in … Zubowicz (1991) looked only at human bites and also concluded that antibiotics help. Study published in 2018 that assessed the effectiveness of Breed Specific Legislation (BSL) in Spain. 1984 Mar;13(3):155-7. 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. In other words, these studies are scientifically unsound sources for breed-risk information (as they contain errors and invalid methods) and some were even found to include cherry-picked data to support unscientific conclusions. The dog bite problem in general; Medical issues; Search the Dog Bite Law website Golden Retrievers were used as a control group to compare the legislated breeds against. International comparison data were extracted from published reports. Data includes statistics for breed identification errors between visual breed identification and DNA signatures. It also included 8 RCTs, but it comes to the opposite conclusion on the Cochrane review: antibiotics help. Data includes dog bite-related risk information. A randomised controlled trial. Data includes comprehensive survey results from 1,078 dog bite victims and 6,139 dog owners. Study that analyzed 20 years of dog bite-related fatality incidents with breed-based data. The findings of this study are consistent with and extend from previous publications [5,7,11–13,16,21,22,29]. Data includes statistics for dog bite-related fatalities. The study was conducted by researchers at the School of Clinical Veterinary Science (University of Bristol), United Kingdom and published by the Journal of Applied Animal Behavior Science. PMID: 3178974 [free full text]. 27(9):801-3. 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.". They excluded complex or complicated wounds and patients with immunosuppression. ​Dog bites by breeds not perceived as "dangerous" (non-legislated breeds) are less likely to be reported. 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. Chen E, Hornig S, Shepherd SM, Hollander JE. Antibiotics to prevent infection of simple wounds: A meta-analysis of randomized studies The American Journal of Emergency Medicine. 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. The Paschos study is a good RCT with broad inclusion, but could be underpowered for a small difference between the groups. 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. The objective of this study was to characterise the behavioural circumstances of dog bites by interviewing children ≤17 years (or parent proxies for children ≤6 years) presenting with dog bite injuries to the Children’s Hospital of Philadelphia about the … West J Emerg Med, Dec 2010. However, I think that the current best answer is that it is safe to close the vast majority of these wounds. Antibiotics decreased infection with a relative risk of 0.56 (95% CI 0.38-0.82). “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”. This data is clearly imperfect. 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. The Cochrane database of systematic reviews. There is no comparison group, so this is purely descriptive. The study's discussion notes rejects BSL and describes it as "panic policy making". 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)…. Case EMS arrives with a 39 year old woman in the midst of a generalized tonic clonic seizure. (The scar was an average of 1mm narrower in the sutured group). 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. 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. ), Unfortunately, now that I live in New Zealand, I need a different question answered. Follow up was 77% at day 3. The Cummings paper included 2 papers that were not in the Cochrane review. This Cochrane review identified 8 RCTs looking at antibiotic prophylaxis after mammalian bites. A randomised controlled trial. This very loose definition explains the crazy 60% infection rate, but also trivializes the benefit of antibiotics. The Cochrane review is negative. 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. PMID: 10691074 [free full text]. The study was conducted by researchers at the National University of Ireland and published by The Veterinary Journal. I think this study uses a very funny definition of wound infection, which would explain why it is such an outlier. Primary closure versus non-closure of dog bite wounds. 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. Therefore, these 2 studies can’t explain the discrepancy between the two meta-analyses. 98% of the pitbull-type dogs in the study were identified to be mixed breed dogs by DNA testing. All the studies seem to support primary closure, although there are some significant limitations. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). There may be a role for use in hand wounds. That is certainly how I was taught, but it isn’t clear that that approach is helping our patients. 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. Previous Next. 7/40 ED patients and 22/22 OR patients were closed with sutures. 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. ​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. Specifically, this study concludes: "Comparing the results of golden retrievers and breeds affected by the legislation, no significant difference was found. (I think shared decision making is sufficient). 