Surgical Interventions After Pediatric Dog Bite Injury In The United States: Analysis Of The Kids' Inpatient Database
Joseph D Forrester, Jared A Forrester, Lakshika Tennakoon, Stephanie Chao, *David A Spain
Stanford University, Stanford, CA
Background (issue): Dog bites are a common cause of trauma that may result in morbidity and mortality. We sought to determine national estimates for the burden of pediatric dog bite injury requiring hospitalization and surgery.
Methods: We performed a retrospective analysis of inpatient encounters after dog bite (E906.0) from the 2012 Kids' Inpatient Database (KID). Outcomes included need for surgical procedure, mortality, and cost. Statistical analyses used KID sampling strata and discharge weights to produce national patient-level estimates. Univariate and multivariate analyses were performed compensating for survey methodology. Findings: 3,105 pediatric patients were admitted after dog bite injury. Median age was 6 (range: <1y-20y) with children 1-3 y accounting for 1,018 (33%) patients; 1,751 (56%) were male. The majority (n=1,728, 55%) of patients were in the lower income quartiles. 95% of patients were in urban hospitals. Most children (n=2,603, 84%) were injured in multiple body regions. 1,021 (33%) patients required surgery. Among the top surgical procedures, 37% (n=144) were head/neck, 12% (n=107) were upper extremity, and 8% (n=140) were a skin graft or tissue flap. On multivariate analysis, older age (OR=1.2, 95%CI 1.1-1.3, P<0.0001) and being in an urban hospital (OR=1.4, 95%CI 1.2-1.8, P<0.0001) was associated with greater odds of undergoing surgery. There was $19,500,000 spent on hospital charges for dog bite injuries. Fewer than 10 hospitalized patients died.
Conclusions (implications for practice): Dog bites are often preventable, and can result in injury requiring surgical intervention. Traumatic dog bite injuries to the face and upper extremity commonly require surgical intervention in the pediatric population.
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