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. 2020 Feb 10;135(2):238–244. doi: 10.1177/0033354920904072

Age- and Sex-Related Differences in Nonfatal Dog Bite Injuries Among Persons Aged 0-19 Treated in Hospital Emergency Departments, United States, 2001-2017

Adelaide Newman Basco 1, Emma Reiss McCormack 1, William T Basco Jr 2,✉
PMCID: PMC7036613  PMID: 32040928

Abstract

Objective:

No studies using national data have evaluated changes in nonfatal dog bite injuries among children, adolescents, and young adults during the past 2 decades. We examined estimates of annual nonfatal dog bite injuries among persons aged 0-19 treated in US emergency departments (EDs) from 2001 through 2017.

Methods:

We examined data from the Web-based Injury Statistics Query and Reporting System to compare estimates of the annual rates of nonfatal dog bite injuries in EDs among all persons aged 0-19, by age group (0-4, 5-9, 10-14, and 15-19), and by sex. We determined significance by comparing 95% confidence intervals (CIs), and we standardized rate calculations to the year 2000 population.

Results:

During 2001-2017, an estimated 2 406 109 (95% CI, 2 102 643-2 709 573) persons aged 0-19 were treated in EDs for nonfatal dog bite injuries (age-adjusted rate of 173.1 per 100 000 persons aged 0-19). The estimated number of nonfatal dog bite injuries declined significantly, from 181 090 (95% CI, 158 315-203 864) in 2001 to 118 800 (95% CI, 97 933-139 667) in 2017. The highest rate was among children aged 5-9. Male children, adolescents, and young adults were significantly more likely than female children, adolescents, and young adults to be treated in the ED for nonfatal dog bite injuries, driven by male–female differences in children and adolescents aged 5-14.

Conclusions:

Although the estimated number of nonfatal dog bite injuries among persons aged 0-19 declined significantly in the past 2 decades, additional regulatory and educational efforts specific to age and sex may lead to further reductions in nonfatal dog bite injuries.

Keywords: animal bite, dog bite, child, children, injury

Dog bite injuries were among the top 10 causes of nonfatal injury treated in US emergency departments (EDs) for children aged 1-9 in 2017.1 Bite injuries from dogs are the most common animal bite injuries treated in EDs.2 Fatal dog bite injuries are rare compared with nonfatal dog bite injuries; from 1979 to 1994, approximately 18.6 dog bite–related deaths occurred annually in the United States.3,4 Data from 1989-1994 estimated a fatal dog bite injury rate of 7.1 per 100 million population per year.3 Although more recent national estimates of annual fatal dog bite injuries have not been published in the peer-reviewed literature, studies have consistently shown that fatal dog bite injuries are concentrated among children and the elderly, with children aged 0-9 being more likely than any other age group to have a fatal dog bite injury.3,5

Nonfatal dog bite injuries are more common than fatal dog bite injuries and are estimated to occur at an annual rate of 109.9 per 100 000 population in the United States, according to the most recent national estimates from 2009.6 Few studies have used national data to evaluate changes in the frequency of nonfatal dog bite injury over time. A study that used national data from the Centers for Disease Control and Prevention (CDC) for 2005-2009 found no significant decline in US population-based estimates of nonfatal dog bite injuries among persons aged 0-85 during the study period.6 Data from the 2010-2014 Nationwide Emergency Department Sample demonstrated that nonfatal dog bite injuries among children and adults decreased from 0.25% of all ED visits in 2010 to 0.19% of all ED visits in 2014, but that study did not include population estimates of injury.7

Few reports using national data have compared age- and sex-related differences in the frequency of nonfatal dog bite injuries.6-8 CDC data from 2001 found that children and adolescents aged ≤14 comprised 42% of all nonfatal dog bite injuries treated in EDs in the United States; the highest annual rate occurred among children aged 5-9. However, children aged <5 were also disproportionately affected.8 A review of the same CDC data source for 2005-2009 found that children aged 5-9 had the highest rate of nonfatal dog bite injuries among children and adults.6 Other national, statewide, and local studies have also found a disproportionate incidence of nonfatal dog bite injuries among children and adolescents aged 0-17.3,5,7,9-11

