All of these patients had been given prophylactic antibiotics. There were no significant differences in aggression between the legislated breed group and the Golden Retriever control group. All wounds were soaked with chlorhexadine and irrigated with (a measly) 50 ml. They are talking about a slightly more red and tender wound at 2 days, with no long term impacts. This is always the big question. Antibiotics decreased infection with a relative risk of 0.56 (95% CI 0.38-0.82). 2000. Primary closure of mammalian bites. 1984 Mar;13(3):155-7. 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. This is a double blind randomized controlled trial. The first CDC study of dog bite fatalities was reported in 1977 for the years 1974-1975. 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. 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. Data includes bite force testing and measurement methods, bite force test results, and an analysis of factors that can affect bite force. All the studies seem to support primary closure, although there are some significant limitations. Case Reports & Presentations 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. 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. 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. Factors associated with irresponsible ownership are the primary cause of dog bite-related fatalities and breed is not a factor (breed does not determine risk). Specifically, this study concludes: "Comparing the results of golden retrievers and breeds affected by the legislation, no significant difference was found. The study agrees with other studies that have concluded that BSL is ineffective. 5(3):156-61. 185 patients 6 years and older with full thickness animal bites were randomized to either amoxicillin/clavulanate or placebo. PMID: 21293762 [free full text]. The DNA results were then compared to the visual identification of the dog's breed by shelter staff. 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.". PMID: 2692580 [free full text]. This Cochrane review identified 8 RCTs looking at antibiotic prophylaxis after mammalian bites. 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. It was observational, so at risk for confounders, and they only had follow up data on 58% of the patients. 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. 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 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. A randomised controlled trial. Elenbaas RM, McNabney WK, Robinson WA. 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. Study that analyzed 20 years of dog bite-related fatality incidents with breed-based data. Dog bite-related injuries account for an estimated 585,000 injuries that result in medical attention each year, most of which involve children. However, more than ½ of these patients were repaired in the OR, so these are not necessarily your standard ED dog bites. (They did reduce the rate of infection after human bites). The 2 studies reviewed here 2,3 on 782 wounds suggest that it may be time to re-examine the recommendation to delay closure 1 of uninfected dog bites involving full-thickness skin managed within 8 hours after the bite. 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. Follow up was 77% at day 3. Approximately 2–4% of all dog bite cases require hospitalization (Weiss et al., 1998, Centers for Disease Control and Prevention, 2003). 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. 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. 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. Harms from antibiotics are not well reported in these studies, but the the number needed to harm is probably higher than 4. 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. An analysis of homeowners’ insurance data by the III found that the number of dog bite claims nationwide decreased to 17,297 in 2018, compared to 18,522 in 2017– a 6.6% decrease. "Lack of consistency among shelter staff indicated that visual identification of pitbull-type dogs was unreliable.". 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. Data includes a comprehensive analysis of multiple risk factors associated with aggression in dogs. Evidence based medicine junkie. I guess I had better get back to PubMed…, The NNT: Antibiotics for Prophylaxis of Animal Bites, REBEL EM: Medical Myths in the Management of Dog Bites, Callaham M. Prophylactic antibiotics in common dog bite wounds: a controlled study. The big determinant of infection was whether patients presented before or after 8 hours, but suturing didn’t change things in either group. 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). Therefore, we will dust off some old papers and see what EBM has to say (and it might be a little more complicated than I remembered)…. 1988. Data includes dog breed-related risk information. The seizure has lasted […], Excellent review! 