An Algorithmic Approach to Operative Management of Complex Pediatric Dog Bites: 3-Year Review of a Level I Regional Referral Pediatric Trauma Hospital

October 2017 | By Kaveh Alizadeh, MD, MSc, FACS, Ali Shayesteh, MD, and Min Li Xu, MD

A retrospective review of 108 dog bite victims over a 3-year period from a pediatric Level 1 trauma center in the Northeast. Pit bull injuries required operative repair 3 times more than other breeds.

Study highlights

  • A retrospective study was performed at Maria Fareri Children’s Hospital of Westchester Medical Center. This is a large tertiary care center with a level 1 Pediatric Trauma designation located in Valhalla, New York. After institutional review board approval was obtained, information on pediatric patients (age, 0–18 years old) who sustained dog bites between January 2012 and December 2014 was gathered.
  • One of the major aims of this study, state the authors, was to determine whether there is an association between the dog breed and frequency of dog bites, severity of injury, and treatment required. Several recent studies published from 2011 to 2016 (See: Level 1 Trauma Dog Bite Studies in All U.S. Geographical Regions: Pit Bulls Highest Prevalence) have named pit bulls as the most common breed to inflict dog bites in the pediatric population across the United States.
  • The authors also reviewed two dog bite facial injury studies from the Denver area. Gurunluoglu et al. (Level I trauma center in Denver metro area, published in 2014) showed in their study that pit bulls continued to be the most common breed to inflict facial dog bite injuries requiring direct and reconstructive repair despite legislation. Chen et al. (University of Colorado Denver, published in 2013) showed that although pit bulls bites only accounted for 3% of all dog bites in their study, those patients suffered the most severe injuries, requiring the longest hospital stay. Of the 11 pit bull victims in the Chen et al. study, one was a "patient who suffered the most extensive injuries and the longest hospitalization of our entire population, indicating that despite legislation, pit bull bites continue to be a public health concern."
  • The New York study found that the location of injury was most commonly isolated to the head/neck region (59.2%). About 17 different breeds of dogs were identified in the study. Of the 56 cases that had an identified dog breed, pit bulls accounted for 48.2% of the dog bites. Other common offending breeds include German Shepard (8.9%), Husky (5.3%), and small terriers. More importantly, 47.8% of pit bull injuries required operative repair, which was 3 times more than other breeds.
  • The authors state that of the breeds that could be identified in their study, pit bulls accounted for almost half of the dog bites. Pit bull bites also accounted for at least 11 of the 23 operative cases. The authors also emphasized, "that of the 9 patients with extended hospitalization, 6 (66.7%) were caused by a pit bull that confirms our theory that this breed results in the most devastating injuries at our center."