Pit Bulls. #10

Here is how I formed my medical perspective on dog breeds and dog attacks. My conclusion after reading medical journal articles is that pit bull-type dogs, Rottweilers, German shepherds, maybe Chow Chows, and mixed breeds thereof cause disproportionately more people to go to the emergency room, the operating room, and the morgue than other breeds. This appears to be especially true for pit bull-type dogs.

Please be sure to read the journal article excerpts and my analysis found below the video. You might notice that some of the articles in the Citations section draw conclusions that disagree with my conclusions. I’ve cited those articles to show that even though I have read their arguments, I still disagree with them about pit bull-type dogs.

Chlidren are at higher risk of serious dog bite than adults. The lifetime risk for adults is 20% and for children 50%.

Some say that there is no pit bull breed per se and that it has no strict and universally agreed upon definition. This makes some sense to me, but I do not go as far as some people do with their conclusions. They further say that because of this, we can’t reliably tell the difference between pit bulls and other dogs. Following that, some finally argue that we must conclude we can’t really know if pit bull-type dogs are more responsible for the dog attacks that maim and kill. This does not makes sense to me. I explain myself in the video. I also address the findings and flaws in three studies that examine whether people can tell pit bull-type dogs from others and why I remain unconvinced we can’t tell the difference.

I’m also not concerned here with whether we should “blame the deed, not the breed.” According to the medical literature cited, regardless of the historical and background reasons, these dogs hurt and kill people disproportionately more than others. Some papers noted a high number of patients from Labrador retriever attacks. But remember, a high absolute number is not the same as a high relative proportion. The Labrador retriever is the most popular dog in the U.S.A. Any dog breed that rarely bites but is a very common breed will still send a detectable number of people to the hospital, but do so in lesser proportions than more dangerous breeds. Numbers documenting disproportionately high attacks from pit bulls are in the excerpts below the video.

Defenders of dog types that disproportionately maim and kill are easy to find. Even the Humane Society peddles the idea that all breeds—including pit bull-type dogs—are equal to all other breeds. Nonsense. Since it’s obvious to me that dogs are unequal, the Humane Society doesn’t appear to be serious about minimizing vicious dog attacks. (If so, that’s their prerogative. I don’t expect others to champion my interests.) Their article says, “Experts have found that no breed is more likely to bite than another.” No support is given for their statement. The anonymous author does not explain who these experts are or in what field they have expertise. Additionally, the statement is about bites, which is a broader category than only attacks that send people to the hospital. Some bites are devastating. Other bites are next to nothing. The author makes no distinction between an innocuous bite from a small, weak dog and a biting attack that maims or kills. You can read it here. If the Humane Society has deleted or changed their web page, there is an archive from 11 July 2022 here.

video content timeline

  • My goal is to summarize the perspective of medical journals to help you decide if you want a dog and what breed to get [0:00]

  • I looked at medical journal articles about dog attacks [0:11]

  • Is this topic a waste of time? Here’s some contextualizing data on dog attacks from medical journals [1:28]

  • What is a provoked attack? [2:29]

  • About 50% of all dog attacks are from a dog known to the victim, not a stray [5:01]

  • Children are a special category [5:45]

  • Plastic surgery rates, rates for all medical care, and death rates [6:04]

  • More on kids [6:55]

  • The main finding regarding breeds: pit bulls attack unlike other dogs [8:32]

  • Is there such a thing as a pit bull? Addressing the objection that there is no such thing as a pit bull or that nobody can reliably tell a pit bull from other dogs [10:10]

  • Definition of pit bull used by the journal articles [11:37]

  • Why I disagree with studies that conclude we cannot tell pit bulls from other dogs [12:19]

  • The Colorado and Ohio Supreme Courts have ruled that pit bulls are identifiable by the average person [16:49]

  • “Blame the deed, not the breed” and why I think this has only partial relevance [18:20]

  • There is evidence that owners of vicious dogs tend to be more psychopathic and antisocial than other people [20:04]

  • Select excerpts from medical journals [21:52]

  • A brief word about prevention and risk mitigation based on secondary trends in the medical literature I read [26:15]

  • You don’t owe me an explanation if you get a pit bull. But I hope you also never have to explain it to a judge or the parents of a dead child [27:59]

BREED-RELATED FINDINGS.

