Summary of Key Peer-Reviewed Medical Studies (2009-2016)
When all major U.S. geographical regions are reporting similar findings, as they are now, this sends a much stronger message to public health officials and legislators.
Level 1 Trauma Studies Table
There are at least 10 peer-reviewed dog bite studies published in medical science journals since 2009 that show a higher frequency of pit bull injuries than all other breeds of dogs in retrospective reviews of level I trauma centers. As of 2016, all major geographical regions in the U.S. are reporting these same findings as well: northwest, west, southwest, south, southeast, midwest and northeast. Since 2011 these medical studies have more closely scrutinized pit bull injuries as well.
"Pit bull bites were implicated in half of all surgeries performed and over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds." - Characteristics of 1616 Consecutive Dog Bite Injuries, July 2016
We selected 11 studies for inclusion in the table because each examines hospital records from level 1 trauma centers, where patients with a higher severity of injury are often treated, incorporate multiple years of data into their study and were conducted by medical doctors, not veterinarians. This post concentrates on studies published from 2011 to 2016, many of which show an urgency to address pit bull injuries due to their higher severity and higher rate of surgical intervention.
We believe three primary factors led to the last 5-years of research in these retrospective level 1 trauma dog bite injury studies. The first is an increased awareness by doctors of the prevalence of severe pit bull maulings (especially regarding children) coming into their trauma center. Secondly, the two major studies that helped lay the groundwork for this research. Thirdly, the desire by trauma doctors to see if the studies' findings were also true in other U.S. geographical regions.
In 2009, a 5-year retrospective review of 551 pediatric dog bite victims at the Children’s Hospital of Philadelphia was published in Plastic and Reconstructive Surgery. When breed was known (269 cases), pit bulls were responsible for 51%.1 In 2011, a 15-year retrospective review of 228 dog bite victims at University Hospital, a level 1 trauma center in south Texas, was published in the Annals of Surgery. This study went further, examining pit bull injuries versus injuries by all other breeds.
The study's results showed that compared with attacks by other breeds of dogs, attacks by pit bulls were associated with a higher median injury severity score, a higher risk of an admission Glasgow Coma Scale score of 8 or lower, higher median hospital charges and a higher risk of death. Now doctors researching dog bite injuries at level 1 trauma centers in other geographical areas are reporting similar findings. These are a body of studies, each building upon another.
We examine five of these studies to show how this research development evolves. No longer are there just a few studies highlighting pit bull injuries -- there is a collection of them. In the most recent study, authors even issued a warning to parents: "Strong consideration to avoidance of any interaction between pit bull breeds and young children, particularly infants." Other recent study authors hope their data helps shape public policy to increase the safety and welfare of children.
Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution
Published July 2016
Southeast (Atlanta, Georgia)
Pediatric Level 1 Trauma Center
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Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution, is a 4-year review of Children’s Healthcare of Atlanta, a pediatric level I trauma center in Georgia. It is one of the largest retrospective studies and examines 1616 dog bite victims. The study refers back to eight different studies and their findings are consistent with six of them regarding pit bull injuries compared to other breeds of dogs: a higher frequency of injury and a higher degree of severity of injury.
Our data confirm what detractors of the breed and child advocates suggest -- that, with rare exceptions, children and pit bulls do not mix well. Of the 8 studies listed in Table 5, 6 report pit bulls as the most prevalent breed, and in many cases, they inflicted the most severe injuries. A large study at Children’s Hospital of Pennsylvania showed that over a 12-year period, 25% of injuries were caused by a pit bull, and two-thirds of those required an operation. Our data were consistent with others, in that an operative intervention was more than 3 times as likely to be associated with a pit bull injury than with any other breed. Half of the operations performed on children in this study as well as the only mortality resulted from a pit bull injury. Our data revealed that pit bull breeds were more than 2.5 times as likely as other breeds to bite in multiple anatomical locations. Although other breeds may bite with the same or higher frequency, the injury that a pit bull inflicts per bite is often more severe. Consistent with these findings is that of Bini et al, who reported on 228 patients and found that attacks by pit bulls resulted in a higher injury severity score, lower Glasgow coma score, higher risk of death, and higher hospital charges than attacks by any other breed.
