Dog-Bite Injuries to the Craniofacial Region: An Epidemiologic and Pattern-of-Injury Review at a Level 1 Trauma Center

November 2019 | By Khurram Khan BDS, DMD, Bruce B.Horswell MD, DDS, MS and Damayanti Samanta, MS

A retrospective review of 182 patients over a 10-year period from a Level 1 trauma center in the Southeast found that pit bulls inflicted more complex wounds compared with other dog breeds.

Study highlights

  • This study is a retrospective review of all facial and associated injuries sustained from dog bites managed by the section of maxillofacial surgery at a regional level 1 trauma center in West Virginia over a 10-year period, from 2009 through 2018. The inclusion criteria for this study required: age at injury, gender, circumstances and provocation leading to the bite, geographic location of injury, scienter status (previous knowledge of a dog’s aggressive behavior), relationship to the dog, vaccination status, specifics of injuries, medical insurance status and other criteria.
  • 182 patients met the criteria. The results showed a trend toward more severe injuries, especially in younger children, and a reversal in gender, with females bitten more often than males (53% girls ≤ 10 and 65% female ≥ 11). "The data showed that compared with other dog breeds, pit bull terriers inflicted more complex wounds, were often unprovoked, and went off property to attack," states the study. Other top-biting breeds resulting in more unprovoked and complex wounds included German shepherds, rottweilers, and huskies. Breed was known in 90% (163) of all cases.
  • This study classified injuries as simple wounds (< 5 centimeters), complex wounds (≥ 5 centimeters), mauling injuries (≥ 3 complex wounds in different anatomical regions) and fractures. Of injuries inflicted by pit bulls, simple represented 16.3% (8/49), complex 83.7% (41/49), fractures 36.8% and "mauling" injuries 24% (12/49). The tendency for a complex injury after a pit bull attack was significant compared with the top-biting breeds collectively. The probability of a bite resulting in a complex wound was 4.4 times higher for pit bulls compared with the other top-biting breeds.
  • This study found that pit bulls also led all breeds in unprovoked attacks (89.8% of bites were unprovoked), except for bulldogs and huskies, of which all had bitten without provocation. All other breeds were generally provoked, according to the study's findings. Thus, provocation distinction was significant for pit bulls (P < .001) compared with the 8 top-biting breeds as a group (German shepherds, rottweilers, bulldogs, great danes, huskies and others). Furthermore, the odds of an off-property attack by a pit bull was 2.7 times greater than for all other breeds of dogs.
  • This study also examined the recorded vaccination status of each dog; most dogs were vaccinated. However, pit bulls had the lowest rate of rabies vaccination, 63.3%, in comparison to the top-biting breeds, 95.6%, and all other breeds, 87.5%. Among pit bulls, 37% (18/49) were unvaccinated or could not be confirmed as vaccinated, which was significant (P < .001). A total of 13 unvaccinated dogs were found among all other dog breeds combined (13 of 133, 9.7%). Therefore, a total of 31 patients were at risk of rabies and pit bulls accounted for 58% (18/31) of these cases.
  • This study confirms the dangerous interactions between some dogs, chiefly pit bulls, and vulnerable persons. The study notes that the American Academy of Pediatrics recommends that no small child be left alone with a dog. "Perhaps for certain breeds, this needs to be taken a step further," states the study. "Given the tendency for a complex wound after a bite(s) by some breeds and the devastating or life-threatening consequences of such a bite, caregivers should put barriers in place to avoid potential violent interactions" between some dogs and young children.
Dog-Bite Injuries to the Craniofacial Region: An Epidemiologic and Pattern-of-Injury Review at a Level 1 Trauma Center, by Khan K, Horswell B and Samanta D, J Oral Maxillofac Surg, [2019 Nov 14, Epub].