Clinical management of dog-bite injuries
Dog bites affect all ages, but children are the most likely victims
Nearly 5 million Americans are bitten by dogs every year, and almost 1 million of these people seek medical attention for their injuries.1 While individuals of all ages are affected, children aged 5-9 years are the most likely victims. With such possible adverse effects as infection, septic arthritis, osteomyelitis, compartment syndrome, loss of a limb, and disfigurement,2 dog bites can be both traumatic and life-threatening. Annual treatment expenditures, including emergency department (ED), hospitalization, and direct provider costs, are estimated to be well over $200 million.3
No standardized published guidelines currently exist for the management of dog bites. Studies conducted during the 1990s are some of the most recent data available. The lack of current prospective randomized controlled trials pertaining specifically to the care of dog-bite injuries makes evidence-based practice difficult; therefore, evidence from those earlier studies provides the best practice guidelines on the initial management of dog bites in primary- and acute-care settings.
A thorough history is essential for any patient presenting with a dog bite. Temporal factors surrounding the incident are critical. Knowing how long the wound has been open is a key factor in deciding the course of action. The more time that passes between the injury and the wound repair, the greater the potential for infection and complications. Knowing the breed of dog involved can also aid in predicting the extent of injury. For example, some dogs clench their jaws when they bite, resulting in deep puncture and crush wounds. Other dogs produce a “hole-and-tear” effect as the canine teeth anchor the victim while the dog violently swings its head from side to side, causing more extensive shearing-type injuries.4 The jaws of a large dog can exert pressure >450 pounds per square inch. Bites from larger dogs most often involve the arms and legs in adults and the face and scalp in children (Figure 1).2 Understanding the events leading up to the incident can lend insight as to the type and extent of the injury as well.