Deaths from dog attacks are rare (estimated 10 fatalities per year in the United States [135,136]). Although severe injuries are associated with large dogs (e.g., pit bulls, Rottweilers, German shepherds), any size dog can cause significant bites (136-140). Young (aged 1 to 5 yr) male dogs are more likely to bite people (140). The vulnerability of the victim is a factor. The majority of victims are young children or elderly individuals (135-143). Sleeping infants have been attacked (136,137).
Pet dogs are involved in most attacks (138,140). Attacks are more frequent in the vicinity of the dog owner's property, and the dog is usually unrestrained (136,144). There are various reasons why a dog is provoked: the animal's position in the family is unsettled (e.g., new baby); the dog fears that its territory, food, or toy is threatened and the animal's distress is unrecognized, particularly by young children; aggression is stimulated by a person's physical activity or vocalization; and the dog's behavior is changed by illness (e.g., rabies [136,138,140,143,145]). Starvation is not necessarily a motivating factor (135,145). Prior aggressive activity by the dog may have been observed (135,137,144).
Dog pack attacks are uncommon (135,143,145). Dogs have a natural pack instinct (143,145). Having engaged in past predatory activities and variable social interaction with humans, pack dogs either perceive threats or are stimulated by human activity (e.g., running [135,143,145]). Consequent defensive actions by the victim (e.g., flailing arms) can exacerbate the attack (135).
The greatest frequency of bites involves the lower extremities, followed by the upper extremities, head, face, neck, and torso (140). Stray dogs tend to bite the upper extremity. A typical scenario is a child attempting to pat the head of a stray dog (140). Pet dogs, which have closer contact with children, tend to bite the head, face, or neck as the child bends over the animal (140,143,144,146). Head and neck injuries are the most common fatal injuries (135,143,147). A pack attack has a greater chance of inflicting severe injury (135). Dogs immobilize prey by first biting the victim's hindquarters, and then the head, neck, and thorax when the victim falls (138,140,143,145).
The bite marks of dogs tend to be longer and narrower than those of cats (148). There can be extensive soft tissue loss on the head, neck, and torso with loss of viscera and extremities as an angry dog moves its head vigorously (135,143,147). Amputation is possible. Clothing can be shredded (135,149). Depressed skull fractures and cranial perforations are possible in a child (136,150,151). Infectious complications (e.g., cellulitis) can occur if the victim survives (143,147). Extensive injuries can mimic homicidal sharp-force trauma (Fig. 36) (149).
Blood, clothing, and hair of the victim can be found on the dog or in its mouth (135,138). The animal's gastrointestinal tract needs to be examined for human body parts by radiographs and during autopsy (136,138,143). An autopsy of the dog also rules out medical conditions that could have precipitated an attack (138). The animal's dentition can be compared with bite marks on the victim (136,138,142,148,149). Sets of
bite marks are found if a pack attack has occurred (145). Material from the dog's mouth may be seen in the wound by microscopy (149).
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