Gilchrist, J., Sacks, J. J., White, D., Kresnow, M. J. (2008). Dog bites: still a problem? Injury Prevention, 14(5), 296-301. doi: 10.1136/ip.2007.016220.
National Canine Research Council Summary and Analysis:
This paper is included as the second of only two broad national randomized telephone surveys of dog bite incidence in the U.S. and as the largest yet completed. In 2008, Gilchrist et al. published dog bite data extracted from the second CDC Injury Control and Risk Survey (ICARIS-2) conducted during 2001-2003 (see Sacks et al., (1996) for the results of the first ICARIS study report). The methodology was largely the same as Sacks et al. (1996), but the updated survey (ICARIS-2) included the number of dogs in each household. As before, dog bite incidence was only a small fraction of the survey, and as such, the questions were broad and general and did not include a definition of a dog bite or any questions about the circumstances. The same methodological limitations from the former study (e.g., low response rate, self-reported data with a long recall period) were still present, and methodological consistencies with the first study (Sacks et al., 1996) allow comparisons between the two. The overall estimated bite rate decreased 13% and the incidence among children decreased by an impressive 47%. Whether or not medical treatment was sought was again used as a surrogate for injurious. Once again a small number of incidents (157 bites to adults and 79 to children among a total of 9,684 households) were extrapolated nationally resulting in a very large confidence interval range. The response rate for this study was even lower than for ICARIS-1 with 48% of individuals contacted completing the survey. Of the participants included in the study, 1.6% of the adults reported a dog bite in the past year and even fewer (1.4%) among the children. These proportions were down from the previous survey. This replicated study revealed that when the rates of dog bites to adults and children were compared according to percentage of the population in the U.S. (counted as persons affected per 1,000), adults were actually more likely to be bitten and the rates of medical treatment sought for adults and children were nearly equal.
The authors concluded that the data suggest that dog bites “remain a public health problem” despite the comparatively low incidence rate and the fact that they declined significantly since the first ICARIS survey (Sacks et al., 1996).
Use of sources
As the largest and probably most rigorous national survey yet completed, this study can serve as a surrogate to examine the use of sources in the dog bite literature. As is typical, the introduction of this paper paints a dire picture of the human-canine relationship, fraught with catastrophizing language like “infection, trauma, post-traumatic stress disorder (PTSD), disfigurement, septic shock, hospitalizations, and death,” when, in fact, such complications are vanishingly rare.
Sources used to support such fear evoking language often do not bear up to scrutiny. As an example, one catastrophizing reference used in this study will be discussed in this analysis. A Belgian study was described as finding that “symptoms of post-traumatic stress disorder were found in over half of children who had been bitten by a dog,” (Peters et al., 2004). When scrutinized beyond the article abstract, however, this finding was unsurprising in that the 22 children studied were only those whose bites had received “surgical treatment,” a very small minority in any population of dog bite victims, and even among these children, only those who suffered multiple deep bites were at risk for PTSD symptoms; those with minor injuries or injuries that were considered to have occurred accidentally did not. Moreover, only 23% of the children in this small study (n = 22) actually expressed enough PTSD symptoms for a definitive diagnosis. So the profoundly unsurprising finding here is that in the rare cases of a truly traumatic injury, the victim may develop PTSD symptoms.
The authors also make a misleading reference that dog bites account for 99.99% of rabies in humans globally. In a study of dog bite incidence in the U.S., however, where the last case of rabies contracted by a human through exposure to a dog while in the U.S. occurred in 1979, this simply has no relevance beyond evoking alarm in the reader.
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