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3. Dog bite studies » 

Level 1 trauma studies :: Download PDF file

A review of 13 retrospective dog bite studies from U.S. Level 1 trauma centers. In the majority of studies, pit bulls inflicted a higher prevalence and severity of injuries than all other dog breeds.

Level 1 Trauma Center Studies Characterizing Dog Bite Injuries Across Major U.S. Geographical Regions (2011-2018)

Summary: Table 1. From 2011 to 2018, 10 peer-reviewed retrospective medical studies from Level 1 trauma centers spanning the Northwest, Northeast, Southeast, South, Southwest and West Coast regions all report similar findings. Pit bulls are inflicting a higher prevalence of injuries than all other breeds of dogs. The majority of these studies also report that pit bulls are inflicting a higher severity of injuries, requiring a higher number of operative interventions -- up to five times higher -- than other dog breeds. Table 2. Three studies from this period -- all from Level 1 trauma centers in the Denver metro area -- show varying results, possibly due to Denver and the surrounding metropolitan regions enforcing pit bull bans over the last 2.5 decades.

Selection Criteria: Criteria for inclusion in this series of studies requires being a multi-year study of Level 1 trauma center dog bite patients, published from 2011 to 2018, the inclusion of dog breed information, and the scientific research conducted by medical doctors.

Table 1: Dog Bite Injuries in U.S. Level 1 Trauma Centers

Dogs and Orthopaedic Injuries: Is There a Correlation to Breed?

View Abstract | by Brice, Joshua, MD, Lindvall, Eric, DO, Hoekzema, Nathan, MD, and Husak, Lisa, MPH, Journal of Orthopaedic Trauma, Volume 32, Number 9, September 2018.

Conclusions: "Thirty-nine percent of all dog bite-related emergency department visits at our facility resulted in an injury requiring orthopaedic treatment. Pit bull terrier bites were responsible for a significantly higher number of orthopaedic injuries and resulted in an amputation and/or bony injury in 66% of patients treated, whereas bites from law enforcement dogs and other breeds were less associated with severe injuries."

Characteristics of Dog Bites in Arkansas

View Abstract | by Aaron Smith, MD, Jacob Carlson, MD, Ashley Bartels, MD, Cody McLeod, MD, and Michael Golinko, MD, Southern Medical Journal, Volume: 111 Issue: 8 August 2018.

Selected Findings: "Our study corroborates much of the previous literature, supporting the notion that pit bull bites are severe enough to require operative intervention more frequently than the bites of other dog breeds … Indeed, when looking at cases that required operative interventions, pit bulls were disproportionately represented in 62.5% of cases."

An Algorithmic Approach to Operative Management of Complex Pediatric Dog Bites: 3-Year Review of a Level I Regional Referral Pediatric Trauma Hospital

View Full Study | Study Highlights | by Alizadeh K, Shayesteh A, Xu ML, Plastic and Reconstructive Surgery - Global Open, October 2017.

Selected Findings: "Of the 56 cases that had an identified dog breed, pit bulls accounted for 48.2% of the dog bites … More importantly, 47.8% of pit bull injuries required operative repair, which was 3 times more than other breeds."

"Of the 9 patients with extended hospitalization, 6 (66.7%) were caused by a pit bull that confirms our theory that this breed results in the most devastating injuries at our center. The penetrating and crushing nature of these bites can lead to lifelong deformities."

Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution

View Full Study | Study Highlights | by Michael Golinko, MD, MA, Brian Arslanian, MD, and Joseph Williams, MD, FAAP, Clinical Pediatrics (Phila), April 2017 [July 2016, Epub].

Selected Findings: "Our data were consistent with others, in that an operative intervention was more than 3 times as likely to be associated with a pit bull injury than with any other breed. Half of the operations performed on children in this study as well as the only mortality resulted from a pit bull injury. Our data revealed that pit bull breeds were more than 2.5 times as likely as other breeds to bite in multiple anatomical locations."

Ocular Trauma From Dog Bites: Characterization, Associations, and Treatment Patterns at a Regional Level I Trauma Center Over 11 Years

View Abstract | Study Highlights | by Prendes MA, Jian-Amadi A, Chang SH, Shaftel SS, Ophthalmic Plast Reconstr Surg, 2016 Jul-Aug;32(4):279-83 [June 2015, Epub].

Selected Findings: "Importantly, this study is the first to accurately establish that pit bulls are the breed most commonly associated with ocular injuries (25%). Most alarming is the observation that when attacks come from unfamiliar dogs, the pit bull was responsible for 60% and 63% of all injuries and ocular injuries, respectively."

"The current study provides strong evidence that pit bulls are indeed highly aggressive, albeit unknown whether by nature or nurture, and are in fact the most common culprits of serious pediatric ocular injuries."

Contemporary Update on the Treatment of Dog Bite: Injuries to the Oral and Maxillofacial Region

View Full Study | by Michael D. Foster, DMD and John W. Hudson, DDS, Oral and Maxillofacial Surgery, May 2015 Volume 73, Issue 5, Pages 935–942.

Results: "The medical records from 20 patients were included and reviewed. More than one half (60%) of the patients were younger than 12 years old. The dog was owned by the patient or a relative in 58% of the cases. The children sustained injuries requiring hospital admission and repair in an operating room setting more often than did the adults. Pit bulls were more frequently associated with injuries than other breeds (9 of 20)."

