Introduction: The authors describe a series of dog attacks on children which required neurosurgical consultation, in order to better understand the pattern of injuries inflicted, the circumstances that place children at risk of attack, and the dog breeds involved.
Methods: We performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a level-one pediatric trauma center over a 15 year period.
Results: Seventeen children incurred injuries requiring neurosurgical consultation. Mean age at the time of attack was 30 months. Eleven (65%) of the attacks were perpetrated by the family pet and 12 (71%) took place at the patients’ home. Breeds involved in the attacks included German Shepherds, Pit Bulls, American Bulldogs, large-mixed breeds, Labrador Retrievers and Akitas, with German Shepherds being the most frequently involved. Neurosurgical injuries included non-depressed skull fracture in 5, depressed skull fracture in 10, intracranial hemorrhage in 5, cerebral contusions in 4, dural laceration in 4, pneumocephalus in 5, clinically evident cerebrospinal fluid leak in 3, spinal fracture with complete spinal cord injury in 1, stroke in 2, vascular injury in 2, and Cranial nerve injury (hypoglossal and facial nerve) in 1. Prophylactic antibiotics were administered in 15 patients (88%). Only one patient had confirmed infection involving the site of injury. Neurosurgical intervention was required in 10 patients (59%). Neurological deficits, all of which were considered catastrophic, developed in 3 patients (18%).
Conclusions: Dog attacks on children requiring neurosurgical consultation commonly involve the family pet, which is usually a large breed dog with no history of prior aggression. Neurosurgical injuries often involve the cranial vault, with depressed skull fractures being the most common injury pattern. Most patients do not suffer a neurological deficit, though catastrophic neurological injury may occur. Prophylactic antibiotics are commonly used and surgical intervention is required in the majority of cases.
Patient Care: This research will increase awareness of the potential of dob bites to result in serious neurological injuries in children. It will also serve as a reference for the various ways of treating these injuries.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify the types of dogs commonly implicated in severe attacks on children, 2)Identify the types of pediatric neurological injuries that may result from a dog attack, 3) Discuss the medical and surgical management of dog bites in children resulting in neurological injury