Injuries of all types are more common among males than among females throughout childhood and adulthood.12-14 The sex-related differences in both fatal and nonfatal injury incidence are evident in all child and adult age groups, with differences accentuated during adolescence and young adult years.13,14 Regional, statewide, and single-center studies, which provide detailed data on predictors of dog bite injury, found that nonfatal dog bite injuries occur at greater rates among males than among females2,9,10,15; the age group with the largest number of cases was often children aged 5-12.2,9,10,15,16

The objectives of this study were (1) to update national estimates of nonfatal dog bite injuries treated in EDs in the United States during a 17-year period (extent of data available through CDC) and (2) to evaluate differences in age- and sex-related risk of these injuries among children, adolescents, and young adults. We hypothesized that national estimates of nonfatal dog bite injuries treated in EDs among persons aged 0-19 declined from 2001 to 2017. Based on published data on all injuries and dog bite injuries specifically, we hypothesized that estimated rates of nonfatal dog bite injuries would be higher among males than among females and that this difference would be greatest between males and females aged 10-14.

Methods

This study used the Web-based Injury Statistics Query and Reporting System (WISQARS) database, an online injury data repository maintained by CDC.17 WISQARS is a public-use data interface that uses data collected as part of the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP).18 The NEISS-AIP, a collaboration between the US Consumer Product Safety Commission and CDC, obtains data from a stratified probability sample of EDs in the United States. Trained personnel at each reporting hospital abstract demographic and clinical data from the records of persons treated for injury. WISQARS uses input from the NEISS-AIP to calculate national estimates of injury based on the number of reported cases, adjusted to the calendar-year 2000 US population.19 The data output results include the number of cases reported, the relevant US Census population estimates, and the estimated number of injuries seen in US EDs per 100 000 population. WISQARS accounts for the complex survey weighting to produce national estimates of injury and accompanying 95% confidence intervals (CIs).

Seeking to update the 2005-2009 report using more recent data and focusing on children, adolescents, and young adults, we examined data on unintentional injuries due to nonfatal dog bite injuries treated in EDs in the United States from 2001 through 2017. We evaluated injuries among all persons aged 0-19 and among age groups (0-4, 5-9, 10-14, and 15-19). We examined sex-related differences between males and females among all ages combined and in each age group. We excluded cases in which sex was unknown (n = 10). Because WISQARS is a data interface, it does not provide raw data that can be used to compute statistical tests. Therefore, we compared 95% CIs to determine significant differences across calendar years and by age group and sex. We standardized rate calculations to the year 2000 population where appropriate. Finally, we used standard epidemiological formulas to calculate the relative risk ratio (RR) of nonfatal dog bite injuries between males and females.20 Because we used publicly available, de-identified data, the Medical University of South Carolina Institutional Review Board deemed the study to be not human research; as such, it did not require review.

Results

During 2001-2017, a total of 48 166 nonfatal dog bite injuries treated in EDs in the United States were reported to the NEISS-AIP for children, adolescents, and young adults aged 0-19, corresponding to a national estimate of 2 406 109 (95% CI, 2 102 643-2 709 573) nonfatal dog bite injuries and an age-adjusted rate of 173.1 nonfatal dog bite injuries per 100 000 persons. During the study period, the estimated number of nonfatal dog bite injuries treated in US EDs among persons aged 0-19 declined significantly, from 181 090 (95% CI, 158 315-203 864) in 2001 to 118 800 (95% CI, 97 933-139 667) in 2017 (Table 1).

Table 1.

