A Dog-Bite-Dog World

Dog bite wounds are a common traumatic injury with many possible complications (eg, infection, systemic inflammatory response syndrome [SIRS], multiple organ dysfunction syndrome [MODS], disseminated intravascular coagulopathy [DIC]). Most cases are easily treated as outpatients, but a subset can be severe and require surgery and treatment in an intensive care unit (ICU).

This retrospective study examined in detail the treatment and outcome of 94 severe bite wound cases that were treated in the ICU of a university teaching hospital. The majority of patients were small dogs (≤10 kg)attacked by larger dogs. Various factors (eg, longer times under anesthesia, presence of SIRS or MODS, cardiovascular injury) were associated with a higher mortality rate. The overall mortality rate was 15%.

A longer time from admission to anesthesia was also associated with a longer recovery time in the ICU. Longer times until anesthesia were most likely because of the severity of the cases, which required longer times to stabilize. Longer anesthetic times were associated with mortality. The authors also noted that the respiratory system was the most common organ system affected. Approximately half of the bite wounds grew no bacteria when cultured, possibly because infection had not set in or antimicrobial treatment was started before the culture was taken.

Bite wounds are seen frequently in emergency practice. This article highlights a unique form of severe bite wounds; specifically, those treated at a critical care unit in a trauma center. The authors identified factors (duration of time to surgery, surgical duration) that could be associated with a lengthy course or poor outcome. Prompt, efficient surgery should be pursued in traumatized dogs. The clinician should recall that smaller dogs may be more severely injured and that tissue trauma, more than infection, may impact survival. Development of organ failure is, as in all studies to date, associated with a more severe outcome. Preventing bite wounds should be addressed through outreach efforts, and wounds should be addressed as quickly and completely as possible.—Elizabeth Rozanski, DVM, DACVIM, DACVECC