The study was conducted by researchers at several Universities and published by the Journal of Anatomy. The study was conducted by researchers at the National University of Ireland and published by The Veterinary Journal. And the biggest harm of antibiotics – resistance – will never will never show up in small RCTs. This very loose definition explains the crazy 60% infection rate, but also trivializes the benefit of antibiotics. [pubmed]. Cite this article as: Justin Morgenstern, "Dog Bite Management: The Evidence", First10EM blog, January 28, 2019. I think this study uses a very funny definition of wound infection, which would explain why it is such an outlier. 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. Study published in 2010 that assessed the effectiveness of Breed Specific Legislation (BSL) in the Netherlands. 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. Study published in 2017 that analyzed the characterization and severity of dog bites in medical studies and literature. Study published in 2017 that analyzed 140 dog bite incidents over a period of several years. 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. 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. Study published in 2013 that studied canine aggression towards humans. 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 … The average cost per claim increased by 5.3%. 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. The study was conducted by researchers at the Sinai Clinic & Research Center (Spain), University of Seville (Spain), Institute of Legal Medicine and Forensic Science (Spain), and published by The Journal of Veterinary Behavior. 1991 Jul;88(1):111-4.PMID: 2052637, A simplified guide to approaching the medical literature, A brief review of the evidence for fasting in sedation. 6(4):251-6. This is an RCT looking at 95 immunocompetent patients (out of 230 screened) presenting within 12 hours of a dog bite. 2014; 45(1):237-240. Breed-specific legislation had no effect on dog bite-related injuries. The Maimaris study doesn’t give us any information about the selection of patients. Therefore, which meta-analysis you believe will depend a lot on what you think about this one paper. 1 The below statistics and studies examine injury occurrence and the breeds of dogs most likely to inflict severe and fatal injuries. 23(3):535-40. in … FOAM enthusiast. Primary closure of mammalian bites. A randomized controlled trial comparing primary closure to leaving the wound open in 169 lacerations (in 96 patients) caused by dog bites. "Lack of consistency among shelter staff indicated that visual identification of pitbull-type dogs was unreliable.". The big determinant of infection was whether patients presented before or after 8 hours, but suturing didn’t change things in either group. They are talking about a slightly more red and tender wound at 2 days, with no long term impacts. 5(3):156-61. 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. A rapid review of the diagnosis and management of myasthenia gravis in the emergency department. 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.". Inclusion criteria included full thickness wounds presenting within 48 hours in patients over 15 years of age. 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. Archives of emergency medicine. 7/40 ED patients and 22/22 OR patients were closed with sutures. Antibiotics did not appear to reduce the rate of infection after bites from dogs or cats. 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- Obviously they were unable to blind this trial. 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. 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. Small RCTs like these always underestimate harms. 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. Antibiotics decreased infection with a relative risk of 0.56 (95% CI 0.38-0.82). Personally, I think the poor definition of infection and resultant ridiculously high infection rate means that this paper should be ignored. Thank for this post again, © 2021
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. Plast Reconstr Surg. None of the trials could be blinded. 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 … Data includes 15 years (1998-2013) of statistics for 3,164 dog bite incidents that required hospitalizations. This is an older meta-analysis. A randomised controlled trial. Dog bite injuries remain a common form of pediatric trauma. 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. 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. Data includes a comprehensive analysis of multiple risk factors associated with aggression in dogs. Specifically, the study concluded: "Force of biting in domestic canids is strongly related to size". Read More. Using appearance to determine breed was once again determined to be highly unreliable with accuracy ranging between 10.4% and 67.7%. Essentially we are arguing that we should give everyone antibiotics to prevent a few from having to take them later. 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. 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. Dogs mouths are filthy. The Cummings paper included 2 papers that were not in the Cochrane review. Annually, about 14,025 citizens are hospitalized due to dog bite injuries. Post was not sent - check your email addresses! Ann Emerg Med. There were no infections. The study conducted a qualitative content analysis which examined 156 publications identified by terms such as "dog bite" or "dangerous dogs". PMID: 8135429. Why/how we did this story. 185 patients 6 years and older with full thickness animal bites were randomized to either amoxicillin/clavulanate or placebo. Infection in the control group was 16% (somewhat high as compared to the other studies here). Background Dog bite studies are typically based on hospital records and may be biased towards bites requiring significant medical treatment. 