Irrigation in facial and scalp lacerations: does it alter outcome?

STUDY OBJECTIVE: Animal and human studies suggest that irrigation lowers the infection rate in contaminated wounds, but there is no evidence that this common practice is beneficial for "clean" lacerations. We tested the null hypothesis that there is no difference in the infection rate for noncontaminated lacerations to the face and scalp that are irrigated before primary closure compared with similar wounds that are closed primarily without irrigation. METHODS: We performed a cross-sectional study of consecutive patients presenting to a suburban, academic emergency department between October 1992 and August 1996. Patients with nonbite, noncontaminated facial skin or scalp lacerations who presented less than 6 hours after injury were included. Structured, closed-question data collection instruments were completed at the time of laceration repair and at suture removal. The primary outcome parameters were the incidence of wound infection and the short-term cosmetic appearance of lacerations in patients who did or did not receive irrigation. RESULTS: A total of 1,923 patients were included in the study group; 1,090 patients received saline irrigation, and 833 patients did not. The irrigation and nonirrigation groups were similar with regard to time from injury to presentation (1.56 versus 1.42 hours, respectively), frequency of linear wound morphology (82% versus 88%), frequency of smooth wound margins (72% versus 82%), number of layers of closure (1.14 versus 1.26), number of skin sutures applied (4.98 versus 4.65), number of deep sutures applied (.70 versus 1.05), and use of oral antibiotic prophylaxis (2.8% versus 4.0%). With respect to outcomes, the incidence of wound infection was not significantly different between the two treatment groups (.9% versus 1.4%, respectively; P = .28). Likewise, the percentage of patients who had an "optimal" cosmetic appearance was similar in the two groups (75.9% versus 81.7%, respectively; P = .07). CONCLUSION: Irrigation before primary closure did not significantly alter the rate of infection or the cosmetic appearance in our study population with clean, noncontaminated facial and scalp lacerations.

Comparison of types of research articles published in emergency medicine and non-emergency medicine journals.

INTRODUCTION: As the specialty of emergency medicine (EM) matures, its journals should be publishing research of a quality similar to that which appears in other premier journals. OBJECTIVE: To compare the types of original research published in 4 EM vs 3 non-EM journals. METHODS: Retrospective review of all 1995 articles published in Academic Emergency Medicine, American Journal of Emergency Medicine, Annals of Emergency Medicine, Journal of Emergency Medicine, Annals of Internal Medicine, JAMA, and New England Journal of Medicine. Research articles were classified as longitudinal vs cross-sectional, prospective vs retrospective, and interventional vs observational. Other characteristics noted were number of subjects, randomization, blinding, control, and power calculations. Journals were reviewed by 4 investigators who received specific training in research classification, adhering to previously reported criteria for retrospective reviews. Interobserver reliability was independently validated. RESULTS: The authors reviewed 3,524 articles, of which 874 (24.8%) were original research. Compared with research reported in non-EM journals, EM journals contained fewer longitudinal studies (40.5% vs 60.4%, p < 0.0001) and fewer prospective studies (70.8% vs 78.7%, p = 0.008). Fewer EM journals had studies that were blinded (13.7% vs 18.9%, p = 0.047) or controlled (36.3% vs 50.0%, p = 0.003). Studies reported in EM journals had fewer subjects (138 vs 300, p < 0.001). Research reports in EM journals were less likely to have been funded, even after adjustment for the differences in study designs (adjusted odds ratio 7.0, 95% CI 5.1-9.7). CONCLUSION: Significant differences in types of research published in EM and non-EN journals were identified.

Comparison of patient satisfaction and practitioner satisfaction with wound appearance after traumatic wound repair.

INTRODUCTION: Existing cosmetic scales for wounds are based only on practitioners' evaluations. They have not been validated using the patient's assessment. OBJECTIVE: To validate a previously developed wound cosmesis scale by determining the relationship between patient and practitioner assessments of cosmetic outcome following traumatic wound repair. METHODS: A convenience sample of patients with lacerations repaired in an ED were evaluated at the time of suture removal. Practitioners assigned 0 or 1 point each for the presence or absence of a step-off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. A total cosmetic score was calculated by adding the categories above. As previously defined, a score of 6 was considered optimal; < 6 was considered "suboptimal." Patients, blinded to the physician score, assessed their degrees of satisfaction with the cosmetic outcome of the wounds using a 100-mm visual analog scale (VAS). Because VAS scores were not normally distributed, practitioner scores were compared with patient satisfaction scores using a Mann-Whitney U test. RESULTS: 125 patients were enrolled, of whom 64% were male; the median age was 19.5 years (interquartile range = 8-33 years). Wounds were located predominantly on the face, scalp, or neck (47%) and upper extremity (35%), and had a median length of 2 cm. The 86 lacerations given optimal practitioner scores had a median patient satisfaction score of 97 mm; the 39 "suboptimal" lacerations had a median patient satisfaction score of 87 mm (p = 0.0006). CONCLUSION: Lacerations that practitioners considered to have optimal cosmetic appearances at the time of suture removal received higher patient satisfaction scores than did lacerations considered to be suboptimal. This provides a measure of validity to this 6-item categorical cosmetic scale.