Surgical delay in the management of dog bite injuries in children, does it increase the risk of infection?
Section snippets
Methodology
A retrospective case note analysis was performed from 1998 to 2002. Clinical coding identified all patients with a dog bite injury admitted under the care of the Plastic Surgery Department at the Sheffield's Children Hospital. This was cross-referenced against casualty admission records and theatre logbooks. We looked at the following:
- (a)
Patient demographics: age, sex, referral source and the location of attack.
- (b)
Injury demographics: site, type and number of injuries.
- (c)
Treatment details: pre-operative
Results
We identified 122 patients. Notes were obtained for 118, giving a retrieval rate of 97%. There was a steady rise in the number of admissions during the study period from 19 in 1998 to 30 in 2002 (Fig. 1).
Discussion
Dog bites are relatively common injuries with a reported incidence from 172 to 740 per 100 000 of the population per year.3 This range reflects the finding that the proportion of bites that are actually reported and for whom medical advice is sought is variable (10–50%).1, 4, 10 Dog bites account for between 0.5–1% of all casualty attendances,4, 11, 12 and 50–75% of these are in children under the age of 12.1, 2
Dog bite injuries result from the crushing and tearing of the tissues, made worse
Conclusion
Current surgical opinion advocates early washout, debridement and primary repair of dog bite injuries to avoid infection and to achieve the best possible functional and cosmetic results. The development of NCEPOD based guidelines to prioritise those procedures that need to be done in the late night period or early hours of the morning, appeared to be in conflict with this surgical practice. However, our study suggests that confirming to these guidelines does not compromise patient care.
Acknowledgements
We would like to acknowledge the help of Christobel Hargraves, Chief Executive NCEPOD, and Ian Martin, Clinical Coordinator NCEPOD and consultant maxillofacial surgeon for their assistance in all our NCEPOD based queries.
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Cited by (0)
☆Presented at the Winter Meeting of the British Association of Plastic Surgeons, London, UK, December 2003.