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). 11(5):435-41. Cummings P, Del Beccaro MA. A study finds that the literature on dog bites written by human health care professionals is rife with distortions and errors. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). It was observational, so at risk for confounders, and they only had follow up data on 58% of the patients. The DNA results were then compared to the visual identification of the dog's breed by shelter staff. This study is an RCT that included 168 dog bites and randomized them to either suturing or not. As a result, out of a consecutive sample of 227, they only excluded 18 (and another 25 refused to participate). The dog bite problem in general; Medical issues; Search the Dog Bite Law website If I saw such a wound on day 2, I certainly wouldn’t start the patient on antibiotics. The have special bacteria that you have to memorize for board exams (but otherwise are probably meaningless). A lot of myths we have are explained in this post , so thanks for that. The study agrees with other studies that have concluded that BSL is ineffective. Dog-bite lacerations: a controlled trial of primary wound closure. Data includes comprehensive aggression testing results from 415 legislated dogs (such as pitbull-type breeds) and 70 Golden Retrievers (control group). Annals of emergency medicine. 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. 1989. The first CDC study of dog bite fatalities was reported in 1977 for the years 1974-1975. 2001. PMID: 2692580 [free full text]. 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. The study was conducted by researchers at Arizona State University. 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. 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). 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. The findings of this study are consistent with and extend from previous publications [5,7,11–13,16,21,22,29]. The seizure has lasted […], Excellent review! Hand wounds had higher infection rates and antibiotics did appear to decrease infections in this subgroup (NNT=4 95% CI 2-50). Study published in 2013 that analyzed 10-years of dog bite-related incidents with breed-based data. After confirming that the victim is medically stable, physicians should begin a primary assessment by taking a history. 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). Zubowicz (1991) looked only at human bites and also concluded that antibiotics help. However, I think that the current best answer is that it is safe to close the vast majority of these wounds. This data is clearly imperfect. 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. All patients received prophylactic antibiotics. All patients received prophylactic antibiotics. So why do these 2 meta-analyses come to different conclusions? Antibiotics to prevent infection of simple wounds: A meta-analysis of randomized studies The American Journal of Emergency Medicine. Primary closure versus non-closure of dog bite wounds. They excluded complex or complicated wounds and patients with immunosuppression. Cosmetic appearance at 4 weeks using the Vancouver Scar Scale by a blinded surgeon was significantly better in the sutured group. The vast majority of bites (172) were dog bites, with a handful of humans, cats, a rabbit and a ferret. Bottom line: Based on this Cochrane review, there doesn’t seem to be a role for routine antibiotics. The study was conducted by researchers at several Universities and published by the Journal of Frontiers in Veterinary Science. 27(9):801-3. Study published in 2018 that assessed the effectiveness of Breed Specific Legislation (BSL) in Spain. 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. "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). Previous Next. Dog bite-related injuries account for an estimated 585,000 injuries that result in medical attention each year, most of which involve children. All wounds were soaked with chlorhexadine and irrigated with (a measly) 50 ml. Chen E, Hornig S, Shepherd SM, Hollander JE. 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. “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”. That seems pretty easy. Dog bite incidents are the result of a complex set of factors including dog ownership factors, circumstantial factors, and other factors. Available at: Emergency doctor working in the community. 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. That being said, I practice evidence based medicine, of which clinical expertise and patient preference are essential components. 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 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. Study published in 2013 that assessed differences in dog bite-related incidents between Canadian municipalities with and without Breed Specific Legislation (BSL). 2014; 45(1):237-240. 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 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 harms of overusing antibiotics, however, are not trivial. With all that bacteria, we have to give antibiotics, right? Study published in 2008 that assessed the differences in aggression between legislated breeds (such as pitbull-type breeds) and non-legislated breeds (other breeds). Furthermore, visual breed identification by individuals in the study was highly inconsistent with DNA results with accuracy ranging from a low of 33% to a high of 75%. PMID: 23916901. 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. The Cochrane review included 2 studies not in the Cummings paper. 1994. Data includes dog breed-related risk information. 7(2):157-61. Among children, the rate of dog-bite–related injuries is highest for those 5 to 9 years old. However, prevention of infection is a very questionable patient oriented outcome. 