Effects Of Bone Fracture On Hospital Course In Pediatric Dog Bite Patients
Dominic Alessio-Bilowus1, Nishant Kumar2, Elika Ridelman2, *Christina Shanti2
1Wayne State University School of Medicine, Detroit, MI;2Children's Hospital of Michigan, Detroit, MI
BACKGROUND: Dog bite injuries are a source of significant morbidity and expense in the United States. While most bites do not require inpatient care, rates of hospitalization have been rising. Children are at increased risk of dog bite compared to adults, yet there is a lack of published material on factors affecting hospital course in pediatric patients. In a previous study, we identified bone fracture as a risk factor for increased length of stay (LOS). The present study further examines this bone fracture cohort.
METHODS: A retrospective chart review was conducted of all patients presenting to our urban, academic children’s hospital for dog bite injuries between January 2016 and May 2021. Data was collected on patients admitted for inpatient care and variables were examined prior to, during and after hospital stay.
RESULTS: 739 pediatric patients were evaluated and treated for dog bite injuries during the study period, of which 349 were admitted. Forty-five (13%) of these presented with bone fractures. Patients with a fracture had an average LOS of 5.3 days compared to 2.5 days without (p=0.01). Those with fracture were also more likely to undergo multiple procedures (18% vs. 4.6%, p=0.00), be transferred between services (24% vs. 6.6%, p=0.00), experience post-operative complications (16% vs. 5.6%, p=0.01) and return for future interventions, both planned (22% vs. 6.3%, p=0.00) and unplanned (13% vs. 2.0%, p=0.00). The most frequent complication was infection, including osteomyelitis. Interestingly, while the head and face region represented the highest proportion of fractures at 51%, long bone injuries were involved in 5/7 post-operative complications and 4/6 unplanned visits.
CONCLUSIONS: Pediatric patients admitted for dog bites experience significantly more complex courses of care when presenting with a fracture, in particular involving long bones. Optimizing triage and management can reduce postoperative complications and LOS, while improving outcomes and decreasing readmission.
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