Derm
Dog Bite
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Dog Bite
, Canine Bite
See Also
Dog Bite Infection
Rabies Prophylaxis
Cat Bite
Animal Bite
Human Bite
Fight Bite
Insect Bite
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 Bite
s 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
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
Less aggressive breeds (Family dogs)
Boxer
Dalmatian
English Setter
English Springer
Golden Retriever
Iris
h Setter
Labrador Retriever
Spaniel
Pathophysiology
Crush or avulsion injuries are more typical from Dog Bite
Extensive
Laceration
s 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
Fracture
s 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
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
Imaging
Imaging is not routinely needed in most Dog Bites
Extremity
Consider XRay imaging in extensive, deep wounds to evaluate for
Fracture
s and retained foreign bodies
Head and Face
Consider imaging if deformity identified
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
Antibiotic
s
See
Dog Bite Infection
for
Antibiotic
selection
Confirm dog has up to date
Vaccination
s including
Rabies
Start
Rabies Prophylaxis
if
Rabies
status cannot be confirmed
Alternatively, quarantine healthy dog and observe for 10 days
Necropsy for
Rabies
if dog dies or shows signs of
Rabies
during 10 day observation
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
Antibiotic
s (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
Chen (2000) Acad Emerg Med 7(2): 157-61 [PubMed]
Paschos (2014) Injury 45(1): 237-40 [PubMed]
Complications
Gene
ral
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
Nightmare
s or avoidance is common (seek medical attention if they persist)
Rabies
Tetanus
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
Staphylococcus
Streptococcus
Other common anaerobic infections
Fusobacterium
Bacteroides
Prevotella
Porphyromonas
Propionibacterium
Disposition
Outpatient
Wound
Check in 24-48 hours Indications
Usually indicated over inpatient care
All hand wounds should be rechecked
Prevention
Dog Bites
Keep dogs updated on
Vaccination
s (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)
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
Resources
Dog Bite Prevention (American Veterinary Medical Association)
https://www.avma.org/resources-tools/pet-owners/dog-bite-prevention
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]
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