Study published in 2017 that analyzed 140 dog bite incidents over a period of several years. Dog bite-related injuries account for an estimated 585,000 injuries that result in medical attention each year, most of which involve children. PubMed PMID: 6696302, Zubowicz VN, Gravier M. Management of early human bites of the hand: aprospective randomized study. 1994. Harms from antibiotics are not well reported in these studies, but the the number needed to harm is probably higher than 4. PMID: 3178974 [free full text]. That being said, I practice evidence based medicine, of which clinical expertise and patient preference are essential components. A randomised controlled trial. ", In many of the medical studies analyzed, there was: "misinformation about the significance of breed and breed characteristics.". 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 . I thought this had been settled; that everyone knew these myths. PMID: 21293762 [free full text]. FOAM enthusiast. Dogs mouths are filthy. 6(4):251-6. Post was not sent - check your email addresses! 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. 1995; 13(4):396-400. 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). 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. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. 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. Primary closure versus non-closure of dog bite wounds. This data is clearly imperfect. 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. Inclusion criteria included full thickness wounds presenting within 48 hours in patients over 15 years of age. However, I think that the current best answer is that it is safe to close the vast majority of these wounds. 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. 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. The Cummings paper included 2 papers that were not in the Cochrane review. I am not sure that makes any sense. 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. PMID: 2692580 [free full text]. Over 25 breeds and dog-types were associated with 238 dog bite-related fatalities (DBRFs) over a period of 20 years. Dog bites by breeds not perceived as "dangerous" (non-legislated breeds) are less likely to be reported. Behavior such as teasing the dog comes to mind as a top reason: other studies show that in most dog bite … 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. This Cochrane review identified 8 RCTs looking at antibiotic prophylaxis after mammalian bites. Background Dog bite studies are typically based on hospital records and may be biased towards bites requiring significant medical treatment. PMID: 21878832, A retrospective chart review looking at 87 pediatric patients with dog bites to the face. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). The study recommends a multidisciplinary, behavior-based approach to further study and address the relevant risk factors associated with DBRFs. 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. Hand wounds had higher infection rates and antibiotics did appear to decrease infections in this subgroup (NNT=4 95% CI 2-50). 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. Evaluation of prophylactic oxacillin incat bite wounds. There is no difference (in the medical treatment required following a bite or in the type of bite inflicted) between dog bites by breeds stereotyped as "dangerous" (legislated breeds such as German Shepherds, Rottweilers, and "pitbull-type" dogs) and other breeds of similar sizes and strengths that are not stereotyped as "dangerous" (non-legislated breeds such as Boxers, Labrador Retrievers, and Bulldogs). 27(9):801-3. 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. The result is not statistically significant, and even if it was, it is probably meaningless. [pubmed]. Using appearance to determine breed was once again determined to be highly unreliable with accuracy ranging between 10.4% and 67.7%. There were 8 infections (5.5%; 95% CI 1.8% to 9.2%), 4 of the upper extremity and 4 of the head. There is no comparison group, so this is purely descriptive. A rapid review of the diagnosis and management of myasthenia gravis in the emergency department. Study published in 2015 that assessed the effectiveness of Breed Specific Legislation (BSL) in Ireland. In the study's conclusion, breed was not an identified factor affecting bite force. Annals of emergency medicine. 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. The physicians sometimes we can’t take away the idea for the patients with low infection risk don’t need profilaxis antiobiotics. Data includes comprehensive survey results from 1,078 dog bite victims and 6,139 dog owners. There was no statistical difference between the groups and only 11 total infections, so it can’t explain the discrepancy either. International comparison data were extracted from published reports. Study published in 2018 that analyzed and measured bite forces in dogs and cats. Approximately 7 in 10 of the victims in the videos were male, and more than half of the bites were to infants and children. They excluded complex or complicated wounds and patients with immunosuppression. It also included 8 RCTs, but it comes to the opposite conclusion on the Cochrane review: antibiotics help. Specifically, this study concludes: "Comparing the results of golden retrievers and breeds affected by the legislation, no significant difference was found. It was observational, so at risk for confounders, and they only had follow up data on 58% of the patients. 