Annual estimates of nonfatal dog bite injuries treated in hospital emergency departments among children, adolescents, and young adults aged 0-19, United States, 2001-2017

Year No. of Injuries Reporteda National Estimate of Injuries, No.b (95% CI) Reference Population, No.c Crude Rated Age-Adjusted Rated,e
2001 3481 181 090 (158 315-203 864)f 80 906 541 223.8 224.2
2002 3243 156 674 (131 584-181 764) 81 173 400 193.0 193.8
2003 3014 155 791 (128 972-182 610) 81 425 816 191.3 192.3
2004 3022 156 890 (127 653-186 127) 81 754 354 191.9 193.6
2005 2829 140 953 (119 443-162 462) 82 005 260 171.9 173.7
2006 2574 133 297 (110 044-156 550) 82 324 418 161.9 163.6
2007 2633 132 837 (112 392-153 282) 82 749 431 160.5 162.0
2008 2786 136 149 (112 523-159 775) 83 118 264 163.8 165.3
2009 2976 144 606 (120 826-168 386) 83 280 391 173.6 174.9
2010 2877 143 329 (120 930-165 728) 83 267 556 172.1 173.2
2011 2948 150 372 (125 188-175 556) 82 830 017 181.5 182.4
2012 2852 146 459 (123 017-169 900) 82 487 297 177.6 178.1
2013 2631 133 133 (111 009-155 257) 82 252 861 161.9 162.3
2014 2627 135 255 (117 825-152 686) 82 116 071 164.7 165.1
2015 2493 118 114 (99 455-136 773) 82 096 458 143.9 144.1
2016 2535 122 360 (100 277-144 442) 82 127 667 149.0 149.3
2017 2645 118 800 (97 933-139 667)f 82 153 212 144.6 144.9
2001-2017 48 166 2 406 109 (2 102 643-2 709 573) NA 173.1 NA
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Abbreviation: NA, not applicable.

a Data source: National Electronic Injury Surveillance System–All Injury Program.18

b Data source: Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System.17

c Data source: US Census Bureau.19

d Rates are per 100 000 persons aged 0-19.

e Adjusted to the year 2000 US population.

f A comparison of 95% CIs revealed a significant difference between the estimates for 2001 and 2017.

The crude rate of nonfatal dog bite injury per 100 000 persons was 194.3 among children aged 0-4, 220.2 among children aged 5-9, 168.7 among children and adolescents aged 10-14, and 109.6 among adolescents and young adults aged 15-19 (Table 2). The rate of nonfatal dog bite injury among adolescents and young adults aged 15-19 was significantly lower than the rate of nonfatal dog bite injury among other age groups.

Table 2.

Estimates of nonfatal dog bite injuries treated in hospital emergency departments, by age group, among children, adolescents, and young adults aged 0-19, United States, 2001-2017

Age Group, y No. of Injuries Reporteda National Estimate of Injuries, No.b (95% CI) Reference Population, No.c Crude Rated
0-4 13 886 657 378 (561 276-753 480) 338 395 727 194.3
5-9 15 598 751 546 (650 923-852 168) 341 323 037 220.2
10-14 11 937 598 757 (519 923-677 591) 354 923 387 168.7
15-19 6745 398 427 (345 255-451 600)e 363 426 863 109.6
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a Data source: National Electronic Injury Surveillance System–All Injury Program.18

b Data source: Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System.17

c 2000 data. Data source: US Census Bureau.19

d Per 100 000 persons in the corresponding age group.

e Comparison of 95% CIs revealed a significant difference between the estimates for adolescents and young adults aged 15-19 compared with children and adolescents in the other 3 age groups.

During the study period, males were significantly more likely than females to have nonfatal dog bite injuries; crude rates of nonfatal dog bite injuries per 100 000 persons aged 1-19 were 191.5 among males and 151.6 among females. The estimate of total nonfatal dog bite injuries was 1 370 255 (95% CI, 1 196 784-1 543 728) among males aged 0-19 and 1 035 219 (95% CI, 902 102-1 168 338) among females, corresponding to an RR of 1.26 (95% CI, 1.26-1.26). Comparisons by sex among the 4 age groups showed that the differences between males and females were driven by boys aged 5-9 (RR = 1.30; 95% CI, 1.29-1.30) and aged 10-14 (RR = 1.50; 95% CI, 1.49-1.51) (Table 3).

