A recent Centers for Disease Control and Prevention report estimates that more than 3.7 million dog bites occur in the United States annually. 1 National Center for Health Statistics data show that dog bites are responsible for more than 334,000 emergency room visits, 4 percent of which require hospitalization. 2 Dog bite-related fatalities from 1979 through 1994 numbered 279, 3,4 and 25 additional fatalities occurred in 1995 and 1996. 5
Dog bites represent a significant cause of morbidity and mortality in the United States. The associated pain and suffering, particularly in children, are incalculable. In addition to the expense of health care, there is substantial long-term disability to injured children. At Bellevue Hospital, the authors recently have treated several children for particularly severe and unprovoked dog bites. The purpose of this study was to define the scope of the dog bite problem in New York City.
Materials and Methods
Data on all reported dog bites treated in New York City during the calendar year 1998 were obtained from the New York City Department of Health. Any dog bite injury treated by a physician in New York City must, by law, be reported to the local authorities. Data from the report forms are entered into a master registry. Information on each bite includes the date of injury, age and sex of the victim, anatomic area affected, the treating hospital, and the borough in which the bite occurred. The data did not include information on the treatment rendered to the victim, nor did it include the circumstances of the attack or breed of dog involved.
Health Department Data
During the 1-year study period, 6568 dog bites were reported by physicians to the NYC Department of Health. Based on population data, this number represents an incidence of 0.85 per 1000. Children were affected more than any other age group, with 41 percent of bites occurring in patients under age 18, with a marked decrease in incidence in the third decade of life (see Fig. 1). The peak incidence was noted in children ages 7 to 9 years old (Fig. 2). with an overall male to female predominance of 1.42 to 1.
The most commonly affected anatomic locations were the upper extremities (42 percent) and the lower extremities (37 percent), followed by the face/head area (14 percent). The trunk and chest (3 percent), abdomen (1.4 percent), and buttock/groin areas (2 percent) were less commonly affected (Fig. 3
By geographic location, 96 percent of the bites occurred within the five boroughs of New York City. Brooklyn had the greatest number of dog bites, with 28 percent of the total, followed by Queens, Bronx, Manhattan, and Staten Island (Fig. 4, above). Using population data, the incidence of reported dog bites among the five boroughs in 1998 is shown in Figure 4, below.
The greatest number of attacks occurred during the summer months, peaking in June and July. A disproportionate number (32 percent) of all attacks occurred during the months of June, July, and August (see Fig. 5). Although we do not have specific data to explain this phenomenon, it is likely that during the warm summer months, dogs are more frequently outside, and more frequently in an uncontrolled environment in their interactions with both familiar and unfamiliar persons.
Dog Bites: A Plastic Surgery Issue
The most debilitating dog bite injuries are frequently referred to plastic surgeons. More than 20 years ago, Dr. Robert Goldwyn, the editor of Plastic and Reconstructive Surgery, discussed this problem and advised public education and dog control measures. 6 For decades, the severe soft-tissue injuries from dog bites have challenged the reconstructive skill of the plastic surgeon. 7–11 Recently, the American Society of Plastic Surgeons assumed a leading role in educating the public, declaring June of 1999 as “National Dog Bite Awareness Month.”
In a recent editorial, Rohrich reviewed the experience at the Children’s Hospital of Dallas. 12 The cases requiring operative intervention were predominantly head and neck injuries. In most cases, the dogs were known to the family and the attacks occurred in the home.
Dog Bites in New York City
In 1998, the incidence of physician reported dog bites in New York City was 0.85 per 1000 inhabitants. This incidence is in concordance with other published reports. The National Center for Health Statistics National Hospital Ambulatory Medical Care Survey (1992 to 1994) estimated the incidence of dog bites treated in emergency departments at 1.3 per 1000 persons per year. 2 A national telephone survey gave a slightly higher estimate of 3 per 1000 persons requiring medical attention due to dog bites. 1 Of course, many bites treated by individual practitioners in New York rather than in emergency rooms, where routine protocols are in place, are not reported. A recent study in Pittsburgh 13 based on capture/re-capture data suggests that only approximately 36 percent of dog bites are in fact reported to hospitals, the police, or animal control authorities.
Why Dogs Bite
According to the Humane Society of the United States, 14 dogs bite out of fear or for protection of territory. Some dog breeds seem to be “genetically mean,” and may be more prone to attack than other breeds. The pit bull, rottweiler, German shepherd, husky, Alaskan malamute, and wolf hybrid have been responsible for the majority of dog bite-related fatalities. 5 Breed-specific data are difficult to obtain because owners of high-risk, aggressive breeds may be less likely to register their animal with the local authorities. 15
The quality of care and treatment of the dog and the quality of the dog’s training have a major impact on the level of aggression displayed by the animal. Some dog owners deliberately train their dogs to be violent “guard dogs” and mistreat them to maximize their aggressiveness.