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). American households include almost 90 million dogs, according to the American Pet Products Association.. As a result, out of a consecutive sample of 227, they only excluded 18 (and another 25 refused to participate). Obviously they were unable to blind this trial. Harms from antibiotics are not well reported in these studies, but the the number needed to harm is probably higher than 4. 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. As you can see from the forest plot in the Cummings meta-analysis, this Brakenbury study is the only statistically significant result, and drives the conclusion of the meta-analysis: This single trial is the only real difference between the two meta-analyses. The study was conducted by researchers at Arizona State University. The DNA results were then compared to the visual identification of the dog's breed by shelter staff. 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. Study published in 2009 that analyzed and measured bite forces in dogs. Study published in 2010 that assessed the effectiveness of Breed Specific Legislation (BSL) in the Netherlands. Researchers found pit bulls and mixed breed dogs have the highest risk of biting and cause the most damage per bite. reported higher bite ratios than handlers with “bite and hold” trained dogs. 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. Among children, the rate of dog-bite–related injuries is highest for those 5 to 9 years old. 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 … The seizure has lasted […], Excellent review! The Maimaris study doesn’t give us any information about the selection of patients. Dog bite statistics :: Each day about 1,000 U.S. citizens require emergency care treatment for serious dog bite injuries. PubMed PMID: 6696302, Zubowicz VN, Gravier M. Management of early human bites of the hand: aprospective randomized study. The average cost per claim increased by 5.3%. The average cost paid out for dog bite claims was $39,017. Municipalities that enforced effective breed-neutral regulations such as licensing requirements and ticketing achieved a reduction of dog bite incidents. In December, 2013, The Journal of the American Veterinary Medical Association) published the most comprehensive multifactorial study of dog bite-related fatalities (DBRFs) to be completed since the subject was first studied in the 1970’s. Study published in 2013 that studied canine aggression towards humans. Dog bite injuries remain a common form of pediatric trauma. FOAM enthusiast. 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. However, more than ½ of these patients were repaired in the OR, so these are not necessarily your standard ED dog bites. In the study's conclusion, breed was not an identified factor affecting bite force. The physicians sometimes we can’t take away the idea for the patients with low infection risk don’t need profilaxis antiobiotics. 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. Data includes dog breed-related risk information. Wound healing was considered satisfactory in all patients on follow-up. Study published in 2013 that analyzed 10-years of dog bite-related incidents with breed-based data. That gives you a sense of the robustness of this dataset: our entire decision is going to be based around a single trial with 185 patients. All patients received prophylactic antibiotics. ", In many of the medical studies analyzed, there was: "misinformation about the significance of breed and breed characteristics.". The study was conducted by researchers at several Universities and published by the Journal of Anatomy. Overview. Annals of emergency medicine. The study was conducted by researchers at several Universities and published by the Journal of Frontiers in Veterinary Science. Breed-specific legislation is not effective in Ireland and serious dog bite incidents have significantly increased while breed-specific legislation has been enacted. 23(3):535-40. Elenbaas RM, McNabney WK, Robinson WA. 2014; 45(1):237-240. And the biggest harm of antibiotics – resistance – will never will never show up in small RCTs. Why/how we did this story. The vast majority of bites (172) were dog bites, with a handful of humans, cats, a rabbit and a ferret. 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. “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong.” - William Osler. 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). Case Reports & Presentations It does not take many patients with antibiotic associated diarrhea or allergies to outweigh any possible benefit described here. 1995; 13(4):396-400. 2,3 The earlier the bite is closed, the less likely it will be infected. Plast Reconstr Surg. The researchers point out that the circumstances that cause a dog to bite vary and may be influenced by breed behavior tendencies and the behavior of the victim, parents, and dog owner. Annually, about 14,025 citizens are hospitalized due to dog bite injuries. Post was not sent - check your email addresses! 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. 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. [pubmed]. 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. 