Table 3.

Estimates of nonfatal dog bite injuries treated in hospital emergency departments, by sex and age group, among children, adolescents, and young adults aged 0-19, United States, 2001-2017

Sexa Age Group, y No. of Injuries Reportedb National Estimate of Injuries,c No. (95% CI) Reference Populationd Crude Ratee
Male 0-4 7606 361 305 (307 583-415 028) 172 939 502 208.9
5-9 9090 432 199 (373 884-490 514)f 174 413 280 247.8
10-14 7336 365 674 (317 246-414 102)g 181 519 438 201.5
15-19 3592 211 077 (182 152-240 002) 186 557 892 113.1
Female 0-4 6274 295 619 (252 543-338 696) 165 456 225 178.7
5-9 6504 319 167 (273 925-364 410)f 166 909 757 191.2
10-14 4601 233 083 (201 171-264 995)g 173 403 949 134.4
15-19 3153 187 350 (160 988-213 713) 176 868 971 105.9
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a Excludes persons with unknown sex (n = 10).

b Data source: National Electronic Injury Surveillance System–All Injury Program.18

c Data source: Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System.17

d 2000 data. Data source: US Census Bureau.19

e Per 100 000 persons in the corresponding age group.

f Comparison of 95% CIs revealed a significant difference in estimates between boys and girls aged 5-9.

g Comparison of 95% CIs revealed a significant difference in estimates between boys and girls aged 10-14.

Discussion

These data suggest that the number of nonfatal dog bite injuries among children, adolescents, and young adults aged 0-19 declined significantly from 2001 to 2017. The decline also represents a clinically important decrease of approximately 34% from 2001 to 2017. Although the annual estimated rates of nonfatal dog bite injuries to children, adolescents, and young adults are declining, these injuries are still common and costly: a dog bite injury resulted in an average cost of $18 200 per hospitalization and an annual aggregate cost of $53.9 million for adults and children, based on 2008 estimates.16,21

The concentration of nonfatal dog bite injuries among children and adolescents aged 5-14 was found in other studies. A study using the same data source found that children aged 5-9 had the highest rate of nonfatal dog bite injuries (215.4 nonfatal dog bite injuries per 100 000 children aged 5-9) during 2005-2009.6 In another nationally representative data set of ED visits during 2008, children aged 5-9 had the highest rate (199.3 ED visits per 100 000 children aged 5-9) and children aged <5 had the second highest rate (175.0 per 100 000 children aged <5) of nonfatal dog bite injuries.16 Regional and local data also consistently show that children in the early school years and early adolescent years are disproportionately affected by nonfatal dog bite injuries.2,9,10,15,22,23 The reasons for the concentration of nonfatal dog bite injuries among children aged 5-14 are likely multifactorial. Data from other studies demonstrate that the scenarios contributing to dog bite injuries differ by age; children aged 5-9 are most frequently bitten by dogs they know, and children and adolescents aged 10-14 are most frequently bitten by unfamiliar dogs.24 Young children may be less able than older children to pick up on dog behavioral cues that might otherwise warn older children or adults to leave the dog alone. The concentration of nonfatal dog bite injuries from unfamiliar dogs among adolescents is often the result of negative interactions with dogs.24,25

