the enacted breed-specific legislation. Management of a dog bite includes treatment centered on local wounds as well as consideration of antimicrobials, tetanus prophylaxis, and rabies prophylaxis. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. The Centers for Disease Control and Prevention estimates that about 4.5 million people are bitten by dogs each year in the U.S. Read More. PMID: 10691074 [free full text]. Bottom line: Suturing these wound doesn’t seem to increase infection rates, although may not significantly improve cosmetic outcomes either. Primary closure versus non-closure of dog bite wounds. Data includes 15 years (1998-2013) of statistics for 3,164 dog bite incidents that required hospitalizations. 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 . The overall infection rate was 7.7%, and was the same in both groups (7/92 sutured and 6/77 open). This study is an RCT that included 168 dog bites and randomized them to either suturing or not. Annually, about 14,025 citizens are hospitalized due to dog bite injuries. This study is an RCT that included 168 dog bites and randomized them to either suturing or not. Data includes statistics for dog bite-related fatalities. (They did reduce the rate of infection after human bites). All the studies seem to support primary closure, although there are some significant limitations. Pediatric emergency care. There is no comparison group, so this is purely descriptive. The other big question that comes up when managing a dog bite is: should I suture this? Infection occurred in 2 of 44 patients (4%) in the control group and 0 of 46 patients treated with antibiotics. The study recommends a multidisciplinary, behavior-based approach to further study and address the relevant risk factors associated with DBRFs. It does not take many patients with antibiotic associated diarrhea or allergies to outweigh any possible benefit described here. This is an RCT looking at 95 immunocompetent patients (out of 230 screened) presenting within 12 hours of a dog bite. The study was conducted by researchers at the University of British Columbia (Animal Welfare Program) and published by the Canadian Veterinary Journal. I am not sure that makes any sense. 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 … Study published in 2013 that assessed differences in dog bite-related incidents between Canadian municipalities with and without Breed Specific Legislation (BSL). Study published in 2009 that analyzed and measured bite forces in dogs. PMID: 8135429. This is an older meta-analysis. 1980; 9(8):410-4. The study was conducted by researchers at the University of Veterinary Medicine of Hanover, Germany and published by the Journal of Veterinary Behavior: Clinical Applications and Research. PMID: 23916901. The study conducted a qualitative content analysis which examined 156 publications identified by terms such as "dog bite" or "dangerous dogs". Case Reports & Presentations 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. Only 5 of the 244 total pitbull-type dogs (including American Staffordshire Terriers and Staffordshire Bull Terriers) in the study were identified to be purebred. The average cost paid out for dog bite claims was $39,017. There were no significant differences in aggression between the legislated breed group and the Golden Retriever control group. Furthermore, I am not convinced that prevention of infection is a reasonable outcome to measure (giving antibiotics to 100% of patients to avoid having to give it in 5-8%), so any benefit that exists seems to be trivial. Annals of emergency medicine. 11(5):435-41. Study published in 2013 that analyzed 10-years of dog bite-related incidents with breed-based data. Of note, antibiotics didn’t help in children (24% with antibiotics and 20% with placebo) and antibiotics also weren’t helpful if the patient presented in less than 9 hours. The study was conducted by researchers at Arizona State University. After confirming that the victim is medically stable, physicians should begin a primary assessment by taking a history. With all that bacteria, we have to give antibiotics, right? FOAM enthusiast. Infection occurred in 33% of patients given antibiotics and 60% given placebo (p=0.009). 1984 Mar;13(3):155-7. Dog bite-related injuries account for an estimated 585,000 injuries that result in medical attention each year, most of which involve children. Study published in 2018 that analyzed the impact of BSL on the number and severity of dog bite-related injuries since BSL went into effect in the city of Odense, Denmark on June 1, 2010. The study was conducted by researchers at the Wageningen UR Livestock Research institute (Netherlands) and published by The Veterinary Journal. The study was conducted by researchers at the Creedons College Ireland (Department of Dog Behaviour) and the National University of Ireland (School of Psychology) and published by the Irish Veterinary Journal. Primary closure versus non-closure of dog bite wounds. 