{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T15:11:59Z","timestamp":1785597119270,"version":"3.56.0"},"reference-count":23,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2023,7,2]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Dog bite injuries are a source of significant morbidity and expense in the USA, and rates of hospitalization have been rising. Children are at increased risk of dog bites compared with adults, yet there is a lack of published material on factors affecting hospital course. The objective of this study is to explore factors associated with increased length of stay (LOS), more complex course of care and post-discharge return rates in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review was conducted of all patients presenting to our urban, academic children\u2019s hospital for dog bite injuries between January 2016 and May 2021. Only those patients admitted for inpatient care were included, as identified through our institution\u2019s trauma registry, and variables were examined prior to, during, and after hospital stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>739 pediatric patients in total were treated for dog bites during the study period, of which 349 were admitted. Analysis revealed two pre-admission predictors of increased LOS: bone fracture (mean LOS=5.3\u2009days vs. 2.5\u2009days, p=0.013) and prior medical comorbidity (4.3\u2009days vs. 2.8\u2009days, p=0.042). After admission, fractures were associated with a higher rate of postoperative complications (16% vs. 5.6%, p=0.014) and return (13% vs. 2.0%, p&lt;0.001), primarily due to wound infection. Although the facial region represented the largest proportion of fractures, long bone fractures of the arm and leg were noted to have comparatively higher LOS and complication rates. Postoperative complications were not associated with any documented infection at admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest that long bone fractures in pediatric dog bites can be an underappreciated source of latent wound infection associated with late-presenting negative outcomes. Increased awareness of these relationships could lead to earlier detection of infection in this vulnerable population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III, Prognostic \/ Epidemiological.<\/jats:p><\/jats:sec>","DOI":"10.1136\/tsaco-2022-001071","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T15:35:29Z","timestamp":1690472129000},"page":"e001071","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Factors affecting length and complexity of hospital stay in pediatric dog bite patients"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1074-0144","authenticated-orcid":false,"given":"Dominic","family":"Alessio-Bilowus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishant","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Donoghue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elika","family":"Ridelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Shanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"2024051312154351000_8.1.e001071.1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jss.2019.09.013","article-title":"An Epidemiological analysis of pediatric dog bite injuries over a decade","volume":"246","author":"Cook","year":"2020","journal-title":"J Surg Res"},{"key":"2024051312154351000_8.1.e001071.2","unstructured":"Holmquist L , Elixhauser A . Emergency Department visits and inpatient stays involving dog bites: statistical brief #101. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality, 2010."},{"key":"2024051312154351000_8.1.e001071.3","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1055\/s-0037-1604073","article-title":"Dog-bite-related craniofacial fractures among pediatric patients: a case series and review of literature","volume":"11","author":"Saadi","year":"2018","journal-title":"Craniomaxillofac Trauma Reconstr"},{"key":"2024051312154351000_8.1.e001071.4","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s40621-021-00349-3","article-title":"Pediatric patients with dog bites presenting to US children's hospitals","volume":"8","author":"Ramgopal","year":"2021","journal-title":"Inj Epidemiol"},{"key":"2024051312154351000_8.1.e001071.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.puhe.2021.04.028","article-title":"US estimates for dog bite injuries presenting to emergency departments","volume":"196","author":"Ramgopal","year":"2021","journal-title":"Public Health"},{"key":"2024051312154351000_8.1.e001071.6","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181937925"},{"key":"2024051312154351000_8.1.e001071.7","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181addad9"},{"key":"2024051312154351000_8.1.e001071.8","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2019.e01360","article-title":"The demographics of dog bites in the United States","volume":"5","author":"Loder","year":"2019","journal-title":"Heliyon"},{"key":"2024051312154351000_8.1.e001071.9","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.jpedsurg.2019.06.025","article-title":"Hospitalizations for pediatric dog bite injuries in the United States","volume":"55","author":"McLoughlin","year":"2020","journal-title":"J Pediatr Surg"},{"key":"2024051312154351000_8.1.e001071.10","first-page":"947","article-title":"Severe dog bites in children","volume":"96","author":"Brogan","year":"1995","journal-title":"Pediatrics"},{"key":"2024051312154351000_8.1.e001071.11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1111\/acem.12312","article-title":"Risk factors for hospitalization after dog bite injury: a case-cohort study of emergency department visits","volume":"21","author":"Rhea","year":"2014","journal-title":"Acad Emerg Med"},{"key":"2024051312154351000_8.1.e001071.12","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.jpedsurg.2014.09.051","article-title":"Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center","volume":"50","author":"Garvey","year":"2015","journal-title":"J Pediatr Surg"},{"key":"2024051312154351000_8.1.e001071.13","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.joms.2019.11.002","article-title":"Dog-bite injuries to the craniofacial region: an epidemiologic and pattern-of-injury review at a level 1 trauma center","volume":"78","author":"Khan","year":"2020","journal-title":"J Oral Maxillofac Surg"},{"key":"2024051312154351000_8.1.e001071.14","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1177\/00031348211024657","article-title":"Nationwide analysis of dog bite injuries: different age groups, different injury patterns","volume":"87","author":"Tam","year":"2021","journal-title":"Am Surg"},{"key":"2024051312154351000_8.1.e001071.15","doi-asserted-by":"publisher","DOI":"10.1097\/00006565-200206000-00024"},{"key":"2024051312154351000_8.1.e001071.16","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1097\/SCS.0000000000007546","article-title":"Pediatric Craniofacial fractures from canine bites","volume":"32","author":"Parent","year":"2021","journal-title":"J Craniofac Surg"},{"key":"2024051312154351000_8.1.e001071.17","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200303000-00018"},{"key":"2024051312154351000_8.1.e001071.18","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200204010-00008"},{"key":"2024051312154351000_8.1.e001071.19","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0b013e3182880114"},{"key":"2024051312154351000_8.1.e001071.20","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/0020-1383(96)00039-3","article-title":"Dog bites causing upper-limb fractures in children","volume":"27","author":"Wass","year":"1996","journal-title":"Injury"},{"key":"2024051312154351000_8.1.e001071.21","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/00006565-199012000-00011","article-title":"Delayed brachial artery occlusion owing to a dog bite of the upper extremity","volume":"6","author":"Rothrock","year":"1990","journal-title":"Pediatr Emerg Care"},{"key":"2024051312154351000_8.1.e001071.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199901143400202"},{"key":"2024051312154351000_8.1.e001071.23","doi-asserted-by":"crossref","first-page":"444","DOI":"10.5999\/aps.2017.44.5.444","article-title":"Acute osteomyelitis in the hand due to dog bite injury: a report of 3 cases","volume":"44","author":"Lee","year":"2017","journal-title":"Arch Plast Surg"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2022-001071","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T19:19:27Z","timestamp":1715627967000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2022-001071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,7,27]]},"published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1136\/tsaco-2022-001071"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2022-001071","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}