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Pediatric Craniofacial Fractures From Dog Bites: A Case-control Study
Brodie Parent, MD MS
Michael R. Bykowski, MD MS
Sriram Ramgopal, MD
Jesse A. Goldstein, MD
Joseph E. Losee, MD FAAP FACS
University of Pittsburgh Department of Plastic Surgery
2019-02-14
Presenter: Brodie Parent
Affidavit:
The project conception, hypothesis, study design, data collection, data analysis and writing of the abstract are all original work of the resident.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
Dog bites are a common source for soft-tissue morbidity in children. Pediatric craniofacial fractures from dog bites tend to be severe injuries but are poorly characterized in the literature.
Methods:
A case-control study was conducted to include all pediatric dog bite victims with craniofacial fractures presenting to our quaternary care hospital from 2008-2019. Control dog bite victims without craniofacial fractures were randomly selected from the same population. We abstracted demographic and clinical details from charts, reported summary statistics, and calculated odds ratios (OR) with 95% confidence intervals.
Results:
Of 3,602 dog bite encounters, we identified 38 patients with 60 craniofacial fractures (11 orbital, 10 mandibular, 10 nasal, 8 parietal, 6 maxillary, 6 dental, 6 frontal, 4 zygomatic, 3 temporal, and 2 occipital). We obtained 38 control dog bite victims without craniofacial fractures. Relative to controls, patients with craniofacial fractures were more likely to require operative repair (16% vs. 61%, p<0.01) and hospital admission (18% vs. 84%, p<0.01). Age under five, rural location, and large dogs (over 30 pounds) were significantly associated with increased risk of craniofacial fractures (OR 4.2 [1.5-12.8], OR 5.4 [1.3-32.0], and OR 6.2 [1.7-28.1], respectively). Nine patients (12%) required multiple reconstructive operations, and four patients (5%) developed post-traumatic stress disorder.
Conclusion:
Dog bite-related pediatric craniofacial fractures are rare but can be highly morbid injuries that lead to multiple surgeries and psychiatric sequelae. Toddlers in rural households with large dogs are at particularly high risk for sustaining craniofacial fractures from bites. These findings have important prevention implications.
