Trauma Visits to a Pediatric Emergency Department During the COVID-19 Quarantine and “Stay at Home” Period

Background Impact of social distancing on pediatric injuries is unknown. Methods We retrospectively compared injury visits to a pediatric emergency department by individuals ≤21 years during “Stay at Home” (SHO) period to the same period in 2019 (non-SHO). Demographics, types, and outcomes of injuries were noted. Results Although, there was a 35.6% reduction in trauma-related emergency department visits during SHO period (1226 vs 1904), the proportion of injury visits increased (15.5% vs 8.1%, P < .001) and mean age was lower (5.8 yrs ±4.5 vs 8.4 yrs ± 5.2, P < .001). There were significant increases in visits related to child physical abuse (CPA), firearms, and dog bites. Further, significant increases in trauma alerts ( P < .01), injury severity ( P < .01), critical care admissions ( P < .001), and deaths ( P < .01) occurred during the SHO period. Conclusions Although overall trauma-related visits decreased during SHO, the proportion of these visits and their severity increased. Trauma visits related to child physical abuse, dog bites, and firearms increased. Further studies are required to assess the long-term impact of pandemic on pediatric trauma epidemiology.

Factors Affecting Human-Directed Aggression Resulting in Dog Bites: Contextual Aspects of the Biting Incidents

Using a web-based questionnaire with 29 close- and open-ended questions about 400 self-reported dog-biting incidents in Slovenia, this research investigated the contexts of dog bites, focusing on characteristics of the dogs and the descriptions of the situations to identify the main risk factors for the occurrence of dog bites. Even though it has been suggested that most dog bites occur during initially non-aggressive interactions with the dog (e.g., during petting, playing), in our study we discerned a wide variety of contexts, including those in which the person did not intend to interact with the dog. Most victims reported unprovoked bites during fast movements near the dog, while coming into close proximity, and during incidents without a reason. These incidents more likely occurred in public than private places and were associated with purebred dogs with a history of aggression.

644. Phenotypic and Genomic Analysis of Novel, Fastidious, Gram-negative Bacilli Isolated from Clinical Wound Specimens

Background Animal bites are considered the thirteenth leading cause of nonfatal ED visits. Epidemiology studies have shown a rise in dog bites during the COVID-19 pandemic in the U.S. In Oct. 2020, we received a facultatively anaerobic, non-hemolytic Gram-negative rod (OL1) from a dog bite wound for identification. 16S rRNA gene sequencing showed OL1 was 95.9% identical to Ottowia pentelensis in the family Comamonadaceae. Our historical sequence database revealed 8 additional isolates (OL2-OL9) from hand wounds/abscesses (including 3 dog bites) since 2012 that had ⩾ 99.8% identity with OL1. Most other Ottowia sp. have been isolated from industrial and food sources, with no reports from patient samples. As these clinical isolates likely represent a novel Ottowia species, we aimed to characterize them using both phenotypic and genomic approaches. Methods The OL isolates were tested in API 20 NE panels (8 conventional and 12 assimilation tests) for 4 d. Paired-end genomic DNA libraries (Nextera DNA Flex Library Prep, Illumina) were sequenced as 150 nt reads by Illumina NovaSeq. De novo assembly, annotation, functional prediction, and phylogenetic analyses were performed with Geneious, PATRIC, and web-prediction databases. Strain comparison was done with StrainTypeMer. Results All 9 OL isolates were negative for indole, urea, arginine, esculin, PNPG, glucose fermentation and carbohydrate assimilation tests. Potassium gluconate assimilation and gelatin hydrolysis were positive for 5 and 4 isolates, respectively. StrainTypeMer showed the isolates from different patients were not closely related, but 2 from the same patient were indistinguishable. The estimated genome size was ~3.1 Mbp, with 66.1% G/C, and ~3523 coding genes. Potential virulence factors (BrkB and MviM), multidrug efflux systems (MdtABC-TolC and Bcr/CflA), and 1-2 intact prophages were identified. Genomic phylogenetic analysis with RAxML showed the OL isolates clustered separately from all known Ottowia spp. Conclusion These OL isolates are fastidious, Gram-negative bacilli from clinical wound specimens, and are associated with dog bites. Genomic and 16S rRNA gene sequence analysis suggests these isolates constitute a novel species within the family Comamonadaceae. Disclosures All Authors: No reported disclosures

Surgical Treatment of Pediatric Dog-bite Wounds: A 5-year Retrospective Review

Introduction: Dog bites are a significant health concern in the pediatric population. Few studies published to date have stratified the injuries caused by dog bites based on surgical severity to elucidate the contributing risk factors. Methods: We used an electronic hospital database to identify all patients ≤17 years of age treated for dog bites from 2013–2018. Data related to patient demographics, injury type, intervention, dog breed, and payer source were collected. We extracted socioeconomic data from the American Community Survey. Data related to dog breed was obtained from public records on dog licenses. We calculated descriptive statistics as well as relative risk of dog bite by breed. Results: Of 1,252 injuries identified in 967 pediatric patients, 17.1% required consultation with a surgical specialist for repair. Bites affecting the head/neck region were most common (61.7%) and most likely to require operating room intervention (P = 0.002). The relative risk of a patient being bitten in a low-income area was 2.24, compared with 0.46 in a high-income area. Among cases where the breed of dog responsible for the bite was known, the dog breed most commonly associated with severe bites was the pit bull (relative risk vs German shepherd 8.53, relative risk vs unknown, 3.28). Conclusion: The majority of injuries did not require repair and were sufficiently handled by an emergency physician. Repair by a surgical specialist was required <20% of the time, usually for bites affecting the head/neck region. Disparities in the frequency and characteristics of dog bites across socioeconomic levels and dog breeds suggest that public education efforts may decrease the incidence of pediatric dog bites.

