Comparison of wound care practices in pediatric and adult lacerations repaired in the emergency department

OBJECTIVEWe compared emergency physicianʼs wound care practices in young children (≤5 years) and adults (≥18 years) and the effect of these different practices on infection rate and cosmetic appearance. DESIGNCross sectional study. SETTINGUniversity hospital emergency department that rarely uses conscious sedation. PARTICIPANTSConsecutive patients who presented with lacerations over a four-year period. METHODSStructured closed question data sheets that assessed 26 separate wound characteristics were prospectively completed at initial presentation and at suture removal. Infection and cosmetic appearance were assessed with previously validated scales, X tests were used for categorical variables, t tests for continuous variables. RESULTSWe evaluated 3624 patients853 children and 2771 adults. Wounds in children were more likely to be on the head (86 vs 38%, P < 0.01); linear (88 vs 77%, P < 0.01); shorter (1.9 vs 3.0 cm, P < 0.01); less often contaminated (4 vs 11%, P < 0.01); and more commonly caused by blunt injury (69 vs 37%, P < 0.01). With respect to treatment, lacerations in children were less likely to receive irrigation (53 vs 77%; P < 0.001) but slightly more likely to be scrubbed (50 vs 45%, P = 0.01). The two groups received similar numbers of sutures per centimeter (2.6 vs 2.3). Using logistic regression, the differences in irrigation were not explained by the differences in laceration characteristics. Despite less frequent irrigation, children had lower wound infection rates (2.1 vs 4.1%; P = 0.004) and better cosmetic appearances (optimal score, 75 vs 64%, P = 0.0003). CONCLUSIONSEmergency physicians at our institution are less likely to irrigate lacerations in children than adults; however, children had a lower infection rate and more favorable cosmetic outcome.