Male children, adolescents, and young adults aged 0-19 are more likely than their female counterparts to sustain any injury, and nonfatal dog bite injuries are no exception.1 Among children and adolescents aged 10-14, the risk of nonfatal dog bite injuries was 49% higher among boys than among girls. This finding suggests that the age- and sex-related differences are exacerbated during childhood and adolescence, which is consistent with findings on other injury types.12 Although we hypothesized that we would find male–female differences in the rate of nonfatal dog bite injuries and RRs, we hypothesized that we would find a significant difference in the annual number of nonfatal dog bite injuries by sex only in the 10-14 age group. We did not expect to find sex-related differences among children aged 5-9. This finding, coupled with the persistent inverse relationship between age and nonfatal dog bite injury rate among persons aged 0-19, suggests that for children aged 0-4, immaturity in how they interact with dogs may be the predominant factor. However, by age 5, differences between girls and boys in their interactions with animals add another layer of complexity to interpretation of risk. One study combined data on ED visits for nonfatal dog bite injuries with clinical and historical patient data to demonstrate that the presence of externalizing behavioral disorders, such as attention deficit–hyperactivity disorder, was one of the comorbid chronic conditions associated with a greater risk of nonfatal dog bite injuries, but only among males. This finding suggests a complex interaction between sex and behaviors that contributes to the risk of nonfatal dog bite injuries.7

As with many patient safety initiatives, further reductions in dog bite injury will likely require a multipronged approach that may include regulatory and legislative efforts along with education in responsible pet ownership.26 Our findings have direct applicability to an important additional recommended approach to limit dog bite injury: education of children and their parents on how to interact with dogs.26 Studies have consistently demonstrated that most nonfatal dog bite injuries are caused by dogs the children know: up to 45% of the dogs involved in dog bite injuries live in the same home as the child victim.15,22,24,25,27 Educational interventions teaching proper behavior around dogs could reduce the number of fatal and nonfatal dog bite injuries.26

Recent studies demonstrated that brief educational interventions can improve knowledge of safe behavior around dogs and the ability of children to interpret a dog’s behavior.28-31 A nonrandomized, quasi-experimental study conducted in 2011 demonstrated that a video-based educational intervention could improve the knowledge of dog bite injury prevention among 120 children aged 5-9 visiting an ED (for all causes), from 58% passing a preintervention assessment to 90% passing a postintervention assessment, based on how the children performed in a simulated dog encounter.28 A randomized controlled trial published in 2015 involving 70 children aged 3-5 demonstrated that a brief video intervention focused on comparing friendly dog activities with aggressive or fearful dog activities resulted in both improvement in knowledge and improvement in recognizing problematic dog behaviors in the intervention group but not in the control group, who watched an unrelated video.29 A randomized trial conducted in 2013-2014 evaluating an educational intervention using mobile technology found that training parents and children in proper behavior around dogs improved child knowledge of safe behaviors and safety skills in field testing with live dogs.32 The pattern of educational interventions improving short-term knowledge of dog bite injury prevention and behaviors has been examined in other studies; however, few studies have evaluated, much less demonstrated, changes in dog bite injury frequency.33

Taken together with other published data on age- and sex-related differences in dog bite injuries, our study suggests that any educational interventions designed to improve behavior around dogs or reduce the risk of dog bite injuries should be tailored to the age group and the sex of the target population. However, it is unclear how well the short-term knowledge and behavioral improvement demonstrated by these interventions will translate to reductions in dog bite injuries. Close parental supervision, including when young children are around dogs, is inversely associated with child injury.34 Because of the risks of dog bite injuries to infants and young children, both CDC and the American Veterinary Medical Association recommend parental education on safety around dogs along with child education and that parents always directly supervise interactions with dogs for infants and young children.35,36

Limitations

This study had several limitations. First, the estimates of rates provided by the WISQARS data likely underestimate the true rate of nonfatal dog bite injuries in the United States because the cases come only from persons who were treated in EDs. Children who were treated for dog bite injuries by health care providers other than EDs or who did not seek medical care were not represented in these data. Because many minor nonfatal dog bite injuries are unreported, these data likely represent underestimates of the true frequency of nonfatal dog bite injuries.37 The data presented were also limited because they are estimates, using data drawn from a nationally representative group of EDs participating in surveillance and then applying those estimates to the overall population. Therefore, some of the observed year-to-year differences in the rates reported may be in part due to changes in the local environments of the surveillance sites or fluctuations in the surveillance processes themselves, resulting in magnified changes when applied to the entire US population. However, the national representativeness of the selected surveillance sites was meant to provide robust national estimates.

