title: "Non-bite dog-related" injuries: an overlooked injury mechanism in the pediatric population.
abstract: BACKGROUND
  Each year, approximately 4.7 million Americans sustain dog bites, the majority of which occur in children. In response to this alarming trend, injury prevention programs across the country have focused efforts on preventing dog bites in children. However, little attention has been given to non-bite dog-related injuries, and to date, no data have been presented on this type of injury in the western literature.
  
  
  METHODS
  After Institutional Review Board approval (IRB No. 07100185) was obtained, data from the trauma registry for all children (ages, 0-20 years) admitted to our Level I pediatric trauma center were evaluated from 2001 to 2007. Information regarding dog-related injuries was obtained. Data were divided into injuries related to bites and non-bites. Demographics, injury pattern, and outcome were evaluated. Descriptive statistics, Student's t test, and Fisher's exact/χ analyses were preformed.
  
  
  RESULTS
  Over the 6-year period reviewed, 191 (2%) children were admitted to the Benedum Trauma Program for dog-related injuries. Thirty-four (18%) children sustained non-bite-related injuries while the remainder sustained bite/scratch injuries. Twenty-six (76%) of the children sustained injuries directly due to contact with dogs; four (12%) of them were injured after falling while being carried by adults who either tripped over a dog or were pushed by a dog. The remaining four (12%) children sustained injuries while colliding with dogs while on motorized and/or nonmotorized vehicles. Abrasions/lacerations and head injury occurred most frequently, followed by extremity fractures, particularly of the femur. Children injured by non-bite-related mechanisms were more severely injured than those sustained a bite, although the Injury Severity Score in both groups was low.
  
  
  CONCLUSIONS
  Dog bites have been recognized around the world as a substantial public health problem particularly in children. In our experience, we have seen that non-bite-related injuries should not be ignored. The injuries seen in this subset of children are the result of being struck or pushed, resulting in multiple, potentially severe injuries. These data underscore the unpredictable nature of animals and the need for adult supervision when animals and children interact.
authors.affiliation: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA.
authors.forename: David
authors.initials: D
authors.lastname: Juang
authors.forename: Megan
authors.initials: M
authors.lastname: Sippey
authors.forename: Noel
authors.initials: N
authors.lastname: Zuckerbraun
authors.forename: John D
authors.initials: JD
authors.lastname: Rutkoski
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gaines
mesh_terms: D000293:Adolescent; D000818:Animals; D001733:Bites and Stings / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011634:Public Health; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D055815:Young Adult