Some of these excerpts are from the original research done by the authors of the cited paper. Other excerpts are the authors paraphrasing the findings of other papers. In parentheses you will find the corresponding citation number directing you to that paper down below. Bolded emphasis is mine.

Pit bulls constituted 27% of all reported dog bites but accounted for only 4.9% of the local dog population. (12)


Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention. Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+31%), and without provocation (+48%). … Although a number of dog breeds were identified, the largest group were pit bull terriers, whose resultant injuries were more severe and resulted from unprovoked, unknown dogs. (1)


The most common breeds involved in the attacks were German Shepherds and Akitas. Other common breeds included American Bulldogs, large mixed breeds, Labrador Retrievers, and Pit Bulls. [Note that Labrador retrievers are the most common breed in the U.S.A. It makes sense that the most common breed would show up in any study examining nearly anything about dogs. What’s noteworthy is that some less common breeds show up disproportionately more often for attacks.] (2)


[veterinary journal] Despite these limitations and concerns, the data indicate that Rottweilers and pit bull-type dogs accounted for 67% of human DBRF [dog bite related fatalities] in the United States between 1997 and 1998. It is extremely unlikely that they accounted for anywhere near 60% of dogs in the United States during that same period and, thus, there appears to be a breed-specific problem with fatalities. (3)


[veterinary journal] [This study quantitatively supports the assertion that some breeds are proportionately more dangerous than others.] The frequency of German Shepherds in the sample of this study was 11.8%, whereas its frequency in the general dog population is 5.51%. The frequency of Rottweilers in our sample was 7.6%, whereas the frequency in the general dog population was 1.13%. In addition, there were quite a high number of Argentinian Dogos in our sample (n. = 10); the frequency of this breed was 5.9%, whereas it is 1% in the general dog population (no precise numbers were provided for breeds with less than 1% frequency in the general dog population). Regarding the breeds belonging to FCI group 3 (terrier), the frequency of American Staffordshire Terriers in our sample was 9.4%, whereas in the general dog population it is less than 1%. In contrast, the percentage of crossbreed and mongrel dogs in the sample of biting dogs reported here (23.5%) was lower than the reported percentage in the general Italian dog population (36.5%). There were some breeds, such as Boxers and Labradors, whose frequency in the present study more or less matched the frequency in the general dog population. (4)


Of the 56 cases that had an identified dog breed, pit bulls accounted for 48.2% of the dog bites, and 47.8% of pit bull bites required intervention in the operating room. … After the pit bull, the German Shepard [sic] (8.9%) and Husky (5.3%) are the most common dogs that cause several severe injuries through their teeth. … More importantly, 47.8% of pit bull injuries required operative repair, which was 3 times more than other breeds. … Several recent studies published from 2011 to 2016 have named pit bulls as the culprit of most common breed to inflict dog bites in the pediatric population across the United States. More importantly, pit bulls are more likely to cause severe injuries that require operative repairs. O’Brien et al. composed a Dog Bite Complication Index that grades severity of dog bite injuries based on size of laceration and extent of tissue, bone, and vascular involvement. In their study, they showed that pit bull bites caused significant injuries and were 5 times more likely to require operative repair compared with other breeds. (7)

The most common breeds were mixed breed (23.0%), Labrador retriever [the most common dog in the U.S.A.] (13.7%), Rottweiler (4.9%), and German shepherd (4.4%). … It is possible that Labrador retrievers, not commonly viewed as aggressive in previous studies, were highly implicated in our study because they are the most popular dogs in the United States and Denver. [Why aren’t pit bulls among this study’s top offenders? Well, note that this study was done in a city banning pit bulls.] … In 1991, Gershman et al performed a case–control study in Denver and found that male, unneutered dogs that were of Chow Chow or German shepherd breed were more likely to bite. No pit bull terriers were identified as a biting dog in this study, consistent with a ban of pit bulls in Denver County that was passed in 1989. (8)