Second, the significance of the observed change from 2001 to 2017 was driven by substantially higher estimates of nonfatal dog bite injuries during calendar year 2001 than during other years. In fact, the 95% CIs for all other years (eg, 2002-2017) overlapped, raising the question of whether 2001 represented an anomalous year in nonfatal dog bite injuries or in how surveillance of nonfatal dog bite injuries was conducted in 2001. Without data from 2000 or earlier, it was not possible to evaluate whether data estimates from 2001 were anomalous or accurate. Other large year-to-year fluctuations in the estimated rate of nonfatal dog bite injuries treated in EDs were evident, such as the decrease of 20 nonfatal dog bite injuries per 100 000 persons aged 0-19 from 2004 to 2005. However, the drop of 30 nonfatal dog bite injuries per 100 000 persons aged 0-19 from 2001 to 2002 was the largest year-to-year difference noted in these data.

Finally, data on clinical person-level details, the circumstances of the injuries, and the degree of injury sustained were not available in WISQARS. Without knowing the circumstances of the injuries, particularly whether the injuries were random or provoked, we were not able to determine why boys and girls in the middle age groups had different rates of estimated nonfatal dog bite injuries. Although single-site studies using medical record review have provided insight on contributing factors, documentation of injury event settings, child or dog behavior precipitating the injury, dog breeds involved, dog ownership, and location of the interaction are often incomplete, even in research centers that have repeatedly studied the issue.22

Conclusions

Nonfatal dog bite injuries treated in EDs in the United States among children, adolescents, and young adults aged 0-19 declined 34% from 2001 to 2017. Males aged 0-19, particularly male children and adolescents aged 5-14, are significantly more likely than their female counterparts to be treated in the ED for nonfatal dog bite injuries. Regulatory changes along with age-appropriate and sex-specific educational programs may further reduce the risk of nonfatal dog bite injury.

Footnotes

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD: William T. Basco Jr, MD Inline graphic https://orcid.org/0000-0002-8626-7405