Preventing the Attack
Public education and legislation are the cornerstones of dog bite prevention. Such measures include the following 14 :
- Behavior modification. Potential victims, especially children, should be taught that behavior sometimes influences the probability of attack. Running past an unfamiliar dog or startling the animal can trigger attacks. If approached by an aggressive dog, one should stand perfectly still and avoid making eye contact. If attacked, the victim should roll into a ball and “play dead.”
- Public education of owners. Owners must be taught to appreciate the importance of proper training, care, and leashing of their animals.
- Spay and neuter laws. Sterilized dogs are safer, less aggressive, and less likely to bite.
- Legislation targeting dog owners. Legislation that holds the dog owner responsible for the pain and suffering of victims is being considered in many areas. More restrictive confinement and leashing laws are being widely debated. In some communities, enforcement of existing laws can make a difference. When the New York City Parks Department began enforcing leashing laws, handing out summonses for $100 fines, the percentage of leashed dogs in city parks rose from approximately 30 percent to more than 80 percent in less than 5 months. 16
- Breed-specific legislation. Laws that target high-risk breeds are controversial and generally have not been effective in communities that have implemented such legislation. The ultimate result of recent pit bull bans in Annapolis, Maryland, and Highland Park, Michigan, will be instructive. Cheektowaga, New York, has even limited the total number of dogs allowed per household to three. 17
- Improved reporting. To guide public policy and assess the efficacy of dog bite prevention measures, reports to local health authorities need to be much more thorough. In New York City, we recommend inclusion of data such as breed, history of prior aggression, circumstances of attack, degree of injury, and treatment rendered. In cases requiring inpatient care, hospitals should report the need for operative intervention and duration of hospitalization.
1. Sacks, J. J., Kresnow, M., and Houston, B. Dog bites: How big a problem? Inj. Prev. 2: 52, 1996.
2. Weiss, H. B., Friedman, D. I., and Coben, J. H. Incidence of dog bite injuries treated in emergency departments. J.A.M.A. 279: 51, 1998.
3. Sacks, J. J., Sattin, R. W., and Bonzo, S. E. Dog bite-related fatalities from 1979 through 1988. J.A.M.A. 262: 1489, 1989.
4. Sacks, J. J., Lockwood, R., Hornreich, J., and Sattin, R. W. Fatal dog attacks, 1989–1994. Pediatrics 97: 891, 1996.
5. Centers for Disease Control and Prevention. Dog bite-related fatalities: United States, 1995–1996. M.M.W.R. 46: 463, 1997.
6. Goldwyn, R. M. Man’s best friend (Editorial). Arch. Surg. 111: 221, 1976.
7. Wynn, S. K. Immediate composite graft to loss of nasal ala from dog bite: Case report. Plast. Reconstr. Surg. 50: 188, 1972.
8. Schultz, R. C., and McMaster, W. C. The treatment of dog bite injuries, especially those of the face. Plast. Reconstr. Surg. 49: 494, 1972.
9. Jamra, F. A. Immediate repair of upper lip defect with a cross-lip flap. Plast. Reconstr. Surg. 66: 288, 1980.
10. Horch, R. E. Immediate versus delayed lip reconstruction after dog bite lesions (Letter). Plast. Reconstr. Surg. 100: 1073, 1997.
11. Hallock, G. G. Secondary expansion of a replanted scalp salvaged by an intrinsic arteriovenous shunt. Plast. Reconstr. Surg. 103: 1957, 1999.
12. Rohrich, R. J. Man’s best friend revisited: Who’s watching the children? (Editorial). Plast. Reconstr. Surg. 103: 2067, 1999.
13. Chang, Y. F., McMahon, J. E., Hennon, D. L., LaPorte, R. E., and Coben, J. H. Dog bite incidence in the city of Pittsburgh: A capture-recapture approach. Am. J. Public Health 87: 1703, 1997.
14. Sinclair, L. Dog Bite Facts. Washington, D.C.: Humane Society of the United States, 1999.
15. Lockwood, R. Humane concerns about dangerous dog laws. Univ. Dayton Law Rev. 13: 267, 1988.
16. Martin, D. Leash patrol touts victory in city parks: Next, pit bulls. New York Times
. July 29, 1999.
17. Martin, D. Political animals: Growling over dogs’ rights. New York Times
. March 14, 1999.