title: Life-threatening dog attacks: a devastating combination of penetrating and blunt injuries.
abstract: OBJECTIVE
  Children often are the victims of dog attacks. Although bite injuries sustained in an attack characteristically are attributed to the penetrating component of the bite, the blunt nature of a bite may represent the most serious and devastating component of injury. The purpose of this study was to characterize a group of children suffering life-threatening dog bites and examine the predominant aspect of injury.
  
  
  METHODS
  Thirty-nine children were admitted to the trauma service at a regional pediatric trauma center with the diagnosis of dog bite injury over a 6-year period (1994 through 1999). Patient demographics, site and description of injury, and surgical procedures performed were recorded from a chart review.
  
  
  RESULTS
  Mean age of the 35 children included for analysis was 5.4 years (range, 0.8 to 17 years). Twenty-five (71%) injuries occurred in the head and neck region. Eight (23%) children sustained life-threatening injuries. Of these, blunt force was the predominant injury in 6. This resulted in 1 (20%) arterial occlusion requiring vascular reconstruction, 2 (40%) permanent neurologic injuries (stroke, spinal cord transection), and 1 (20%) death (exsanguination).
  
  
  CONCLUSIONS
  On evaluation of a dog attack, the focus generally is on the obvious penetrating aspect of the bite. Yet, we found the blunt component of injury can have devastating consequences reflected in acute arterial, brain, and spinal cord injury. Even in the absence of significant penetrating trauma, further evaluation should be considered to exclude occult blunt arterial or neurologic injury.
authors.affiliation: Division of Pediatric Surgery, The Children's Hospital, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Calkins
authors.forename: D D
authors.initials: DD
authors.lastname: Bensard
authors.forename: D A
authors.initials: DA
authors.lastname: Partrick
authors.forename: F M
authors.initials: FM
authors.lastname: Karrer
mesh_terms: D000293:Adolescent; D000818:Animals; D001733:Bites and Stings / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D016638:Critical Illness; D004285:Dogs; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000453:epidemiology* / Q000601:surgery; D014950:Wounds, Penetrating / Q000145:classification / Q000453:epidemiology* / Q000601:surgery