Dog Bites

A recent trauma patient presented after being mauled by her own dog. She had never had any problems before that night, when the dog went to attack her son’s friend. When she intervened the dog caused massive soft tissue damage to one of her extremities which eventually required plastic surgery and a prolonged hospitalization.

Is the fact that her dog was a pit bull significant? Despite protestations from animal enthusiasts the evidence overwhelming states that pit bulls are a special population of dogs, and their reputation is well-deserved. Pit bull attacks tend to be especially morbid because they can generate over 1800 lb/in² of force and tend to latch on after biting rather than the usual “nip” of a bite.¹ Multiple studies have noted the gross over-representation of pit bulls in hospital records of dog bites. This ranges from simple reports of bites² to fatalities.³ This has led to multiple municipalities restricting the ability to own these dogs as well as making the owners legally responsible for all medical bills of victims. This has been recently reported to have made a statistically significant, though modest, decrease in the number of dog-bite hospitalizations overall, and in the more vulnerable population less than 20 years of age.⁴

A counter-argument can be made that the overall risk is very small of either a hospitalization or fatality from a dog-bite due to the hundreds of millions of dogs just in the United States versus the published rate of bites. Using a study in which pit bulls represented 15% of the breeds responsible for dog-bite emergency department visits an estimated 5128 dogs would be need to be banned in the United States to prevent one related emergency visit.⁵ Other authors comment that in at least 37% of the cases in one study the owner/caretaker of the dog had previous knowledge of aggressive behavior by the animal and in 21% of cases there was clear abuse of the animal beforehand.⁶ Society routinely restricts dangerous objects and practices with such a high number needed to ban and due to the high profile nature of these types of injuries seems to be inclined to further restrict dog ownership.

Clear differences in the literature exist for recommendations depending on whether the heath professional treats animals or humans. It is perhaps not surprising that bias exists but having personal exposure to treating these injuries does provide a unique and valuable perspective.

1. Boenning DA, Fleisher GR, Campos JR. Dog bites in children: Epidemiology, microbiology, and -penicillin prophylactic therapy. Am. J. Emerg. Med., 1: 17-21, 1983.

2. Garvey EM, Twitchell DK, Ragar R, Egan JC, Jamshidi R. Morbidity of pediatric dog bites: A case series at a level one pediatric trauma center. J Ped Surg 50 (2015) 343-346.

3. Shields LBE, Bernstein ML, Hunsaker III JC, Stewart DM. Dog Bite-Related Fatalities: A 15-Year Review of Kentucky Medical Examiner Cases. Am J Forensic Med Pathol 2009;30: 223-230.

4. Raghaven M, Martens PJ, Chateau D, Burchill C. Effectiveness of breed-specific legislation in decreasing the incidence of dog-bite injury hospitalizations in people in the Canadian province of Manitoba. Injury Prevention 2013; 19: 177-183.

5. Patronek GJ, Slater M, Marder AR. Use of a number-needed-to-ban calculation to illustrate limitations of breed-specific legislation in decreasing the risk of dog bite-related injury. JAVMA, vol 237, No 7, 2010.

6. Patronek GJ, Sacks JJ, Delise KM, Cleary DV, Marder AR. Co-occurrence of potentially preventable factors in 256 dog bite-related fatalities in the United States (2000-2009). 

from Dr. Joshua Nash