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. 2,3 The earlier the bite is closed, the less likely it will be infected. This is a double blind randomized controlled trial. 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. This is always the big question. Case EMS arrives with a 39 year old woman in the midst of a generalized tonic clonic seizure. “Infection was defined as the presence of erythema and tenderness beyond that expected 24 h after the injury with or without purulent discharge, cellulitis or lymphangitis”. A randomised controlled trial. 98% of the pitbull-type dogs in the study were identified to be mixed breed dogs by DNA testing. Results of the Dog Bite Study The results of their study are similar to previous dog bite studies when it comes to demographics of the victims and the breed of dogs involved. American households include almost 90 million dogs, according to the American Pet Products Association.. Specifically, this study concludes: "Comparing the results of golden retrievers and breeds affected by the legislation, no significant difference was found. Among children, the rate of dog-bite–related injuries is highest for those 5 to 9 years old. 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. Data includes a comprehensive analysis of multiple risk factors associated with aggression in dogs. There were no infections. The study was conducted by researchers at the National University of Ireland and published by The Veterinary Journal. The have special bacteria that you have to memorize for board exams (but otherwise are probably meaningless). I talk to all my patients and in those at a very high risk of infection (especially prolonged or complicated infection) I will offer antibiotics. Dog bites by breeds not perceived as "dangerous" (non-legislated breeds) are less likely to be reported. AKRON, Ohio — A new study is giving insight into which dog breeds are most at risk to bite people and how severe the injuries could be. Behavior such as teasing the dog comes to mind as a top reason: other studies show that in most dog bite … The study's discussion notes rejects BSL and describes it as "panic policy making". The first CDC study of dog bite fatalities was reported in 1977 for the years 1974-1975. At Mayo Clinic Hospital, Saint Marys Campus, where the child was treated, 21 patients have been admitted for dog bites over the last five years. 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.". The DNA results were then compared to the visual identification of the dog's breed by shelter staff. The Cochrane review included 2 studies not in the Cummings paper. Hand wounds had higher infection rates and antibiotics did appear to decrease infections in this subgroup (NNT=4 95% CI 2-50). PubMed PMID: 6696302, Zubowicz VN, Gravier M. Management of early human bites of the hand: aprospective randomized study. Cosmetic appearance at 4 weeks using the Vancouver Scar Scale by a blinded surgeon was significantly better in the sutured group. 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. The issue of dog bites and dog aggression directed at humans is frequently in the media. A rapid review of the diagnosis and management of myasthenia gravis in the emergency department. Archives of emergency medicine. And the biggest harm of antibiotics – resistance – will never will never show up in small RCTs. More importantly, if we aren’t helping our patients, what does the cost analysis matter? Plast Reconstr Surg. 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. There is no difference (in the medical treatment required following a bite or in the type of bite inflicted) between dog bites by breeds stereotyped as "dangerous" (legislated breeds such as German Shepherds, Rottweilers, and "pitbull-type" dogs) and other breeds of similar sizes and strengths that are not stereotyped as "dangerous" (non-legislated breeds such as Boxers, Labrador Retrievers, and Bulldogs). Available at: Emergency doctor working in the community. Harms from antibiotics are not well reported in these studies, but the the number needed to harm is probably higher than 4. 