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      Uncovering a Failed Pediatric Patient Population in Rural America: A Statewide Analysis of Over 1,000 Dog Bite Injuries

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      1 , 2 , 2 , 3 , 4 , 5 , 1 ,
      ,
      Cureus
      Cureus
      rural, pediatrics, urban, animal bite, dog bites

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          Abstract

          Pediatric dog bites are prevalent and often devastating. Population-based data on these injuries can aid public health intervention efforts. However, most existing literature comes from single institutions in urban settings. We assess a statewide cohort to compare injury characteristics in urban and rural regions and find predictors for inter-hospital transfer. Data from 1,007 injuries from 2000 to 2015 were analyzed. Patients in rural areas were younger, more likely to be white and low-income, and more likely to receive delayed patient care. Injuries occurring in public settings as opposed to the private residence were more likely to involve males, occur in low-income areas, and involve non-white patients. Patients who required inter-hospital transfer were more likely to require a surgical subspecialist and operative repair. Our population analysis reveals children living in rural areas as a previously unidentified vulnerable patient population that may be suitable targets for public health interventions.

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          Most cited references30

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          Dog bites: still a problem?

          To estimate the incidence of dog bites in the USA and compare it with similar estimates from 1994. Nationally representative cross-sectional, list-assisted, random-digit-dialed telephone survey conducted during 2001-2003. Weighted estimates were generated from data collected by surveying 9684 households during 2001-2003 and compared with results from a similar survey conducted in 1994. Estimates for persons aged 15-17 years were extrapolated on the basis of rates for 10-14-year-olds. Whereas the incidence of dog bites among adults remained relatively unchanged, there was a significant (47%) decline in the incidence of dog bites among children compared with that observed in the 1994 survey, particularly among boys and among those aged 0-4 years. Between 2001 and 2003, an estimated 4 521 300 persons were bitten each year. Of these, 885 000 required medical attention (19%). Children were more likely than adults to receive medical attention for a dog bite. Among adults, bite rates decreased with increasing age. Among children and adults, having a dog in the household was associated with a significantly increased incidence of dog bites, with increasing incidence also related to increasing numbers of dogs. Dog bites continue to be a public health problem affecting 1.5% of the US population annually. Although comparison with similar data from 1994 suggests that bite rates for children are decreasing, there still appears to be a need for effective prevention programs.
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            The demographics of dog bites in the United States

            Dog bites are a significant public health issue. There is no comprehensive study of dog bite demographics. It was the purpose of this study to perform such an analysis across the US. The National Electronic Injury Surveillance System All Injury Program data for the years 2005 through 2013 was accessed; dog bite injuries were extracted and analyzed. Statistical analyses were performed with SUDAAN 11.0.01™ software to account for the weighted, stratified nature of the data. Incidence values were calculated using population data from the US Census Bureau. A P 85 years of age, 4.88 [2.89, 8.24] 75–84 years, and 2.79 [1.77, 4.39] those ≤4 years of age, with the 10–14 year age group the reference group. The average annual incidence was 1.1 per 1,000, and was slightly higher in males (1.18 vs 1.02 per 1,000). The estimated cost was at least 400 million US$ per year. Potential prevention strategies are educational programs directed at both children and parents/caretakers outlining the responsibilities of owning a dog. This information can be disseminated in health care facilities, radio/TV/Internet venues, and dog kennels/shelters.
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              Unreported dog bites in children.

              In 1981, more than 3,200 Pennsylvania children, ages 4 to 18 years, were surveyed about their dog bite histories and attitudes toward animals. Dog bites were much more common than previously reported: 45 percent of children had been bitten during their lifetimes, and 15.5 percent had been bitten in 1980, more than 36 times the rate reported to health authorities. In 1980, the highest bite rate occurred among children 7-12 years old (20 percent). Children were bitten more frequently by the dogs owned by their neighbors, followed by their own dogs, than by strays or by dogs whose owners were not known. Boys were bitten twice as frequently as girls by neighbors' dogs and strays; the bite rates from family dogs were identical in boys and girls. Despite the high bite rates, being bitten was not significantly associated, in most groups of children studied, with a dislike of dogs. These positive attitudes toward dogs may lead to inadequate precautions against bites and to biases in the reporting of bites to health authorities.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                7 June 2022
                June 2022
                : 14
                : 6
                : e25734
                Affiliations
                [1 ] Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
                [2 ] College of Medicine, Pennsylvania State University, Hershey, USA
                [3 ] Division of Outcomes Research and Quality, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
                [4 ] Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, USA
                [5 ] Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
                Author notes
                Article
                10.7759/cureus.25734
                9270082
                a42d576d-2ab4-49cd-9077-ac17be0cf751
                Copyright © 2022, Massand et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 April 2022
                : 4 June 2022
                Categories
                Emergency Medicine
                Pediatrics
                Plastic Surgery

                rural,pediatrics,urban,animal bite,dog bites
                rural, pediatrics, urban, animal bite, dog bites

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