Patient priorities with traumatic lacerations

Clinical trials should use outcomes that are important to patients. We soug ht to determine the aspects of laceration management that are most importan t to patients. A prospective observational survey was conducted at one subu rban and one urban university ED during November to December 1998 that incl uded ED patients and visitors with and without current or prior lacerations . Trained research assistants approached 747 people of which 724 (97%) comp leted a 25-item closed question survey that evaluated demographics, prior l aceration repairs, and assessed the relative importance of least painful re pair, ED length of stay, cosmetic outcome, functional recovery, practitione r compassion, avoidance of wound infection, total costs, and missed days of work or school using a five item Likert scale (not important-extremely imp ortant). Additionally, the relative importance of these items was compared. Data were analyzed with descriptive statistics and 95% confidence interval s (Cls). Seven hundred twenty-four people participated; 383 (53%) had prior lacerations; 92 (14%) had lacerations at the time of the survey. The most important aspect of care for respondents were normal function (28%), avoidi ng infection (20%), cosmetic outcome (17%), and least painful repair (17%). Based on Likert scale data, most important aspects of care were: avoiding wound infection (mean [95% CI], 4.58 [4.52 to 4.64]), normal function (4.54 [4.48 to 4.6]), cosmetic outcome (3.78 [3.68 to 3.88]), and least painful repair (3.84 [3.76 to 3.92]). Cost, length of stay, missed work/school, and compassion were less important (range, 3.0 to 3.7). Patients with facial l acerations chose cosmetic outcome as the most important aspect of care whil e all others chose function. Patients prioritize the medical outcomes of la ceration repair (function, avoiding infection, cosmesis, pain) more than co st, compassion, ED length of stay and inconvenience (missed work/school). C osmetic outcome is particularly important to patients with facial laceratio ns. This information should be useful when designing outcome studies of lac eration management. (Am J Emerg Med 2000;18:683-686 Copyright (C) 2000 by W .B. Saunders Company).