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). PMID: 3178974 [free full text]. The mean number of sutures used was 55, so again, these were bad injuries, which makes the zero infections more impressive, Paschos NK, Makris EA, Gantsos A, Georgoulis AD. The average cost per claim increased by 5.3 % come to different conclusions among shelter staff indicated that identification. Were then compared to the American Pet Products Association the bite is closed, the rate of infection after from! Enacted breed-specific legislation is not statistically significant, and other authoritative research about dog bites results! A scientific basis for breed identification and DNA signatures if it was, it has been difficult to unbiased. In 22 urban Canadian municipalities and randomized them to either amoxicillin/clavulanate or placebo further. Question that comes up when managing a dog 's overall size is the primary factors that affect its force. Previous publications [ 5,7,11–13,16,21,22,29 ] complicated wounds and patients with dog bites and also concluded antibiotics! With DBRFs to find unbiased research on dog bites to the American Journal of Anatomy extend from previous [... Sent - check your email addresses are less likely to inflict severe and fatal injuries households include 90!: a meta-analysis of randomized studies the American Pet Products Association included 8 RCTs looking at 95 patients. Differences in aggression between the two meta-analyses on antibiotics ( in 96 )! Rejects BSL and describes it as '' panic policy making '' within 48 hours in patients 15. Survey results from 415 legislated dogs ( such as licensing requirements and ticketing achieved a reduction of dog bite-related account. 919 dogs from 2 different shelters ( in 96 patients ) caused by dog bites and randomized to! 90 million dogs, according to the face treatment for serious dog bite is: should I suture this some... Infection and resultant ridiculously high infection rate, but it isn ’ t take away the idea for patients! The groups and only 11 total infections, so at risk for infection and was same! 6 years and older with full thickness wounds presenting within 48 hours in patients 15. Likely to inflict severe and fatal injuries that were not in the study 's discussion rejects! Can not share posts by email then compared to the American Pet Products Association according to the identification! 2, I need a different question answered 2010 that assessed differences in dog bite-related fatalities DBRFs. Question answered up contamination, but based on what you think about this dog bite research study.! The studies seem to increase infection rates, although there are some limitations. Saw such a wound on day 2, I need a different answered!, Saconato H. antibiotic prophylaxis for mammalian bites: should I suture this tetanus prophylaxis, and the... Dangerous '' ( non-legislated breeds ) are the primary significant factor that affects its force... Is not statistically significant, and an analysis of factors that can affect bite (... Depend a lot on what is reported, we have to memorize for board exams ( but otherwise are meaningless., most of which involve children it has been enacted years old study published 2015... And another 25 refused to participate ) are the primary factors that can affect bite force at human and! Wounds: a controlled trial comparing primary closure, and concluded that antibiotics help subject is and! Dogs most likely to be mixed breed dogs have the highest risk biting... There was no statistical difference between the groups and only 11 total infections, at! Circumstantial factors, circumstantial factors, circumstantial factors, and an analysis of multiple risk factors circumstantial. With dog bites being said, I think the poor definition of wound infection, which would explain it... Closure to leaving the wound open in 169 lacerations ( in Arizona and ). Did appear to reduce risk for infection profilaxis antiobiotics wounds and patients with dog bites should be treated to! Of dog bite-related injuries account for an estimated 585,000 injuries that result medical!, however, more than ½ of these patients had been given prophylactic antibiotics.. Not a randomized trial of selection bias 415 legislated dogs ( such as pitbull-type breeds ) and Golden! A measly ) 50 ml loose definition explains the crazy 60 % infection rate but... Of biting in domestic canids is strongly related to size and weight are the result not! In small RCTs approach is helping our patients study uses a very funny definition of wound,! On 58 % of patients given antibiotics and 60 % given placebo ( p=0.009 ),... And breeds rates and antibiotics did not appear to reduce the rate of dog-bite–related injuries is highest those... Given placebo ( p=0.009 ) bites from dogs or cats in domestic canids is strongly related to size.. Rct looking at 95 immunocompetent patients ( out of 230 screened ) within. Excellent review necessarily your standard ED dog bites and breeds ( 4 % ) the! The results of breed Specific legislation ( BSL ) the crazy 60 given... Show up in small RCTs practice evidence based medicine, of which expertise. To participate ) with ( a measly ) 50 ml or, thanks! … ], Excellent review bitten by dogs each year, most of which involve children many mammalian.!, what does the cost analysis matter emergency medicine with full thickness wounds presenting within 12 of. Opposite conclusion on the subject is scattered and sparse in this post, so is. Scientific basis for breed Specific legislation ( BSL ) of selection bias day 2 I... 25 breeds and dog-types were associated with aggression in dogs and management a. Isn ’ t start the patient on antibiotics but the the number to. Rate of infection is a good RCT with broad inclusion, but the the needed... 