Dog bite and injury prevention--analysis, critical review, and research agenda.

OBJECTIVES To analyze Australian dog bite injury data and make international comparisons; to review risk and protective factors relating to the dog, injured person, and environment; and to recommend action for prevention and research. METHODS Australian dog bite injury data, complemented by detailed Victorian and regional data from routine health records and vital statistics, were analyzed to determine incidence, severity, nature, circumstances, and trends. International comparison data were extracted from published reports. Risk and protective factor studies were selected for review from electronic and bibliographic searches where data were recent, sample sizes substantial, and bias limited. RESULTS The Australian dog bite death rate (0.004/100,000) is lower than both the United States (0.05-0.07/100,000) and Canadian rates (0.007/100,000). Victorian hospitalized trend rates were stable between 1987 and 1998, but there was a decline for children <5 years (p=0.019) corresponding with a reduction in dog ownership. Children 0-4 years have the highest rate of serious injury, particularly facial. Adults have longer hospitalizations, most frequently for upper extremity injury. Risk factors include: child, males, households with dogs, certain breeds, male dogs, home location, and leashed dog. CONCLUSIONS Dog bite rates are high and it may therefore be assumed that current preventative interventions are inadequate. Responsible dog ownership, including separating young children from dogs, avoiding high risk dogs, neutering, regulatory enforcement, and standardized monitoring of bite rates are required. Controlled investigations of further risk and protective factors, and validated methods of breed identification, are needed.