Wound Registry: Development and Validation,☆☆,

This paper was presented in part at the American College of Emergency Physicians Research Forum in San Diego, March 1994.
https://doi.org/10.1016/S0196-0644(95)70183-4Get rights and content

Abstract

Study objective: More than 11 million patients with traumatic wounds are seen annually in emergency departments. We developed and validated a data registry for traumatic wounds treated in the ED.

Design: Prospective, consecutive patient enrollment with a validation cohort of a convenience sample of 100 patients.

Setting: University-affiliated hospital ED.

Participants: For all patients with traumatic wounds requiring sutures, wound registry data sheets were completed at the time of initial visit using a closed-question format. Data recorded included demographic characteristics, time from injury to evaluation, pertinent medical history, wound characteristics, type of anesthesia, details of wound-cleansing methods, details of wound closure, and postoperative care. We devised a follow-up tool to evaluate for the presence of infection and short-term cosmetic appearance. Interphysician reliability was assessed for wound description, presence of infection, and cosmetic appearance by use of the κ statistic.

Results: A wound registry data collection instrument that takes less than 1 minute to complete and enables the collection of most wound management techniques used by emergency physicians was found to have substantial interobserver concordance for wound description (κ range, .55 to .97), wound infection (κ=1.0), and overall cosmetic appearance (κ=.61).

Conclusion: The wound registry is a reliable data collection instrument that is easy to use. It may be useful as a continuous quality-improvement tool or for standardization of wound surveillance and treatment data to facilitate future prospective studies in wound management.

[Hollander JE, Singer AJ, Valentine S, Henry MC: Wound registry: Development and validation. Ann Emerg Med May 1995;25:675-685.]

Section snippets

INTRODUCTION

Traumatic wounds are one of the most common problems encountered in the emergency department. Emergency physicians treat an estimated 11.5 million wounds annually.1Development of successful strategies to reduce wound occurrence would provide the optimal method of preventing injury-related complications. Unfortunately, emergency physicians mainly treat patients in whom wounds have already been inflicted. Wound infection rates range from 1% to 31% 2, 3, 4, 5, 6, 7, 8, 9depending on the wound

MATERIALS AND METHODS

The development of the wound registry comprised seven steps: survey of practitioners' wound care and suture techniques, revisions of initial registry to adjust to the needs of all practitioners, development of registry definitions for categories of data entry, pilot phase of data collection to ensure ease of use, development of a system for patient follow-up, validation of the data collection instrument, and implementation of the wound registry data collection instrument.

Initial Survey of

RESULTS

Pilot Phase of Data Collection From October 27, 1992, through September 6, 1993, 1,000 patients were entered in the wound registry.

The mean±SD age of patients was 23±18 years. There were 738 men (74%) and 262 women (26%). Injuries were evaluated shortly after occurrence (median time, 1 hour; interquartile range (IQ25-75, 0 to 2 hours).

The causes and locations of wounds are shown in Tables 1 and 2, respectively. The median laceration length was 2 cm (IQ25-75, 1 to 3 cm). Wounds were linear in

DISCUSSION

Wound management should focus on the prevention of infection, enhancement of cosmetic appearance, and restoration of function. Most studies of wound care have focused on the infection rate after primary wound closure.2, 3, 4, 5, 6, 7, 8, 9Many factors that influence the rate of wound infection cannot be affected at the time of medical intervention. These factors, along with the time elapsed before the initiation of medical treatment, can be influenced only by patient education directed at

Acknowledgements

The authors acknowledge Henry C Thode, Jr, PhD, for his assistance and statistical support.

References (29)

  • D Lindsey et al.

    Effectiveness of penicillin irrigation in control of infection in sutured lacerations

    J Trauma

    (1982)
  • PB Wood

    Wound infection in undressed sutured wounds of the hand

    Br J Surg

    (1971)
  • RC Thirlby et al.

    Value of prophylactic antibiotics for simple lacerations

    Surg Gynecol Obstet

    (1983)
  • JAI Grossman et al.

    Value of prophylactic antibiotics in simple hand lacerations

    JAMA

    (1981)
  • Cited by (0)

    From the Department of Emergency Medicine, University Medical Center, State University of New York Health Sciences Center, Stony Brook, New York.

    ☆☆

    Address for reprints: Judd E Hollander, MD, Department of Emergency Medicine, University Hospital, Room L4-515, State University of New York, Stony Brook, New York 11794-7400, 516-444-2499, Fax 516-444-3919

    Reprint no. 47/1/64107

    View full text