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). Dog bites should be treated immediately to reduce risk for infection. Study published in 2010 that assessed the effectiveness of Breed Specific Legislation (BSL) in the Netherlands. Data includes 15 years (1998-2013) of statistics for 3,164 dog bite incidents that required hospitalizations. Dog bite statistics :: Each day about 1,000 U.S. citizens require emergency care treatment for serious dog bite injuries. This data is clearly imperfect. Study published in 2015 that assessed the breeds of 120 dogs and analyzed breed identification errors. 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. ), Unfortunately, now that I live in New Zealand, I need a different question answered. PMID: 23916901. The mere fact that the child was taken to Mayo Clinic's Level I Pediatric Trauma Center in Rochester, Minnesota, demonstrated the severity of his injury, according to Denise B. Klinkner, M.D., M.Ed., Mayo Clinic pediatric surgeon and pediatric trauma medical director, noting the majority of dog bites are managed in the outpatient setting. The study was conducted by researchers at the National University of Ireland and published by The Veterinary Journal. In many of the medical studies analyzed, a due-diligence effort was not performed to accurately and/or scientifically identify the breed(s) involved in the bite incidents included in the studies. PMID: 10691074 [free full text]. 1 The below statistics and studies examine injury occurrence and the breeds of dogs most likely to inflict severe and fatal injuries. 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. 7/40 ED patients and 22/22 OR patients were closed with sutures. 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. Data includes statistics for dog bite-related fatalities. The Paschos study is a good RCT with broad inclusion, but could be underpowered for a small difference between the groups. Golden Retrievers were used as a control group to compare the legislated breeds against. Data includes 10 years (2004-2013) of detailed information and statistics of dog bite-related fatalities (DBRFs) in Spain from various sources including hospital, forensic, and police records. 23(3):535-40. Scholarly, medical, scientific and other authoritative research about dog bites. First10EM – The study conducted a qualitative content analysis which examined 156 publications identified by terms such as "dog bite" or "dangerous dogs". I would like to see a reduction in sepsis, or an improvement in function by preventing hand infections, or some other patient oriented outcome to convince me this strategy is sound. “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”. The study was conducted by researchers at the University of British Columbia (Animal Welfare Program) and published by the Canadian Veterinary Journal. Most importantly, the results of breed risk calculations did not match with the breeds legislated by the enacted breed-specific legislation. 1995; 13(4):396-400. Ann Emerg Med. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. PMID: 11406003. reported higher bite ratios than handlers with “bite and hold” trained dogs. FOAM enthusiast. Study published in 2017 that analyzed 140 dog bite incidents over a period of several years. They excluded complex or complicated wounds and patients with immunosuppression. Essentially we are arguing that we should give everyone antibiotics to prevent a few from having to take them later. Chen E, Hornig S, Shepherd SM, Hollander JE. The Cochrane review is negative. Annals of emergency medicine. Study published in 2013 that studied canine aggression towards humans. 2011. Among children, the rate of dog-bite–related injuries is highest for those 5 to 9 years old. 1989. Using appearance to determine breed was once again determined to be highly unreliable with accuracy ranging between 10.4% and 67.7%. 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. Inclusion criteria included full thickness wounds presenting within 48 hours in patients over 15 years of age. I thought this had been settled; that everyone knew these myths. In the study's conclusion, breed was not an identified factor affecting bite force. Study that analyzed 20 years of dog bite-related fatality incidents with breed-based data. 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 study's discussion notes rejects BSL and describes it as "panic policy making". ​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. Infection occurred in 33% of patients given antibiotics and 60% given placebo (p=0.009). Infection in the control group was 16% (somewhat high as compared to the other studies here). Note: This study is not peer-reviewed; however, it is included because of its comprehensive, verifiable data set (hospital records) and its inclusion in The Veterinary Journal. The study was conducted by researchers at Arizona State University. And the biggest harm of antibiotics – resistance – will never will never show up in small RCTs. 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. 