Pit bull attacks have been found to also account for higher morbidity rates, higher hospital charges, and a higher risk of death than attacks from other dog breeds in addition to a higher proportion of fatal injuries reported in the United States. (9)


Pit bull and Rottweiler breeds account for most of the human fatalities related to dog bites over the past two decades. (11)


Although breed information was missing for many cases (48.7%), of the cases in which the breed was recorded, Pit bulls were most frequently involved. (13)


The most common breed was a Pit bull-type dog (n=12); other breeds included Rottweiler (n=6), Collie (n=4), Bulldog (n=3), Husky (n=3), and Saint Bernard (n=2) (Table 3). (14)


The commonest dogs producing bites were Staffordshire bull terriers (15 cases), Jack Russell terriers (13), medium sized mongrels (10), and Alsatians (nine). (15)


Pit Bulls were responsible for a large proportion of the injuries (Figure 6). (19)


There is a substantial worldwide amount of evidence indicating that the following breeds are most commonly involved in biting incidents targeting humans: Dachshunds, German Shepherds, Rottweilers, and Bull-type breeds such as Pit Bull Terriers. … Pit Bull Terriers are reported to be more likely to bite strangers unprovoked. Their bites are more likely to require medical attention than those of other dogs. At the same time, bites from Labradors or Golden Retrievers rarely result in serious injury, unlike the Rottweiler or German Shepherd, which are more frequently involved in serious or lethal biting incidents, albeit less frequently than Pit Bull Terriers. However, these studies were carried out in areas with a high proportion of Labrador or Golden Retrievers, and therefore, their overrepresentation in biting incidents could be misleading. (20)


Pit bull bites were implicated in half of all surgeries performed and over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds. … With regard to breed, operative intervention was most strongly associated with a pit bull injury: OR = 3.361 (CI = 2.011-5.592); P < .001. Pit bull breeds were also more likely to bite in multiple anatomical locations, OR = 2.660 (CI = 1.598-4.436); P < .001. (22)

Our data confirm what detractors of the breed and child advocates suggest—that, with rare exceptions, children and pit bulls do not mix well. … Our data were consistent with others, in that an operative intervention was more than 3 times as likely to be associated with a pit bull injury than with any other breed. … Our data revealed that pit bull breeds were more than 2.5 times as likely as other breeds to bite in multiple anatomical locations. Although other breeds may bite with the same or higher frequency, the injury that a pit bull inflicts per bite is often more severe. Consistent with these findings is that of Bini et al, who reported on 228 patients and found that attacks by pit bulls resulted in a higher injury severity score, lower Glasgow coma score [lower is worse], higher risk of death, and higher hospital charges than attacks by any other breed. (22)

Breeds involved in the attacks included German Shepherd, Pit Bull, American Bulldog, large mixed breed, Labrador Retriever, and Akita, with German Shepherds and Akitas being the most frequently involved. (2)

From 1979 to 1988, pit bull breeds accounted for more than 41 percent of dog bite–related fatalities, three times as many as German shepherds. (27)

Indeed, pit bulls (even though they do not belong to an officially recognized breed) are frequently involved in biting episodes worldwide and particularly in the US and UK. “Fighting dog breed” (including pit bulls) selection also fixed behavioral and personality characteristics that were useful their work:

−  Gameness: high perseverance until the goal is reached, causing the lack of sensibility toward the other subject’s surrender signals;

−  Low inhibition for fighting: high reactivity to minimum threats (moving or non-moving stimuli) activates behavioral responses until the complete exhaustion or death;

−  Low sensitivity to pain;

−  Scarce communication, which enhances the unpredictability of the attack. (17)

CHILDREN ARE AT HIGHER RISK.

The likelihood of a child sustaining a dog bite in their lifetime has been estimated at 50%, compared with 20% in the adult population. (13)

Studies from many countries indicate that the majority of child victims of biting incidents are bitten by dogs of their own household or dogs familiar to their family members. (20)

Most victims are involved in normal, nonprovoking activities before the dog attacks. For example, neonatal deaths resulting from a dog bite most often involve a sleeping baby. (27)

PREVENTION-RELATED STATEMENTS.

