Talk:Dog bite

References: with notes

O'Brien CM. Richard B. A surgeon's duty in dog bite prevention in children. Annals of Plastic Surgery. 56(1):106-7, 2006 Jan. UI: 16374108An audit of dog bite referrals to the Plastic Surgery Department at Birmingham Children's Hospital revealed the following concerns: 28 consecutive children referred to the plastic surgery team were prospectively audited. The mean age was 6 years. Twenty-two children required surgery. Nineteen of the total had suffered dog bites to the face. Eighteen of the attacks were witnessed and unprovoked. Seventeen dogs were either a family pet or known to the child (eg, belonged to a neighbor or grandparent). Following the attack, 12 dogs remained in the home with the child, 2 dogs were sent to a different home, 2 were taken to the Royal Society for the Protection of Cruelty to Animals, 7 were destroyed, 1 was muzzled, and the fate of 4 is unknown. Of the 7 dogs that were destroyed, 3 were family pets and 4 were known to the child. Six children had been bitten before, and 3 by the same dog. All of those children required surgery. In 5 cases, owners admitted that their dog had bitten before. The most common type of dog to bite in this series was a crossbreed (9 cases), followed by Staffordshire bull terrier (4 cases).Is there not a duty for practitioners to provide advice to prevent repeat attacks on children, particularly by the same animal in the home Birmingham Children's Hospital Birmingham, UK

Soueid NE. Khoobehi K. Microsurgical replantation of total upper eyelid avulsion. Annals of Plastic Surgery. 56(1):99-102; discussion 102-3, 2006 Jan. UI: 16374105 22yo woman attacked by her own dog, who completelt removed her eyelid, which (brought in by a family member) was replaced.

Chaudhry MA. Macnamara AF. Clark S. Is the management of dog bite wounds evidence based? A postal survey and review of the literature. European Journal of Emergency Medicine. 11(6):313-7, 2004 Dec. UI: 15542987 Objectives: To determine current practice in the management of dog bite wounds with regard to the use of prophylactic antibiotics and primary closure and to compare the available evidence.Methods: We conducted a national postal survey of Accident and Emergency (A&E) departments in the UK to ascertain the current practice in the management of recent dog bite wounds. A questionnaire was designed and posted to a named A&E consultant. Non-respondents were sent a single reminder 8 weeks after the initial mailing. A detailed literature search was carried out using Medline, Embase and Cochrane databases to look at the available evidence. Results: The postal survey yielded an 80% response. Prophylactic antibiotics were routinely used by 53% of the respondents. Although 99% of the respondents were happy to close facial dog bite lacerations, 60% were reluctant to suture other body regions. Recent available evidence suggests that restricting the use of prophylactic antibiotics for high-risk dog bite wounds and the primary suturing of appropriate dog bite lacerations is safe.Conclusions: The management of recent dog bite wounds is not entirely evidence based in many A&E departments in the UK.

• "Dog bites account for 80–90% of all animal bites, and 10% of these require suturing" (Dire DJ, Quick G. Dog-bite wounds. Emerg Dec 1986; 2:38–46.)
• The evidence regarding the role of primary closure in dog bite wounds is very limited. Maimaris and Quinton [12] reported a prospective RCT (2b) of 96 patients with 169 wounds to assess infection and cosmesis. The patients were then randomly assigned into two groups: one group had primary wound closure and in the other group wounds were left open. No antibiotics were used. All the patients were reviewed by one of the authors at 2, 7 and 14 days from injury. Out of 92 wounds sutured, seven wounds developed infection. Of 77 wounds left open, six got infected. Statistical analysis showed no significant difference in the infection rates. This was in agreement with three other studies [5,19,20] that have shown a lower infection rate in dog bite wounds that were sutured in comparison with wounds that were left open.The recent available evidence favours the suturing of facial dog bite lacerations. In other body regions, clean deep lacerations with minimal contusions may be sutured after copious irrigation and meticulous debridement if patients present within 4 h.
• There are no good studies of dog bite that include follow-up and a large number of patients that demonstrate worth of prophylactic antibiotics in dog bite. Such studies are needed.

Deshmukh PM. Camp CJ. Rose FB. Narayanan S. Capnocytophaga canimorsus sepsis with purpura fulminans and symmetrical gangrene following a dog bite in a shelter employee. [Case Reports. Journal Article] American Journal of the Medical Sciences. 327(6):369-72, 2004 Jun. UI: 15201655

Healthy young woman dies from septicemia after being bitten by dog at shelter where she volunteers: purpura fulminans with symmetrical peripheral gangrene and sepsis caused by Capnocytophaga canimorsus. Did not seek treatment until 3 weeks after bite on hand."Cases of C. canimorsus infection have been reported from the United States, Canada, Europe, and Australia. Infection occurs 2 to 3 days after wound contamination, but symptoms may appear after 2 to 4 weeks. Patients presenting longer than 8 hours after injury usually have established infection."

Peters V. Sottiaux M. Appelboom J. Kahn A. Posttraumatic stress disorder after dog bites in children.Journal of Pediatrics. 144(1):121-2, 2004 Jan.

"Of the 22 child victims of dog bites, 12 had either partial (7 children) or complete (5 children) PTSD, but none received psychological support."

