History
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Although the incidence of infection transmission is quite low, the risk of rabies is probably the best reason for investigating animal bite injuries. Regardless, many animal bites remain unreported because they are minor and can be self-treated.
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When evaluating a patient following an animal bite, the nature of the injury is pertinent, including whether or not the animal was known to the victim. The time of injury may have implications for treating potential wound infections or for addressing avulsed appendages.
Physical
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Following an animal bite, patients require a full physical examination to address all bite wounds.
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Adults are injured most often in the extremities. Children are injured more often in the head and neck region compared with adults.
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The degree of injury is important. Some patients can be managed with local wound care or simple suturing by emergency department staff. Others require a consultation with a specialist or a trip to the operating room to address their wounds.
Causes
Epidemiologic studies have shown that most dog and cat bites are not from stray animals. Rather, the animal is often the pet of the victim or an acquaintance of the victim. In many animal bites in children, the animal was inadvertently provoked by the child. Infant swings have been linked to dog attacks. [12]
A prospective study by Touré indicated that risk factors for dog bites to the face include young age, a single-parent environment, and the presence of a German shepherd–type dog. In the study, which included 108 facial dog-bite patients, 68.5% of victims were under age 16 years, with 33.3% of them aged 2-5 years; 91.3% of bites took place in a single-parent environment. [13]
A study by Parent et al indicated that risk factors for dog bite–related craniofacial fractures in children include dog weight of greater than 30 pounds (odds ratio [OR] 19.6), Caucasian race (OR 7.3), presence of child on the floor (OR 6.2), age under 5 years (OR 4.1), and rural location (odds ratio [OR] 3.9). [14]
A study by Rezac et al indicated that human behaviors that increase the risk of dog bites to the face include bending over a dog and putting one’s face near a dog’s face (76% and 19% of cases, respectively). Gazing between humans and dogs also increased the risk (5% of cases). In the study, which involved 132 cases, more than two thirds of those bitten were children. [15]
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The child in this photo sustained a dog bite to the face. Courtesy of Wikimedia Commons, Tanner Ford, TRFPhotography.
