Incidence of Dog Bite-Associated Emergency Department Visits in Maryland,

Transcription

1 Incidence of Dog Bite-Associated Emergency Department Visits in Maryland, Financial and Policy Implications Emily Pieracci, DVM, MPH Candidate

2 Project Introduction & Overview 4.7 million dog bites occur every year 1 million of which are in children under 18 years of age IR in children is per 100,000 persons Highest injury rates are observed in children 5-9 years of age Males are disproportionately represented among dog bite victims Over 53% of males accounting for all injuries Dog bites can be psychologically traumatizing, disfiguring, incapacitating, and even fatal

3 Project Introduction & Overview Incidence of dog bites has been associated with the age of the patient Younger children bitten due to unintentionally provocative behavior Children are shorter in stature Parents or dog owners may have limited supervision of children while they are interacting with dogs

4 Financial Costs An estimated annual medical cost of over $100 million for dog biterelated emergency services in the U.S Estimated mean medical cost >$630 for ED visits per individual between

5 Methods- Health Service Cost Review Commission (HSCRC) The non-confidential outpatient HSCRC dataset for the years was searched for emergency room visits for dog biteassociated injuries. The HSCRC diagnoses are recorded using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

6 Methods- ICD-9-CM Official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. Categorized primary diagnostic codes with additional external cause of injury codes (E codes) being assigned as needed. The code E906.0 is specifically used to denote dog bite-related injuries

7 Methods-Patients Cross-sectional study All patients that were seen in an emergency room in a Maryland healthcare facility during All records with E906.0 and Emergency room charges greater than $0 Maryland census data from 2010 and population estimates from the U.S. Census Bureau were used for analyzing data.

8 Annual Trends Linear regression analyses 2008 was the baseline year for analysis Incidence Rate Incidence Rate of ER Visit due to Dog Bite Injuries by Year Year

9 Incidence Rates of Dog Bite Injuries in Maryland by Year Year Frequency Maryland Incidence per 100,000 Population ,470 5,684, ,388 5,730, ,087 5,773, ,500 5,839, ,240 5,884, Total 26,685 5 year average 92.4

10 Incidence rates of Dog Bite Injuries; Descriptive Analysis ED Visits Maryland Population 2010 Average Annual Incidence Rate per 100,000 Sex Male 13,775 2,791, Female 12,910 2,981, Age Category 0-4 2, , to 9 3, , to 14 2, , , , , , , , , , , , , , , , , , ,

11 Incidence rates of Dog Bite Injuries; Descriptive Analysis ED Visits Maryland Population 2010 Average Annual Incidence Rate per 100,000 Race White 17,583 3,359, Black /African 6,930 1,700, American Asian/Pacific Islander , Am. Indian, Eskimo 75 20, Other 1, , Biracial , Unknown 73 Ethnicity Hispanic 1, , Not Hispanic 22,216 5,302, Unknown 3,425 Total 26,685 5,773,

12 Sex of Dog Bite Victims in Maryland, Male 48% 52% Female

13 Incidence Rates of Dog Bites by Age Category Incidence Rates Under Age Group

14 5 Year Frequency and Average Annual Incidence Rates by County: County Average County Population Number of ED Visits Average Annual ED Visit IR Number of Aggregate Reports Average Annual Aggregate IR Allegany County 74, Anne Arundel County 538, Baltimore City 620, Baltimore County 807, Calvert County 88, Caroline County 32, Carroll County 167, Cecil County 101, Charles County 146, Dorchester County 32, Frederick County 234, Garrett County 30,

15 5 Year Frequency and Average Annual Incidence Rates by County County Average County Population Number of ED Visits Average Annual ED Visit IR Number of Aggregate Reports Average Annual Aggregate IR Harford County 245, Howard County 288, Kent County 20, Montgomery County 973, Prince George's County Queen Anne's County 864, , St. Mary's County 105, Somerset County 26, Talbot County 37, Washington County 147, Wicomico County 98, Worcester County

16 Aggregate Bite Reports vs. Emergency Room Visits Statewide more aggregate bite reports than ER visits 33% more aggregate bite reports than ER visit reports Maryland aggregate bite report system is working effectively at county level

17 Total Charges Associated with Dog Bite Injuries by Year Year Minimum Charge Maximum Charge Median Charge Total Annual Charges 2008 $22.00 $10, $ $2,150, $28.39 $11, $ $2,430, $26.02 $13, $ $2,650, $7.00 $18, $ $3,250, $25.50 $47, $ $3,740,000.00

