Harold B. Weiss, MS, MPH; Deborah I. Friedman; Jeffrey H. Coben, MD
—Emergency departmentsurvey fromtheNationalCenterforHealthStatisticsNationalHospitalAmbulatoryMedicalCareSurveyfor1992to1994.
Main Outcome Measure.—
THECLOSEASSOCIATIONbetweenhumansanddomesticateddogsbeganatleast 12000 years ago.
Since then,people have been intimately involved indomesticating the wild dog into hunter,guard,andcompanion.However,thedo-mesticated dog retains many of its wildinstincts,includingbehaviorsthatalltoooften lead to human attacks. This riskhasalwaysbeenpresent.Onlynow,how-ever, are we beginning to gain a full un-derstandingoftheimpactofdogbitesonpopulations.
Estimates of dog bite injuries havebeen reported from data derived fromhouseholdsurveys,hospital-basedstud-ies, school-based surveys, local animalshelter monitoring, police reports, andnewspaper articles.
Because of lack of a national reporting system and varia-tion of local reporting procedures, accu-rate national incidence rates for dogbite–related emergency department(ED)visitsandhospitalizationshavenotbeen well quantified. The reported inci-dence of ED-treated dog bite injuries inthe United States ranges from 0.3% to1.1% of all ED visits.
With regard to overall morbidity, theannual number of total bites that occurintheUSpopulationhasbeenestimatedtorangefrom500000to4.5million.
Ithasbeenestimatedthatalmosthalfofallchildren have been bitten by a dog atsome point in their lives.
Among chil-dren, more than 50% of documentedbites have been to the head, face, orneck.
Unfortunately, most of thestudiesthatprovidedthisdescriptivein-formation were limited because of smallsample size and lack of consistent defi-nitions,ortheywerenotrepresentativeof the general population.Recent work by Sacks et al
has im-proved the precision of national esti-matesfordogbite–relatedmortalityandfor dog bites receiving any medical at-tention. For the 10-year period, 1979through1988,anannualaverageofabout15 fatal dog attacks was documented intheUnitedStates,withextrapolatedes-timates suggesting that as many as 20per year may have actually occurred.
Based on a random household survey,theInjuryControlandRiskSurveycon-ducted by the Centers for Disease Con-trol and Prevention, it was estimatedthat about 800000 bites occur annuallythat require medical attention.
How-ever,thisestimatewasnotabletobreakdown the proportion of patients seen inhospitals owing to the small size of thesample.Theonlynationwidestudyfromany country that examined both majormorbidity and mortality from dog biteinjuries was conducted in New Zeal-and.
This study predicted an incidenceof hospitalization due to dog bites in theyear 2000 of 9.6 per 100000 persons,twice the incidence for 1979.
From the Department of Emergency Medicine, Cen-ter for Injury Research and Control, University of Pitts-burgh, Pittsburgh, Pa. Mr Weiss, Ms Friedman, and DrCoben are now with the Department of EmergencyMedicine, Center for Violence and Injury Control, Al-legheny University of the Health Sciences, Pittsburgh.Presented in part at the American Public Health As-sociationannualmeeting,SanDiego,Calif,October30,1995, and the Pennsylvania Public Health Associationannual meeting, Pittsburgh, October 1, 1996.Reprints: Harold B. Weiss, MS, MPH, Center for Vio-lence and Injury Control, Allegheny University of theHealth Sciences, 1 Allegheny Center, Suite 510, 320East North Ave, Pittsburgh, PA 15212-4772 (e-mail:email@example.com).
JAMA, January 7, 1998—Vol 279, No. 1 Dog Bites Treated in Emergency Departments—Weiss et al