This study also emphasizes an increased risk of infants being injured by dogs. "Infants were more than 4 times as likely to be bitten by the family dog and more than 6 times as likely to be bitten in the head/neck region," the study states. Table 3 examines injuries by age group. The 0 to 1-year old age group shows that 67% (97) were bitten by family dogs. Pit bulls inflicted 15 of these bites. The 5 to 12-year old group had the highest number of bites, 746. Pit bulls inflicted 13% (99).
Ocular Trauma From Dog Bites: Characterization, Associations, and Treatment Patterns at a Regional Level I Trauma Center Over 11 Years
Published June 2015
Northwest (Seattle, Washington)
Regional Level 1 Trauma Center
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Ocular Trauma From Dog Bites: Characterization, Associations, and Treatment Patterns at a Regional Level I Trauma Center Over 11 Years, is a review of 342 dog bite victims treated at Harborview Medical Center, a regional level 1 trauma center in Seattle serving 5 states. The study reports that pit bulls were responsible for more than 1 in 4 (27%) of all injuries and 25% of ocular injuries. When attacked by unknown dogs, pit bulls were responsible for 60% of these injuries.
Importantly, this study is the first to accurately establish that pit bulls are the breed most commonly associated with ocular injuries (25%). Most alarming is the observation that when attacks come from unfamiliar dogs, the pit bull was responsible for 60% and 63% of all injuries and ocular injuries, respectively. In attempts to thwart the ownership of aggressive dog breeds and to reduce injuries from attacks, breed restrictions have been enacted in the United States and elsewhere. These measures are controversial as many remain skeptical as to the aggressive nature of this breed and insist that this breed is safe around children. It is interesting to note that the largest pediatric facial dog bite series did not find the pit bull to be the most common breed responsible, however it was performed in a county where pit bulls are banned [Aurora, CO].2 The current study provides strong evidence that pit bulls are indeed highly aggressive, albeit unknown whether by nature or nurture, and are in fact the most common culprits of serious pediatric ocular injuries. The authors hope these data can help guide awareness and help shape public policy to increase the safety and well being of children.
Morbidity of Pediatric Dog Bites: A case series at a level one pediatric trauma center
Published February 2015
Southwest (Phoenix, Arizona)
Pediatric Level 1 Trauma Center
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Morbidity of Pediatric Dog Bites: A case series at a level one pediatric trauma center, is a review of 282 dog bite victims treated at Phoenix Children's Hospital, a pediatric level 1 trauma center. Pit bulls were most frequently responsible, accounting for 39% (83/213) of all injuries when dog breed was documented and 38% of all head, neck or facial bite injuries. This study examined patients brought in by ambulance and/or seen by the trauma team -- higher injury severity victims.
Results: Of 650 dog bite incidents, 282 met the criteria for inclusion in the trauma database. Median age was 5 years (range, 2 months to 17 years) and 55% (154/282) of patients were male. Pit bulls were most frequently responsible, accounting for 39% (83/213) of incidents in which dog breed was documented. Fifty-three percent (150/282) of dogs belonged to the patient's immediate or extended family. Sixty-nine percent (194/282) of patients required operative intervention: 76% laceration repairs, 14% tissue transfers, and 2% neurosurgical interventions. The most severe injuries were depressed skull fractures, intracranial hemorrhage, laryngotracheal transection, and bilateral orchiectomy. Median length of stay was 1 day (range, 0 to 25 days). There were no mortalities.
Among the 11 patients with the highest AIS (3–5), Pit bulls were responsible in 45.5% (5/11) of cases, followed by mixed breeds in 18.2% (2/11) of cases. Pit bulls were also responsible for 38% (11/29) of all head, neck or face bites.Conclusions: Pediatric dog bites span a wide range of ages, frequently require operative intervention, and can cause severe morbidity. Dog familiarity did not confer safety, and in this series, Pit bulls were most frequently responsible. These findings have great relevance for child safety.