18 Limitations and Challenges Medical record review not performed to verify E-coding, chief complaints, or triage notes. Includes only patients seen in MD Don t capture MD residents bitten and treated in other jurisdictions No reference group No control group, everyone in dataset was a dog bite victim Is the population being treated for dog bites in the ER different from the rest of the population seen in the ER? Coding error with county variables Slowed data analysis Had to recode and re-run analysis

19 Lessons Learned Be flexible Sometimes you have to go back to drawing board Collaboration is the key Get to know people who work in areas that you are less knowledgeable in Ask your colleagues for help Recognize your limitations There s always another analysis you can run know when to stop

20 Policy Implications Breed Specific Legislation are laws that regulate dog ownership based on the breed of the dog Advocates claim it reduces the number of attacks resulting in severe injuries to people Opponents state that there is little evidence that such laws actually reduce the number of dog bites Source:

21 Policy Implications Annual trends for don t support change in incidence of dog bite injuries May need to follow for longer time Focus on targeting interventions toward high risk groups Children Dog Owners

22 Practice Implications Interventions should be aimed at high risk groups Children in pre-school Children 5-9 years old in elementary school Consideration for spring/summer programs when interactions with dogs may be higher

23 References Overall, K. L., & Love, M. (2001). Dog bites to humans- demography, epidemiology, injury and risk. Journal of the American Veterinary Medical Association, Maryland Health Services Cost Review Commission. (2013, November 15). Retrieved from Maryland Health Services Cost Review Commission Website: ICD-9-CM. (2013, November 15). Retrieved from Centers for Disease Control and Prevention: V-Codes and E-Codes FAQ. (2013, November 15). Retrieved from American College of Emergency Physicians: REFERENCE DROPPPING $0 ER CHARGES- FROM ANDREA, HSCRC ADDENDUM 2010 Census Interactive Population Search. (2014, March 28). Maryland Statistical Handbook.. (4 April, 2014). Retrieved from Department of Planning, Maryland State Data Center Website: page 4. By County Order (2012). (4, April 2014). Retrieved from Department of Planning, Maryland State Data Center Website: Age Profile 1: Age by Sex for Persons in Households and Persons in Group Quarters (2010). (15, April 2014). Retrieved from Department of Planning, Maryland State data Center Website: page 1 & 2. American Veterinary Medical Association: Task Force n Canine Aggression and Human-Canine Interactions (2001). A Community Approach to Dog Bite Prevention. Journal of the American Veterinary Medical Association, 218; 11; Protect Maryland Dogs, Accessed November 20,

24 References Quirck, J. T. (2012). Non-fatal dog bite injuries in the USA, Public Health, Dixon, C. A., Pomerantz, W. J., Hart, K. W., Lindsell, C. J., & Mahabee-Gittens, E. M. (2013). An evaluation of a dog bite prevention intervention in the pediatric emergency department. Journal of Trauma Acute care and Surgery, S308-S312. Wei, L. A., Chen, H. H., Hink, E. M., & Durairaj, V. D. (2013). Pediatric facial Fractures From Dog Bites. Opthalmic Plastic Reconstructive Surgery, Eppley, B. L., & Schleich, A. R. (2013). Facial Dog Bite Injuries in Children:Treatment and Outcome Assessment. The Journal of Craniofacial Surgery, Beck, A. M., & Jones, B. A. (1985). Unreported Dog Bits in Children. Public Health Reports, Sinclair, C. L., & Zhou, C. (1995). Descriptive Epidemiolgy of Animal Bites in Indiana, A Rationale for Intervention. Public Health Reports, Bernardo, L. M., Gardner, M. J., Rosenfield, R. L., Cohen, B., & Pitetti, R. (2002). A comparison of dog bite injuries in younger and older children treated in a pediatric emergency department. Pediatric Emergency care, Centers for Disease Control. (2003). Morbidity and Mortality Weekly Report (MMWR). Atlanta: Department of Health and Human Services. Feldman, K. A., Trent, R., & Jay, M. T. (2004). Epidemiology of Hospitalizations From Dog Bites in California, Research and Practice, Weiss, H. B., Friedman, D. I., & Coben, J. H. (1998). Incidence of dog bite injuries treated in emergency departments. Journal of the American Medical Association, De Keuster, T., & Overall, K. L. (2011). Preventing dog bite injuries: the need for a collaborative approach. Veterinary Record, Davis, A. L., Schwebel, D. C., Morrongiello, B. A., Stewart, J., & Bell, M. (2012). Dog Bite Risk: An Assessment of Child Temperament and Child- Dog Interactions. International Journal of Environmental Research and Public Health,

25 Acknowledgements Dr. Katherine Feldman, DHMH Ms. Kimberly Mitchell, DHMH Ms. Brenna Hogan, DHMH Ms. Mary Armolt, DHMH Dr. Meghan Davis, JHU