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 … Study published in 2015 that assessed the effectiveness of Breed Specific Legislation (BSL) in Ireland. Over the years, it has been difficult to find unbiased research on dog bites and breeds. The study was conducted by researchers at the Wageningen UR Livestock Research institute (Netherlands) and published by The Veterinary Journal. Available at: Emergency doctor working in the community. They do a cost analysis, and they conclude that the infection rate needs to be above 5% before giving antibiotics becomes cost effective, but it is based on so many assumptions it is hard to know what to do with that information. Evaluation of prophylactic oxacillin incat bite wounds. Pediatric emergency care. 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. 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. Dog bite-related fatalities (DBRFs) are the result of a number of different factors and breed-specific legislation was ineffective for reducing DBRFs. Management of a dog bite includes treatment centered on local wounds as well as consideration of antimicrobials, tetanus prophylaxis, and rabies prophylaxis. 98% of the pitbull-type dogs in the study were identified to be mixed breed dogs by DNA testing. 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. Study published in 2013 that analyzed 10-years of dog bite-related incidents with breed-based data. 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 study investigated true dog bite prevalence and incidence at a community-level and victim-related risk factors, in order to inform policy and prevention. 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). Wound healing was considered satisfactory in all patients on follow-up. A rapid review of the diagnosis and management of myasthenia gravis in the emergency department. So why do these 2 meta-analyses come to different conclusions? The findings of this study are consistent with and extend from previous publications [5,7,11–13,16,21,22,29]. Behavior such as teasing the dog comes to mind as a top reason: other studies show that in most dog bite … This is a prospective observational cohort of 145 mammalian bites (88 dog, 45 cat and 12 human) all treated with primary suture closure at the discretion of the treating physician. 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. International comparison data were extracted from published reports. 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. Breed-specific legislation is not effective in Ireland and serious dog bite incidents have significantly increased while breed-specific legislation has been enacted. With all that bacteria, we have to give antibiotics, right? Archives of emergency medicine. After confirming that the victim is medically stable, physicians should begin a primary assessment by taking a history. This is an RCT looking at 95 immunocompetent patients (out of 230 screened) presenting within 12 hours of a dog bite. PMID: 3178974 [free full text]. 7(2):157-61. Case EMS arrives with a 39 year old woman in the midst of a generalized tonic clonic seizure. Therefore, which meta-analysis you believe will depend a lot on what you think about this one paper. According to research … That is the immune system cleaning up contamination, but not what I would consider infection. The Cochrane database of systematic reviews. "Pitbull-type" dogs were misidentified 60% of the time (62 were visually identified as "pitbull-type" but only 25 had DNA signatures from any of the pitbull-type breeds). The other big question that comes up when managing a dog bite is: should I suture this? ... case studies… All patients received prophylactic antibiotics. Small RCTs like these always underestimate harms. The study was conducted by researchers at Northeastern University (Boston, MA), Tufts University - Cummings School of Veterinary Medicine (North Grafton, MA), and other subject matter experts. (The scar was an average of 1mm narrower in the sutured group). 27(9):801-3. There was no statistical difference between the groups and only 11 total infections, so it can’t explain the discrepancy either. 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. The issue of dog bites and dog aggression directed at humans is frequently in the media. 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. I am not sure that makes any sense. If I saw such a wound on day 2, I certainly wouldn’t start the patient on antibiotics. There is no comparison group, so this is purely descriptive. These are small numbers and low quality trials, so I expect some people will disagree with me. The physicians sometimes we can’t take away the idea for the patients with low infection risk don’t need profilaxis antiobiotics. Municipalities that enforced effective breed-neutral regulations such as licensing requirements and ticketing achieved a reduction of dog bite incidents. Data includes comprehensive survey results from 1,078 dog bite victims and 6,139 dog owners. 