"This report is the first addressing the characteristics of all types of pediatric dog bites in the southwestern US," states the study. "Prior retrospective studies from the northeast and midwest have shown a predilection for male victims in the five to 12 year age range, with injuries frequently occurring during summer months by dogs that are familiar to the child (most commonly Pit bulls)." The authors also note that pit bulls only accounted for 6.25% of the licensed dogs in the county.
"In 2008, there were 122,017 licensed dogs in Maricopa County, the most populous county in Arizona. Pit bulls accounted for 6.25% of the licensed dog population, only the seventh most popular breed. Labrador retrievers were the most popular breed accounting for 25.7%," states the study. Yet in this retrospective study of a pediatric trauma center that serves this county, pit bulls were responsible for 29% (83) of all bites (282) and labradors just 3.5% (10). View related chart.
Dog Bites of the Head and Neck: An Evaluation of a Common Pediatric Trauma and Associated Treatment
Published January-February 2015
West (Sacramento, California)
Level 1 trauma center
Download full study | open access
Dog Bites of the Head and Neck: An Evaluation of a Common Pediatric Trauma and Associated Treatment, is a review of 334 dog bite victims treated at the University of California Davis Medical Center, a level I trauma center in Sacramento. The retrospective study shows a higher frequency of pit bull injuries, a higher degree of severity of injuries and a greater number of surgical interventions required -- 5 times the relative rate -- than attacks by other breeds of dogs.
Results: 334 unique dog bites were identified, of which 101 involved the head and neck. The mean patient age was 15.1 ± 18.1 years. Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention. Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+31%), and without provocation (+48%). Injuries of the head and neck had an average follow-up of 1.26 ± 2.4 visits, and average specialty follow-up of 3.1 ± 3.5 visits.
Conclusions: The patients most likely to suffer dog bite injuries of the head and neck are children. Although a number of dog breeds were identified, the largest group were pit bull terriers, whose resultant injuries were more severe and resulted from unprovoked, unknown dogs. More severe injuries required a greater number of interventions, a greater number of inpatient physicians, and more outpatient follow-up encounters.
The study also states, "The key finding from our second objective, determining the dogs responsible for bites, is the importance of pit bull terriers in patients with dog bites of the head and neck. The findings of this study are consistent with and extend from previous publications [5,7,11–13,16,21,22,29]. Dog bites from pit bull terriers, compared to bites from all other dogs are more common, more severe, and not related to the dog being provoked." View related chart.
Mortality, Mauling, and Maiming by Vicious Dogs
Published April 2011
South (San Antonio, Texas)
Level 1 trauma center
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Mortality, Mauling, and Maiming by Vicious Dogs, is a 15-year review of all dog bite victims admitted to the regional level I trauma center at University Hospital San Antonio from 1994 to 2009 and treated by the Trauma and Emergency Surgery Service. As noted earlier, this study helped lay the groundwork for future studies by showing that attacks by pit bulls were associated with higher injury severity, higher hospital charges and a higher risk of death than other breeds of dogs.
Results: Our Trauma and Emergency Surgery Services treated 228 patients with dog bite injuries; for 82 of those patients, the breed of dog involved was recorded (29 were injured by pit bulls). Compared with attacks by other breeds of dogs, attacks by pit bulls were associated with a higher median Injury Severity Scale score (4 vs. 1; P = 0.002), a higher risk of an admission Glasgow Coma Scale score of 8 or lower (17.2% vs. 0%; P = 0.006), higher median hospital charges ($10,500 vs. $7200; P = 0.003), and a higher risk of death (10.3% vs. 0%; P = 0.041).
Conclusions: Attacks by pit bulls are associated with higher morbidity rates, higher hospital charges, and a higher risk of death than are attacks by other breeds of dogs. Strict regulation of pit bulls may substantially reduce the US mortality rates related to dog bites.
Summary
Retrospective dog bite studies from level 1 trauma centers from all major geographical regions in the U.S. are reporting a higher prevalence of pit bull injuries than all other breeds of dogs. In many cases, the studies also report that pit bull injuries have a higher severity of injury and require a greater number of operative interventions. Only one study in 11 reported different results, a level 1 pediatric trauma center in the Denver-Aurora region, where pit bulls have long been banned.