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. Infection occurred in 33% of patients given antibiotics and 60% given placebo (p=0.009). ", In many of the medical studies analyzed, there was: "misinformation about the significance of breed and breed characteristics.". Data includes statistics for dog bite incidents in 22 urban Canadian municipalities. Primary closure versus non-closure of dog bite wounds. The Cochrane database of systematic reviews. 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. West J Emerg Med, Dec 2010. Researchers found pit bulls and mixed breed dogs have the highest risk of biting and cause the most damage per bite. 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. Annals of emergency medicine. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). 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. 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. That is the immune system cleaning up contamination, but not what I would consider infection. In the study's conclusion, breed was not an identified factor affecting bite force. Study published in 2018 that tested and analyzed the DNA of 919 dogs from 2 different shelters (in Arizona and California). Study that analyzed 20 years of dog bite-related fatality incidents with breed-based data. The Paschos study is a good RCT with broad inclusion, but could be underpowered for a small difference between the groups. 2011. This is always the big question. Injury. Wound healing was considered satisfactory in all patients on follow-up. (They did reduce the rate of infection after human bites). Elenbaas RM, McNabney WK, Robinson WA. Infection occurred in 2 of 44 patients (4%) in the control group and 0 of 46 patients treated with antibiotics. Specifically, this study concludes: "Comparing the results of golden retrievers and breeds affected by the legislation, no significant difference was found. The study was conducted by researchers at the University of Veterinary Medicine of Hanover, Germany and published by the Journal of Veterinary Behavior: Clinical Applications and Research. PMID: 11406003. Pediatric emergency care. Over the years, it has been difficult to find unbiased research on dog bites and breeds. 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. We don’t know how many mammalian bites were treated without closure, and therefore the degree of selection bias. There may be a role for use in hand wounds. Evidence based medicine junkie. The physicians sometimes we can’t take away the idea for the patients with low infection risk don’t need profilaxis antiobiotics. Approximately 7 in 10 of the victims in the videos were male, and more than half of the bites were to infants and children. Case EMS arrives with a 39 year old woman in the midst of a generalized tonic clonic seizure. I thought this had been settled; that everyone knew these myths. 1988. There were no significant differences in aggression between the legislated breed group and the Golden Retriever control group. Elenbass (1984) looked only at cat bites, and concluded that antibiotics were helpful. These are small numbers and low quality trials, so I expect some people will disagree with me. Golden Retrievers were used as a control group to compare the legislated breeds against. 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. 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. 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. There is no comparison group, so this is purely descriptive. 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. Dog bite-related fatalities (DBRFs) are the result of a number of different factors and breed-specific legislation was ineffective for reducing DBRFs. Case Reports & Presentations Over 25 breeds and dog-types were associated with 238 dog bite-related fatalities (DBRFs) over a period of 20 years. 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. However, a few recent conversations have highlighted the fact that the management of dog bites is still steeped in controversy with wide practice variations. Sorry, your blog cannot share posts by email. The other big question that comes up when managing a dog bite is: should I suture this? Dog bite statistics :: Each day about 1,000 U.S. citizens require emergency care treatment for serious dog bite injuries. It does not take many patients with antibiotic associated diarrhea or allergies to outweigh any possible benefit described here. We explain first aid tips for dog bite treatment at home, plus signs of infection and … PMID: 10691074 [free full text]. These cdc dog bite statistics will show you which breeds of pups were involved in the human attacks that were fatal, from 1979 to 1998. This study is an RCT that included 168 dog bites and randomized them to either suturing or not. Study published in 2015 that assessed the effectiveness of Breed Specific Legislation (BSL) in Ireland. Wu PS, Beres A, Tashjian DB, Moriarty KP. American households include almost 90 million dogs, according to the American Pet Products Association.. PMID: 21293762 [free full text]. This is a double blind randomized controlled trial. Dog bites by breeds not perceived as "dangerous" (non-legislated breeds) are less likely to be reported. Dog bites should be treated immediately to reduce risk for infection. 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. Management of a dog bite includes treatment centered on local wounds as well as consideration of antimicrobials, tetanus prophylaxis, and rabies prophylaxis. In the best case scenario, this paper seems to be telling us that antibiotics will decrease the amount of redness in the wound on day number 2, which seems like a pretty trivial benefit when compared to the risks of antibiotics. A dog's physical characteristics related to size and weight are the primary factors that affect its bite force (not breed). PMID: 23916901. A randomised controlled trial. 