The results of this review showed that the risk factors for dog attacks include: school-aged children (but highest rate of serious injury from dog bite is to children under 5 years of age), male [victim], households with dogs and certain breeds (german shepherds, bull terriers, blue/red heelers, dobermans and rottwellers [sic]), male dogs. (5)

In most cases the victim either owns the dog or is well known to it, and the attack occurs in the dog’s home. Certain situations seem to be dangerous—for example, approaching or bending over dogs, especially if they are lying quietly; approaching them immediately after entering their territory; teasing or waking them; or playing with them til they become overexcited. (15)

OVERALL RISKS. EPIDEMIOLOGY.

More than 70% of bites are from a dog that is known to the victim, and about 50% are self-reported as unprovoked.  (11)

In a majority of instances in which the dog was identified (n=31, 78%), it was known to the victim or to the victim’s parents. … In 78% of the attacks, the dog was known to the victim or to the victim’s care givers, a finding consistent with the literature. … Other studies have shown that the majority of dog attacks are documented as “unprovoked”. (14)

Dog ownership is common across the world, yet the United States has more dogs per person than any other country, with 38.4% of U.S. households owning a dog (21).

Unfortunately, familiarity may lead to injury. The existing literature reveals that the family dog inflicts injury between 27% and 45% of the time, more so than a neighbors’ dog or a stray. (22)

Twelve (71%) of the attacks were perpetrated by the family pet, and 13 (76%) occurred at the patient’s home. (22)

The bite was most likely to be unprovoked (46.8%) and caused by a family pet (53.2%), with the dog owner present (51.3%). (13)

The greatest risk of bites does not come from wandering feral dogs. Based on multiple regression, the victim was most likely bitten in their own yard by a single neighborhood dog that escaped from its home or yard. (26)

In 2014 alone, roughly 1 million Americans required medical attention and over 28,000 people underwent reconstructive surgery as a result of dog bites according to the American Society of Plastic Surgeons. … A 2010 study performed by Agency for Healthcare Research and Quality, showed that the average cost of a dog bite–related hospital stay was $18,200, about 50% higher than the average injury-related hospital stay… (7)

For plastic surgeons in particular, dog bite-related repairs are among one of the top 5 reconstructive procedures annually with over 28 000 performed each year in the United States. (13)

COURT STATEMENTS.

Pit bull dogs possess unique and readily identifiable physical and behavioral traits which are capable of recognition both by dog owners of ordinary intelligence and by enforcement personnel. (30)

The trial court found that the classification of pit bulls as dangerous animals had a rational basis in fact and that the prohibition of their possession bears a rational relationship to the legitimate governmental objective of protecting the public's health, safety, and welfare. … Since the standards for determining whether a dog is a pit bull are readily accessible to dog owners, and because most dog owners are capable of determining the breed or phenotype of their dog, the trial court properly determined that the ordinance provides adequate notice to dog owners and is not unconstitutionally vague. …The uncontradicted testimony of the various veterinarians in this case reflects that most dog owners know the breed of their dog. In fact most dog owners look for and select a dog of a particular breed because of their knowledge of or interest in a particular breed. (31)

IS THAT A PIT BULL?

I read three articles describing studies that tried to find out if people can tell the difference between a pit bull and other dogs. Here is my analysis.

IS THAT A PIT BULL? STUDY #1

Hoffman, C. L., Harrison, N., Wolff, L., & Westgarth, C. (2014). Is that dog a pit bull? A cross-country comparison of perceptions of shelter workers regarding breed identification. Journal of applied animal welfare science : JAAWS, 17(4), 322–339. https://doi.org/10.1080/10888705.2014.895904

The authors conclude: “Our findings indicate a lack of consensus, both between and within the United States and United Kingdom, about what constitutes a pit bull terrier.”

This study has weaknesses that cloud any result it would get. The authors don’t convince me we can’t tell a pit bull from another type of dog.

Here are its weaknesses:

  • No actual dogs were shown to the participants. Instead, one photo of each dog was shown. The photos were not standardized. They were taken at different angles and some do not include the dog’s whole body. I would prefer to have standardized photos, or even better to have the staff look at the actual live dog in its presence.

