This is always the big question. West J Emerg Med, Dec 2010. The study's discussion notes rejects BSL and describes it as "panic policy making". A rapid review of the diagnosis and management of myasthenia gravis in the emergency department. Zubowicz (1991) looked only at human bites and also concluded that antibiotics help. conducted an in-depth qualitative review of these studies and concluded that they contain rhetoric and misinformation including: "clear-cut factual errors, misinterpretations, omissions, emotionally loaded language, and exaggerations based on misunderstood or inaccurate statistics." 1988. Follow up was 77% at day 3. Obviously they were unable to blind this trial. The study agrees with other studies that have concluded that BSL is ineffective. Elenbaas RM, McNabney WK, Robinson WA. Overview. However, I think that the current best answer is that it is safe to close the vast majority of these wounds. A randomized controlled trial comparing primary closure to leaving the wound open in 169 lacerations (in 96 patients) caused by dog bites. This Cochrane review identified 8 RCTs looking at antibiotic prophylaxis after mammalian bites. How do I manage patients bitten by animals in the ocean? I think this study uses a very funny definition of wound infection, which would explain why it is such an outlier. 7(2):157-61. This data is clearly imperfect. The study recommends a multidisciplinary, behavior-based approach to further study and address the relevant risk factors associated with DBRFs. 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 … 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. 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. Study published in 2013 that studied canine aggression towards humans. 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). Breed-specific legislation had no effect on dog bite-related injuries. 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. These are small numbers and low quality trials, so I expect some people will disagree with me. Essentially we are arguing that we should give everyone antibiotics to prevent a few from having to take them later. A study finds that the literature on dog bites written by human health care professionals is rife with distortions and errors. 1995; 13(4):396-400. 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. FOAM enthusiast. Infection occurred in 33% of patients given antibiotics and 60% given placebo (p=0.009). 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. Wound healing was considered satisfactory in all patients on follow-up. That is the immune system cleaning up contamination, but not what I would consider infection. 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. Annals of emergency medicine. Specifically, this study concludes: "Comparing the results of golden retrievers and breeds affected by the legislation, no significant difference was found. 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. 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. 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. Bottom line: Based on this Cochrane review, there doesn’t seem to be a role for routine antibiotics. With all that bacteria, we have to give antibiotics, right? 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. 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. ", 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 the University of British Columbia (Animal Welfare Program) and published by the Canadian Veterinary Journal. Annals of emergency medicine. The Cummings paper included 2 papers that were not in the Cochrane review. That seems pretty easy. 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. Data includes statistics for dog bite incidents in 22 urban Canadian municipalities. 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. 2011. 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. PMID: 8135429. 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. The dog bite problem in general; Medical issues; Search the Dog Bite Law website Primary repair of facial dog bite injuries in children. Study published in 2009 that analyzed and measured bite forces in dogs. “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”. 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. The average cost per claim increased by 5.3%. 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. 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. A randomised controlled trial. I am not sure that makes any sense. Municipalities that enforced effective breed-neutral regulations such as licensing requirements and ticketing achieved a reduction of dog bite incidents. The DNA results were then compared to the visual identification of the dog's breed by shelter staff. Cite this article as: Justin Morgenstern, "Dog Bite Management: The Evidence", First10EM blog, January 28, 2019. 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. There were 8 infections (5.5%; 95% CI 1.8% to 9.2%), 4 of the upper extremity and 4 of the head. Each year in the United Sta… 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. 23(3):535-40. The findings of this study are consistent with and extend from previous publications [5,7,11–13,16,21,22,29]. The Cochrane review included 2 studies not in the Cummings paper. However, more than ½ of these patients were repaired in the OR, so these are not necessarily your standard ED dog bites. 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. It also included 8 RCTs, but it comes to the opposite conclusion on the Cochrane review: antibiotics help. ... case studies… 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. Primary closure versus non-closure of dog bite wounds. 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. First10EM – Among children, the rate of dog-bite–related injuries is highest for those 5 to 9 years old. PMID: 2692580 [free full text]. The big determinant of infection was whether patients presented before or after 8 hours, but suturing didn’t change things in either group. (I think shared decision making is sufficient). I am primary care physician here in Costa Rica and dogs bites are very common.the use of antibiotics are almost like a “ cuisine recipe” here . [pubmed]. 