Incidence, Prevalence, and Risk Factors of Dog Bites in Pediatric Populations: Protocol for a Systematic Review.

Background: Dog bites represent a significant global public health concern, particularly among children and adolescents. Approximately 330,000 emergency department visits occur annually in the United States alone due to dog-bite injuries, with pediatric populations bearing a disproportionate burden. Despite this, existing systematic reviews remain fragmented, focusing on isolated aspects such as breed-specific risk, educational interventions, or legislative measures, without comprehensively addressing the global incidence, prevalence, and multifactorial risk profile in pediatric cohorts. Objective: This protocol describes a planned systematic review aimed at synthesizing international evidence on the incidence and prevalence of dog bites in pediatric populations (aged ≤18 y), with concurrent analysis of demographic, behavioral, and environmental risk and protective factors. Secondary objectives are to characterize the clinical severity, psychological sequelae, and health economic consequences of pediatric dog-bite injury as reported in the eligible literature. Methods: This protocol is reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 statement. A comprehensive search of PubMed, Embase, Web of Science, Scopus, CINAHL, and the World Health Organization Global Index Medicus, supplemented by forward and backward citation tracking and gray literature sources, will be conducted with no date restrictions and limited to English-language observational studies (cross-sectional, case-control, and cohort) and population-based surveys. The PECOS (population, exposure, comparator, outcome, and study design) framework will guide inclusion and exclusion criteria. Two independent reviewers will screen records and extract data using a standardized codebook, with discrepancies resolved by consensus or by a third reviewer. Study quality will be assessed using validated tools appropriate for each study design. Findings will be synthesized narratively with descriptive statistics. When studies are sufficiently homogeneous, prevalence and incidence will be pooled using random-effects meta-analysis of Freeman-Tukey double arcsine-transformed proportions, with prediction intervals reported alongside pooled estimates. The certainty of evidence for each outcome will be rated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: The systematic database search across PubMed, Embase, and Web of Science was conducted on August 1, 2025. At the time of manuscript submission, study screening and data extraction are ongoing. The anticipated completion of data extraction and evidence synthesis is in December 2026, with submission of the completed systematic review for publication expected thereafter. As this manuscript describes the review protocol, no study findings are available at this time. Conclusions: By aggregating data across diverse populations and settings, this systematic review will deliver the most comprehensive global assessment of pediatric dog-bite epidemiology to date, stratified by age group, geographic region, sex, and socioeconomic context, with direct implications for reducing the burden of these preventable injuries worldwide.