References

  • 1. Centers for Disease Control and Prevention. National estimates of the 10 leading causes of nonfatal injuries treated in hospital emergency departments, United States—2017. https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_nonfatal_injury_2017-508.pdf. Published January 18, 2019. Accessed March 18, 2019.
  • 2. Bregman B, Slavinski S. Using emergency department data to conduct dog and animal bite surveillance in New York City, 2003-2006. Public Health Rep. 2012;127(2):195–201. doi:10.1177/003335491212700208 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Sacks JJ, Lockwood R, Hornreich J, Sattin RW. Fatal dog attacks, 1989-1994. Pediatrics. 1996;97(6 pt 1):891–895. [PubMed] [Google Scholar]
  • 4. Sacks JJ, Sattin RW, Bonzo SE. Dog bite-related fatalities from 1979 through 1988. JAMA. 1989;262(11):1489–1492. doi:10.1001/jama.262.11.1489 [DOI] [PubMed] [Google Scholar]
  • 5. Shields LB, Bernstein ML, Hunsaker JC III, Stewart DM. Dog bite-related fatalities: a 15-year review of Kentucky medical examiner cases. Am J Forensic Med Pathol. 2009;30(3):223–230. doi:10.1097/PAF.0b013e3181a5e558 [DOI] [PubMed] [Google Scholar]
  • 6. Quirk JT. Non-fatal dog bite injuries in the U.S.A., 2005-2009. Public Health. 2012;126(4):300–302. doi:10.1016/j.puhe.2012.01.010 [DOI] [PubMed] [Google Scholar]
  • 7. Holzer KJ, Vaughn MG, Murugan V. Dog bite injuries in the USA: prevalence, correlates and recent trends. Inj Prev. 2019;25(3):187–190. doi:10.1136/injuryprev-2018-042890 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Gilchrist J, Gotsch K, Annest JL, Ryan G. Nonfatal dog bite-related injuries treated in hospital emergency departments—United States, 2001. MMWR Morb Mortal Wkly Rep. 2003;52(26):605–610. [PubMed] [Google Scholar]
  • 9. Kaye AE, Belz JM, Kirschner RE. Pediatric dog bite injuries: a 5-year review of the experience at the Children’s Hospital of Philadelphia. Plast Reconstr Surg. 2009;124(2):551–558. doi:10.1097/PRS.0b013e3181addad9 [DOI] [PubMed] [Google Scholar]
  • 10. Matthias J, Templin M, Jordan MM, Stanek D. Cause, setting and ownership analysis of dog bites in Bay County, Florida from 2009 to 2010. Zoonoses Public Health. 2015;62(1):38–43. doi:10.1111/zph.12115 [DOI] [PubMed] [Google Scholar]
  • 11. Rhea SK, Weber DJ, Poole C, Waller AE, Ising AI, Williams C. Use of statewide emergency department surveillance data to assess incidence of animal bite injuries among humans in North Carolina. J Am Vet Med Assoc. 2014;244(5):597–603. doi:10.2460/javma.244.5.597 [DOI] [PubMed] [Google Scholar]
  • 12. Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries Among 0-19 Year Olds in the United States, 2000-2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008. [Google Scholar]
  • 13. US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child Health USA 2014: Nonfatal Injury. Rockville, MD: US Department of Health and Human Services; 2014; https://mchb.hrsa.gov/chusa14/special-features/nonfatal-injury.html#source3. Accessed March 14, 2019. [Google Scholar]
  • 14. Sorenson SB. Gender disparities in injury mortality: consistent, persistent, and larger than you’d think. Am J Public Health. 2011;101(suppl 1):S353–S358. doi:10.2105/AJPH.2010.300029 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Garvey EM, Twitchell DK, Ragar R, Egan JC, Jamshidi R. Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center. J Pediatr Surg. 2015;50(2):343–346. doi:10.1016/j.jpedsurg.2014.09.051 [DOI] [PubMed] [Google Scholar]
  • 16. Holmquist L, Elixhauser A. Emergency Department Visits and Inpatient Stays Involving Dog Bites, 2008: Statistical Brief #101. Rockville, MD: Agency for Healthcare Research and Quality; 2006; https://www.ncbi.nlm.nih.gov/books/NBK52650. Accessed March 14, 2019. [PubMed] [Google Scholar]
  • 17. Centers for Disease Control and Prevention. Welcome to WISQARS: Web-based Injury Statistics Query and Reporting System. https://www.cdc.gov/injury/wisqars/index.html. Accessed March 14, 2019.
  • 18. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, and US Consumer Product Safety Commission. National Electronic Injury Surveillance System—All Injury Program, [United States], 2014. Ann Arbor, MI: Inter-university Consortium for Political and Social Research; 2018; doi.org/10.3886/ICPSR37100.v1 [Google Scholar]
