Dog bite injuries to the face: Is there risk with breed ownership? A systematic review with meta-analysis

Int J Pediatr Otorhinolaryngol. 2019 Feb;117:182-188. doi: 10.1016/j.ijporl.2018.11.028. Epub 2018 Nov 29.


Introduction: Dog bite injuries to the face are a serious, yet modifiable public health concern. This study explores the relationship between dog breed and the risk of biting and injury. The objective of this study is to determine the relative risk and severity of dog bite injuries to the face by breed.

Methods: Retrospective chart review of facial dog bite injuries presenting to the University of Virginia Health System and Nationwide Children's Hospital. Additionally, descriptive data was collected from 240 patients over the last 15 years. Bite risk by breed was assessed by a literature search from 1970 to current. A composite measure was used to determine the severity of injury, and characterize each patient into an ordinal scale of bite severity. An average of each breed bite rate within each study was calculated and combined to create an empiric bite risk by breed. Dog breeds were also further characterized morphologically.

Results: Bite risk by breed from the literature review and bite severity by breed from our case series were combined to create a total bite risk plot. Injuries from Pitbull's and mixed breed dogs were both more frequent and more severe. This data is well-suited for a bubble plot showing bite risk on the x-axis, bite severity on the y-axis, and size of the bubble by number of cases. This creates a "risk to own" graphic for potential dog owners.

Conclusions: Breeds vary in both rates of biting and severity. The highest risk breeds had both a high rate of biting and caused significant tissue injury. Physical characteristics can also help determine risk for unknown or mixed dog breeds. Potential dog owners can utilize this data when assessing which breed to own.

Keywords: Bite severity; Dog bite; Facial injuries; Risk to own.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Animals
  • Bites and Stings / complications
  • Bites and Stings / epidemiology*
  • Dental Occlusion
  • Dogs / classification*
  • Facial Injuries / epidemiology*
  • Facial Injuries / etiology
  • Humans
  • Ownership
  • Risk Factors
  • Trauma Severity Indices