Table 3.
Author(s) Year | Objective | Methods | Results | Conclusions |
---|---|---|---|---|
Rossman et al., 1997 [20] | To investigate and determine factors predicting the occurrence of PTSD symptoms and the adaptive functioning of children exposed to dog bites | 86 parents and their children, aged 4–9 years, were interviewed through PTSD-RI, CDC and CBCL | ↑ trauma symptoms with younger age and female sex. | Children exhibit ↑ PTSD symptoms after ≥ 1 bites. Positive parental support correlates with ↓ symptoms and improved adaptation |
Thompson, 1997 [6] | To assess the impact of dog bites, determining the incidence and risk factors associated with dog attacks | Queen Elizabeth Hospital, Adelaide, South Australia, 1990–1993. 356 victims of dog attacks who presented to the ED and 3093 respondents to the 1992 South Australian Health Omnibus Survey | 6500 people are injured in Adelaide each year as a result of dog attacks: children 0–4 years were attacked and required hospital treatment twice as often as adults 21–59 years, and men > 76 years twice as often as men 36–75 years. Hospital admission rates were ↑ × 5 for the elderly and ↑ × 7 for children ≤12 years compared with people aged 13–59 years | The public health impact of dog attacks is significant, especially concerning young children. Proposed interventions: stricter controls on high-risk breeds, mandatory leash laws and implementing insurance system |
Bernardo et al., 2002 [45] | To determine if differences exist in agent, host, and environmental characteristics among younger and older patients treated in a paediatric ED for dog bites | Patients in 1999–2000 were identified through a review of ED records (n = 386) of children suffering dog bites. Records were extracted in a researcher-designed and validated form | Children < 6 years constituted 52.8% (n = 204) of the sample. Younger children were bitten by their family dogs, on the face, in their own homes | Findings from this study could be used to develop age-specific strategies for dog bite prevention |
Peters et al., 2004 [16] | 2001–2002, children bitten by dogs were consecutively enrolled at the ED of UCH. Inclusion criteria: <16 years; having only minor surgery within 48 h from dog bite | Parents agreed to complete a questionnaire 2–9 months after the accident. DSM-IV PTSD diagnosis. Statistical analyses with non-parametric tests | 22/26 children, with a median age of 7.5 years old, met inclusion criteria. 50% boys. 7 months post-accident, 12 PTSD symptoms lasting >1 month | Children experiencing multiple/deep wounds from violent dog attacks more likely to develop PTSD. Some children displayed aggressive play imitating dogs or were reluctant to go out alone. Even minor bites cause emotional distress |
Hon et al., 2007 [46] | To analyse the pattern of dog bites presenting at the ED of a university hospital | Patients < 22 years, evaluated at the ED with a discharge diagnosis of animal bites, were identified through a computerised discharge network | 144 cases of animal bites, recorded at the ED, were mostly from dog bites (89%). Children <10 years ↑ facial injuries and were often triaged as urgent. Symptoms: pain, bleeding, bruising | Young children are at a ↑ risk of facial injuries. Pain severity and psychological impacts are often overlooked in emergency assessments. Hospitalisation was usually unnecessary |
Ji et al., 2010 [21] | To analyse the incidence and predictors of PTSD after dog bite injuries | Data for 358 children injured by animals. PTSD screening and Family Apgar Scale assessment conducted upon ED admission. AcStD diagnosis within the 1st week using the CASQ. 3 months later, PTSD screening using the CAPS-C-A | 19 patients developed PTSD. There were no significant gender or age differences in PTSD occurrence. Family Apgar Scale scores did not show a significant association with PTSD. However, there was a significant correlation between AcStD and PTSD symptom severity scores | Severe animal attacks can lead to PTSD in children. Family support does not seem to affect PTSD symptoms in school-aged children after such attacks. Early symptoms of AcStD may predict later development of PTSD |