Despite the difficulty of gaining breed information for more patients in these studies, doctors continue to pursue this data. Some do so by accessing data at the city or county animal control department. In the case of Harborview Medical Center, researchers were able to obtain breed information in 79% of the cases from chart documentation. This indicates that Harborview has already been collecting breed data from dog bite patients and other records for some time.
Finally, authors in the most recent studies voice their alarm about the gravity of pit bull injuries, particularly concerning children, and the urgent need to raise more awareness among parents. Some authors hope their data helps shape public policies, which may involve breed restrictions. At the very least, accurate information must be provided to parents. The flyer we released in April 2012 carries this very same theme: Is it worth the risk? Children and pit bulls do not mix.
When all major U.S. geographical regions are reporting similar findings, as they are now, this sends a much stronger message to public health officials and legislators.
Study graphic from Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution
2The authors of the Denver-Aurora pediatric hospital study also make an important statement about pit bulls and the multiple pit bull bans in the area: "Our study found 11 victims of pit bull bites from 2003 to 2008, including the patient who suffered the most extensive injuries and the longest hospitalization of our entire population, indicating that despite legislation, pit bull bites continue to be a public health concern."
Related articles:
09/20/17: Peer-Reviewed Medical Studies Show Pit Bulls Highest Prevalence - Meme Campaign
09/01/16: Pit Bulls Lead 'Bite' Counts Across U.S. Cities and Counties
09/01/16: Cities with Successful Pit Bull Laws; Data Shows Breed-Specific Laws Work
02/19/16: 11-Year U.S. Dog Bite Fatality Chart by Breed (2005 to 2015)
02/19/16: 11-Year U.S. Dog Bite Fatality Chart by Age Groups (2005 to 2015)
08/31/15: Who Can Identify a Pit Bull? A Dog Owner of 'Ordinary Intelligence' Say the High Courts
07/24/14: Nonprofits Urge CDC to Resume Tracking Richer Data Set for Children and Adults...
Related website pages:
Dog Bite Death and Injury Studies
U.S. Dog Bite Fatalities
Congratulations on this massive report on these scientific based studies, which undeniably corroborates what has been argued for decades: Pit Bulls ARE more dangerous than other breeds. Thanks to groups like DogsBite.org, the TRUTH is being shared and motivating victims, victims families, first responders, the human health care providers, and responsible policy makers, like the Mayor of Montreal Canada. This information needs to be shared with ER administrators, any public oversight committees, and public policy makers.
It also needs to be shared with animal control agencies. Especially those that are under the jurisdiction of public health departments.
I'll be sharing this to my Pinterest board dedicated to raising awareness of the risks of pit bulls. So very validating to see that others have noticed the pattern of severe injury associated with these dogs and have been conducting research studies. Thank you for compiling this information.
As someone who has 46 years of experience living and working with dogs of all breeds, I look forward to seeing pit bulls completely eradicated from the bloodline.
My oldest daughter was attacked by a pit when she was 7. The dog belonged to a friend of her father and I who had passed away. Her father had talked me into fostering the dog. We had him 3wks when he attacked her, with my 5yr old sitting right next to her, and me in the room as well! I had to pull the dog off of my child and put him in another room until the squad and police got to my house to contact animal control.
Nearly 4yrs later, I still have flashbacks of that entire day. I almost lost my child twice, once when the dog attacked, and again while she was in surgery having her face repaired. Luckily she only needed two surgeries.
After all of this happened, I refuse to own any dog. I like dogs, don't get me wrong, but I won't own one.
The laws in the US for dog owner must be much stricter.
Here in germany a pit bull owner has to pay 1000 Euro Tax/year!
Therefore very few pit bulls were hold here in Germany
We need a website that neighbors could report pits and rotts by there address. And the home insurance companies could look up. Hit them in the pocket, that is the only way to get any where. Safer neighborhoods for everyone. More money for insurance companies.
I wish the United States would ban all pit bulls in this country and owners of other aggressive dogs should be charged with assault or attempted murder if their dogs attack any human being for no reason. All dogs should be leashed and possibly muzzled if known to be aggressive. Additionally all large dogs should be taxed and licensed.