When the Dog Bites: A 5-Year Retrospective on Canine Bite Encounters in Pediatrics

Sara Beth Rowell, BS
Michele Nichols, MD
Charli Cohen, MD
William King, MPH, RPh, DrPH
Jennifer McCain, MD
Kathy Monroe, MD, MSQI

Dog bites are a common cause of injury, with the CDC estimating that 4.5 million occur annually. Children are particularly susceptible to this injury, with one study finding that 46.1% of school aged children report being bitten in their lifetime. Families experience long term consequences following this injury, as 50% of children develop PTSD symptoms for more than one month. According to WISQARS the total cost of nonfatal emergency department pediatric dog bite visits including medical expenses, work loss and quality of life loss in 2023 was $859.36 million. It is estimated that 45.5% of U.S. households own a dog, making the emphasis of safe ownership practices among families with small children essential in preventing this injury.

A retrospective ICD 10 query over five years was performed to identify canine related bites (W54.OXXA) presenting to a Children’s Hospital in the Southeast. Data was exported to a standardized review sheet and demographic data was categorized. Injuries due to falls or scratches were excluded. Data analysis was performed using Epi Info 7 (CDC), Version 7.2.4.0.

Between 2019-2023, our emergency department saw 1,403 dog bite related visits. There were 1,252 initial visits and 151 return visits for follow-up care related to the same injury. The most common reason for a return visit was rabies prophylaxis (n=114). Despite experiencing an overall reduction of ED visits in 2020, there was a significant change in dog bite related visits per 1000 emergency department visits, increasing 70% from the previous year. Nearly 12% of patients required admission. Injuries occurred to the head/neck/face (64%, n=805), extremities (38%, n=471) and torso/pelvis/buttocks (9%, n=99). Frequently consulted specialties include OMFS (n = 170), ENT (n=90), plastic surgery (n=86), ophthalmology (n=82), and surgery (n=59). The most common procedure performed was wound closure (63%, n=784), and severe injuries required interventions such as facial nerve repair, fracture reduction and subdural drain placement. Males (57%, n=711) were more likely to be affected than females (43%, n=541). Injuries occurred most often in the patient’s own home (38%, n=480). Age groups involved include less than 2 (n=155), 2 to 5 (n=431), 6 to 12 (n=538), and older than 12 (n=138). Dog breeds were identified in 596 cases, and the most frequently involved were Pit Bulls (41%, n=243), German Shepherds (11%, n=67) and Labrador Retrievers (10%, n=60).

Dog bite injuries are a common reason for emergency department visits. Our institution experienced a significant increase in the proportion of dog bite related visits in 2020. This may be due to the increase in dog adoptions that occurred during the COVID-19 pandemic and stay-at-home ordinances causing children to spend more time in the household. Pediatricians have a crucial role in reducing this type of injury by educating families on ways to make the home safer for both children and dogs.

1. The prevalence of dog bite related injuries among the pediatric population.
2. Epidemiologic characteristics of patients who have been bitten by dogs.
3. The role of pediatricians in educating families about strategies they can implement to reduce this type of injury.