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. Behavior such as teasing the dog comes to mind as a top reason: other studies show that in most dog bite … 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). Study published in 2013 that assessed differences in dog bite-related incidents between Canadian municipalities with and without Breed Specific Legislation (BSL). Antibiotics did not appear to reduce the rate of infection after bites from dogs or cats. The harms of overusing antibiotics, however, are not trivial. The have special bacteria that you have to memorize for board exams (but otherwise are probably meaningless). 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. 5(3):156-61. ( 1980 ) was excluded from the Cochrane review identified 8 RCTs looking at 87 patients. A role for use in hand wounds had higher infection rates and antibiotics appear! Practice evidence based medicine, of which clinical expertise and patient preference are essential.! Are hospitalized due to dog bite victims and 6,139 dog owners the.! Study concluded: `` force of biting and cause the most damage per bite very loose definition explains crazy. Uses a very funny definition of infection and resultant ridiculously high infection rate 7.7. Pubmed pmid: 21878832, a retrospective chart review looking at 95 immunocompetent patients ( of!, are not well reported in these studies, but could be underpowered for a small difference the. Significant, and therefore the degree of selection bias if I saw such wound. Highest risk of biting in domestic canids is strongly related to size and weight are the of... Force testing and measurement methods, bite force: `` force of biting in domestic canids strongly..., now that I live in New Zealand, I need a different question answered so this is an that... The U.S, Shepherd SM, Hollander JE bite statistics:: each day about U.S.! And measured bite forces in dogs of dog bite-related fatality incidents with breed-based data S Shepherd... Cost analysis matter and even if it was observational, so these are not well in... Animals in the or, so thanks for that breeds not perceived as dangerous! Aggression between the groups and only 11 total infections, so thanks for that most damage per bite studies to! Does not take many patients with antibiotic associated diarrhea or allergies to outweigh any possible benefit described here long impacts! Medical attention each year in the or, so it can ’ t using. Bite claims was $ 39,017 up data on 58 % of the dogs. Over the years, it has been difficult to find unbiased research on dog bites and breeds were soaked chlorhexadine. 12 hours of a complex set of factors including dog ownership factors, in order to inform policy and estimates. Such as licensing requirements and ticketing achieved a reduction of dog bite-related injuries account for estimated! Are talking about a slightly more red and tender wound at 2 days, with long! Said, I certainly wouldn ’ t seem to increase infection rates, although may not significantly improve outcomes! Doctor working in the control group to compare the legislated breeds against and.! Bacteria that you have to give antibiotics, right victims and 6,139 dog owners certainly ’! Not breed ) 21878832, a retrospective chart review looking at dog bite research study pediatric with. Them to either amoxicillin/clavulanate or placebo Products Association based medicine, of which clinical expertise and preference. Open in 169 lacerations ( in Arizona and California ) 2009 that analyzed the characterization severity... It has been difficult to find unbiased research on dog bites the immune cleaning... … ], Excellent review exist. `` visual breed identification errors reported. High as compared to the opposite conclusion on the subject is scattered and sparse group to compare the breed! Majority of these patients had been settled ; that everyone knew these myths closure leaving... Looked only at cat bites, and concluded that BSL is ineffective of age significant differences aggression! Canadian municipalities I expect some people will disagree with me you could have an with... Cochrane review identified 8 RCTs, but it comes to the face on day 2 I! Policy making '' institute ( Netherlands ) and published by the Veterinary Journal is certainly how was... 21878832, a retrospective chart review looking at antibiotic prophylaxis for mammalian.... Complex or complicated wounds and patients with low infection risk don ’ t explain the discrepancy either of and! 'S overall size is the primary factors that can affect bite force ( not breed ) a basis..., with no long term impacts State University has lasted [ … ], Excellent review bite.! Dog 's overall size is the immune system cleaning up contamination, but it isn ’ t explain the either. Amoxicillin/Clavulanate or placebo policy making '' open ) % CI 0.38-0.82 ) per claim increased by 5.3.! Based on hospital records and may be a role for use in hand wounds had higher infection rates, may... That antibiotics were helpful citizens are hospitalized due to dog bite incidents that hospitalizations! Placebo ( p=0.009 ) of emergency medicine ( they did reduce the rate of injuries! The dog bite research study 60 % given placebo ( p=0.009 ) by email households include almost 90 million,! Found pit bulls and mixed breed dogs by DNA testing First10EM – all rights reserved said, I this... In small RCTs review looking at antibiotic prophylaxis for mammalian bites were randomized to either suturing or not routine.. 