Elsevier

Annals of Emergency Medicine

Volume 19, Issue 9, September 1990, Pages 1001-1005
Annals of Emergency Medicine

Original contribution
The management and outcome of lacerations in urban children

https://doi.org/10.1016/S0196-0644(05)82563-6Get rights and content

We prospectively studied the management and outcome of 2,834 children, aged 1 month to 18 years, who presented to the emergency department of the Children's Hospital of Philadelphia for laceration repair. Patients with bite wounds were excluded from the study. Eight percent (239) of all patients had complications on initial evaluation; the most common was the presence of a foreign body (55). Infection on presentation was diagnosed in 22 cases (0.8%). All of these patients had delayed their initial care beyond 18 hours (range, 18 to 288 hours; mean, 18 hours). Other factors significantly associated with infection on presentation included occurrence of the injury outdoors (16; P < .001), injury due to broken “street” glass (seven; P < .02), and injury of an extremity (18; P < .01). The rate of prerepair infection was not influenced by the size of the wound. Infections developed subsequent to initial repair in 34 cases (1.2%). Factors associated with development of subsequent infection included use of prophylactic antibiotics, use of subcutaneous sutures, laceration length of more than 5.0 cm, glass or ice as a causative agent, and upper- or lower-extremity involvement. The majority of injuries were repaired by ED personnel without surgical consultation. Postrepair infection rates were not influenced by the specialty of the physician managing the case. Although our study was not designed to specifically test the issue, prophylactic antibiotics were of no proven benefit in reducing infection rates in any group of patients analyzed.

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Cited by (53)

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    In a multicenter study of 2663 ED patients treated for lacerations, patients who were treated more than 12 h after injury had rates of wound infection similar to those treated < 12 h after injury (8). Similarly, in a study of 2834 children in Philadelphia, wound infection rate was not associated with time to repair (15). Well-vascularized areas of the body are particularly resistant to infection, even in older lacerations.

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  • The impact of wound age on the infection rate of simple lacerations repaired in the emergency department

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    Lastly, Van der Baar et al. excluded patients who were given antibiotics. The main outcome for the trials conducted by Baker and Lanuti,16 Morgan et al.,15 and Van den Baar et al.17 was wound infection judged by a physician at the time of follow-up. Van den Baar et al.17 additionally photographed the wound before repair and at the time of follow up for review by two independent surgeons.

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Research funded in part by the Children's Hospital Trauma Foundation.

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