Lakestani et al., 2011 [47] | To develop and conduct an initial assessment of a dog attitude scale for preschool children and adult across European nations | Brief questionnaires to 107 nursery school children (mean age 4.5 years) and 120 university students (mean age 21.3 years) in Milan, Barcelona and Edinburgh | Dog ownership correlated with positive attitudes in both children and adults. No significant differences were found based on country or gender | A single questionnaire can assess young children’s attitudes towards dog, suggesting a uniform approach to dog bite prevention and help education programs |
Yeh et al., 2011 [48] | Case-control studies to assess whether individuals with mental disorders are predisposed to dog bites and subsequent post-bite cellulitis | Case-control studies 2000–2007, comparing 4660 patients with dog bites to 18,640 controls without dog bites. Additional comparison between 286 patients with and 4374 patients without post-bite cellulitis | Children, older adults and individuals with ↓ socioeconomic status at ↑ risk of dog bites. Patients with both psychotic and non-psychotic mental disorders had ↑ risks of both dog bites and post-bite cellulitis | Individuals with mental disorders face an ↑ risk of severe dog bites and subsequent post-bite cellulitis |
Davis et al., 2012 [35] | This study investigated the effects of children’s temperament on their interaction with dogs and how it can be a risk-taking for the children | 88 children 3.5–6 years interacted with a live dog. Dog and child behaviours were assessed through observational coding. 4 child temperament constructs were assessed via the parent-report CBQ | Less shy children took ↑ risks with the dog, even after controlling for child and dog characteristics. No other temperament traits were associated with risk-taking with the dog | Dog bite intervention programs to target children at risk; parent-oriented interventions |
Vargo et al., 2012 [49] | To delineate a pressing public health concern in American Samoa, which could potentially affect other regions permitting a substantial population of free-roaming dogs | A dataset (patient from 2004–2010) from the only ED in the Territory was analysed. A survey of 437 adolescents was conducted to document their encounters with dogs attacking them unprovoked during the 2010/2011 school year | Males aged 55–59 years had the highest incidence of dog bites, closely followed by males aged 10–14 years. ≈⅓ of adolescents reported experiencing a dog bite during 2010–2011 | Children, adolescents, and elderly people are particularly vulnerable to dog bite injuries. Fear of being bitten by a dog was cited as a factor preventing more physical activity by 10% of males and 16% of females |
Eppley & Schleich, 2013 [50] | Describe treatment and outcomes of facial, scalp, and neck dog bites in 107 children over 10 years. | Analysed cases focusing on patient age, relationship with the dog, bite circumstances, and treatment outcomes, including surgeries. | Average age was 5.9 years; 95% knew the dog, 77% of bites were provoked; most wounds closed primarily, 77% opted for scar revision, 39 cases involved lawsuits. | Facial dog bites in children often require multiple scar revisions for best outcomes; families should be informed early. |
Morrongiello et al., 2013 [26] | This study focused on how parents supervise and react to their young children about unfamiliar dogs | A randomized controlled trial with pre/post intervention and control groups evaluated whether exposure to The Blue Dog, a program for dog bite prevention and education, improved parent behaviours regarding their children’s interactions with dogs | The study found no significant differences between groups in pre/post-intervention measures, suggesting that The Blue Dog program did not lead to improvements in parents’ behaviours | These findings underscore the significance of addressing parent behaviour, alongside child behaviour, in initiatives aimed at reducing the risk of childhood dog bites. Despite this, The Blue Dog program did not successfully alter parent behaviour |
Shen et al., 2013 [8] | To study the contextual antecedents and consequences of paediatric dog bites in rural China | 101 caregivers from rural Anhui Province, China, whose children had suffered dog-bite injuries in the past year, participated in a structured interview about the circumstances, antecedents and consequences of their child’s injury | Frequent antecedents were dogs’ initiation of the encounter, children walking to/from school, and dogs unleashed. Frequent consequences were rabies vaccines, restricted activity, and fear of dogs | Results represent a necessary prerequisite for developing empirically supported prevention programs in a vulnerable population |