  • Participants were shown only twenty photos of twenty dogs. I would prefer more than twenty to lessen random effects and mitigate or identify any outlier.

  • The participants are volunteers who responded to emails inviting them to do an online survey for the study. Better to select participants randomly.

  • The definiiton of a pit bull-type dog is different between the U.S. and the UK. “According to the UK government, pit bull-type dogs are distinct from Staffordshire bull terriers…” In the U.S., a Staffordshire bull terrier is considered a pit bull-type dog.

  • Participants admitted to lying about dog breeds. They are not objective about identifying and labelling dogs. “Among participants who reported working in shelters subject to BSL [breed-specific legislation], 40.7% (n = 33) stated they would intentionally label a dog thought to be a mix of a banned breed as a breed that is not banned. … A U.S. participant’s comment reflected the tendency to avoid identifying a dog as a pit bull or Staffordshire bull terrier: ‘I would put Lab mix because they get adopted easier, but he looks like he could be a Staffie (Staffordshire bull terrier).’” … “In contrast, one U.S. participant reported using the label pit bull even when a dog was not a pit bull to ensure adopters were aware they may face extra challenges due to adopting a dog who some individuals and businesses may consider a restricted breed: ‘I feel like it is important to note that while I may see a difference in an American bulldog (or Dogo, etc.), the public (landlords, insurance companies, etc.) lump them all in one category. Therefore, almost for the safety of the dog, sometimes they are lebelled [as] American bulldog/pit bull cross so that people adopting will be aware of the fact that landlord, insurance, etc. may discriminate.’”

IS THAT A PIT BULL? STUDY #2

Olson, K. R., Levy, J. K., Norby, B., Crandall, M. M., Broadhurst, J. E., Jacks, S., Barton, R. C., & Zimmerman, M. S. (2015). Inconsistent identification of pit bull-type dogs by shelter staff. Veterinary journal (London, England : 1997), 206(2), 197–202. https://doi.org/10.1016/j.tvjl.2015.07.019

This study’s design produces a foregone conclusion. I remain unconvinced we can’t agree on which dogs are pit bulls.

This study had two aims. “The primary objective of this study was to determine the level of agreement among shelter workers in designating pit bull-type breeds for shelter dogs. A secondary objective was to compare shelter workers’ breed assignments with DNA breed signatures.”

“Only dogs that staff considered safe to handle were eligible for inclusion.” It is possible that dogs with more pit bull in them are (1) more likely to be considered unsafe and therefore excluded and (2) also more easily identified as pit bull by looking at them because they have more pit bull in their heritage. This muddies the waters at best. At worst, this design is set up to favor produce data supporting the hypothesis that people cannot tell pit bulls from other dogs.

“Dogs were coded as ‘pit bull-type’ if the breed American Staffordshire terrier or Staffordshire bull terrier was identified to comprise at least 12.5% of the breed signature.” I think this standard is too high. If the dog is 1/8 pit bull by genetic testing, then the authors count that dog as a pit bull. I would not expect the staff to look at a dog that is 1/8 pit bull and identify it as pit bull.

Even with this 1/8 DNA standard, most of the time the staff agreed with each other and agreed with the DNA tests when asked if a dog was a pit bull-type dog. “Using visual identification only, the median inter-observer agreements and kappa values in pair-wise comparisons of each of the five staff breed assignments (one admission breed and four assessor breeds) for pit bull-type dog vs non pit bull-type dog ranged from 76 to 83% and from 0.44 to 0.52, respectively.” … “The median inter-observer agreements and kappa values in pairwise comparisons of each of the five staff breed assignments (one intake breed assignment and four breed assessor assignments) with the DNA breed signature for pit bull-type or non pit bull-type ranged from 67 to 78% and from 0.1 to 0.48, respectively.”

“The results of this study confirm that shelter staff members, including veterinarians, frequently disagree with each other on whether dogs fall into the pit bull-type category, and their assessments of whether or not a dog was a pit bull-type only moderately agree with DNA breed profiles.” I disagree with the authors. Most of the time the staff agree with each other (76% to 83% of the time). And most of the time they agree with the DNA (67% to 78% of the time), even though the experiment is designed such that they must look at a dog and identify it as a pit bull even if the dog is only 1/8 pit bull.