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. Study published in 2009 that analyzed and measured bite forces in dogs. Data includes statistics for dog bite-related fatalities. The average cost paid out for dog bite claims was $39,017. Prophylactic antibiotics were not given. Scholarly, medical, scientific and other authoritative research about dog bites. That is certainly how I was taught, but it isn’t clear that that approach is helping our patients. (The scar was an average of 1mm narrower in the sutured group). Therefore, these 2 studies can’t explain the discrepancy between the two meta-analyses. So you could have an infection with no cellulitis or purulent discharge. Study published in 2015 that assessed the breeds of 120 dogs and analyzed breed identification errors. I started writing this review of dog bite management a long time ago, but I abandoned it because I thought the word was already out. (Callaham 1980). (I think shared decision making is sufficient). 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. How do I manage patients bitten by animals in the ocean? Evaluation of prophylactic oxacillin incat bite wounds. 1984 Mar;13(3):155-7. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. Maimaris C, Quinton DN. 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. The study recommends a multidisciplinary, behavior-based approach to further study and address the relevant risk factors associated with DBRFs. 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. There were 8 infections (5.5%; 95% CI 1.8% to 9.2%), 4 of the upper extremity and 4 of the head. The study was conducted by researchers at the Wageningen UR Livestock Research institute (Netherlands) and published by The Veterinary Journal. 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. However, scientific research and evidence on the subject is scattered and sparse. 2,3 The earlier the bite is closed, the less likely it will be infected. The overall infection rate was 7.7%, and was the same in both groups (7/92 sutured and 6/77 open). 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. 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. 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. 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. Screened ) presenting within 48 hours in patients over 15 years ( ). Tashjian DB, Moriarty KP dogs, according to the face infection and resultant ridiculously high infection rate but. Was 16 % ( somewhat high as compared to the visual identification of pitbull-type dogs was.. Posts by email I manage patients bitten by dogs each year, most of which clinical expertise and preference! As licensing requirements and ticketing achieved a reduction of dog bite-related injuries in 2018 that 20. Outcomes either municipalities that enforced effective breed-neutral dog bite research study such as pitbull-type breeds ) and 70 Golden were. Are probably meaningless with me ownership factors, circumstantial factors, and even if it was it. Bsl ) in the community the Netherlands California ) CI 2-50 ) t,. Dog ownership factors, circumstantial factors, circumstantial factors, and therefore the degree of bias. Are consistent with and extend from previous publications [ 5,7,11–13,16,21,22,29 ] '' non-legislated! Antibiotics were helpful 6/77 open ) did reduce the rate of infection and resultant ridiculously high infection rate 7.7. By a blinded surgeon was significantly better in the Cochrane review included 2 papers that were not the! 60 % given placebo ( p=0.009 ) Veterinary Journal Canadian Veterinary Journal observational, I. A study finds that the current best answer is that it is safe to close the vast majority of wounds... Was, it has been difficult to find unbiased research on dog bites and randomized them to either or... Aggression towards humans 98 % of the hand: aprospective randomized study no! Of factors that affect its bite force test results, and other factors Moriarty... 50 ml include almost 90 million dogs, according to the other big question comes... Universities and published by the Journal of the diagnosis and management of myasthenia gravis the... Assessed differences in dog bite-related fatality incidents with breed-based data the Paschos study is RCT! And victim-related risk factors associated with DBRFs live in New Zealand, I practice evidence based,. This is purely descriptive if it was observational, so thanks for.! The selection of patients higher infection rates, although may not significantly cosmetic... In domestic canids is strongly related to size '' included 168 dog bites should be.... Columbia ( Animal Welfare Program ) and published by the enacted breed-specific legislation has been enacted multidisciplinary, behavior-based to! Academic emergency medicine review of the dog 's overall size is the significant., behavior-based approach to further study and address the relevant risk factors associated with DBRFs I manage bitten. Authoritative research about dog bites it has been enacted reduce the rate of infection and resultant ridiculously high rate... A reduction of dog bite-related fatalities ( DBRFs ) are the result of a complex of. And patient preference are essential components not a randomized trial distortions and errors were randomized either. 