  • 19. US Census Bureau, US Department of Commerce, Economics and Statistics Administration Current Population Reports, P25-1130. Washington, DC: US Government Printing Office; 1996; https://www.census.gov/prod/1/pop/p25-1130/p251130.pdf. Accessed December 12, 2019. [Google Scholar]
  • 20. Altman DG. Practical Statistics for Medical Research. London, UK: Chapman and Hall; 1991. [Google Scholar]
  • 21. Daniels DM, Ritzi RB, O’Neil J, Scherer LR. Analysis of nonfatal dog bites in children. J Trauma. 2009;66(3 suppl):S17–S22. doi:10.1097/TA.0b013e3181937925 [DOI] [PubMed] [Google Scholar]
  • 22. Bykowski MR, Shakir S, Naran S, et al. Pediatric dog bite prevention: are we barking up the wrong tree or just not barking loud enough? Pediatr Emerg Care. 2019;35(9):618–623. doi:10.1097/PEC.0000000000001132 [DOI] [PubMed] [Google Scholar]
  • 23. Golinko MS, Arslanian B, Williams JK. Characteristics of 1616 consecutive dog bite injuries at a single institution. Clin Pediatr (Phila). 2017;56(4):316–325. doi:10.1177/0009922816657153 [DOI] [PubMed] [Google Scholar]
  • 24. Reisner IR, Nance ML, Zeller JS, Houseknecht EM, Kassam-Adams N, Wiebe DJ. Behavioural characteristics associated with dog bites to children presenting to an urban trauma centre. Inj Prev. 2011;17(5):348–353. doi:10.1136/ip.2010.029868 [DOI] [PubMed] [Google Scholar]
  • 25. Schalamon J, Ainoedhofer H, Singer G, et al. Analysis of dog bites in children who are younger than 17 years. Pediatrics. 2006;117(3):e374–e379. doi:10.1542/peds.2005-1451 [DOI] [PubMed] [Google Scholar]
  • 26. American Veterinary Medical Association Task Force on Canine Aggression and Human-Canine Interactions. A community approach to dog bite prevention. J Am Vet Med Assoc. 2001;218(11):1732–1749. doi:10.2460/javma.2001.218.1732 [DOI] [PubMed] [Google Scholar]
  • 27. Smith AM, Carlson J, Bartels AB, McLeod CB, Golinko MS. Characteristics of dog bites in Arkansas. South Med J. 2018;111(8):494–500. doi:10.14423/SMJ.0000000000000848 [DOI] [PubMed] [Google Scholar]
  • 28. Dixon CA, Pomerantz WJ, Hart KW, Lindsell CJ, Mahabee-Gittens EM. An evaluation of a dog bite prevention intervention in the pediatric emergency department. J Trauma Acute Care Surg. 2013;75(4 suppl 3):S308–S312. doi:10.1097/TA.0b013e31829be2bc [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Lakestani N, Donaldson ML. Dog bite prevention: effect of a short educational intervention for preschool children. PLoS One. 2015;10(8):e0134319 doi:10.1371/journal.pone.0134319 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Meints K, de Keuster T. Brief report: don’t kiss a sleeping dog: the first assessment of “the blue dog” bite prevention program. J Pediatr Psychol. 2009;34(10):1084–1090. doi:10.1093/jpepsy/jsp053 [DOI] [PubMed] [Google Scholar]
  • 31. Chapman S, Cornwall J, Righetti J, Sung L. Preventing dog bites in children: randomized controlled trial of an educational intervention. West J Med. 2000;173(4):233–234. doi:10.1136/ewjm.173.4.233 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Dixon CA, Ammerman RT, Johnson BL, et al. A randomized controlled field trial of iBsafe—a novel child safety game app. Mhealth. 2019;5:3 doi:10.21037/mhealth.2019.01.02 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Shen J, Rouse J, Godbole M, Wells HL, Boppana S, Schwebel DC. Systematic review: interventions to educate children about dog safety and prevent pediatric dog-bite injuries: a meta-analytic review. J Pediatr Psychol. 2017;42(7):779–791. doi:10.1093/jpepsy/jsv164 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34. Morrongiello BA, Midgett C, Shields R. Don’t run with scissors: young children’s knowledge of home safety rules. J Pediatr Psychol. 2001;26(2):105–115. doi:10.1093/jpepsy/26.2.105 [DOI] [PubMed] [Google Scholar]
  • 35. American Veterinary Medical Association. Dog bite prevention. https://www.avma.org/public/Pages/Dog-Bite-Prevention.aspx. Published 2019. Accessed September 3, 2019.
  • 36. Centers for Disease Control and Prevention. Healthy pets, healthy people. https://www.cdc.gov/healthypets/specific-groups/children.html. Updated February 25, 2019. Accessed September 3, 2019.
  • 37. Beck AM, Jones BA. Unreported dog bites in children. Public Health Rep. 1985;100(3):315–321. [PMC free article] [PubMed] [Google Scholar]

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