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The management and outcome of lacerations in urban children
1Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia.
Insights
This study on pediatric laceration repair found that delayed care and outdoor injuries increased infection risk. Prophylactic antibiotics showed no benefit in preventing infections in children treated in the emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Wound Management
- Infectious Disease
Background:
- Laceration repair is common in pediatric emergency departments.
- Understanding risk factors for infection is crucial for optimal patient outcomes.
Purpose of the Study:
- To prospectively evaluate the management and outcomes of pediatric laceration repairs.
- To identify factors associated with pre-repair and post-repair infections.
Main Methods:
- Prospective study of 2,834 children (1 month to 18 years) undergoing laceration repair.
- Exclusion of bite wounds; data collection on injury characteristics, management, and complications.
- Analysis of factors associated with infection on presentation and subsequent to repair.
Main Results:
- Eight percent of patients had initial complications, most commonly foreign bodies.
- Infection on presentation (0.8%) was linked to delayed care (>18 hours), outdoor injuries, street glass, and extremity involvement.
- Subsequent infections (1.2%) were associated with prophylactic antibiotics, subcutaneous sutures, longer lacerations, glass/ice, and extremity injuries.
- Prophylactic antibiotics did not demonstrate a benefit in reducing infection rates.
Conclusions:
- Delayed care and specific injury mechanisms are key risk factors for pediatric laceration infections.
- Current evidence does not support the routine use of prophylactic antibiotics for pediatric laceration repair.
- Standardized management protocols may improve outcomes and reduce infection rates.
Abstract:
We prospectively studied the management and outcome of 2,834 children, aged 1 month to 18 years, who presented to the emergency department of the Children's Hospital of Philadelphia for laceration repair. Patients with bite wounds were excluded from the study. Eight percent (239) of all patients had complications on initial evaluation; the most common was the presence of a foreign body (55). Infection on presentation was diagnosed in 22 cases (0.8%). All of these patients had delayed their initial care beyond 18 hours (range, 18 to 288 hours; mean, 18 hours). Other factors significantly associated with infection on presentation included occurrence of the injury outdoors (16; P less than .001), injury due to broken "street" glass (seven; P less than .02), and injury of an extremity (18; P less than .01). The rate of prerepair infection was not influenced by the size of the wound. Infections developed subsequent to initial repair in 34 cases (1.2%). Factors associated with development of subsequent infection included use of prophylactic antibiotics, use of subcutaneous sutures, laceration length of more than 5.0 cm, glass or ice as a causative agent, and upper- or lower-extremity involvement. The majority of injuries were repaired by ED personnel without surgical consultation. Postrepair infection rates were not influenced by the specialty of the physician managing the case. Although our study was not designed to specifically test the issue, prophylactic antibiotics were of no proven benefit in reducing infection rates in any group of patients analyzed.