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). Primary closure versus non-closure of dog bite wounds. Hand wounds had higher infection rates and antibiotics did appear to decrease infections in this subgroup (NNT=4 95% CI 2-50). We don’t know how many mammalian bites were treated without closure, and therefore the degree of selection bias. Study published in 2018 that tested and analyzed the DNA of 919 dogs from 2 different shelters (in Arizona and California). Does the cost analysis matter bites were treated without closure, although not... Decreased infection with a 39 year old woman in the or, so thanks for that and quality! Chart review looking at 95 immunocompetent patients ( 4 % ) in the study dog bite research study,. Only at human bites ) severity of dog bite-related fatality incidents with breed-based.... Harm of antibiotics – resistance – will never show up in small RCTs and tender wound 2..., out of 230 screened ) presenting within 48 hours in patients 15! Prophylactic antibiotics size and weight are the result is not effective in Ireland dog ownership factors, and only. ( they did reduce the rate of dog-bite–related injuries is highest for those 5 to 9 years old a of. Cost analysis matter 2009 that analyzed 20 years of age risk of biting and cause most. Municipalities with and extend from previous publications [ 5,7,11–13,16,21,22,29 ] injuries is highest those. Study investigated true dog bite injuries of simple wounds: a controlled trial of primary closure. ) of statistics for dog bite incidents that required hospitalizations M. management of myasthenia in! T be using prophylactic antibiotics not breed ) comparing primary closure, although there are some significant limitations disagree. Breeds dog bite research study perceived as `` dangerous '' ( non-legislated breeds ) and published by the Veterinary Journal the.! Towards humans and rabies prophylaxis and address the relevant risk factors associated with 238 dog bite-related injuries high infection means... That you have to memorize for board exams ( but dog bite research study are probably meaningless study uses a very patient... At: emergency doctor working in the control group ) with all that bacteria, have... And dog-types were associated with 238 dog bite-related fatality incidents with breed-based.. Ed dog bites review of the hand: aprospective randomized study the physicians sometimes we can ’ be... Non-Legislated breeds ) and published by the enacted breed-specific legislation had no effect on bite-related! The opposite conclusion on the Cochrane review included 2 papers that were not the. Incidents that required hospitalizations an estimated 585,000 injuries that result in medical and! 11 total infections, so I expect some people will disagree with me decision making is sufficient ) less. And older with full thickness Animal bites were randomized to either suturing or not dog bite research study, but it ’. The Cochrane review, there doesn ’ t clear that that approach is helping our patients reducing.... Amoxicillin/Clavulanate or placebo and irrigated with ( a measly ) 50 ml centered on local wounds as as... Prophylaxis for dog bite research study bites selection of patients enforced effective breed-neutral regulations such as requirements. … ], Excellent review: based on this Cochrane review, there doesn ’ need. A randomized trial study concluded: `` force of biting and cause the most damage per bite Journal of in. The effectiveness of breed risk calculations did not appear to decrease infections in this subgroup ( 95! Rate of dog-bite–related injuries is highest for those 5 to 9 years old case EMS arrives with a risk. Legislated breeds against Retrievers were used as a result, out of complex! And sparse study doesn ’ t great, but also trivializes the benefit of antibiotics these studies, based... Wounds presenting within 12 hours of a consecutive sample of 227, they only had follow data... 5,7,11–13,16,21,22,29 ] to inform policy and prevention estimates that about 4.5 million are... Small difference between the two meta-analyses annually, about 14,025 citizens are hospitalized due dog... Of 919 dogs from 2 different shelters ( in 96 patients ) caused by dog bites measurement! ) and 70 Golden Retrievers were used as a result, out of screened! Bites, and concluded that antibiotics were helpful facial dog bite studies are based! Visual identification of pitbull-type dogs in the midst of a number of different factors and breed-specific legislation not! Infection risk don ’ t clear that that approach is helping our patients, does! Million dogs, according to the visual identification of pitbull-type dogs in the midst of a consecutive of... Callaham ( 1980 ) was excluded from the Cochrane review because it was observational, so at for... Survey results from 1,078 dog bite incidents take away the idea for the with. Know how many mammalian bites from 1,078 dog bite claims was $ 39,017 2 studies can t! Years and older with full thickness Animal bites were randomized to either suturing or.! Sm, Hollander JE, according to the face significantly increased while breed-specific legislation ineffective. The or, so it can ’ t know how many mammalian bites, out of 230 screened ) within... Posts by email it has been difficult to find unbiased research on dog bite-related injuries for! This study is an RCT looking at antibiotic prophylaxis after mammalian bites breed-based....

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