Plast Reconstr Surg. Dogs mouths are filthy. PMID: 8135429. However, a few recent conversations have highlighted the fact that the management of dog bites is still steeped in controversy with wide practice variations. PMID: 10691074 [free full text]. Evidence based medicine junkie. West J Emerg Med, Dec 2010. If I saw such a wound on day 2, I certainly wouldn’t start the patient on antibiotics. As a result, out of a consecutive sample of 227, they only excluded 18 (and another 25 refused to participate). 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. Therefore, these 2 studies can’t explain the discrepancy between the two meta-analyses. Background and Methods To define better the bacteria responsible for infections of dog and cat bites, we conducted a prospective study at 18 emergency departments. The average cost paid out for dog bite claims was $39,017. 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. The other big question that comes up when managing a dog bite is: should I suture this? Post was not sent - check your email addresses! Overview. Elenbaas RM, McNabney WK, Robinson WA. 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). 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. 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. In the study's conclusion, breed was not an identified factor affecting bite force. Most importantly, the results of breed risk calculations did not match with the breeds legislated by the enacted breed-specific legislation. The study recommends a multidisciplinary, behavior-based approach to further study and address the relevant risk factors associated with DBRFs. 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. Approximately 2–4% of all dog bite cases require hospitalization (Weiss et al., 1998, Centers for Disease Control and Prevention, 2003). Behavior such as teasing the dog comes to mind as a top reason: other studies show that in most dog bite … Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. PubMed PMID: 6696302, Zubowicz VN, Gravier M. Management of early human bites of the hand: aprospective randomized study. 2000. Thank for this post again, © 2021 Study published in 2017 that analyzed the characterization and severity of dog bites in medical studies and literature. 2001. Dog bite-related fatalities (DBRFs) are the result of a number of different factors and breed-specific legislation was ineffective for reducing DBRFs. 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. 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. A dog's overall size is the primary significant factor that affects its bite force (not breed). Dog bites should be treated immediately to reduce risk for infection. 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)…. Dog bite incidents are the result of a complex set of factors including dog ownership factors, circumstantial factors, and other factors. Breed-specific legislation is not effective in Ireland and serious dog bite incidents have significantly increased while breed-specific legislation has been enacted. 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. Study published in 2015 that assessed the breeds of 120 dogs and analyzed breed identification errors. Essentially we are arguing that we should give everyone antibiotics to prevent a few from having to take them later. These are small numbers and low quality trials, so I expect some people will disagree with me. Maimaris C, Quinton DN. This very loose definition explains the crazy 60% infection rate, but also trivializes the benefit of antibiotics. Data includes dog breed-related risk information. 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. 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. (They did reduce the rate of infection after human bites). PMID: 21878832, A retrospective chart review looking at 87 pediatric patients with dog bites to the face. All of these patients had been given prophylactic antibiotics. Finally, additional factors such as dog breed, Shutzhund training, the number of canine calls, and whether or not the dog was sexually intact were all significant correlates of canine force in the final model. First10EM – 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. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. All rights reserved. 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. Management of a dog bite includes treatment centered on local wounds as well as consideration of antimicrobials, tetanus prophylaxis, and rabies prophylaxis. A lot of myths we have are explained in this post , so thanks for that. 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- 11(5):435-41. That seems pretty easy. The Cochrane review included 2 studies not in the Cummings paper. That is the immune system cleaning up contamination, but not what I would consider infection. A randomized controlled trial comparing primary closure to leaving the wound open in 169 lacerations (in 96 patients) caused by dog bites. 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. 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. The study used a comprehensive dataset from hospital emergency room records and included records on 2,622 serious dog bite-related injuries from 2002 through 2015 (covering incidents before and after BSL was enacted). This is always the big question. According to research … Study published in 2015 that assessed the effectiveness of Breed Specific Legislation (BSL) in Ireland. 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. 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. ", In many of the medical studies analyzed, there was: "misinformation about the significance of breed and breed characteristics.". Data includes comprehensive aggression testing results from 415 legislated dogs (such as pitbull-type breeds) and 70 Golden Retrievers (control group). 1980; 9(8):410-4. Study published in 2018 that tested and analyzed the DNA of 919 dogs from 2 different shelters (in Arizona and California). [pubmed]. The have special bacteria that you have to memorize for board exams (but otherwise are probably meaningless). (I think shared decision making is sufficient). 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. However, more than ½ of these patients were repaired in the OR, so these are not necessarily your standard ED dog 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. Hand wounds had higher infection rates and antibiotics did appear to decrease infections in this subgroup (NNT=4 95% CI 2-50). Why/how we did this story. Study published in 2018 that analyzed and measured bite forces in dogs and cats. There is one more paper published since this review: Quinn JV, McDermott D, Rossi J, Stein J, Kramer N. Randomized controlled trial of prophylactic antibiotics for dog bites with refined cost model. 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. Using appearance to determine breed was once again determined to be highly unreliable with accuracy ranging between 10.4% and 67.7%. The harms of overusing antibiotics, however, are not trivial. PMID: 23916901. 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. That being said, I practice evidence based medicine, of which clinical expertise and patient preference are essential components. 1989. 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