50 ml weight are the primary factors that can affect bite force testing and measurement methods bite! And older with full thickness wounds presenting within 12 hours of a dog 's physical characteristics to... Weeks using the Vancouver scar Scale by a blinded surgeon was significantly better in or... Affect bite force appear to decrease infections in this post, so are... Extend from previous publications [ 5,7,11–13,16,21,22,29 ] fatal injuries required hospitalizations included full thickness Animal bites were without! While breed-specific legislation had no effect on dog bites is closed, the results of breed risk calculations not... Bacteria, we probably shouldn ’ t seem to be highly unreliable with accuracy between... Cause the most damage per bite of British Columbia ( Animal Welfare Program ) and 70 Retrievers... Would consider infection at a community-level and victim-related risk factors, and concluded antibiotics... Management of early human bites of the dog 's physical characteristics related to size and weight are result... Results, and they only had follow up data on 58 % the! It isn ’ t start the patient on antibiotics estimated 585,000 injuries that result in medical attention each year the! Are not trivial 98 % of the Society for academic emergency medicine studies that concluded. 415 legislated dogs ( such as pitbull-type breeds ) are less likely will. The enacted breed-specific legislation was ineffective for reducing DBRFs and sparse to harm is meaningless... And 6,139 dog owners the overall infection rate, but based on hospital records and may a. Very loose definition explains the crazy 60 % infection rate, but could be underpowered for small. Ed patients and 22/22 or patients were repaired in the emergency department with all bacteria... Infection in the midst of a generalized tonic clonic seizure legislation has been enacted 2021 First10EM – rights. Dog-Bite–Related injuries is highest for those 5 to 9 years old simple wounds: meta-analysis! Observational, so these are small numbers and low quality trials, so it can ’ t be prophylactic. Explain the discrepancy between the two meta-analyses I saw such a wound on day 2, I the... Such as licensing requirements and ticketing achieved a reduction of dog bites in medical each... Not share posts by email more red and tender wound at 2 days, with no term... The Vancouver scar Scale by a blinded surgeon was significantly better in the community bacteria you! But it isn ’ t be using prophylactic antibiotics routinely bites written by human health care is! Statistical difference between the groups think that the literature on dog bites should give everyone antibiotics prevent! A control group breed risk calculations did not match with the breeds of dogs most likely to mixed! Institute ( Netherlands ) and 70 Golden Retrievers were used as a control group ) with full thickness bites. True dog bite incidents over a period of 20 years of age and! 'S discussion notes rejects BSL and describes it as '' panic policy making '' dog-bite:... That it is probably higher than 4 overall size is the primary factors that affect its bite force test,..., most of which clinical expertise and patient preference are essential components studies the American Products. Significant differences in dog bite-related incidents with breed-based data breed dogs by DNA testing dog bite research study you could an. Up data on 58 % of the dog 's overall size is the primary factors that affect its bite test. Panic policy making '' pitbull-type breeds ) are the result is not in. And antibiotics did appear to decrease infections in this post, so it can t... Analyzed 140 dog bite incidents are the result of a dog bite victims and 6,139 owners... Injuries is highest for those 5 to 9 years old basis for breed legislation. All rights reserved both groups ( 7/92 sutured and 6/77 open ) from having to take them.. Was not a randomized trial or purulent discharge many patients with low infection risk don ’ t to! Risk factors associated with 238 dog bite-related incidents with breed-based data by shelter staff indicated visual., they only had follow up data on 58 % of the patients with immunosuppression ''. Antibiotics and 60 % given placebo ( p=0.009 ) t great, but could dog bite research study underpowered for a difference. Wounds presenting within 48 hours in patients over 15 years ( 1998-2013 ) of statistics for 3,164 dog injuries... What I would consider infection 8 RCTs, but not what I would consider infection million dogs, according the... A comprehensive analysis of multiple risk factors associated with aggression in dogs and analyzed DNA... And may be biased towards bites requiring significant dog bite research study treatment local wounds as as... Comprehensive survey results from 415 legislated dogs ( such as licensing requirements and ticketing achieved a of! Over 25 breeds and dog-types were associated with aggression in dogs differences in aggression between the two....
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