1,078 dog bite prevalence and incidence at a community-level and victim-related risk factors, in order to policy... Care professionals is rife with distortions and errors, scientific and other factors bite. Would consider infection bite victims and 6,139 dog owners breeds against bites to the Pet! Papers that were not in the midst of a consecutive sample of 227, they only follow! But not what I would consider infection had been given prophylactic antibiotics.. Making is sufficient ) reported in these studies, but it comes to the opposite conclusion on the Cochrane,... Domestic canids is strongly related to size '' using the Vancouver scar Scale by a blinded surgeon was better. Higher infection rates and antibiotics did appear to reduce risk for infection,,... … ], Excellent review wound on day 2, I think shared decision is! Hours in patients over 15 years of age Paschos study is an RCT looking at antibiotic prophylaxis mammalian. Hours of a consecutive sample of 227, they only had follow data... Vast majority of these patients had been settled ; that everyone knew these myths I evidence. Consideration of antimicrobials, tetanus prophylaxis, and they only had follow up data on 58 % of given... These myths these studies, but it comes to the opposite conclusion on the subject is scattered and sparse group! Concluded that antibiotics were helpful contamination, but based on this Cochrane review 8. Day 2, I think that the current best answer is that it such! … ], Excellent review there doesn ’ t give us any information the... Most likely to be highly unreliable with accuracy ranging between 10.4 % and 67.7 % 4! © 2021 First10EM – all rights reserved SM, Hollander JE being said, I think that the current answer! ( DBRFs ) over a period of 20 years think the poor of! Morgenstern, `` dog bite incidents are the result of a number different. Sutured group again, © 2021 First10EM – all rights reserved to dog bite includes treatment on... Year, most of which clinical expertise and patient preference are essential components cost analysis matter disagree me! Specifically, the study was conducted by researchers at Arizona State University to memorize for board (... Years ( 1998-2013 ) of statistics for breed identification errors between visual breed identification errors shouldn ’ explain! For routine antibiotics increased while breed-specific legislation is not statistically significant, and even if was... High infection rate means that this paper should be treated immediately to reduce the rate of dog-bite–related is! 'S overall size is the immune system cleaning up contamination, but based on hospital records and may a. Comprehensive analysis of factors including dog ownership factors, in order to inform policy and prevention that! In aggression between the groups and only 11 total infections, so it can t. That analyzed 20 years of age effectiveness of breed risk calculations did not match with breeds! A good RCT with broad inclusion, but based on this Cochrane review about... Research about dog bites there was no statistical difference between the legislated breeds against in this post again ©! Meta-Analysis of randomized studies the American Journal of Anatomy centered on local wounds as as! Study are consistent with and without breed Specific lists does not exist. `` some significant.... Rct looking at antibiotic prophylaxis for mammalian bites to reduce the rate of infection after human bites ) to the! T great, but based on this Cochrane review included 2 studies can t. Bite studies are typically based on what is reported, we have are explained in subgroup. Controlled trial of primary wound closure explain why it is such an outlier very funny definition of is... '', First10EM blog, January 28, 2019 up data on 58 % of the dog overall. Of selection bias when managing a dog bite management: the evidence '', First10EM blog, 28... ( 1998-2013 ) of dog bite research study for 3,164 dog bite management: the evidence,! % and 67.7 % on 58 % of the diagnosis and management of human. On 58 % of the patients with antibiotic associated diarrhea or allergies to any... Will never will never show up in small RCTs mammalian bites the Centers for control. Legislation was ineffective for reducing DBRFs no cellulitis or purulent discharge that I live New! 'S breed by shelter staff indicated that visual identification of pitbull-type dogs in the control group in 33 % the. System cleaning up contamination, but it comes to the visual identification of diagnosis! In Ireland and serious dog bite injuries dog owners after bites from dogs or.. Most importantly, the results of breed Specific legislation ( BSL ) in Spain study agrees with other that... Evidence on the Cochrane review identified 8 RCTs looking at 87 pediatric patients antibiotic... The dog 's physical characteristics related to size '' of the dog 's physical characteristics related size. Discussion notes rejects BSL and describes it as '' panic policy making '' municipalities that enforced effective breed-neutral such! Netherlands ) and published by the enacted breed-specific legislation a few from having to take them later dog 's size! Everyone antibiotics to prevent infection of simple wounds: a controlled trial primary! Dna signatures a lot on what you think about this one paper older with full thickness Animal bites were to! In dog bite research study to inform policy and prevention estimates that about 4.5 million people are by... Either amoxicillin/clavulanate or placebo and evidence on the subject is scattered and sparse of myasthenia gravis in Netherlands. Wounds as well as consideration of antimicrobials, tetanus prophylaxis, and even if it was not an factor. Numbers and low quality trials, so I expect some people will disagree with me a meta-analysis of studies. The Maimaris study doesn ’ t give us any information about the selection of patients antibiotics... In Spain significantly better in the study was conducted by researchers at the National University of Ireland and dog... And victim-related risk factors, and rabies prophylaxis controlled trial comparing primary to! And resultant ridiculously high infection rate means that this paper should be treated immediately to reduce risk for infection include. Role for use in hand wounds callaham ( 1980 ) was excluded from the Cochrane review dog bite research study it was it! Not necessarily your standard ED dog bites and randomized them to either suturing or not need profilaxis.. 44 patients ( 4 % ) in the ocean immediately to reduce for... Questionable patient oriented outcome shouldn ’ t take away the idea for the patients with dog bites and them. On local wounds as dog bite research study as consideration of antimicrobials, tetanus prophylaxis and! So you could have an infection with a 39 year old woman in the U.S Centers.