Bradshaw SE. Endocarditis due to Staphylococcus aureus after minor dog bite. [Case Reports. Journal Article] Southern Medical Journal. 96(4):407-9, 2003 Apr. UI: 12916563

• Although this paper describes case of endocarditis from staph aureus- discusses literature in which endocarditis more often from C.canimorus

Mitchell RB. Nanez G. Wagner JD. Kelly J. Dog bites of the scalp, face, and neck in children. Laryngoscope. 113(3):492-5, 2003 Mar. UI: 12616202

Objective: To update the surgical management of injuries from dog bites of the scalp, face, and neck in children.

Study Design: Retrospective case review.

Methods: A retrospective review of 44 children with dog bites of the scalp, face, and neck was carried out at the University of New Mexico Health Sciences Center (Albuquerque, NM) between January 1, 1995, and December 31, 2000. Data on demographics, hospitalization, surgery, and outcome were collected and entered into an Access 2000 database.

Results: The children ranged in age from 1.0 to 12.1 years. The mean age of the study population was 5.2 years (±2.9 y standard deviation). Sixteen severely injured children (36%) were hospitalized to repair damage to the airway and blood vessels of the neck or to treat hemodynamic compromise. The length of stay in hospital ranged from 1 to 16 days. The most common injury in these children was a scalp laceration (57%). Twenty-six less severely injured children (64%) were not hospitalized. The most common surgery in these children (88%) was repair of multiple facial lacerations. Attention deficit hyperactivity disorder was noted in the medical records of 12 children (29%). Complications occurred in five children (31%) who were hospitalized and nine children (35%) who were not hospitalized.

Conclusions: The injured child is typically a 5-year-old boy attacked by a familiar dog at home or in the local neighborhood. Children with the diagnosis of attention deficit hyperactivity disorder appear to be at a higher risk of dog bite injuries and should be monitored during interactions with dogs. The goal of surgical management for severely injured children is to avoid immediate mortality and to establish a schedule of multiple-staged procedures for revision surgeries. An optimal cosmetic result is the principal goal for less severely injured children.

• "The rate of infection reported in the present study was approximately 14%. This rate is greater than that reported by Chen et al. 4 but less than that reported by Lackmann et al. 5 The children who developed infections were all treated with antibiotics, and only one child was hospitalized. Children who are hospitalized are likely to receive multiple intravenous antibiotics, and this may account for the low rate of wound infections in this group. This suggests that the rate of infection after dog bite injuries is not related to the severity of injuries or to the need for hospitalization. Extensive use of intravenous antibiotics may be the most important factor in reducing the rate of infection. However, the small size of the study population limits the development of specific recommendations for antibiotic therapy to treat dog bites of the head and neck in children."

Rosenman JR. Reynolds JK. Kleiman MB. Capnocytophaga canimorsus meningitis in a newborn: an avoidable infection. [Review] [15 refs] [Case Reports. Journal Article. Review] Pediatric Infectious Disease Journal. 22(2):204-5, 2003 Feb. UI: 12613462

• "Capnocytophaga canimorsus causes dog-bite wound induced sepsis in adults, but infection may follow mucous membrane exposure. Systemic infection in children is extremely rare. A neonate with frequent exposure to a family dog and no cutaneous infection developed C. canimorsus meningitis. Suspicion of this pathogen requires laboratory consultation. Parental counseling can limit the risk of pet acquired infections."
• Note-this 12 day old infant was immunosuppressed having just come off systemic steroids

Burroughs JR. Soparkar CN. Patrinely JR. Williams PD. Holck DE. Periocular dog bite injuries and responsible care. [Journal Article] Ophthalmic Plastic & Reconstructive Surgery. 18(6):416-19; discussion 419-20, 2002 Nov. UI: 12439053

Bacteriology Pasteurella important in cat bites, but also important in dog bites Bach G,Shah NA,Mejia A,Weinzweig N,Brown A,Gonzalez MH. Department of Orthopaedic Surgery, Chicago, IL 60612, USA. Upper extremity dog bite wounds comprise a large percentage of all mammalian bite wounds. The purpose of the study was to assess the bacteriology of patients presenting with such injuries to the emergency room that required consultation by a hand surgeon. The study also analyzed the effect of delayed intervention on growth of invasive pathogens, on the incidence of multiple pathogens, on treatment interventions, and on length of hospital stay. Objective data and subjective descriptions of the wound were collected on 32 patients who presented to Chicago area hospitals. The authors retrospectively analyzed the data and grouped the patients into two categories based on time of intervention: early or those treated within 48 hours, and delayed to include those treated after 48 hours. Incidence of bacterial growth and Pasteurella species growth in cultures was similar to that reported in the literature. Delayed patients had a significantly higher incidence of positive bacterial growth from wound cultures (100%) compared with nondelayed patients (54%). Delayed patients also had a higher incidence of treatment intervention (delayed group 86% surgical irrigation and debridement compared with 48% for the early group). There was a trend toward increased length of hospital stay (delayed group 4.6 days compared with 2.6 days), although this was not significant. The growth of multiple pathogens between the two groups was similar and not significant (delayed group 43% compared with 54% early group).

PMID: 16442016 [PubMed - indexed for MEDLINE]