title: Dog bites to the upper extremity in children.
abstract: OBJECTIVE
  Dog bites are common injuries in children. A large percentage of these dog bites affect the upper extremity. There is little information describing the results of treatment of upper extremity injuries in children.
  
  
  METHODS
  We retrospectively reviewed the medical records for all children less than 19 years old who presented to the emergency department in our level one trauma centre because of dog bites from 2005 to 2011.
  
  
  RESULTS
  During the study period, there were 254 paediatric emergency department visits for animal bites, among these there were 118 dog bites, two were excluded because of inadequate documentation leaving 116 patients; 26 of them (22.4%) had bites to the upper extremity. Among the 26 children with dog bites to the upper extremity, 6 (23.1%) were admitted to the hospital for surgery (four patients) or parenteral antibiotics (two patients). Among the four surgeries, two were for extensive laceration and two were for abscess debridement. Of the 41 who presented with bites to the lower extremities, none were admitted to the hospital (P = 0.002). Compared with those who presented the same day they were injured, the relative risk of hospitalization or surgery in patients who presented 1 and 2 days after their injury was 3.5 and 7.0, respectively.
  
  
  CONCLUSIONS
  Dog bites at the upper extremity are more prone to require surgical intervention and develop infection than those at the lower extremity, and delayed presentation of these injuries is associated with higher incidence of developing infection.
authors.affiliation: Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Speirs
authors.affiliation: Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA.
authors.forename: James
authors.initials: J
authors.lastname: Showery
authors.affiliation: Department of Paediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA.
authors.forename: Marwa
authors.initials: M
authors.lastname: Abdou
authors.affiliation: Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Pirela-Cruz
authors.affiliation: Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA.
authors.forename: Amr A
authors.initials: AA
authors.lastname: Abdelgawad
mesh_terms: D000293:Adolescent; D000818:Animals; D001733:Bites and Stings / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D034941:Upper Extremity / Q000293:injuries*
keywords: dog bite; hand; infection; paediatric; pediatric; upper extremity