O’Brien et al., 2014 [51] | Identifying patients with dog bites and their impact on health systems | January 2012–June 2013 cohort of an academic tertiary care centre | Pit bull terriers are the dogs most likely to attack children aged 15–18 years, who then require more consultation and more surgery | Children are more susceptible to dog bite injuries to the head and neck |
Shen et al., 2014 [52] | Examine the contextual factors leading to paediatric dog bites and their consequences in rural China | Structured interviews of 101 caregivers whose children experienced dog-bite injuries in the past year | Common contextual factors: being outdoors and with no adult supervision. Consequences: rabies vaccines, restricted activity, and fear of dogs | The study provides insights into the prevalent outcomes of paediatric dog bites in rural China |
Lakestani and Donaldson, 2015 [27] | To investigate whether preschool children can learn how to interpret dogs’ behaviours, with the purpose of helping avoid dog bites | 3–5-years-old children were tested on their ability to answer questions about dogs’ emotional states before and after participating in either an educational intervention about dog behaviour (intervention group) or an activity about wild animals (control group) | Children in the intervention group were significantly better at judging the dogs’ emotional states compared to before. In contrast, the control group’s performance did not differ significantly between the two testing times | Preschool children can be taught how to correctly interpret dogs’ behaviours. This implies that incorporating such training into prevention programs may help reducing dog bite accidents |
Ó Súilleabháin, 2015 [53] | To evaluate the effectiveness of current breed-specific legislation in Ireland by analysing all hospital admissions due to dog bites since the implementation of this legislation | Data for statistical analysis were obtained from the National Hospital In-Patient Enquiry Scheme, for dog bites in Ireland from 1998 to 2013 | The incidence of hospitalisations ↑ significantly over the years. After dog bites, males had a ↑risk of hospitalisation compared to females. Children <10-years-old were identified as a particularly vulnerable group | The current breed-specific legislation in Ireland is not effective in mitigating dog bites and may be contributing to ↑ hospitalisations |
Cohen-Manheim et al., 2018 [2] | To investigate demographic and injury characteristics of dog bites requiring hospitalisation on a national scale | Data on hospitalisations due to dog bite injuries were extracted from the Israeli National Trauma Registry from 2009 to 2016 | 2009–2016, 986 individuals hospitalised for dog bite injuries in Israel. Children 0–14 years show ↑ hospitalisations compared to other traumas. In 2016, hospitalisation rates are significantly ↑ in boys compared to girls | Prevention programs should target children <15-years-old (particularly boys) who are at a ↑ risk of dog bites |
Habarth-Morales et al., 2022 [54] | During the COVID-19 pandemic, reports from various centres suggest an ↑ in dog bite injuries, particularly in paediatric populations | Authors examined hospital’s electronic health record and NEISS for dog bite records from 2015 to 2020 and calculated the annual incidence | Both institutional and national cohorts showed relative ↑ in dog bite injury incidence over the study period. Significant ↑ of 44% and 25% in annual incidence relative to 2019 observed in both cohorts. The ↑ incidence of dog bites is related to ↑ psychosocial stress of the pandemic condition | Findings underscore the ongoing public health significance of dog bites and highlight the need for continued attention and action from public health agencies to address this issue |
Abbreviations: AcStD, Acute Stress Disorder; CAPS-C-A, Clinician-Administered PTSD Scale for Children and Adolescents; CASQ, Child Acute Stress Questionnaire; CBCL, Child Behavior Checklist; CBQ, Children’s Behavioral Questionnaire; CDC, Child Dissociative Checklist; ED, Emergency Department; NEISS, National Electronic Injury Surveillance System; PTSD, post-traumatic stress disorder; PTSD-RI, Post-traumatic Stress Disorder Reaction Index; UCH, University Children’s Hospital Brussels; ↓, decreased, low; ↑, increased, high.