Morbidity of Pediatric Dog Bites: A Case Series at a Level One Pediatric Trauma Center

View Abstract | by Garvey EM, Twitchell DK, Ragar R, Egan JC, Jamshidi R, Journal of Pediatric Surgery, February 2015;50:343-6.

Selected Findings: "Pit bulls were most frequently responsible, accounting for 39% (83/213) of incidents in which dog breed was documented ... Among the 11 patients with the highest AIS (3–5), Pit bulls were responsible in 45.5% of cases, followed by mixed-breeds in 18.2% (2/11) of cases. Pit bulls were also responsible for 38% of all head, neck or face bites."

"Dog familiarity did not confer safety, and in this series, pit bulls were most frequently responsible. These findings have great relevance for child safety."

Dog Bites of the Head and Neck: An Evaluation of a Common Pediatric Trauma and Associated Treatment

View Full Study | Study Highlights | by O'Brien DC, Andre TB, Robinson AD, Squires LD, Tollefson TT, Am J Otolaryngol, 2015 Jan-Feb; 36(1): 32–38. [2014 Sep 28, Epub].

Results: "334 unique dog bites were identified, of which 101 involved the head and neck. The mean patient age was 15.1 ± 18.1 years. Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention. Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+31%), and without provocation (+48%)."

Dog Bites of the Face, Head and Neck in Children

View Full Study | by Bruce B. Horswell, MD, DDS, MS, FACS and Carol J. Chahine, DMD, FRCD (c), West Virginia Medical Journal, Nov-Dec 2011.

Selected Findings: "Bites from large-breed dogs, especially pit bull-type dogs and rottweilers are more likely to result in more severe injuries, subsequent medical care and report, which may over-represent those breeds among biting dogs -- in other words, creating reporting bias. However the severity of injury necessitating medical attention should not be overlooked when considering the breed of dog generating more severe injuries."

Mortality, Mauling, and Maiming by Vicious Dogs

View Abstract | Study Highlights | by Bini JK, Cohn SM, Acosta SM, McFarland MJ, Muir MT, Michalek JE; TRISAT Clinical Trials, Annals of Surgery, April 2011;253:791-797.

Results: "Of the 228 attacks reviewed, the breed of dog was reported for 82 attacks. Of those 82 attacks, 29 (35%) were attributed to pit bulls and 53 (65%) were attributed to all other breeds of dogs combined."

Conclusions: "Attacks by pit bulls are associated with higher morbidity rates, higher hospital charges, and a higher risk of death than are attacks by other breeds of dogs. Strict regulation of pit bulls may substantially reduce the US mortality rates related to dog bites."

Table 2: Dog Bite Injuries in Denver Level 1 Trauma Centers

Summary: In October 1989, the city and county of Denver adopted a pit bull ban. Notably, in 1994, one of the first epidemiological studies of "breeds of biting dogs" was carried out in the county of Denver, despite the absence of pit bull terriers due to the ban (Which Breeds Bite? A Case-Control Study of Risk Factors). As a result, pit bulls did not appear in the case-control study's "biting" or "nonbiting" breed findings.

From 2011 to 2018, one of three Level 1 trauma center studies in the Denver metro area showed that pit bulls continue to have a high prevalence of facial injuries (Gurunluoglu, 2014). Another study, also limited to facial injuries, states that while the prevalence of pit bull injuries was low during their study period (2003-2008), the severity of pit bull injury included, "the patient who suffered the most extensive injuries and the longest hospitalization of our entire population" (Chen, 2013).

Neurosurgical Sequelae of Domestic Dog Attacks in Children

View Full Study | by Kumar R, Deleyiannis FW, Wilkinson C, O'Neill BR, Journal of Neurosurgery: Pediatrics, January 2017:24-31 [Epub 2016 Oct 21].

Conclusions: "In this study, large-breed dogs were responsible for all attacks on children requiring neurosurgical consultation. Most dogs were family pets with no history of prior aggression, and most of the attacks occurred at home."

"Parental supervision, though important, may not be enough, given that the majority of attacks in this series occurred in the presence of an adult, even those with catastrophic neurological injury."

Retrospective Analysis of Facial Dog Bite Injuries at a Level I Trauma Center in the Denver Metro Area

View Abstract | by Gurunluoglu, Raffi MD, PhD; Glasgow, Mark DDS; Arton, Jamie PA-C; Bronsert, Michael PhD, J Trauma Acute Care Surg, 2014 May;76(5):1294-300.

Selected Findings: "The highest number of facial dog bite injuries requiring plastic surgery consultation resulted from German shepherd and pit bull breeds."

"Twelve different breeds were identified. There was no significant association between the type of dog breed and the number of bite injuries … There was no statistically significant association between wounds needing reconstruction versus direct repair according to dog breed."

Analysis of Pediatric Facial Dog Bites

View Full Study | by Henry Chen, MD, MBA, Anna Neumeier, MD, Brett Davies, MD, MS, and Vikram Durairaj, MD, FACS, Craniomaxillofac Trauma Reconstr, 2013 Dec; 6(4): 225–232.

Selected Findings: "Pit bulls were banned in Denver because of several gruesome maulings and fatalities that occurred between 1984 and 1989. Our study found 11 victims of pit bull bites from 2003 to 2008, including the patient who suffered the most extensive injuries and the longest hospitalization of our entire population, indicating that despite legislation, pit bull bites continue to be a public health concern."

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