A Comparison Between Backpropagation, Holt-Winter, and Polynomial Regression Methods in Forecasting Dog Bites Cases in Bali

Rabies is a zoonotic disease that is usually transmitted to humans through animal bites. It can cause severe damage to the central nervous system and is generally fatal. Dog bite cases are considered the leading cause of rabies transmission in Bali. The government's preventive action is expected to reduce the problem of increasing the number of dog bite cases so that it does not spread quickly and cause casualties. Data mining is an attempt to extract knowledge from a set of data. The use of data mining in this study is to forecast the number of dog bite cases in Bali. Forecasting predicts what will happen in the future based on relevant data in the past and placing it in a mathematical model. Data mining methods used in forecasting dog bite cases are backpropagation, holt-winters, polynomial regression methods. This forecasting aims to help the government predict dog bite cases in the coming period to prepare appropriate countermeasures. Forecasting is done using data on bite cases every month in Bali province for five years, from 2015 to 2019. Dog bite case data is divided into four datasets for each attribute, namely data on the number of dog bite cases, the number of vaccinations, the number of male deaths, the number of female deaths. The four datasets are divided into training data and testing data to share 80% training data and 20% testing data. The results obtained are that the backpropagation method is better at predicting dog bite case data with an average MAPE error rate of 11.59%, while the holt-winters method has an average MAPE error rate of 16.05%, and the polynomial regression method has an average MAPE error rate of 19.91% Keywords : Dog Bites, Rabies, Forecasting, Backpropagation, Holt-Winter, Polynomial Regression

Dog Bites and Gastrointestinal Disorders: Our Everyday Bodies in Teaching Anthropology and Fieldwork Preparation

What are the physical experiences of fieldwork really like? This article invites anthropologists engaged in teaching to transform the way research methods are currently taught to include frank and thoughtful conversations on how bodies, in their mundane physicality, are implicated in fieldwork. While the (mindful) body that actively and purposefully engages with the reality under investigation has gained centrality in anthropological discussions about “being there”, the body that things happen to has been ignored or marginalised. We contend that an exploration of the body that falls ill, feels uncomfortable, or simply does not match with an idealised image of the skilled and productive fieldworker (often male and able-bodied) has practical, pedagogical, political, and analytical merits. By recounting some of our own private anecdotes of challenges encountered in fieldwork, we emphasise the centrality of our physical experiences to our ethnographic approach. Discussing the glamourless, bodily aspects of fieldwork is crucial to preparing ourselves and our students for fieldwork, to combating ableism in anthropology, and to downplaying anxiety over narrow standard goals of “good” fieldwork. We also argue that theoretical considerations of the messy and unpleasant physical experiences that fieldwork involves can bring further insight into how research is (un)done.

Pattern and Outcome of Dog Bite Injuries among Children-a Study in 200 Cases

Introduction: Dog bites in humans are a major public health problem. Globally, millions of people are bitten by dogs but most of the fatal cases occur in children. Dog bites in human are a serious public health problem and have been well documented worldwide. As rabies is not a notifiable disease in Bangladesh and most deaths occur in rural areas where surveillance is poor. Objectives: To determine the pattern of dog bite injuries and associated health problems among children. Methods: The study was an observational retrospective study carried out at the Dept. of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh. The study reviewed the clinical data of patients managed for dog bite related injuries and rabies over a four and half year period between January 2016 and June 2020. A proforma was designed to extract relevant clinical data from the case records. Information extracted included the age, sex of the victims, site of the bite, time of presentation in the hospital, pre-hospital treatment, hospital treatment including post-exposure prophylaxis and complication. Results: In all, 200 cases of dog bite injuries were managed constituting 0.89% of the total consultations; 5 (2.5%) had rabies. Most of the victims were aged 6-12 years (55.0%) and majority (67.0%) was boys. Eighty two percent of the victims presented within 24hrs of the injury. 92 (46.0%) had WHO grade 3 dog bite injury at presentation and the lower limb was the commonest (56.0%) bite site. Use of herbal preparation was the most common pre-hospital treatment 60%. Although 95.0% received anti-rabies vaccine, only 55.5% of them completed the vaccination schedule. The case fatality rate for dog bite was 5.0%. The 5 that died all presented late, had no post exposure prophylaxis and died within 24 hours of admission. Conclusion: There is need for public enlightenment on dangers associated with dog bites and also for the government to ensure vaccination for cost of post exposure prophylaxis treatment for children free of cost

Child safety programs for primary school children decrease the injury severity of dog bites

This study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994–2003 to 9.0% in the period between 2014 and 2018 (p < 0.05).Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites. What is Known:• Dog bites are a substantial healthcare problem especially in children. What is New:• This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.