**1. Introduction**

According to the American Veterinary Medical Association, over 48 million households in the United States own a pet dog. This equates to 38.4% of all Americans owning a dog. The estimated total number of dogs in the United States is approximately 76.8 million [1]. With these statistics in mind, it is not surprising that an estimated 4.5 million dog bites occur each year [1, 2]. Of these, approximately 800,000 seek medical attention and 386,000 require treatment in the Emergency Department [3].

Over the past 16 years, canines killed 568 Americans [2]. Pit bulls constitute 6.2% of the total US dog population but accounted for 380 (67%) of these fatalities [2]. Rottweilers had the second-largest contribution with 51 (9%) fatalities [2]. The other breeds implemented included American bulldogs, German shepherds, Mastiffs, Bull Terriers, Cane Corso, Belgian Malinois, Labrador retriever, and mixed-breeds [2].

In 2020, there were 46 fatalities from dog bites [2]. Pit bulls accounted for 33 (72%) of these deaths [2]. Of the dogs whose gender was known, 82% were male [2]. Fatal dog attacks involving multiple dogs accounted for 43% (20) of the victims [2]. Of these 20 attacks, 14 (70%) involved two or more pit bulls [2]. The data also showed that 20% (9) of dog bite fatalities involved dogs with a known history of human aggression and 13% (6) had a history of animal aggression [2].

In addition, the majority of dog bite victims were over 19 years of age (61%) [2]. Among the pediatric cohort of children 18 years or younger, 53% were infants less than 12 months of age [2]. Unfortunately, family dogs resulted in 59% (27) of the

fatalities over the past year [2]. Of the 33 deaths inflicted specifically by pit bulls, 55% (18) were family members while 45% (15) were non-family members [2].

Location of dog bite injuries, laceration, or puncture wounds, is an important discussion point among children. Recent studies have reported that the average age of children who receive a dog bite is about 5 years of age [4, 5]. The most severe injuries requiring repair in an operating room involve children less than 3 years of age and tend to be above the clavicle [5, 6]. Rupture globes, avulsed ears, lips, nose, and eyelids have all been reported. The location of dog bite injuries appears to correlate with the child's age. As mentioned, younger children have a higher risk of sustaining injuries to their facial structures, scalp, and neck [5, 6]. Older children, because they are taller, are more likely to have injuries to their hands, feet, and extremities [5, 6]. One study reported that up to 92% of all dog bites in children are located in the head and neck region, followed by the extremities (15.7%) and the trunk (4.9%) [5]. The majority of children are bitten in only one anatomic location [6]. The most common setting for sustaining a dog bite injury was the home [5]. A parent was present at the time of injury for almost half of the cases (43.6%) [5]. The circumstances surrounding an attack, when documented, identified 39.2% of children were playing with the dog [5]. Other scenarios included no initiated interaction (18.9%), attacks related to food, especially disturbing a dog when it is eating (13.5%), territorial encounters (9.5%), intervening between fighting animals (5.4%), playing with another person (5.4%), and disturbing a dog while asleep (4.1%) [5].