“None of the authors of this paper has a financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper.” … “This study was made possible by support from Maddie’s Fund…” I invite you to go to Maddie’s Fund’s website, search for “pit bull,” and decide for yourself if the search results show any bias about pit bulls at Maddie’s Fund.

IS THAT A PIT BULL? STUDY #3

Gunter, L. M., Barber, R. T., & Wynne, C. (2018). A canine identity crisis: Genetic breed heritage testing of shelter dogs. PloS one, 13(8), e0202633. https://doi.org/10.1371/journal.pone.0202633

The authors of this article quantify how well study participants can identify a pit bull-type dog. But their discussion oddly does not comment on whether they conclude pit bull-type dogs are generally identifiable. The results support that these dogs are visually distinct from other types.

“The present paper has two main aims. First, to report the breed heritage of a large sample of mixed breed shelter dogs based on genomic breed testing. … Second, to assess agreement of visual breed identification by shelter staff at one of these locations by comparing the primary and secondary breeds indicated by staff and those identified by DNA analysis.”

“Dogs with pit bull-type ancestry as identified by DNA analysis at both shelters had a mean length of stay nearly twice as long as non-pit bull-type breeds.” This could be because people can tell the difference between a pit bull and a different type of dog.

More than two-thirds of the time (or three-fourths, depending on how you count), the participants could tell if the dog was at least 1/4 pit bull: “Considering those dogs in whom the pit bull-type concentration was 25% or higher (114 dogs), shelter staff matched those dogs’ DNA analyses by identifying their primary breed assignment as a pit bull-type in 67% of cases. An additional 8.8% of dogs’ breed assignments by staff were in agreement when including assignments that were placed in the secondary breed position.”

The following excerpt supports the assertion that the staff can tell a pit bull-type dog from other types. “In exploring the relationship between identification and pit bull heritage, we found a significant correlation between the number of DNA-identified pit bull-type relatives and the probability that shelter staff identified the dogs as pit bulls (r (85) = .75, p < .001). Dogs whose heritage was 25% pit bull or less were the most likely to be misidentified by staff as not having any of these breed ancestors. Conversely, shelter personnel were 92% successful in identifying dogs with 75% pit bull heritage or higher in their DNA analysis (Fig 2).” … “Visual identification by shelter staff at SDHS matched at least one breed in a dog’s heritage over two-thirds of the time.” … “We did find, though, that as the number of pit bull-type relatives increased in a dog’s heritage, so did the staff’s ability to match its breed type.”

I don’t know why the authors did not come out and say that pit bull-type dogs are visually identifiable. But their results support that.

RESOURCES.

  1. Dogs Bite. (Note: Some entries on this website are derived from medical perspectives, some are from other angles.) https://www.dogsbite.org/

  2. “Find The Pit Bull” Game Debunked. https://safetybeforebulldogs.blogspot.com/2011/04/find-pit-bull-game-debunked.html

  3. Advice if you are attacked by a dog. https://www.dogsbite.org/dog-bite-victim-guide.php

  4. Addressing misconceptions about pit bulls. https://www.dogsbite.org/dangerous-dogs-pit-bull-myths.php

CITATIONS.

1. O'Brien, D. C., Andre, T. B., Robinson, A. D., Squires, L. D., & Tollefson, T. T. (2015). Dog bites of the head and neck: an evaluation of a common pediatric trauma and associated treatment. American journal of otolaryngology, 36(1), 32–38. https://doi.org/10.1016/j.amjoto.2014.09.001

2.. Kumar, R., Deleyiannis, F. W., Wilkinson, C., & O'Neill, B. R. (2017). Neurosurgical sequelae of domestic dog attacks in children. Journal of neurosurgery. Pediatrics, 19(1), 24–31. https://doi.org/10.3171/2016.7.PEDS1646

3. Sacks, J. J., Sinclair, L., Gilchrist, J., Golab, G. C., & Lockwood, R. (2000). Breeds of dogs involved in fatal human attacks in the United States between 1979 and 1998. Journal of the American Veterinary Medical Association, 217(6), 836–840. https://doi.org/10.2460/javma.2000.217.836

