COMPARISON OF WOUND CARE PRACTICES IN PEDIATRIC AND ADULT LACERATIONSREPAIRED IN THE EMERGENCY DEPARTMENT

Objective: We compared emergency physician's wound care practices in y oung children (less than or equal to 5 years) and adults (greater than or equal to 18 years) and the effect of these different practices on infection rate and cosmetic appearance, Design: Cross sectional study, Setting: University hospital emergency department that rarely uses co nscious sedation, Participants: Consecutive patients who presented wit h lacerations over a four-year period, Methods: Structured closed ques tion 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 valid ated scales, chi(2) tests were used for categorical variables, t tests for continuous variables, Results: We evaluated 3624 patients: 853 ch ildren and 2771 adults, Wounds in children were more likely to be on t he 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 rec eive 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 number s of sutures per centimeter (2.6 vs 2.3), Using logistic regression, t he 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 c osmetic appearances (optimal score, 75 vs 64%, P = 0.0003), Conclusion s: Emergency physicians at our institution are less likely to irrigate lacerations in children than adults; however, children had a lower in fection rate and more favorable cosmetic outcome.