Sutured wounds: factors associated with patient-rated cosmetic scores

To determine the association between wound characteristics, wound management in the ED and patient-rated cosmetic appearance of sutured wounds. Our hypothesis was that practitioner seniority would most strongly predict outcome.

Prospective recruitment of patients with lacerations sutured at the primary ED visit was performed. Data collected included patient demographics, wound characteristics and wound management. A standardized telephone questionnaire was administered 14 days and 3 months later. Scar appearance was scored using a verbal rating scale from zero to 10. Data were obtained about suture removal, antibiotic compliance, infection and dehiscence rates at 2 weeks. Associations of variables with cosmetic scores were analysed using multivariate linear regression.

One hundred and thirty-two patients were evaluated. Mean cosmetic scores were not significantly associated with seniority (P = 0.07). Lacerations repaired by senior practitioners were more likely to result from glass or general trauma (P = 0.007), be shorter (P = 0.03), be cleaned with antiseptic (P = 0.03), not to re-open (P = 0.01) or require re-suturing (P = 0.03). Following multivariate regression factors significantly associated with cosmetic scores at 14 days and 3 months were site of injury (P < 0.003) and time from injury to repair (P < 0.009). Wounds of the torso, leg or foot had lower cosmetic scores at both time-points. An association with age (P = 0.04) was present at 3 months.

Previous research found improvement between short-term doctor-rated cosmesis and training beyond internship. Our study demonstrated a non-significant trend relationship between seniority and patient-rated outcome, both short and long-term. However, staff seniority was overshadowed by the site of laceration and time from injury to repair.