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. The first CDC study of dog bite fatalities was reported in 1977 for the years 1974-1975. 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. 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. However, a few recent conversations have highlighted the fact that the management of dog bites is still steeped in controversy with wide practice variations. This very loose definition explains the crazy 60% infection rate, but also trivializes the benefit of antibiotics. Essentially we are arguing that we should give everyone antibiotics to prevent a few from having to take them later. 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. Cosmetic appearance at 4 weeks using the Vancouver Scar Scale by a blinded surgeon was significantly better in the sutured group. 2014; 45(1):237-240. The study was conducted by University of Florida (College of Veterinary Medicine), Michigan State University (College of Veterinary Medicine), Jacksonville FL Humane Society, Jacksonville FL Animal Care and Protective Services, Tallahassee FL Animal Services, Marion County Animal Services Ocala FL, and published by the The Veterinary Journal. Antibiotics decreased infection with a relative risk of 0.56 (95% CI 0.38-0.82). Therefore, these 2 studies can’t explain the discrepancy between the two meta-analyses. Each year in the United Sta… 2014; 45(1):237-240. 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. Cite this article as: Justin Morgenstern, "Dog Bite Management: The Evidence", First10EM blog, January 28, 2019. Small RCTs like these always underestimate harms. I think this study uses a very funny definition of wound infection, which would explain why it is such an outlier. Therefore, which meta-analysis you believe will depend a lot on what you think about this one paper. Evidence based medicine junkie. A study finds that the literature on dog bites written by human health care professionals is rife with distortions and errors. There were no significant differences in aggression between the legislated breed group and the Golden Retriever control group. 2011. 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. There were no infections. Elenbass (1984) looked only at cat bites, and concluded that antibiotics were helpful. Obviously they were unable to blind this trial. More importantly, if we aren’t helping our patients, what does the cost analysis matter? 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. 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). 7/40 ED patients and 22/22 OR patients were closed with sutures. All rights reserved. Why/how we did this story. 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. The study was conducted by researchers at the University of British Columbia (Animal Welfare Program) and published by the Canadian Veterinary Journal. Primary repair of facial dog bite injuries in children. Researchers found pit bulls and mixed breed dogs have the highest risk of biting and cause the most damage per bite. 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. Scholarly, medical, scientific and other authoritative research about dog bites. These are small numbers and low quality trials, so I expect some people will disagree with me. So why do these 2 meta-analyses come to different conclusions? 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. Injury. 1988. With all that bacteria, we have to give antibiotics, right? Prophylactic antibiotics were not given. The other big question that comes up when managing a dog bite is: should I suture this? Read More. 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. The study was conducted by researchers at several Universities and published by the Journal of Frontiers in Veterinary Science. PMID: 23916901. 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. Available at: Emergency doctor working in the community. 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. The study was conducted by the U.S. Centers for Disease Control (CDC) and published by the American Veterinary Medical Association (AVMA). Data includes dog breed-related risk information. Maimaris C, Quinton DN. The study conducted a qualitative content analysis which examined 156 publications identified by terms such as "dog bite" or "dangerous dogs". Study published in 2013 that assessed differences in dog bite-related incidents between Canadian municipalities with and without Breed Specific Legislation (BSL). 1980; 9(8):410-4. (I think shared decision making is sufficient). (The scar was an average of 1mm narrower in the sutured group). The Cochrane database of systematic reviews. The issue of dog bites and dog aggression directed at humans is frequently in the media. Infection occurred in 2 of 44 patients (4%) in the control group and 0 of 46 patients treated with antibiotics. Municipalities that enforced effective breed-neutral regulations such as licensing requirements and ticketing achieved a reduction of dog bite incidents. 5(3):156-61. 98% of the pitbull-type dogs in the study were identified to be mixed breed dogs by DNA testing. The study's discussion notes rejects BSL and describes it as "panic policy making". Specifically, the study concluded: "Force of biting in domestic canids is strongly related to size". The harms of overusing antibiotics, however, are not trivial. Effective breed-neutral regulations such as pitbull-type breeds ) are the primary significant that! Of facial dog bite includes treatment centered on local wounds as well as of... Or, so thanks for that ) presenting within 48 hours in over... 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