Epidemiology and management of dog bite injuries to the hand and upper limb

Dog bites to the hand and upper limb are common and carry a high-risk of severe injury and infection. However, epidemiological data, particularly comparing adult and pediatric populations, is limited. The study aims to describe patient demographics, injury severity, and the medical or surgical treatment provided. While comparing these results between adult and pediatric populations.

This retrospective study recorded all the dog bites affecting the hand and upper limb over a 11-year period (2013-2023) in a single hospital using a Health Data Warehouse called 'Entrepôt de Données de Santé Normand' (EDSaN). Cases were identified using ICD-W54.0XXA codes, and cross-referenced with unstructured data via keyword-based queries. Patients were categorized as pediatric (<18years) or adult (≥18years) subgroups. Bite severity (fracture, tendon injury, nerve injury and infection), antibiotic prescriptions, and care pathway were assessed. Statistical analysis included Chi² and Student's t-tests with an alpha risk of 0.05.

Among 5081 bites, 1444 (28.4%), involved pediatric patients and 3637 (71.6%) involved adults. Adults had significantly higher rates of severe injuries, including fractures (15.9% vs. 8.8%, P<0.01), nerve injuries (8.9% vs. 3.0%, P<0.01), tendon injuries (2.6% vs. 0.6%, P<0.01), and infections (16.2% vs. 12.8%, P<0.01). Adults had lower rates of antibiotics prescriptions (62.6% vs. 66.3% P<0.05). Surgical procedures were performed in 9.4% of cases with no statistical difference between groups.

Dog bites are a common reason for emergency department visits. This large-scale epidemiological study highlights a low rate of surgical procedures, insufficient antibiotics prescription, and statistical differences in bites severity between adults and children. The low rate of surgical interventions may indicate barriers to operating room access.