Background There is little consensus on the management of dog bite victims. Few studies have examined long-term patient outcomes. This study was designed to evaluate two outcomes: infection and unfavorable scar formation.
Methods A retrospective study of dog bite cases from January 2013 to May 2016 was conducted at our level I pediatric trauma center. Forty-five patients were identified who received definitive repair and had long-term follow-up for reasons other than rabies vaccination. Variables recorded were wound characteristics including presence of tissue loss, location in the hospital of the wound repair procedure, personnel performing the repair, postrepair infection, and a binary assessment of unfavorable scar formation.
Results Unfavorable scarring was not significantly related to either repair location or personnel. Rate of infection was not significantly related to repair location. However, infection rate was significantly related to personnel performing the repair (p=0.002), with 8 of 11 (73%) infections after repair by emergency physicians compared with surgeons.
Discussion The presence of infection was significantly related to bedside repair by emergency physicians. The data are suggestive of differences in wound preparation and repair technique between emergency department and surgical personnel. Standardizing technique could reduce infectious complications and long-term morbidity associated with repairing dog bites and other contaminated wounds. A robust and practical classification system for dog bite wounds would be helpful in stratifying these wounds for research comparison and healthcare triage.
Level of evidence The level of evidence for this retrospective study is level III.
- bites and stings
- outcome assessment, health care
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Presented at The data and the results were previously presented at the American Pediatric Surgery Association (APSA) Annual Meeting in May 2018.
Contributors Study conception and design: BB, LD, CS. Data acquisition: BD, BB. Analysis and data interpretation: BD, BB, AR, CS. Drafting of the article: BD, BB. Critical revision: BD, AR, CS.
Funding Funding for this study was provided by the Children’s Hospital of Michigan Foundation.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement Data are available upon reasonable request. Data for this study is in a deidentified database and available for use for analysis verification only. For further information, contact PI Christina Shanti, MD at Children’s Hospital of Michigan Pediatric Surgery Division, 3901 Beaubien Boulevard, Detroit, MI 48201.
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