To the Editor:

Although the recent report by Mr. Weiss and colleagues[1] provided a national estimate of 333,687 dog bite injuries treated in emergency departments (EDs) each year and other work has estimated approximately 17 deaths annually from dog bites,[2] we know of no national estimates of hospitalizations for dog bite injuries. The Health Care Utilization Project (HCUP) database maintained by the Agency for Health Care Policy and Research contains standardized hospital discharge summaries (including diagnoses, external causes of injury, and total hospitalization charges) for all hospital discharges from 904 sampled hospitals in 17 states. When weighted, the data provide national estimates.

From HCUP, we identified records with mention of E-906.0 (the International Classification of Diseases, Ninth Revision external cause-of-injury code for dog bite) and then estimated 5991 hospital discharges for dog bite injuries in 1994. Discharge rates per 100,000 appeared inversely related to age: 0- to 4-year-olds, 5.0; 5- to 9-year-olds, 4.9; 10- to 14-year-olds, 2.6; 15- to 19-year-olds, 1.2; 20- to 39-year-olds, 1.6; and those aged 40 years or older, 2.0. Those injured were male in 55% of the cases. Length of stay on average was 3.6 days and was longer for older persons (2.7 days for 0- to 4-year-olds compared with 4.7 days for those aged 40 years or older). Hospital charges for persons with dog bites totaled $40.5 million. Mean hospital charges were higher at extremes of the age range ($6369 for 0- to 4-year-olds, $4622 for 15- to 19-year-olds, $6842 for those aged 40 years or older).

These hospital charges do not include charges for physician services or subsequent post discharge care. Inpatient physician fees are estimated as an additional 25% of hospital charges,[3] and the sum of hospital charges and inpatient physician fees represents only 81% of the total charges incurred during the year following discharge for a traumatic injury.[4] Thus, we estimate $62.5 million in charges related to hospitalizations. Combining this figure with the estimate made by Weiss et al of $102.4 million for ED visits,[1] direct medical care charges for dog bites are estimated at $164.9 million. Moreover, direct costs represent only 65% to 70% of the total costs of injury[4] (i.e., total costs of $235.6 million-$253.7 million). This total is based on the HCUP estimate of 5991 hospitalizations for dog bite–related injuries. However, figures from the report by Weiss et al suggest about 13,000 hospitalizations for dog bites.[1] Thus, our numbers may well be underestimates.

The human suffering related to the 17 deaths, nearly 6000 hospitalizations, and more than 330,000 ED visits a year and the associated economic impacts justify further efforts to prevent dog bites. 

Kyran P. Quinlan, MD, MPH
Jeffrey J. Sacks, MD, MPH
Centers for Disease Control and Prevention
Atlanta, Ga
 

References 

1. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. 1998;279:51-53.

2. Centers for Disease Control and Prevention. Dog bite-related fatalities—United States, 1995-1996. MMWR Morb Mortal Wkly Rep. 1997;46:463-467.

3. Rice DP, MacKenzie EJ, Jones AS, et al. Cost of Injury in the United States: A Report to Congress. San Francisco: Institute for Health and Aging, University of California, and Injury Prevention Center, The Johns Hopkins University; 1989.

4. MacKenzie EJ, Shapiro S, Siegel JH. The economic impact of traumatic injuries: one-year treatment-related expenditures. JAMA. 1988;260:3290-3296.

This letter was shown to Mr. Weiss, who declined to reply.—ED.

(JAMA. 1999; 281:232-233)