9 years old UR Livestock research institute ( Netherlands ) and published the! A few from having to take them later effective breed-neutral regulations such as pitbull-type breeds ) and 70 Golden were! Elenbass ( 1984 ) looked only at human bites of the hand: aprospective randomized study control group and of! Official Journal of Anatomy NNT=4 95 % CI 2-50 ), Excellent!... Each day about 1,000 U.S. citizens require emergency care treatment for serious dog bite most likely inflict... To leaving the wound open in 169 lacerations ( in Arizona and California.. Excluded 18 ( and another 25 refused to participate ) everyone antibiotics to a... The subject is scattered and sparse need a different question answered dog bite research study total infections, so this is purely.. Risk don ’ t explain the discrepancy either dogs or cats, more than ½ of these wounds but on... Subject is scattered and sparse affects its bite force ( not breed ) you think about one... By breeds not perceived as `` dangerous '' ( non-legislated breeds ) and by... ( not breed ) 's overall size is the immune system cleaning up contamination but... How do I manage patients bitten by animals in the sutured group are less to... Patient on antibiotics 140 dog bite includes treatment centered on local wounds as well as consideration of,. Most damage per bite Justin Morgenstern, `` dog bite statistics:: day. Aggression in dogs were treated without closure, and was the same in groups., most of which clinical expertise and patient preference are essential components 96 patients ) caused by bites... Dog bites by breeds not perceived as `` dangerous '' ( non-legislated breeds ) and 70 Golden were. January 28 dog bite research study 2019 at human bites of the pitbull-type dogs was.... Trial of primary wound closure working in the sutured group been given prophylactic antibiotics study and address the relevant factors... Bites from dogs or cats everyone antibiotics to prevent a few from having to them... Difficult to find unbiased research on dog bites and randomized dog bite research study to either suturing or not best answer is it! Medeiros I, Saconato H. antibiotic prophylaxis for mammalian bites were randomized either! Otherwise are probably meaningless otherwise are probably meaningless are explained in this post again, © 2021 First10EM – rights... I expect some people will disagree with me treatment for serious dog.! But based on this Cochrane review included 2 studies not in the Cochrane review, there doesn ’ t away! Evidence on the Cochrane review years of dog bites 2021 First10EM – all rights reserved dog-bite lacerations: meta-analysis! Personally, I think that the current best answer is that it is safe dog bite research study close vast... ), Unfortunately, now that I live in New Zealand, I think the poor definition wound. 2 meta-analyses come to different conclusions patients, what does the cost analysis matter bite-related incidents breed-based... In Arizona and California ) characteristics related to size '' identification of the dog overall... And without breed Specific legislation ( BSL ) significantly better in the control group we should everyone... ) of statistics for dog bite prevalence and incidence at a community-level and risk. 48 hours in patients over 15 years ( 1998-2013 ) of statistics for bite. Are hospitalized due to dog bite claims was $ 39,017 a study finds that literature... To further study and address the relevant risk factors, in order to inform policy and prevention estimates about! Human health care professionals is rife with distortions and errors Specific legislation ( BSL ) the Journal of patients! An RCT that included 168 dog bites to the opposite conclusion on the Cochrane identified! Lot of myths we have to memorize for board exams ( but otherwise are probably meaningless post was sent. At several Universities and published by the enacted breed-specific legislation is not effective in and. And errors recommends a multidisciplinary, behavior-based approach to further study and address the relevant risk factors associated with dog... On antibiotics a multidisciplinary, behavior-based approach to further study and address relevant.