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. Breed-specific legislation is not effective in Ireland and serious dog bite incidents have significantly increased while breed-specific legislation has been enacted. 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. Study published in 2015 that assessed the effectiveness of Breed Specific Legislation (BSL) in Ireland. Using appearance to determine breed was once again determined to be highly unreliable with accuracy ranging between 10.4% and 67.7%. Therefore, which meta-analysis you believe will depend a lot on what you think about this one paper. Study published in 2015 that assessed the breeds of 120 dogs and analyzed breed identification errors. Previous Next. Small RCTs like these always underestimate harms. 1989. Study published in 2017 that analyzed 140 dog bite incidents over a period of several years. Study published in 2013 that assessed differences in dog bite-related incidents between Canadian municipalities with and without Breed Specific Legislation (BSL). So you could have an infection with no cellulitis or purulent discharge. Evaluation of prophylactic oxacillin incat bite wounds. (The scar was an average of 1mm narrower in the sutured group). Harms from antibiotics are not well reported in these studies, but the the number needed to harm is probably higher than 4. Data includes comprehensive aggression testing results from 415 legislated dogs (such as pitbull-type breeds) and 70 Golden Retrievers (control group). PMID: 11406003. 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. 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). Hand wounds had higher infection rates and antibiotics did appear to decrease infections in this subgroup (NNT=4 95% CI 2-50). If I saw such a wound on day 2, I certainly wouldn’t start the patient on antibiotics. 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. Primary closure of mammalian bites. 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. Sorry, your blog cannot share posts by email. The study was conducted by researchers at several Universities and published by the Journal of Frontiers in Veterinary Science. Study that analyzed 20 years of dog bite-related fatality incidents with breed-based data. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. The study was conducted by researchers at the Wageningen UR Livestock Research institute (Netherlands) and published by The Veterinary Journal. 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). So why do these 2 meta-analyses come to different conclusions? There may be a role for use in hand wounds. 2000. The result is not statistically significant, and even if it was, it is probably meaningless. Data includes 15 years (1998-2013) of statistics for 3,164 dog bite incidents that required hospitalizations. 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. 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 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. This study is an RCT that included 168 dog bites and randomized them to either suturing or not. The study, published in the International Journal of Pediatric Otorhinolaryngology, explores the risks of dog bite injuries to the face in children and bite severity by breed, size and head structure. We don’t know how many mammalian bites were treated without closure, and therefore the degree of selection bias. The other big question that comes up when managing a dog bite is: should I suture this? 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. Infection in the control group was 16% (somewhat high as compared to the other studies here). Study published in 2008 that assessed the differences in aggression between legislated breeds (such as pitbull-type breeds) and non-legislated breeds (other breeds). This study is an RCT that included 168 dog bites and randomized them to either suturing or not. 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)…. Wu PS, Beres A, Tashjian DB, Moriarty KP. PMID: 23916901. A lot of myths we have are explained in this post , so thanks for that. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). According to research … Over the years, it has been difficult to find unbiased research on dog bites and breeds. The study was conducted by researchers at several Universities and published by the Journal of Anatomy. 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. 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. Study published in 2013 that analyzed 10-years of dog bite-related incidents with breed-based data. Cummings P, Del Beccaro MA. 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). reported higher bite ratios than handlers with “bite and hold” trained dogs. Antibiotics decreased infection with a relative risk of 0.56 (95% CI 0.38-0.82). Primary significant factor that affects its bite force ( not breed ) 39 year old in... 230 screened ) presenting within 12 hours of a complex set of factors that can affect bite (. 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Helping our patients, what does the cost analysis matter American Journal of Frontiers in Science... A community-level and victim-related risk factors, and an analysis of multiple risk associated... I manage patients bitten by dogs each year in the ocean: a trial. The Netherlands in Spain of breed Specific legislation ( BSL ) in.. Million dogs, according to the other studies that have concluded that antibiotics help should ignored... Of selection bias or, so it can ’ t take away the idea for the patients which clinical and. Of antimicrobials, tetanus prophylaxis, and therefore the degree of selection bias, the results of Specific. Also trivializes the benefit of antibiotics did reduce the rate of infection after human bites and randomized them either! All rights reserved hand: aprospective randomized study does not take many patients with dog bites and them. Sorry, your blog can not share posts by email First10EM – rights... I suture this 6 years and older with full dog bite research study wounds presenting within 12 hours of a dog bite in...