4. Notari, L., Cannas, S., Di Sotto, Y. A., & Palestrini, C. (2020). A Retrospective Analysis of Dog-Dog and Dog-Human Cases of Aggression in Northern Italy. Animals : an open access journal from MDPI, 10(9), 1662. https://doi.org/10.3390/ani10091662

5. Abuabara A. (2006). A review of facial injuries due to dog bites. Medicina oral, patologia oral y cirugia bucal, 11(4), E348–E350. https://pubmed.ncbi.nlm.nih.gov/16816820/

6. O'Sullivan, E. N., & Hanlon, A. J. (2012). A review of official data obtained from dog control records generated by the dog control service of county cork, Ireland during 2007. Irish veterinary journal, 65(1), 10. https://doi.org/10.1186/2046-0481-65-10

7. Alizadeh, K., Shayesteh, A., & Xu, M. L. (2017). An Algorithmic Approach to Operative Management of Complex Pediatric Dog Bites: 3-Year Review of a Level I Regional Referral Pediatric Trauma Hospital. Plastic and reconstructive surgery. Global open, 5(10), e1431. https://doi.org/10.1097/GOX.0000000000001431

8. Chen, H. H., Neumeier, A. T., Davies, B. W., & Durairaj, V. D. (2013). Analysis of pediatric facial dog bites. Craniomaxillofacial trauma & reconstruction, 6(4), 225–232. https://doi.org/10.1055/s-0033-1349211

9. Tang, J., & Arneja, J. S. (2018). Are Dog Bites a Problem of Nature or Nurture?. Plastic surgery (Oakville, Ont.), 26(4), 297–298. https://doi.org/10.1177/2292550318800326

10. Ledger RA, Orihel JS, Clarke N, Murphy S, Sedlbauer M. Breed specific legislation: considerations for evaluating its effectiveness and recommandations for alternatives. Can Vet J. 2005 Aug;46(8):735-43. PMID: 16187720; PMCID: PMC2834488. https://pubmed.ncbi.nlm.nih.gov/16187720/

11. Ellis, R., & Ellis, C. (2014). Dog and cat bites. American family physician, 90(4), 239–243. https://www.aafp.org/pubs/afp/issues/2014/0815/p239.html

12. Ramgopal, S., Brungo, L. B., Bykowski, M. R., Pitetti, R. D., & Hickey, R. W. (2018). Dog bites in a U.S. county: age, body part and breed in paediatric dog bites. Acta paediatrica (Oslo, Norway : 1992), 107(5), 893–899. https://doi.org/10.1111/apa.14218

13. McGuire, C., Morzycki, A., Simpson, A., Williams, J., & Bezuhly, M. (2018). Dog Bites in Children: A Descriptive Analysis. Plastic surgery (Oakville, Ont.), 26(4), 256–262. https://doi.org/10.1177/2292550318767924

14. Horswell, B. B., & Chahine, C. J. (2011). Dog bites of the face, head and neck in children. The West Virginia medical journal, 107(6), 24–27. https://pubmed.ncbi.nlm.nih.gov/22235708/

15. Shewell, P. C., & Nancarrow, J. D. (1991). Dogs that bite. BMJ (Clinical research ed.), 303(6816), 1512–1513. https://doi.org/10.1136/bmj.303.6816.1512

16. Raghavan, M., Martens, P. J., Chateau, D., & Burchill, C. (2013). Effectiveness of breed-specific legislation in decreasing the incidence of dog-bite injury hospitalisations in people in the Canadian province of Manitoba. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 19(3), 177–183. https://doi.org/10.1136/injuryprev-2012-040389

17. d'Ingeo, S., Iarussi, F., De Monte, V., Siniscalchi, M., Minunno, M., & Quaranta, A. (2021). Emotions and Dog Bites: Could Predatory Attacks Be Triggered by Emotional States?. Animals : an open access journal from MDPI, 11(10), 2907. https://doi.org/10.3390/ani11102907

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John Fuhrman